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Liu X, Zhai M, Li J, Liu D, Yuan L, Wang H, Yu B, Yan H. Longitudinal effects of sexual minority stigma on depressive symptoms among young men who have sex with men: Distinguish between and within person effects. J Adolesc 2024; 96:1293-1303. [PMID: 38769773 DOI: 10.1002/jad.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/17/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND Young men who have sex with men (YMSM) may experience high levels of sexual minority stigma (SMS) and depressive symptoms (DS) over the world and in China. However, there is a lack of studies investigating the longitudinal effects of SMS on DS of YMSM, especially focusing on YMSM and separating the between-person and within-person effects. This study aimed to fill the said gaps. METHODS Study data were derived from a prospective cohort of 349 YMSM from central China (Wuhan, Changsha, Nanchang), the baseline survey was started in 2017 with one follow-up visit every year. SMS and DS were measured three times using valid and reliable instruments. The cross-lagged panel model (CLPM) and the random intercept CLPM (RI-CLPM) were used to examine the between-person and within-person concurrent and lagged effects, respectively. RESULTS Findings of CLPM revealed bidirectional associations between SMS and DS over time. RI-CLPM suggested that at the between-person level, SMS was significantly associated with DS, echoing the results of CLPM. However, this reciprocal relationship has not been found at the within-person level. CONCLUSION The associations between SMS and DS among YMSM at the population level is more significant than that at the individual level. We suggest that interventions should be against the adverse effects of cultural marginalization and systemic change the social concepts to reduce the amount of SMS in society.
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Affiliation(s)
- Xin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Mengxi Zhai
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Jiayu Li
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Dan Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Liang Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Huihao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Bin Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
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Fang X, Ren K, Li Y, Meng Q, Li M, Miao M, Zhan J, Wang X, Wu F, Zhang M. Prevalence and influencing factors of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer. Curr Urol 2024; 18:98-103. [PMID: 39176292 PMCID: PMC11338006 DOI: 10.1097/cu9.0000000000000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 12/06/2023] [Indexed: 08/24/2024] Open
Abstract
Objectives This study aims to not only investigate the prevalence of social alienation among elderly patients undergoing radical prostatectomy for prostate cancer but also identify the contributing factors. Materials and methods A total of 245 elderly patients diagnosed with prostate cancer and undergoing radical prostatectomy at a tertiary care general hospital in Jinan were included in this study. To assess the patients, several questionnaires were used. These included the General Situation Questionnaire, General Alienation Scale, Social Impact Scale, Modified Memorial Anxiety Scale for Prostate Cancer, and Perceived Social Support Scale. Pearson correlation analysis was conducted to examine the relationships between variables, whereas multiple linear regression was used to identify the factors influencing social alienation among patients who underwent radical prostatectomy. Results Patients who underwent radical prostatectomy had a mean total score of 44.13 ± 7.24 on the Social Alienation Scale. The results of the Pearson correlation analysis indicated that social alienation showed an inverse association with social support (r = -0.627, p < 0.05) and positive associations with age, disease stigma, and anxiety (r = 0.325, 0.575, 0.421, all p's < 0.01) among patients who underwent radical prostatectomy. The findings from multiple linear regression analysis demonstrated that educational level, age, urinary incontinence, disease stigma, anxiety, and social support significantly influenced social alienation among elderly patients who underwent radical prostatectomy (p < 0.05). Conclusions Elderly patients who undergo radical prostatectomy often experience social alienation. This study found that social alienation was associated with factors such as educational level, age, urinary incontinence, social support, anxiety, and disease stigma. Consequently, healthcare providers should actively monitor the degree of social alienation in elderly patients after radical prostatectomy and provide suitable psychological care to facilitate positive social reintegration and alleviate their feelings of social alienation.
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Affiliation(s)
- Xiao Fang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Kong Ren
- Department of Urology, The Second Clinical Medical College of Binzhou Medical University, Yantai, China
| | - Yan Li
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Qiao Meng
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Mingyue Li
- Department of Hematology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Miao Miao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jing Zhan
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xia Wang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Fei Wu
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Meixia Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Wang D, Scherffius A, Ouyang X, Deng Q. Family Functioning and Depressive Symptoms Among HIV-Positive Men Who Have Sex with Men: Mediating Roles of Stigma and Resilience. Psychol Res Behav Manag 2024; 17:755-764. [PMID: 38434956 PMCID: PMC10906277 DOI: 10.2147/prbm.s449825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Depressive symptoms are common among HIV-positive men who have sex with men (MSM). This study aims to explore (1) the relationship between family functioning and depressive symptoms and (2) the mediating roles of stigma and resilience in the relationship among HIV-positive MSM. Methods We used data from a cross-sectional study of a convenience sample in Hunan Province, China, conducted in 2019. The data analysis included 191 HIV-positive MSM with an average age of 26.98 years. All participants completed self-report questionnaires on demographic variables, family functioning, stigma, resilience, and depressive symptoms. Results Better family functioning was significantly associated with lower depressive symptoms. Both stigma (Indirect effect = -0.04, 95% CI, -0.10 ~ -0.001) and resilience (Indirect effect = -0.06, 95% CI, -0.12 ~ -0.01) were significant partial mediators in the relationship between family functioning and depressive symptoms. A parallel and chain mediating role of stigma and resilience in the relationship between family functioning and depressive symptoms was also supported (Indirect effect = -0.03, 95% CI, -0.08 ~ -0.01). Conclusion Improving family functioning is crucial for alleviating depressive symptoms among HIV-positive MSM in China. Depression assessment and reduction should be an integral part of prevention and treatment programs targeting stigma and resilience.
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Affiliation(s)
- Dongfang Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
- School of Psychology, Centre for Studies of Psychological Applications, Guangdong Key Laboratory of Mental Health and Cognitive Science, Ministry of Education Key Laboratory of Brain Cognition and Educational Science, South China Normal University, Guangzhou, People’s Republic of China
| | - Andrew Scherffius
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Xuan Ouyang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
| | - Qijian Deng
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, People’s Republic of China
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Zhao Y, Khoshnood K, Sheng Y. Social support as a mediator between mental health and stigma among newly HIV-positive men who have sex with men. Int J STD AIDS 2024:9564624241227653. [PMID: 38314565 DOI: 10.1177/09564624241227653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
OBJECTIVES The sociocultural context of China gives rise to unique experiences of HIV-related stigma and adverse impacts on mental health among men who have sex with men (MSM) living with HIV. However, few studies have explored the stigma among families in the cultural context of China and the role of social support as a mediator to explain how HIV-related stigma results in poor psychological well-being. This study aims to test the mediating effect of social support between HIV-related stigma and family stigma on the mental health of MSM. METHODS This cross-sectional study recruited newly MSM with HIV in two cities (Beijing and Wuhan) in China as participants from February 2021 to August 2022. A total of 257 MSM with HIV were recruited for the study. The mediating effects were examined using mediation models (SAS PROC CAUSALMED). RESULTS The overall total effect of HIV-related stigma on mental health was β = -1.483 (bootstrap 95% CI = -1.881, -1.104 p < 0.001), and the mediating effect of social support was β = -0.321 (bootstrap 95% CI = -0.571, -0.167 p = .001). A higher level of stigma from family predicts lower mental health with an overall total effect of β = -1.487 (bootstrap 95% CI = -1.823, -1.101 p < 0.001), while the indirect effect (mediation effect) of social support on mental health is β = -0.281 (bootstrap 95% CI = -0.477, -0.142 p = .003). CONCLUSIONS Given the mediating effect of social support on mental health, programs enhancing social support and decreasing stigmatization should be designed to improve the mental health of MSM with HIV, the interventions are needed at both the family and community levels. Public health campaigns in China that frame HIV and same-sex behavior as chronic issues and normal phenomena can correct misinformation related to HIV and MSM that leads to stigma and negative emotional reactions.
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Affiliation(s)
- Yafang Zhao
- Department of Ophthalmology, Chinese Academy of Medical Sciences, Peking Union Medical College Hospital, Beijing, China
| | - Kaveh Khoshnood
- Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Yu Sheng
- School of Nursing, Peking Union Medical College, Beijing, China
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5
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Yuan GF, Liu C, Li X, Fung HW, Wong MYC, Lam SKK, An Y, Feng X. Hurting myself to cope: Using network analysis to understand the association between perceived stigma and non-suicidal self-injury functions among men who have sex with men in China. Arch Psychiatr Nurs 2024; 48:43-50. [PMID: 38453281 DOI: 10.1016/j.apnu.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/04/2023] [Accepted: 01/05/2024] [Indexed: 03/09/2024]
Abstract
Prior studies have demonstrated that perceived stigma is robustly associated with risky and life-threatening behaviors, including non-suicidal self-injury (NSSI), among men who have sex with men (MSM). However, studies regarding the relationship between perceived stigma and NSSI are limited. The present study aimed to investigate the network structure of perceived stigma and NSSI functions, along with bridge nodes, to elucidate how they co-exist. A sample of 2610 Chinese MSM (mean age = 23.99, age range: 18-68 years) was recruited from an online survey platform. All participants completed a web-based survey with measures of perceived stigma and NSSI functions. Results indicated that 'negative attitudes towards homosexuality' and 'disappointment in gay son' were identified as the most central nodes in the perceived stigma network, whereas 'seeking attention' and 'influencing others to change' ranked highest on centrality in the NSSI network. Two bridge connections were exhibited within the combined perceived stigma and NSSI network model: 'unwelcoming in public' and 'avoiding unpleasant tasks' from perceived stigma and NSSI communities, respectively. This is among the first studies investigating the co-occurrence between perceived stigma and NSSI from the network approach. Our findings provide an empirically-based perspective on the importance of family- and community-based interventions, with potential clinical implications for reducing NSSI among sexual and gender minority groups.
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Affiliation(s)
- Guangzhe Frank Yuan
- School of Education Science, Leshan Normal University, Leshan, China; Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Caimeng Liu
- School of Education Science, Leshan Normal University, Leshan, China.
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Hong Wang Fung
- Department of Social Work, Faculty of Social Sciences, The Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Stanley Kam Ki Lam
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - Yuanyuan An
- School of Psychology, Nanjing Normal University, Nanjing, Jiangsu, China.
| | - Xueyou Feng
- Center for Mental Health Education and Counseling, Guangzhou College of Commerce, Guangzhou, China
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Wang D, Zhou Y, Wu D, Tucker JD, Ni Y, Lu Y, Lyu H, Ong J, He X, Huang S, Tang W. Factors Associated with the First-time HIV Testing Among Chinese men who have sex with men Who Received HIV Self-tests from Partners or Friends. AIDS Behav 2024; 28:705-712. [PMID: 38194057 DOI: 10.1007/s10461-023-04259-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
Secondary distribution of HIV self-testing (HIVST) among individual social networks was an effective approach to expanding HIV testing among men who have sex with men (MSM). However, understanding the factors associated with first-time HIV testing behaviors in the secondary distribution of HIVST programs is limited. Hence, this study aims to identify factors related to first-time testers in the secondary distribution of HIVST. Participants were recruited from five provinces in southern China through Blued, a geo-social gay networking app in China from January 2021 to December 2021. Eligible consented participants (referred to as "seeds") finished a baseline survey and then applied for up to five HIVST kits. They were encouraged to distribute HIVST kits to other MSM (referred to as "alters") and alters were encouraged to scan a QR code to return their photographed testing results. All alters were invited to finish an online survey. In total, 229 seeds reached 292 alters, among whom 126 (43.2%) were first-time testers whereas 166 (56.8%) were non-first-time testers. Importantly, our results demonstrated that the first-time HIV testers were more likely to self-report as heterosexual (aOR = 4.88, 95% CI 1.01-23.61), disclose sexual orientation and/or SSB (aOR = 1.73, 95% CI 1.01-2.96), and receive HIVST knowledge from the seeds (aOR = 3.25, 95% CI 1.02-10.34). However, those who had sex with male partners in the last three months were less likely to be first-time testers (aOR = 0.43, 95% CI 0.23-0.82). Practical implications and limitations were also discussed to improve future HIV prevention programs.
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Affiliation(s)
- Dongya Wang
- School of Communication, University of Miami, Miami, FL, USA
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Yi Zhou
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Dan Wu
- University of North Carolina Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Yuxin Ni
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Ying Lu
- Dermatology Hospital of Southern Medical University, Guangzhou, China
- University of North Carolina Project-China, Guangzhou, China
| | - Hang Lyu
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Jason Ong
- London School of Hygiene and Tropical Medicine, London, UK
| | - Xi He
- Zhuhai Xutong Voluntary Services Center, Zhuhai, China
| | - Shanzi Huang
- Zhuhai Center for Diseases Control and Prevention, Zhuhai, China
| | - Weiming Tang
- Dermatology Hospital of Southern Medical University, Guangzhou, China.
- University of North Carolina Project-China, Guangzhou, China.
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Nelson CL. Coping with Discrimination: A Longitudinal Study of Health Outcomes in Lesbian, Gay, and Bisexual and Heterosexual Midlife and Older Adults. J Aging Health 2023:8982643231218474. [PMID: 38006399 DOI: 10.1177/08982643231218474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
OBJECTIVES This study explored how coping moderates the association between discrimination and health outcomes in lesbian, gay, and bisexual (LGB) and heterosexual midlife and older adults. METHODS This study analyzed longitudinal data from 163 LGB and 326 propensity-matched heterosexual midlife and older adults over approximately 20 years, using the Midlife in the United States study. RESULTS Discrimination was associated with slower chronic condition accumulation over time for LGB individuals. Problem-focused and avoidance coping moderated discrimination's impact on mental health in LGB participants over time, and in heterosexual participants, they moderated the association between discrimination and chronic conditions. DISCUSSION The results suggest a potential "steeling" effect in LGB midlife and older adults facing higher discrimination levels. Furthermore, the findings suggest that effective coping strategies for mitigating the adverse impacts of discrimination on physical and mental health may vary by sexual orientation.
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Affiliation(s)
- Christi L Nelson
- School of Social Work, University of Washington, Seattle, WA, USA
- School of Aging Studies, University of South Florida, Tampa, FL, USA
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Brooks BD, Kaniuka A, Job SA, Hodgkinson N, Kelliher Rabon J, Williams SL, Hirsch JK. Anticipated Sexual Minority Stress and Mental Health after the 2016 Presidential Election: Examining a Psychological Mediation Framework. JOURNAL OF HOMOSEXUALITY 2023; 70:3125-3148. [PMID: 35759638 DOI: 10.1080/00918369.2022.2087481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sexual minorities are at an increased risk for psychopathology, compared to heterosexual counterparts, in part due to stressors unique to their sexual minority identity. The greater socio-political climate may exacerbate sexual minority stress, and the context of the 2016 United States presidential election infringed upon the rights and well-being of LGBQ individuals. In our sample of sexual minorities (n = 253), we examined the association between anticipated stigma in response to the 2016 presidential election and symptoms of anxiety and depression, and the potential mediating role of self-compassion, hopelessness and social support. Greater anticipated stigma was associated with less self-compassion, less perceived social support, and greater hopelessness, and, in turn, greater symptoms of anxiety and depression. Anticipated stigma may erode feelings of environmental support and may be internalized as negative views of the self and future. From a public health perspective, policy-makers should be aware that the discussion and/or enactment of policies which discriminate against LGBQ persons may negatively impact mental health. Clinically, bolstering self-compassion and interpersonal functioning, and targeting hopelessness, through strategies such as Acceptance and Commitment Therapy and Compassion-Focused Therapy, may buffer the impact of minority stress among sexual minorities.
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Affiliation(s)
- Byron D Brooks
- Department of Psychology, Loyola University Chicago, Chicago, Illinios, USA
- Chicago Center for HIV Elimination, University of Chicago, Chicago, Illinois, USA
| | - Andrea Kaniuka
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Sarah A Job
- Department of Population Health Sciences, University of Central Florida, Orlando, Florida, USA
| | - Nicole Hodgkinson
- Department of Psychology, Loyola University Chicago, Chicago, Illinios, USA
| | - Jessica Kelliher Rabon
- Division of Pediatric Psychology, Prisma Health - Upstate, Greenville, South Carolina, USA
| | - Stacey L Williams
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
| | - Jameson K Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee, USA
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Abboud S, Seal DW, Pachankis JE, Khoshnood K, Khouri D, Fouad FM, Heimer R. Experiences of stigma, mental health, and coping strategies in Lebanon among Lebanese and displaced Syrian men who have sex with men: A qualitative study. Soc Sci Med 2023; 335:116248. [PMID: 37742387 DOI: 10.1016/j.socscimed.2023.116248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND In Lebanon, men who have sex with men (MSM) face high rates of stigma, discrimination, and violence. Minority stress, or the unique stressors related to anti-MSM stigma and discrimination, negatively impacts the mental health of MSM. These stressors are heightened for those with intersectional minority identities such as displaced Syrian MSM in Lebanon. METHODS In this qualitative study conducted in 2020-21, part of a larger study focused on the mental and sexual health risks among MSM, we collected qualitative data from Lebanese and displaced Syrian MSM living in Lebanon and analyzed reports of their experiences with stigma, mental health, and coping strategies. We conducted semi-structured, in-depth interviews with 12 displaced Syrian MSM and 13 Lebanese MSM. RESULTS Our findings highlight how MSM in Lebanon navigate stigma and the mental health risks that result. Common stressors among Lebanese and displaced Syrian MSM were related to finances, sexual orientation discrimination, and social isolation. Comparing the two groups, we found that stressors specific to displaced Syrian MSM were related to adverse childhood experiences, recent exposure to the Syrian war, displacement, and discrimination in Lebanon based on their intersectional identities as MSM and Syrians. For Lebanese participants, the most common stigma coping strategies were avoidance, drinking alcohol, using drugs, or having sex. As for displaced Syrian MSM, the most common stigma coping strategy was seeking the freely available mental health services offered to them through non-governmental organizations. CONCLUSION Our findings suggest that increased targeted mental health and social support interventions, informed by the unique experiences of Lebanese and displaced Syrian MSM, are highly needed to improve the coping and mental health resources of all MSM in Lebanon.
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Affiliation(s)
- Sarah Abboud
- University of Illinois Chicago College of Nursing, 845 S. Damen Ave, Chicago, IL, 60612, USA
| | - David W Seal
- Tulane University School of Public Health & Tropical Medicine, 1440 Canal St, New Orleans, LA, 70112, USA.
| | - John E Pachankis
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT, 06510, USA
| | - Kaveh Khoshnood
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT, 06510, USA
| | - Danielle Khouri
- American University of Beirut, Faculty of Health Sciences, Bliss Street, Beirut, Lebanon
| | - Fouad M Fouad
- American University of Beirut, Faculty of Health Sciences, Bliss Street, Beirut, Lebanon
| | - Robert Heimer
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases, 60 College St, New Haven, CT, 06510, USA
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10
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Yi L, Wu C. 'How can I fix my disrupted life?' Embodied experiences and biocitizenship among men who have sex with men living with HIV in China. CULTURE, HEALTH & SEXUALITY 2023; 25:1387-1401. [PMID: 36547370 DOI: 10.1080/13691058.2022.2157884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
Drawing on qualitative data collected from men who have sex with men living with HIV in Fujian and Sichuan provinces in southeast and southwest China, respectively, this study aims to understand their lived experiences in the context of social norms, institutions and roles. We argue that informants encountered biographical disruption as a result of their diagnosed infection. They then painfully experienced different forms of social death on the one hand, while on the other, some also exerted agency/autonomy by strategically fighting for their rights and interests in both private and public domains. By examining these lived experiences, this study discusses the biological citizenship of the respondents so as to deepen understanding of embodied life experiences and trajectories.
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Affiliation(s)
- Lin Yi
- Department of Sociology, Xiamen University, Xiamen, China
| | - Chuanhong Wu
- Department of Sociology, Xiamen University, Xiamen, China
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11
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Liu C, Yuan GF, Li X, Fung HW, Wong MYC, Zhao J, Feng X. Associations among internalized and perceived stigma, state mindfulness, self-efficacy, and depression symptoms among men who have sex with men in China: A serial mediation model. Arch Psychiatr Nurs 2023; 45:81-88. [PMID: 37544707 DOI: 10.1016/j.apnu.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 08/08/2023]
Abstract
Previous research has demonstrated that stigma is strongly related to depressive symptoms among men who have sex with men (MSM). However, data are limited regarding the associations between stigma, state mindfulness, self-efficacy, and depression symptoms. The current study aimed to analyze state mindfulness and self-efficacy as possible mediators between internalized and perceived stigma and depression symptoms. A sample of 2610 Chinese MSM (Mage = 23.99, SD = 6.09, age range: 18-68 years) was recruited from an online survey platform and completed the HIV and Homosexuality Related Stigma Scale, Patient Health Questionnaire-9, the short version of Five Facet Mindfulness Questionnaire, and the Chinese General Self-Efficacy Scale. Results indicated that state mindfulness significantly mediated the linkage between internalized and perceived stigma and depressive symptoms, and self-efficacy significantly mediated the relation between state mindfulness and depression symptoms. Furthermore, internalized and perceived stigma were associated with depression symptoms through a serial mediation of state mindfulness and self-efficacy. This study highlights that state mindfulness and self-efficacy might play important roles in the psychological response of MSM to stigmatization and psychopathology symptoms.
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Affiliation(s)
- Caimeng Liu
- College of Teacher Education, Institute of Education Science, Leshan Normal University, Leshan, China
| | - Guangzhe Frank Yuan
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA.
| | - Xiaoming Li
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, USA
| | - Hong Wang Fung
- Department of Social Work, Faculty of Social Sciences, The Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Ming Yu Claudia Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong
| | - Jingjing Zhao
- Department of Psychology, Beijing Forestry University, Beijing, China
| | - Xueyou Feng
- Center for Mental Health Education and Counseling, Guangzhou College of Commerce, Guangzhou, China
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Cheung CK, Tsang EYH. Conditions for Social Exclusion Leading to Distress Change in Chinese Lesbian, Gay, and Bisexual (LGB) People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105911. [PMID: 37239639 DOI: 10.3390/ijerph20105911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 05/28/2023]
Abstract
Lesbian, gay, and bisexual (LGB) people are likely to be at risk of distress because of social exclusion, including the feelings of resentment, resistance, and rejection they might experience from society. Nevertheless, the conditions for social exclusion leading to changes in distress are empirically unclear, especially in Chinese LGB people. To examine these conditions, this study surveyed 303 Chinese LGB people in Taiwan, Hong Kong, and various places in Mainland China. For comparability with other LGB studies, the study did not explicitly identify asexual, demisexual, or pansexual people in the LGB group. Results show that the retrospective reporting of social exclusion in 2016 did not significantly and unconditionally predict levels of distress in 2017. However, the reporting of exclusion significantly predicted current distress when the retrospective report of distress in 2016 was high. These results from the stress-vulnerability model indicate that prior distress is a vulnerability condition that allows social exclusion to exert its stressful effect. This study implies the need to prevent the social exclusion of highly distressed LGB people.
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Affiliation(s)
- Chau-Kiu Cheung
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong 518000, China
| | - Eileen Yuk-Ha Tsang
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong 518000, China
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13
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Huang YT, Chou WJ, Hang YC, Yen CF. Sexual Orientation Microaggression Experiences and Coping Responses of Lesbian, Gay, and Bisexual Individuals in Taiwan: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2304. [PMID: 36767671 PMCID: PMC9915295 DOI: 10.3390/ijerph20032304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
This qualitative study explored the sexual orientation microaggression (SOM) experiences and coping strategies of lesbian, gay, and bisexual (LGB) individuals in Taiwan. In total, 30 LGB individuals (17 women and 13 men; 17 homosexual and 13 bisexual individuals) who experienced SOMs participated in qualitative, semistructured interviews, during which their SOM experiences were assessed. Through the interviews, several types of SOMs were identified, corresponding to three main types of microaggression (microassaults, microinsults, and microinvalidations) previously identified in Western studies. The participants reported various coping responses to SOMs, ranging from active responses to choosing not to respond, to protecting themselves or to minimizing the negative consequences of confrontation. The results provide mental health professionals with insight regarding the contexts of and coping responses to the SOMs experienced by LGB individuals.
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Affiliation(s)
- Yu-Te Huang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong RM543, China
| | - Wen-Jiun Chou
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83301, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Yi-Chen Hang
- Taiwan Gender Equity Education Association, Taipei 10089, Taiwan
| | - Cheng-Fang Yen
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Department of Psychiatry, School of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan
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14
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Ma H, Bu M, Zhai H, Li B, Xiong L. New Insight into HIV-Related Psychological Distress: A Concept Analysis. Clin Nurs Res 2023; 32:60-72. [PMID: 35259946 DOI: 10.1177/10547738221081002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Psychological distress is a frequently reported outcome measure in HIV research. However, because of its poor conceptualization, many studies only partially capture it because they focus solely on depression or anxiety based on symptoms. This study undertook a concept analysis of HIV-related psychological distress (HRPD) using Walker and Avant's method. The findings include HRPD's (a) attributes, including changes to emotional status, symptom burden, HIV disclosure distress and HIV-related stigma; (b) antecedents, including HIV-related stressors, cognitive appraisal of stressors and difficulty coping with the disease or treatment; and (c) consequences, including poor health outcomes and posttraumatic growth. Lazarus and Folkman's theory and the conservation of resources theory were adapted to further understand HRPD. This article provides insight into HRPD and increases the awareness of how to screen and assess HRPD at an early stage. The findings indicate the need to develop specific and rigorous measures and to provide appropriate interventions.
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Affiliation(s)
- Haiqi Ma
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Mengru Bu
- Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Huimin Zhai
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Bing Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ling Xiong
- Nanfang Hospital, Southern Medical University, Guangzhou, China
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15
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Suen YT, Chan RCH, Wong EMY. Sex Conservatism, Internalized Homonegativity, PrEP Stigma, and Intention to Use PrEP: A Study of Chinese-Speaking Gay and Bisexual Male Youth in Hong Kong. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:467-480. [PMID: 36454136 DOI: 10.1521/aeap.2022.34.6.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) stigma has been found to be a major barrier to PrEP acceptability and uptake. Research has found that different ethnic/cultural groups display varying levels of PrEP stigma. This article studies sex conservatism and internalized homonegativity as two sexuality- and culture-related aspects that influence PrEP stigma and intention to use PrEP. An online survey of 279 young gay and bisexual men in Hong Kong found that internalized homonegativity was positively associated with PrEP stigma. Respondents who were more conservative about sex showed lower intention to use PrEP, whereas those who had higher income and more positive attitudes about PrEP were more likely to express intention to use PrEP. This study provides novel empirical evidence for understanding PrEP stigma and uptake from a sexuality and cultural perspective. The influence of sexuality- and culture-related factors on PrEP stigma and uptake warrants greater attention, especially in the Asia-Pacific region.
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Affiliation(s)
- Yiu Tung Suen
- Gender Studies Programme, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Eliz Miu Yin Wong
- Department of Social Policy, London School of Economics and Political Science, London, UK
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16
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Shen Y, Zhang C, Valimaki MA, Qian H, Mohammadi L, Chi Y, Li X. Why do men who have sex with men practice condomless sex? A systematic review and meta-synthesis. BMC Infect Dis 2022; 22:850. [PMCID: PMC9661788 DOI: 10.1186/s12879-022-07843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 11/04/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Despite a large amount of behavioral interventions to reduce human immunodeficiency virus (HIV)-related high-risk sexual behaviors, consistent condom use remains suboptimal among men who have sex with men (MSM). However, current databases are lack of synthesized evidence to explain why MSM practiced condomless sex.
Objective
Our study aims to conduct a systematic review and meta-synthesis of 39 eligible qualitative studies to explore the barriers to condom use among MSM.
Methods
A systematic review and meta-synthesis of qualitative studies (1994–2021). On March 4, 2021, a comprehensive search was conducted in 14 electronic databases. The study was conducted based on the Joanna Briggs Institute’s recommendations.
Results
Thematic analysis produced six synthesized themes, which were classified into three levels according to the Social-ecology Model. Individual level barriers to condom use included physical discomfort, lack of HIV/STI-related knowledge and substance use; interpersonal-level barrier was mainly the condom stigma, namely regarding using condom as symbols of distrust or HIV/sexually transmitted infections (STIs) prevention, or as violating traditional cognition of sex, or as an embarrassing topic; environmental/structural-level barriers included situational unavailability, unaffordability of condoms and power imbalance in the sexual relationship.
Conclusion
This meta-synthesis offered in-depth understanding of condom use barriers for MSM and could guide the development of multifactorial interventions according to the identified barriers, especially targeting to reduce condom stigma, which has not been focused and intervened previously.
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17
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Shao J, Chen C, Borelli JL. Rethinking the dichotomy of sexual identity and relational intimacies: Chinese gay men’s mental health in mixed-orientation marriages. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2021.1929424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Jianmin Shao
- Department of Psychological Science, University of California, Irvine, USA
| | - Chuansheng Chen
- Department of Psychological Science, University of California, Irvine, USA
| | - Jessica L. Borelli
- Department of Psychological Science, University of California, Irvine, USA
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18
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Plant K, Connell A, Hosking W, Lyons A. Internalized Homonegativity and Mental Health Among Chinese Gay and Bisexual Cisgender Men: Exploring the Moderating Influences of Psychosocial and Sexual Identity Factors. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3541-3556. [PMID: 35999423 DOI: 10.1007/s10508-022-02314-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 06/15/2023]
Abstract
Much research on Chinese gay and bisexual men has focused on sexual health and, in particular, HIV-related issues. However, relatively little research has considered psychosocial aspects of being a gay or bisexual man in China. The present study was designed to address this gap by examining psychosocial predictors of mental health from a minority stress perspective. Results from an online survey of 1,786 Chinese gay and bisexual cisgender men revealed that higher levels of internalized homonegativity predicted greater psychological distress and a lower sense of positive well-being. Higher self-esteem, social support, and resilience were strong predictors of lower psychological distress and higher well-being, but these psychosocial factors mostly did not moderate associations between internalized homonegativity and mental health. A stronger sense of sexual identity superiority weakened the associations between internalized homonegativity and both mental health measures, but sexual identity centrality only moderated the association between internalized homonegativity and positive well-being. This study is among the first to examine minority stressors and psychosocial factors, distinct from the HIV-focussed literature, in a Chinese context. These findings may inform interventions targeting increased self-esteem, social support, and resilience, which could be beneficial for the mental health of Chinese gay and bisexual cisgender men.
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Affiliation(s)
- Kylie Plant
- Institute for Health and Sport, Victoria University, P.O. Box 14428, Melbourne, VIC, 8001, Australia
| | - Aneira Connell
- Institute for Health and Sport, Victoria University, P.O. Box 14428, Melbourne, VIC, 8001, Australia
| | - Warwick Hosking
- Institute for Health and Sport, Victoria University, P.O. Box 14428, Melbourne, VIC, 8001, Australia.
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
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Patterns of sexual and HIV-related stigma among men who have sex with men and women living with HIV in Haiti. Sci Rep 2022; 12:7511. [PMID: 35525876 PMCID: PMC9079062 DOI: 10.1038/s41598-022-11647-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Vulnerability to contracting HIV among Men who have Sex with Men and Women (MSMW) was recognized early in the epidemic. However, while global HIV efforts have made tremendous progress for the heterosexually-identified population, the specific needs of MSMW were not directly addressed with tailored and context-adapted interventions. The purpose of this study was to inform this area of research by exploring patterns of stigma through sexual identity developmental history as well as coping mechanisms among MSMW living with HIV in Haiti. A qualitative descriptive study comprised of in-depth interviews with 32 MSMW living with HIV was carried out. Participants were recruited using snowball techniques. An inductive thematic analysis was conducted in NVivo, contextualized by the socio-ecological context of Haiti. MSMW reported struggling with their sexuality since their adolescence, often because of enacted stigma from family members, the community, and cultural conflicts. Most participants described experiencing anxiety, psychological distress, depression, social isolation, suicidal ideation and suicide attempts. Mechanisms for coping with stigma included self-acceptance, social support, hiding their sexual orientation, and tolerance of the voodoo religion. To combat stigma, and improve HIV treatment adherence and retention among MSMW, culturally-tailored multilevel initiatives should be implemented.
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Tan S, Cen P, Fang T, Yang X, Zhang Y, Zhu J, Huang H, Wang M, Jiang L, Mo J, Ning C. Chained multimediator model of sexual orientation disclosure, sexual minority stigma, sexual minority identity, social support, and resilience among ymsms. BMC Public Health 2022; 22:797. [PMID: 35449098 PMCID: PMC9026989 DOI: 10.1186/s12889-022-13231-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 04/11/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction This study aimed to investigate sexual orientation disclosure and mental health among young men who have sex with men (YMSMs). To this end, we constructed a chained multimediator model of sexual minority stigma, sexual minority identity, social support, and resilience, with the moderator of sexual orientation disclosure. Methods We conducted a cross-sectional survey of 345 YMSMs in Nanning, China. Bivariate analysis was used to evaluate factors associated with sexual orientation disclosure. Sexual minority stigma was used to predict identity, with social support as the step 1 mediator and resilience as the step 2 mediator. Sexual minority identity was analyzed using a chained moderated mediation model; sexual orientation disclosure was included as a moderator in all models to control its confounding effect. Results The average age of YMSMs was 20.0 ± 1.3 years. Bivariate analysis indicated that YMSMs who disclosed sexual orientation may have experienced less stigma (15.49 ± 3.02 vs 16.21 ± 2.74), obtained more social support (65.98 ± 11.18 vs 63.19 ± 11.13), had strong psychological resilience (37.40 ± 8.57 vs 35.39 ± 7.73), and had a more positive self-identity (104.12 ± 21.10 vs 95.35 ± 16.67); differences between subgroups were statistically significant (p < 0.05). Sexual minority stigma, perceived stigma, and enacted stigma were significantly associated with social support and resilience. The association between sexual minority stigma and sexual minority identity was significantly mediated by social support (indirect effect [95% CI] = − 3.307 [− 4.782, − 1.907]). Resilience significantly mediated the same association for identity (− 2.544 [− 4.052, − 1.114]). The chained relationship from sexual minority stigma to social support, resilience, and identity was also significant, with an indirect effect of − 0.404 [− 0.621, − 0.249]. Conclusion Among YMSMs in China, sexual minority stigma affects sexual minority identity through social support and resilience. Given the psychological effects of stigma, social support and resilience must be considered to better promote positive self-identity and mental health among YMSMs.
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Affiliation(s)
- Sumin Tan
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Ping Cen
- Nanning Municipal Center for Disease Prevention and Control, Nanning, Guangxi, China.,School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Ting Fang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Xing Yang
- School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yun Zhang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jiawen Zhu
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Haimei Huang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Min Wang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Jiang
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China
| | - Jieling Mo
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China.
| | - Chuanyi Ning
- Nursing College, Guangxi Medical University, Nanning, Guangxi, China.
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21
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Septarini NW, Hendriks J, Maycock B, Burns S. Methodologies of Stigma-Related Research Amongst Men Who Have Sex With Men (MSM) and Transgender People in Asia and the Pacific Low/Middle Income Countries (LMICs): A Scoping Review. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:688568. [PMID: 36304052 PMCID: PMC9580832 DOI: 10.3389/frph.2021.688568] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022] Open
Abstract
Much stigma-related research focuses on marginalized populations, including men who have sex with men (MSM) and transgender people. The importance of research in this area is widely recognized, however methodologies and measures vary between studies. This scoping review will collate existing information about how stigma-related research has been conducted in low/middle income countries (LMICs) within the Asia Pacific region, and will compare research designs, sampling frameworks, and measures. Strengths and limitations of these studies will inform recommendations for future stigma-related health research. A methodological framework for scoping studies was applied. Searches of Psych INFO, Scopus, ProQuest, Global Health and PubMed were used to identify articles. Stigma-related research amongst MSM and transgender communities, published between 2010 and 2019 in LMICs within the Asia Pacific region were included. A total of 129 articles based on 123 different studies were included. Of the 129 articles 51.19% (n = 66) were quantitative; 44.96% (n = 57) were qualitative and 3.88% (n = 5) were mixed methods studies. The majority of studies (n = 57; 86.36%) implemented a cross sectional survey. In-depth interviews (n = 20, 34.48%) were also common. Only 3.88% of studies utilized mixed-methods design. Non-probabilistic and probabilistic sampling methods were employed in 99.22 and 0.78% of studies respectively. The most common measures used in quantitative studies were the Center for Epidemiological Study on Depression (CES-D) (n = 18) and the Self Stigma Scale (SSS) (n = 6). Strengths and limitations proposed by researchers included in this review are summarized as lesson learnt and best practices in stigma-related research.
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Affiliation(s)
- Ni Wayan Septarini
- School of Population Health, Curtin University, Perth, WA, Australia
- Department of Community and Preventive Medicine, Faculty of Medicine, Udayana University, Bali, Indonesia
- *Correspondence: Ni Wayan Septarini ;
| | - Jacqueline Hendriks
- School of Population Health, Curtin University, Perth, WA, Australia
- Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, WA, Australia
| | - Bruce Maycock
- European Center for Environmental and Human Health, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Sharyn Burns
- School of Population Health, Curtin University, Perth, WA, Australia
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22
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Sun S, Hoyt WT, Tarantino N, Pachankis JE, Whiteley L, Operario D, Brown LK. Cultural context matters: Testing the minority stress model among Chinese sexual minority men. J Couns Psychol 2021; 68:526-537. [PMID: 33030914 DOI: 10.1037/cou000053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men (n = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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23
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Boundless China and Backward Asians: Hegemonic Confucianism as Epistemological Violence in Queer Psychology. Integr Psychol Behav Sci 2021; 56:491-505. [PMID: 34561844 DOI: 10.1007/s12124-021-09657-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
The formation of queer psychology has been a critical intervention in breaking apart the psychological tendency of reifying categories of gender and sexuality. Nonetheless, latent Orientalism and white-centered epistemologies in psychology have continued to produce culturally essentialist depictions of a repressive "Chinese sexuality" and "backward Asian culture." In this article, I present three main problems in psychological representations of Sinophone queers: (a) "cultural colorblindness" resulting from the conflation of race and culture, (b) the problematic analytical category of "Chineseness," and (c) race and culture being theorized as a burden for Sinophone and Asian queers. In order for psychology and queer studies scholars to destabilize these epistemologically violent interpretations, this article argues that we must engage with Sinophone critique and shift away from a framework of culture to one of "concerns" in order to capture the heterogeneity of queer Sinophone subjectivities.
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Wu C, Choi EPH, Chau PH. The Holistic Health Status of Chinese Homosexual and Bisexual Adults: A Scoping Review. Front Public Health 2021; 9:710575. [PMID: 34504828 PMCID: PMC8421524 DOI: 10.3389/fpubh.2021.710575] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 07/26/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Same-sex marriage is currently not legalized in China, despite the considerably large number of homosexual and bisexual Chinese populations. At the same time, their holistic health status remains unclear. This is the first scoping review conducted to comprehensively examine all the available literature and map existing evidence on the holistic health of homosexual and bisexual Chinese. Methods: This scoping review used the framework of Arksey and O'Malley and followed the Preferred Reporting Items for Systematic Review and Meta-Analysis extension for scoping reviews (PRISMA-ScR). A comprehensive search strategy was carried out across 20 English (EN) and Chinese (both traditional and simplified) electronic databases from January 1, 2001, to May 31, 2020. Two reviewers conducted the reference screening and study selection independently and consulted a third senior reviewer whenever a consensus must be achieved. Data extraction was conducted using a structured data form based on the Cochrane template, after which a narrative synthesis of the findings was performed. Results: A total of 2,879 references were included in the final analysis, with 2,478 research articles, 167 reviews, and 234 theses. Regarding the study populations, the vast majority of studies centered on men only (96.46%), especially men who have sex with men (MSM). Only 1.32% of the studies targeted female sexual minorities. The geographical distribution of all research sites was uneven, with most of them being conducted in mainland China (95.96%), followed by Hong Kong (2.05%), Taiwan (2.02%), and Macau (0.06%). Regarding the specific study focus in terms of the health domain, around half of the studies (45.93%) focused on sexual health only, and an additional quarter of the studies (24.15%) investigated both sexual health and social well-being. Meanwhile, the studies focusing on mental health only accounted for approximately 15% of the total. Conclusions: This scoping review revealed that previous research focused more on male than female sexual minorities, on disease-centered surveys than person-centered interventions, and investigations on negative health conditions than positive health promotion. Therefore, investigations centered on the female sexual minorities and corresponding person-centered interventions are highly needed. Review Registration: The protocol of this review has been registered within Open Science Framework (https://osf.io/82r7z) on April 27, 2020.
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Affiliation(s)
| | - Edmond Pui Hang Choi
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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25
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Minority stress, depression, and cigarette smoking among Chinese gay versus bisexual men: a two-group structural equation model analyses. BMC Public Health 2021; 21:1358. [PMID: 34243745 PMCID: PMC8268265 DOI: 10.1186/s12889-021-10888-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Literature in the West suggested that bisexual men have a higher smoking rate compared to gay men. Data on patterns of smoking among gay and bisexual men are limited in Eastern Asian countries like China. This study examined the cigarette smoking prevalence for gay versus bisexual men in China and their unique minority stress - smoking pathways. Methods Between September 2017 and November 2018, we surveyed a convenience sample of 538 gay men and 138 bisexual men recruited from local sexual minority organizations in four metropolitan cities in China (i.e., Beijing, Wuhan, Nanchang, and Changsha). Measures included sexual orientation, sociodemographics, theory-based minority stressors, depressive symptoms, and past 30-day cigarette smoking. Two-group (gay men vs. bisexual men) structural equation modeling (SEM) was used to test possible distinct mechanisms between theory-based stressors, depressive symptoms, and cigarette smoking among gay men and bisexual men, respectively. Results The mean age of participants was 26.51 (SD = 8.41) years old and 76.3% of them had at least a college degree. Bisexual men reported a higher rate of cigarette smoking compared to gay men (39.9% vs. 27.3%). Two-group SEM indicated that the pathways for cigarette smoking were not different between gay and bisexual men. Higher rejection anticipation was associated with greater depressive symptoms (standardized β = 0.32, p < .001), and depressive symptoms were not associated with cigarette smoking. Conclusions Minority stress, specifically rejection anticipation, may be critical considerations in addressing depressive symptoms, but not smoking, among both gay and bisexual men in China. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10888-5.
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Improving HIV Self-Testing Social Network Interventions: The Role of Sexual Behavior Disclosure Among Chinese Men Who Have Sex with Men. AIDS Behav 2021; 25:1984-1992. [PMID: 33471242 DOI: 10.1007/s10461-020-03128-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2020] [Indexed: 10/22/2022]
Abstract
We assessed if same-sex sexual behavior disclosure of index men who have sex with men (MSM) was related to number of HIV self-testing (HIVST) kits requested by index participants, and number of test results successfully uploaded by alters in a network-based HIVST intervention. Index participants are men who accessed and distributed HIVST kits and alters are index's social contacts who received kits. We analyzed treatment arm data [N = 106, mean age = 27 (SD = 5.3)] of an intervention conducted among MSM in Guangzhou, China, May 2019-December 2019. Index MSM who disclosed sexual behavior to their family tended to request more kits [adjusted incidence rate ratio (aIRR) 1.42, 95% CI 1.06, 1.90, p < .05]. Index men who disclosed sexual behavior to their family (aIRR 2.47, 95% CI 1.17, 5.24, p < .05) tended to yield an increase in number of alter test results uploaded. Findings have implications for the development of network-based interventions for key populations.
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Association between enacted stigma, internalized stigma, resilience, and depressive symptoms among young men who have sex with men in China: a moderated mediation model analysis. Ann Epidemiol 2021; 56:1-8. [DOI: 10.1016/j.annepidem.2021.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/08/2020] [Accepted: 01/02/2021] [Indexed: 12/13/2022]
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Mo PKH, Hu H, Ip M, Dong W, Lau JTF, Wang Z. Effect of stress and avoidant coping on depression and the moderating role of age among men who have sex with men: Findings from a 6-month prospective cohort study. J Affect Disord 2021; 283:310-316. [PMID: 33578343 DOI: 10.1016/j.jad.2021.01.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 01/06/2021] [Accepted: 01/30/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Men who have sex with men (MSM) are at increased risk of mental health problems. Few studies have examined the risk factors for mental health problems of Chinese MSM and identified potential moderators using a longitudinal design. OBJECTIVES The present study examined the effect of stress and avoidant coping on depression among MSM, and the moderating role of age on such relationship. METHODOLOGY A 6-month observational prospective cohort study was conducted among Chinese MSM. Respectively 592 and 402 MSM completed a survey at baseline and 6-month follow-up. RESULTS The prevalence of probable depression was 36.1% at baseline and 34.1% at 6-month follow-up. After adjusting for background characteristics and baseline depression score, both stress (β = .22, p<.05) and avoidant coping (β = .14, p<.05) showed significant positive relationship with depression at 6-month follow-up. The interaction effect of age and stress / avoidant coping was also significant. The effect of stress on depression was stronger among younger MSM, and the effect of avoidant coping on depression was significant among younger MSM but non-significant among older MSM. CONCLUSIONS Mental health promotion for MSM should reduce stress and avoidant coping, and specific intervention should be designed for younger MSM.
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Affiliation(s)
- Phoenix K H Mo
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Huahua Hu
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Mary Ip
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Willa Dong
- Department of Health Behavior, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, North Carolina, US.
| | - Joseph T F Lau
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
| | - Zixin Wang
- Center for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
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Pan S, Sun S, Li X, Chen J, Xiong Y, He Y, Pachankis JE. A pilot cultural adaptation of LGB-affirmative CBT for young Chinese sexual minority men's mental and sexual health. Psychotherapy (Chic) 2021; 58:12-24. [PMID: 32538644 PMCID: PMC7736310 DOI: 10.1037/pst0000318] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Young men who have sex with men (YMSM) represent one of the most at-risk groups for HIV infection and experience sexual minority stress especially in high-stigma settings, which affects their psychological health and increases likelihood of HIV-risk behaviors. The HIV epidemic in China is increasing rapidly among YMSM. However, no evidence-based intervention has specifically targeted Chinese YMSM's minority stress to improve their mental and sexual health. Adaptation of evidence-based interventions to promote the mental and sexual health of YMSM is one promising way to achieve the global target of HIV epidemic control. The current adaptation study followed the Assessment-Decision-Administration-Production-Topical Experts-Integration-Training-Testing model. YMSM (n = 41) and key stakeholders (n = 16) in China provided feedback into the selected intervention, a cognitive-behavioral therapy called Effective Skills to Empower Effective Men, originally developed with efficacy in the United States. An open pilot (n = 8) was also then conducted. Qualitative and quantitative data collected from each adaptation phase were analyzed to form the adapted intervention: "Yi Si Tang ()." Adaptations addressed a cultural context prioritizing family needs, limited support from the health system, as well as YMSM delivery preferences. YMSM and key stakeholders deemed the intervention acceptable and preliminarily feasible for the Chinese context. The pre-post comparison of mental and sexual health outcomes indicated improvement in mental health and sexual health of Chinese YMSM. Outcomes of the small initial pilot suggest future promise for this first-of-its-kind intervention for Chinese YMSM. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Phillips TR, Medland N, Chow EPF, Maddaford K, Wigan R, Fairley CK, Ong JJ, Bilardi JE. "Moving from one environment to another, it doesn't automatically change everything". Exploring the transnational experience of Asian-born gay and bisexual men who have sex with men newly arrived in Australia. PLoS One 2020; 15:e0242788. [PMID: 33216802 PMCID: PMC7678978 DOI: 10.1371/journal.pone.0242788] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 11/10/2020] [Indexed: 12/02/2022] Open
Abstract
Asian-born gay, bisexual and other men who have sex with men (gbMSM) who are newly arrived in Australia are at a higher risk of acquiring HIV than Australian-born gbMSM. We used a social constructionist framework to explore HIV knowledge and prevention strategies used by newly-arrived Asian-born gbMSM. Twenty four Asian-born gbMSM, aged 20–34 years, attending Melbourne Sexual Health Centre, who arrived in Australia in the preceding five years, participated in semi-structured, face-to-face interviews. Interviews were recorded, transcribed verbatim and analysed thematically. Participants described hiding their sexual identities in their country of origin, particularly from family members, due to fear of judgement and discrimination resulting from exposure to sexual identity and HIV related stigma in their countries of origin, although some were open to friends. Despite feeling more sexual freedom and acceptance in Australia, many were still not forthcoming with their sexual identity due to internalised feelings of stigma and shame. Exposure to stigma in their country of origin led many to report anxiety around HIV testing in Australia due to a fear of testing positive. Some described experiencing racism and lack of acceptance in the gay community in Australia, particularly on dating apps. Fear of discrimination and judgement about their sexual identity can have a significant impact on Asian-born gbMSM living in Australia, particularly in terms of social connectedness. Additionally, HIV-related stigma can contribute to anxieties around HIV testing. Our data highlights the potential discrimination Asian-born gbMSM face in Australia, which has implications for social connectedness, particularly with regard to LGBTQI communities and HIV testing practices. Future studies should determine effective strategies to reduce sexual identity and HIV-related stigma in newly-arrived Asian-born gbMSM.
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Affiliation(s)
- Tiffany R. Phillips
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- * E-mail:
| | - Nicholas Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Eric P. F. Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kate Maddaford
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Rebecca Wigan
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
| | - Christopher K. Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jason J. Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Jade E. Bilardi
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, VIC, Australia
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31
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Sun S, Hoyt WT, Tarantino N, Pachankis JE, Whiteley L, Operario D, Brown LK. Cultural context matters: Testing the minority stress model among Chinese sexual minority men. J Couns Psychol 2020; 68:526-537. [PMID: 33030914 DOI: 10.1037/cou0000535] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Minority stress theory (e.g., Meyer, 2003b), a model for understanding mental health disparities affecting sexual minorities, has primarily been tested in Western samples yet has not been carefully applied to the experiences of sexual minorities in a global context, including in East Asian countries. Combining minority stress theory with considerations of Chinese culture, the current study tested the associations among norm conformity, distal minority stressor (enacted stigma), proximal minority stressors (sexual identity concerns and concealment), lesbian, gay, and bisexual (LGB) family support, and psychological distress among Chinese sexual minority men (n = 748). Structural equation modeling showed that sexual identity concerns mediated the associations of norm conformity, enacted stigma, and lower family support with concealment. Psychological distress was associated with enacted stigma and lower family support, but not with proximal stressors (sexual identity concerns and concealment). Alternative model testing found sexual identity acceptance concerns predicted psychological distress and mediated the associations of norm conformity and LGB family support with distress. Findings provide partial support for the minority stress model in a Chinese context and suggest the importance of incorporating cultural considerations into minority stress conceptualizations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Chen C, Huang J, Zhao J, Zhang Y, Xiaonan Yu N. Resilience Moderated the Predictive Effect of Dual Stigma on Distress Among Chinese Newly Diagnosed HIV-Positive Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:403-415. [PMID: 33112678 DOI: 10.1521/aeap.2020.32.5.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Previous studies have examined the distinct stigmas of people living with HIV or of men who have sex with men (MSM). To capture the composite stress of HIV-positive MSM and the mixed stigma they experience, we conceptualized a compound stigma combining HIV status and homosexual identity. At two waves with an interval of 6 months, the results of 112 Chinese newly diagnosed HIV-positive MSM showed that dual stigma at baseline increased distress symptoms 6 months later. Resilience moderated these effects, as the dual stigma increased, distress symptoms intensified more rapidly for individuals with lower resilience than they did for those with higher resilience. Our findings highlight that dual stigma, as an intensified risk factor, predicted distress among the Chinese newly diagnosed HIV-positive MSM, conditioned by the protective factor of resilience. The results have strong implications for developing resilience-based intervention programs in this population.
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Affiliation(s)
- Chen Chen
- Department of Social and Behavioural Sciences, City University of Hong Kong, China
| | - Jiasheng Huang
- Department of Social and Behavioural Sciences, City University of Hong Kong, China
- Department of Psychology, Sun Yat-Sen University, Guangdong, China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention, China
| | - Yan Zhang
- Shenzhen Center for Disease Control and Prevention, China
| | - Nancy Xiaonan Yu
- Department of Social and Behavioural Sciences, City University of Hong Kong, China
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33
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Wen G, Zheng L. The Influence of Internalized Homophobia on Health-Related Quality of Life and Life Satisfaction Among Gay and Bisexual Men in China. Am J Mens Health 2020; 13:1557988319864775. [PMID: 31311400 PMCID: PMC6637842 DOI: 10.1177/1557988319864775] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The aim of this study was to examine the influences of internalized homophobia on Chinese gay and bisexual men's quality of life and life satisfaction. Four hundred and eighty-three participants completed the Internalized Homophobia Scale, Chinese SF-12 Health Survey Version 2, and Satisfaction With Life Scale via the Internet. Scores for quality of life in several domains and life satisfaction were significantly lower than the heterosexuals' norm scores. The present study revealed that internalized homophobia significantly negatively correlated with the mental component summary score and life satisfaction. The mental component summary score mediated the relationship between internalized homophobia and life satisfaction. Sexual orientation moderated the relationship between internalized homophobia and mental component score. Gay and bisexual men in China experience poorer quality of life and less satisfaction with life compared to heterosexuals, and internalized homophobia contributes to both.
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Affiliation(s)
- Guangju Wen
- 1 Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, Chongqing, China.,2 Faculty of Psychology, Southwest University, Chongqing, China
| | - Lijun Zheng
- 1 Key Laboratory of Cognition and Personality (Southwest University), Ministry of Education, Chongqing, China.,2 Faculty of Psychology, Southwest University, Chongqing, China
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34
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Zheng L, Hart TA, Noor SW, Wen G. Stressors Based on Sexual Orientation and Mental Health Among Lesbian, Gay, and Bisexual Individuals in China: Minority Stress and Perceived Pressure to Get Married. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1769-1782. [PMID: 32285312 DOI: 10.1007/s10508-020-01693-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 03/23/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Chinese Confucian filial piety posits that getting married and having children to maintain family bloodlines is a fundamental duty of children to their parents. Chinese lesbian, gay, and bisexual (LGB) individuals experience added stresses because of the pressure to get married from parents, social environments, and themselves. However, no research thus far has examined the influence of this added stressor, called "pressure to get married," on the mental health of LGB individuals in China. This study examined the influence of sexual orientation-based stresses (i.e., LGB minority stress and perceived pressure to get married) on mental health among 543 Chinese single LGB individuals (259 gay men, 161 lesbians, 68 bisexual men, and 55 bisexual women). We developed a new measure of stress based on perceived pressure to get married and found three factors based on pressure sources: social pressure, parental pressure, and internalized pressure. Both minority stress and perceived pressure to get married were associated with worse mental health. Minority stress and perceived external pressure (i.e., perceived social and parental pressure) were found to be components of a second-order latent variable, called sexual orientation-based stress, which was associated with worse mental health. Sexual orientation-based stress is associated with mental health through coping/emotion and cognitive, but not social, processes. The results indicate that the pressure to get married experienced by Chinese LGB individuals need to be examined further. The findings indicated that the perceived pressure to get married was another significant stressor based on sexual orientation and minority stress, and was associated with mental health among Chinese LGB individuals.
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Affiliation(s)
- Lijun Zheng
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China.
- Faculty of Psychology, Southwest University, Chongqing, 400715, China.
| | - Trevor A Hart
- Department of Psychology, Ryerson University, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Syed W Noor
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Guangju Wen
- Key Laboratory of Cognition and Personality (Ministry of Education), Southwest University, Chongqing, China
- Faculty of Psychology, Southwest University, Chongqing, 400715, China
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35
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Meanley SP, Stall RD, Hawk ME, Surkan PJ, Shoptaw SJ, Matthews DD, Teplin LA, Egan JE, Plankey MW. Multifactorial discrimination, discrimination salience, and prevalent experiences of internalized homophobia in middle-aged and older MSM. Aging Ment Health 2020; 24:1167-1174. [PMID: 30938175 PMCID: PMC7041891 DOI: 10.1080/13607863.2019.1594161] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/11/2019] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
Objectives: We sought to test whether discrimination salience and multifactorial discrimination were associated with prevalent experiences of internalized homophobia among middle-aged and older men who have sex with men (MSM).Methods: We analyzed data from 498 middle-aged and older MSM from the Multicenter AIDS Cohort Study (MACS) who reported any lifetime discrimination experience. We estimated the prevalence ratio of current internalized homophobia using multivariable Poisson regressions, accounting for discrimination salience, multifactorial discrimination, and covariates. We then assessed whether multifactorial discrimination moderated the association between discrimination salience and internalized homophobia.Results: Over half (56.4%) of our sample reported any current experience of internalized homophobia. More than two-thirds reported multifactorial discrimination (68.2%) and more than one-third (36.7%) reported moderate-to-high discrimination salience. Increases in discrimination salience (PR = 1.11; 95% CI: 1.03-1.20) were associated with any current internalized homophobia among middle-aged and older MSM. Multifactorial discrimination was not statistically associated with internalized homophobia and did not moderate the association between discrimination salience and internalized homophobia.Conclusions: Our study underscores internalized homophobia as a persisting concern among MSM in midlife and older adulthood. Our findings suggest that salience, as a characteristic of discrimination experiences, may have a greater impact on internalized homophobia compared with exposure. Future research efforts should assess facets of discrimination salience, such as severity, frequency, and chronicity, to better understand how discrimination shapes psychosocial well-being across the life course. Mental health advocates at policy, organizational, and community levels should aim to reduce intersectional stigma and address individual experiences of internalized homophobia.
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Affiliation(s)
- Steven P. Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ron D. Stall
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Mary E. Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Pamela J Surkan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Steven J. Shoptaw
- Department of Family Medicine and Psychiatry and Biobehavioral Sciences, University of California – Los Angeles, Los Angeles, CA, USA
| | - Derrick D. Matthews
- Department of Health Behavior, University of North Carolina – Chapel Hill, Chapel, Hill, NC, USA
| | - Linda A. Teplin
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James E. Egan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Michael W. Plankey
- Division of Infectious Diseases, Georgetown University Department of Medicine, Washington, DC, USA
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36
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Chuang DM, Newman PA, Weaver J. HIV Vaccine Preparedness among Men Who Have Sex with Men in Taiwan: Sociocultural and Behavioral Factors. J Int Assoc Provid AIDS Care 2020; 18:2325958219832285. [PMID: 30907256 PMCID: PMC6748505 DOI: 10.1177/2325958219832285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
In Taiwan, men who have sex with men (MSM) are at disproportionate risk of HIV infection. We examined awareness and acceptability of future HIV vaccines. From July to August 2014, we conducted a cross-sectional survey with MSM recruited through community-based organizations (CBOs) in 2 cities. Among 200 participants (mean age, 27.6 years), half reported multiple partners and one-third condomless anal sex (past 3 months); 12% were HIV-positive. Traditional Chinese medicine (TCM) use was reported by 42.7%. Over two-thirds (69.0%) were aware of HIV vaccine research, but less than half (43.8%) would accept an HIV vaccine if available. In multivariable analysis, higher educational attainment, >5 sex partners, and TCM use were positively associated with HIV vaccine awareness. Culturally informed HIV vaccine preparedness in Taiwan may be supported by a complementary approach to TCM and HIV prevention technologies, tailoring information for MSM with lower education and targeting those at high risk through gay-identified CBOs.
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Affiliation(s)
- Deng-Min Chuang
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Peter Adam Newman
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - James Weaver
- 1 Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
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37
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Kumar N, Forastiere L, Zhang T, Yang F, Li KT, Tang W, Tucker JD, Christakis NA, Alexander M. Lack of sexual behavior disclosure may distort STI testing outcomes. BMC Public Health 2020; 20:616. [PMID: 32366241 PMCID: PMC7197169 DOI: 10.1186/s12889-020-08768-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out. METHODS This was a secondary analysis of data from a cross sectional MSM survey conducted at a multisite randomized controlled trial (RCT) (December 2018 to January 2019) around uptake of gonorrhea and chlamydia testing among Chinese MSM (N = 431). We collected socio demographics, relevant medical and sexual history, and disclosure of sexual behavior (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision making. RESULTS Among 431 MSM, mean age was 28 years (SD = 7.10) and 65% were out to someone. MSM who indicated versatile sexual behavior and were out to someone had a 26.8% (95%CI = 6.1, 47.5) increased likelihood for selecting the rectal test vs the ure thral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI = 6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider. CONCLUSIONS Sexual behavior and outness may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community based efforts may reduce stigma based barriers to testing.
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Affiliation(s)
- Navin Kumar
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
| | - Laura Forastiere
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
- Department of Biostatistics, Yale School of Public Health, New Haven, CT USA
| | - Tiange Zhang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Loyola University Chicago Stritch School of Medicine, Maywood, IL USA
| | - Fan Yang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
| | | | - Weiming Tang
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- Southern Medical University Dermatology Hospital, Guangzhou, China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill Project-China, No. 2 Lujing Road, Guangzhou, 510095 China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Marcus Alexander
- Human Nature Lab, Department of Sociology, Yale University, New Haven, CT USA
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38
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Doshi M, Macharia P, Mathenge J, Musyoki H, Amico KR, Battacharjee P, Blanchard J, Reza-Paul S, McKinnon LR, Kimani J, Lorway RR. Beyond biomedical and comorbidity approaches: Exploring associations between affinity group membership, health and health seeking behaviour among MSM/MSW in Nairobi, Kenya. Glob Public Health 2020; 15:968-984. [PMID: 32172670 DOI: 10.1080/17441692.2020.1739729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We explored general health and psychosocial characteristics among male sex workers and other men who have sex with men in Nairobi, Kenya. A total of 595 MSM/MSW were recruited into the study. We assessed group differences among those who self-reported HIV positive (SR-HIVP) and those who self-reported HIV negative (SR-HIVN) and by affinity group membership. Quality of life among SR-HIVP participants was significantly worse compared to SR-HIVN participants. Independent of HIV status and affinity group membership, participants reported high levels of hazardous alcohol use, harmful substance use, recent trauma and childhood abuse. The overall sample exhibited higher prevalence of moderate to severe depressive symptoms compared to the general population. Quality of life among participants who did not report affinity group membership (AGN) was significantly worse compared to participants who reported affinity group membership (AGP). AGN participants also reported significantly lower levels of social support. Membership in affinity groups was found to influence health seeking behaviour. Our findings suggest that we need to expand the mainstay biomedical and comorbidity focused research currently associated with MSM/MSW. Moreover, there are benefits to being part of MSM/MSW organisations and these organisations can potentially play a vital role in the health and well-being of MSM/MSW.
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Affiliation(s)
- Monika Doshi
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Pascal Macharia
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - John Mathenge
- Health Options for Young Men on HIV/AIDS/STI (HOYMAS), Nairobi, Kenya
| | - Helgar Musyoki
- National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya
| | - K Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Parinita Battacharjee
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - James Blanchard
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sushena Reza-Paul
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Lyle R McKinnon
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Joshua Kimani
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Canada.,Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Robert R Lorway
- The Centre for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
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39
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Minority stress and health: A grounded theory exploration among men who have sex with men in China and implications for health research and interventions. Soc Sci Med 2020; 252:112917. [PMID: 32197142 DOI: 10.1016/j.socscimed.2020.112917] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 12/18/2019] [Accepted: 03/08/2020] [Indexed: 01/19/2023]
Abstract
RATIONALE Men who have sex with men (MSM) in China are disproportionately affected by HIV and mental health issues. Although predominately western-based research suggests a minority stress perspective to explain health disparities, how Chinese MSM experience stress related to being a sexual minority and how such experiences affect their health have not been carefully examined. OBJECTIVE This study was a qualitative investigation of how stress related to sexuality (e.g., stigma, discrimination, and oppression) are experienced among MSM in China and how these experiences affect their psychological and behavioral health. METHOD In-depth, semi-structured interviews were conducted with 24 MSM in China. Grounded theory was employed to guide data analysis. RESULTS Six categories emerged, which included: A Family-Oriented, Heteronormative Culture, Interpersonal Rejections and Marginalization, Internalization of Stigma, the Psychological Impact of Minority Stress, Impact on HIV-related Behavioral Health, and Coping. A conceptual model was developed, which illustrated relationships among categories and described sources, processes, and impact of minority stress among MSM in China. Cultural, social, and internalized sources of minority stress were shown to have detrimental effects on participants' psychological health and HIV-related behavioral health. Various coping strategies shared the purpose of navigating well-being in one's direct environment and in the larger culture. CONCLUSIONS Findings demonstrate the relevance of minority stress in behavioral health among Chinese MSM as well as the need to conceptualize minority stress within MSM's sociocultural context. HIV prevention efforts may benefit from a contextualized understanding of minority stress and addressing minority stress in a culturally congruent, community-centered fashion.
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Xu W, Tang W, Zhang J, Shi X, Zheng Y, Kaufman MR. Cigarette Smoking and Its Associations with Substance Use and HIV-Related Sexual Risks among Chinese Men Who Have Sex with Men. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1653. [PMID: 32150802 PMCID: PMC7084185 DOI: 10.3390/ijerph17051653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/24/2020] [Accepted: 02/25/2020] [Indexed: 02/05/2023]
Abstract
China has the largest population of male smokers globally. Men who have sex with men (MSM) are at greater risk of cigarette smoking compared to the general population. Limited data are available regarding cigarette smoking and its associations with other health issues among Chinese MSM. Eligible MSM (n = 1100) were recruited from mainland China using an online national cross-sectional survey conducted in 2014-2015. Socio-demographic characteristics, smoking behavior, substance use, homosexual stigma and outness, HIV-related risk behavior, and HIV status were obtained. Logistic regression analyses were performed to evaluate predictors of current cigarette smoking frequency and the co-occurrence of smoking and drug use. Nearly 41% (n = 446) of participants had ever smoked cigarettes; 25% (n = 278) were current frequent smokers; and 13% (n = 138) were current infrequent smokers. Factors associated with a history of smoking included age, employment status, and monthly salary. Risk factors associated with current frequent smoking included self-identification as gay, having female sexual partners, binge drinking, drug use, higher levels of homosexual stigma, and being partially or fully "out" as gay. Adjusted multinomial analysis showed that human immunodeficiency virus (HIV) related risks, including risky sexual behaviors, lack of condom use, and a reported history of sexually transmitted infections (STIs), were associated with co-occurrence of current smoking and drug use. Cigarette smoking rates remain high among MSM in China. Cigarette smoking is associated with binge drinking, drug use, and HIV-related risks in this community. There is a clear opportunity for smoking cessation interventions to be linked with HIV and substance use prevention interventions, thereby addressing multiple health issues simultaneously for the MSM community in China.
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Affiliation(s)
- Wenjian Xu
- Department of Sociology & Psychology, School of Public Administration, Sichuan University, Chengdu 610065, China;
- Faculty of Psychology, Southwest University, Chongqing 400715, China; (J.Z.); (X.S.)
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
| | - Wanjie Tang
- Center for Educational and Health Psychology, Sichuan University, Chengdu 610065, China;
- Institute of Emergency Management and Post-disaster Reconstruction, Sichuan University, Chengdu 610065, China
- Mental Health Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu 610065, China
| | - Jing Zhang
- Faculty of Psychology, Southwest University, Chongqing 400715, China; (J.Z.); (X.S.)
| | - Xin Shi
- Faculty of Psychology, Southwest University, Chongqing 400715, China; (J.Z.); (X.S.)
| | - Yong Zheng
- Faculty of Psychology, Southwest University, Chongqing 400715, China; (J.Z.); (X.S.)
| | - Michelle R. Kaufman
- Department of Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA;
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Sun S, Pachankis JE, Li X, Operario D. Addressing Minority Stress and Mental Health among Men Who Have Sex with Men (MSM) in China. Curr HIV/AIDS Rep 2020; 17:35-62. [PMID: 31950336 PMCID: PMC7050812 DOI: 10.1007/s11904-019-00479-w] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Men who have sex with men (MSM) in China experience elevated risks of mental health issues in comparison to the general population in China, which contribute to vulnerability to HIV/STI risks and can comprise the effectiveness of HIV prevention efforts. A conceptual framework for understanding this mental health disparity is minority stress theory, which posits that experiences of external prejudice events (i.e., distal stressors) and internal stress processes such as internalized homophobia and concealment (i.e., proximal stressors) contribute to sexual minorities' elevated risk of psychological distress. To deepen the understanding of mental health among Chinese MSM and explore the potential utility of minority stress theory in this population, this paper synthesizes research evidence regarding prevalent mental health issues as well as how minority stress may be linked to psychological health in Chinese MSM. RECENT FINDINGS Results indicate that Chinese MSM experience a high prevalence of several mental health issues including depression, anxiety, suicidal behaviors, and alcohol dependence. This review further reveals minority stress to be an important determinant of psychological distress among Chinese MSM, though evidence is mixed regarding the relationship between proximal minority stress and psychological health. Nonetheless, there is a lack of mental health services and interventions focusing on MSM in China. Culturally relevant, competent, and LGBT-affirmative mental health interventions are needed for Chinese MSM. To guide future intervention research, we provide considerations for reducing minority stress and promoting psychological health among Chinese MSM.
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Affiliation(s)
- Shufang Sun
- Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, 167 Point St, Providence, RI, 02906, USA.
| | - John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina Arnold School of Public Health, Columbia, SC, 29208, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown School of Public Health, Providence, RI, USA
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Sexual Minority Stigma, Sexual Orientation Concealment, Social Support and Depressive Symptoms Among Men Who have Sex with Men in China: A Moderated Mediation Modeling Analysis. AIDS Behav 2020; 24:8-17. [PMID: 31664571 DOI: 10.1007/s10461-019-02713-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Men who have sex with men (MSM) often experience depressive symptoms. However, the potential mechanisms resulting in depressive symptoms are not fully understood. Here, we explore possible mechanisms behind the associations between sexual minority stigma (SMS), sexual orientation concealment (SOC), and social support (SS) with depressive symptoms among MSM. Data (N = 715) used in the study were from the baseline survey of a 3-year cohort study in China. Computer-assisted self-interview was used to collect data. Mediation and moderated mediation modeling analysis were employed to address the question. It was found that SOC partially mediated the association between SMS and depressive symptoms (indirect effect = 0.11, 95% CI 0.05-0.17). SS moderated the mediation model by buffering the path from SMS to SOC (β = 0.17, t = 3.18, P = 0.002). These findings suggested that SS might strengthen the association between SMS and depressive symptoms by moderating the pathway between SMS and SOC.
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Miedema SS, Haardörfer R, Keyes CLM, Yount KM. Does Socio-structural Context Matter? A Multilevel Test of Sexual Minority Stigma and Depressive Symptoms in Four Asia-Pacific Countries. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2019; 60:416-433. [PMID: 31771346 DOI: 10.1177/0022146519877003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In the Asia-Pacific region, individual sexual stigma contributes to elevated rates of depression among sexual minority men. Less well understood is the role of socio-structural sexual stigma despite evidence that social context influences the experience of stigma. We use data from the United Nations Multi-country Study on Men and Violence to conduct a multilevel test of associations between individual- and cluster unit-level indicators of sexual stigma and depressive symptoms among sexual minority men (n = 562). In the full model, individual-level sexual stigma is not associated with depressive symptoms, although there is significant variation in the association between individual stigma and depressive symptoms across clusters. Contrary to expectation, at the community level, homophobic injunctive norms are negatively associated with depressive symptoms. We discuss the implications for policies, programs, and future research to improve mental health among sexual minority men in the region.
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Affiliation(s)
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Kathryn M Yount
- Department of Sociology, Emory University, Atlanta, GA, USA
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Aunon FM, Simoni JM, Yang JP, Shiu C, Chen WT, Edmunds SR, Ramaiya M, Cheng J, Zhao H. Depression and anxiety among HIV-positive men who have sex with men and men who have sex with women in China. AIDS Care 2019; 32:362-369. [PMID: 31672027 DOI: 10.1080/09540121.2019.1683803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing's Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β = -1.37, p < .05) and greater endorsement of maladaptive coping (β = 2.39, p < .05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β = 0.78, p < .05), diminished physical health (β = -0.86, p < .05), and a high school or greater level of education (β = 4.13, p < .05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men.
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Affiliation(s)
- Frances M Aunon
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Jane M Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Joyce P Yang
- Department of Psychology, University of San Francisco, San Francisco, CA, USA
| | - Chengshi Shiu
- School of Nursing, University of California, Los Angeles, Los Angeles, USA
| | - Wei-Ti Chen
- School of Nursing, University of California, Los Angeles, Los Angeles, USA
| | - Sarah R Edmunds
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Megan Ramaiya
- Department of Psychology, University of Washington, Seattle, Washington, USA
| | - Joy Cheng
- Kaiser Permanente San Leandro Medical Center, San Leandro, California, USA
| | - Hongxing Zhao
- Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China
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Xu W, Zheng Y, Wiginton JM, Kaufman MR. Alcohol use and binge drinking among men who have sex with men in China: Prevalence and correlates. Drug Alcohol Depend 2019; 202:61-68. [PMID: 31319361 DOI: 10.1016/j.drugalcdep.2019.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 04/21/2019] [Accepted: 04/28/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Both alcohol use/misuse and HIV incidence are increasing among men who have sex with men (MSM) in China. Little is known about predictors of alcohol use/misuse. METHODS An online nationwide sample (n = 1100) of MSM from mainland China was recruited between 2014 and 2015. The study objective was to examine the prevalence of a history of alcohol use and frequency of binge drinking in the previous 6 months in this population and assess their relationship with psychological and public health issues. RESULTS Nearly 62.1% of respondents reported a history of alcohol use; 30.7% were current infrequent binge drinkers; and 13.6% were current frequent binge drinkers. Adjusted logistic models showed that MSM who reported a history of alcohol use were more likely to report drug use in the previous 6 months (AOR = 1.67); higher levels of internalized homophobia (AOR = 1.49); and partial or full disclosure of their sexual orientation (AOR = 1.46). MSM engaging in current frequent binge drinking were more likely to report female sexual partners (AOR = 2.04) and drug use (AOR = 1.61) in the previous 6 months; higher levels of sexual sensation seeking (AOR = 1.68); and higher levels of homosexual stigma (AOR = 1.69). MSM who reported being unsure of their HIV status were less likely to be current frequent binge drinkers (AOR = 0.46). CONCLUSIONS A high prevalence of a history of alcohol use and binge drinking exists among Chinese MSM. Strategies that target alcohol use/misuse in this population are needed.
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Affiliation(s)
- Wenjian Xu
- Department of Sociology & Psychology, School of Public Administration, Sichuan University, Chengdu 610065, Sichuan, China; Faculty of Psychology, Southwest University, Beibei, Chongqing, 400715, China; Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Yong Zheng
- Faculty of Psychology, Southwest University, Beibei, Chongqing, 400715, China.
| | - John Mark Wiginton
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Michelle R Kaufman
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA
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Jiang D, Hou Y, Chen X, Wang R, Fu C, Li B, Jin L, Lee T, Liu X. Interpersonal Sensitivity and Loneliness among Chinese Gay Men: A Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:2039. [PMID: 31181720 PMCID: PMC6603862 DOI: 10.3390/ijerph16112039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/20/2022]
Abstract
To understand the current status of, and factors related to interpersonal sensitivity (IS) and loneliness among Chinese gay men. The Chinese version SCL-90-R was used to evaluate the status of IS, and the short-form UCLA Loneliness scale (ULS-8) was used for assessing loneliness level. Associations between demographics and IS were examined by chi-square tests and multivariable logistic regress analysis. Linear regression was used to assess the correlations between demographic factors and IS and loneliness. Dating practices and venues were summarized by multiple responses. Gay men who screened positive IS was identified in 36%. Age (OR25-29 = 8.731, 95% CI 2.296 to 33.139), education level (ORcollege = 0.037, 95% CI 0.046 to 0.911), being the only-child at home (ORyes = 4.733, 95% CI 2.293 to 9.733), monthly income (OR>7000 = 0.228, 95% CI 0.055 to 0.944), numbers of current sexual partners (OR1 = 0.285, 95% CI 0.129 to 0.629; OR2 = 0.109 95% CI 0.027 to 0.431) were related to IS. IS was also associated with a higher score of ULS-8 (β = 6.903, p < 0.001). Other variables associated with the score of ULS-8 included: living in a non-nuclear family (β = 0.998, p = 0.020), being a college student (β = -1.556, p = 0.044), having a higher monthly income (β for 3000-5000 yuan = -1.177, p = 0.045; β for over 7000 yuan = -2.207, p = 0.002), having sexual partners (all β < 1, p < 0.001), being the only-child (β = 1.393, p = 0.005). Nearly half of the sample (46.78%) reported that they looked for dating partners on the Internet or dating apps. IS and loneliness are positively correlated. Our study suggests that more humanistic care and social support should be given to Chinese gay men.
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Affiliation(s)
- Dongdong Jiang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Yitan Hou
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Xiangfan Chen
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Rui Wang
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Chang Fu
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Baojing Li
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
| | - Lei Jin
- Department of Sociology, The Chinese University of Hong Kong, RM 431, Sino Building, Shatin, Hong Kong, China.
| | - Thomas Lee
- Office of Public Health Studies, University of Hawaii at Manoa, Honolulu, HI 96822, USA.
| | - Xiaojun Liu
- School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China.
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Cao B, Saffer AJ, Yang C, Chen H, Peng K, Pan SW, Durvasula M, Liu C, Fu H, Ong JJ, Tang W, Tucker JD. MSM Behavior Disclosure Networks and HIV Testing: An Egocentric Network Analysis Among MSM in China. AIDS Behav 2019; 23:1368-1374. [PMID: 30680538 PMCID: PMC6511288 DOI: 10.1007/s10461-019-02404-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Men who have sex with men (MSM) disclose same-sex behaviors with others, creating disclosure networks. This study examined the characteristics of disclosure networks that are associated with HIV testing among MSM in China through an online nationwide survey. Name-generator questions were used to ask each participant ("ego") to nominate up to five social network members ("alters") with whom he had disclosed same-sex behaviors. Among the 806 men, the average disclosure network size was 4.05. MSM who reported larger disclosure networks were more likely to have been tested for HIV (aOR 1.21, 95% CI 1.08-1.34). The most common disclosure network alters were friends (45.1%), followed by sex partners (18.7%) and healthcare professionals (2.5%). Men who disclosed to healthcare professionals were more likely to test for HIV compared to men who disclosed to family members (aOR 5.43, 95% CI 2.11-14.04). Our findings can inform disclosure network-based interventions to promote MSM HIV testing.
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Affiliation(s)
- Bolin Cao
- School of Media and Communication, Shenzhen University, Shenzhen, China
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
| | - Adam J Saffer
- University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Cui Yang
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Hexin Chen
- Department of Media and Communication, City University of Hong Kong, Hong Kong, Hong Kong
| | - Kun Peng
- Faculty of Humanities and Arts, Macau University of Science and Technology, Taipa, Macau, China
| | - Stephen W Pan
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- Department of Public Health, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Maya Durvasula
- Sanford School of Public Policy, Duke University, Durham, USA
| | - Chuncheng Liu
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- Department of Sociology, University of California, San Diego, La Jolla, USA
| | - Hongyun Fu
- Eastern Virginia Medical University, Norfolk, USA
| | - Jason J Ong
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- London School of Hygiene and Tropical Medicine, London, UK
| | - Weiming Tang
- University of North Carolina Project-China, Guangzhou, China
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China
- Guangdong Provincial Centre for Skin Diseases and STI Control, Number 2 Lujing Road, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, Guangzhou, China.
- Social Entrepreneurship to Spur Health (SESH), Guangzhou, China.
- University of North Carolina at Chapel Hill, Chapel Hill, USA.
- London School of Hygiene and Tropical Medicine, London, UK.
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Chuang DM, Newman PA. Pre-Exposure Prophylaxis (PrEP) Awareness and Acceptability Among Men Who Have Sex With Men in Taiwan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:490-501. [PMID: 30966765 DOI: 10.1521/aeap.2018.30.6.490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Gay and other men who have sex with men (MSM) account for the vast majority of new HIV infections in Taiwan, yet utilization of pre-exposure prophylaxis (PrEP) remains low. We examined correlates of PrEP awareness and acceptability among MSM in Taiwan. A cross-sectional survey was conducted with 176 MSM (mean age = 27.4 years) recruited through community-based organizations in two cities. Less than half of participants (47.2%) were aware of PrEP; however, when it was described to them, the majority (72.2%) indicated PrEP acceptability. In multivariable analyses, condomless anal sex was negatively associated with PrEP awareness, and higher levels of vicarious stigma and anticipated PrEP disclosure to sexual partners were positively associated with PrEP acceptability. Our findings indicate the need for targeted interventions to increase PrEP awareness among MSM engaged in high-risk behaviors and implementation strategies that address sociocultural factors to accelerate PrEP utilization among MSM in Taiwan.
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Affiliation(s)
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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49
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Wu F, Zhang A, Babbitt A, Ma Q, Eyal N, Pan X, Cai W, Hu F, Cheng Y, Tucker JD. Overcoming HIV Stigma? A Qualitative Analysis of HIV Cure Research and Stigma Among Men Who Have Sex with Men Living with HIV. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2061-2069. [PMID: 29149399 PMCID: PMC5957764 DOI: 10.1007/s10508-017-1062-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
Despite global progress in HIV stigma reduction, persistent HIV stigma thwarts effective HIV service delivery. Advances in HIV biomedical research toward a cure may shift perceptions of people living with HIV and HIV stigma. The purpose of this study was to examine how men who have sex with men (MSM) living with HIV in Guangzhou, China perceive HIV cure research and its potential impact on MSM and HIV stigma. We conducted in-depth interviews with 26 MSM living with HIV about their perceptions of HIV cure research and the potential impact of an HIV cure on their lives. Thematic coding was used to identify themes and structure the analysis. Two overarching themes emerged. First, participants stated that an HIV cure may have a limited impact on MSM-related stigma. Men noted that most stigma toward MSM was linked to stereotypes of promiscuity and high rates of sexual transmitted diseases in the MSM community and might persist even after a cure. Second, participants believed that an HIV cure could substantially reduce enacted, anticipated, and internalized stigma associated with HIV. These findings suggest that a biomedical cure alone would not remove the layered stigma facing MSM living with HIV. Comprehensive measures to reduce stigma are needed.
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Affiliation(s)
- Feng Wu
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
| | - Alice Zhang
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
- Department of Family Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrew Babbitt
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
| | - Qingyan Ma
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Nir Eyal
- Harvard University Program in Ethics and Health, Harvard University, Boston, MA, USA
| | - Xin Pan
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China
| | - Weiping Cai
- Infectious Diseases Institute, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Fengyu Hu
- Infectious Diseases Institute, Guangzhou Eighth People's Hospital, Guangzhou, China
| | - Yu Cheng
- School of Sociology and Anthropology, Sun Yat-Sen University, Guangzhou, China
| | - Joseph D Tucker
- University of North Carolina Project-China, 2 Lujing Road, Guangzhou, Guangdong Province, China.
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
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Ye Z, Chen L, Lin D. The Relationship Between Posttraumatic Stress Disorder Symptoms and Posttraumatic Growth Among HIV-Infected Men Who Have Sex With Men in Beijing, China: The Mediating Roles of Coping Strategies. Front Psychol 2018; 9:1787. [PMID: 30319492 PMCID: PMC6170659 DOI: 10.3389/fpsyg.2018.01787] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022] Open
Abstract
The traumatic experience of contracting and living with HIV/AIDS may produce a myriad of mental health problems, especially posttraumatic stress disorder (PTSD) symptoms, and conversely, bring posttraumatic growth (PTG), that is, positive changes resulting from a struggle with trauma. The growing body of research into the relationship between PTSD symptoms and PTG has produced mixed results. In addition, some research has suggested that psychosocial and cognitive factors may mediate the development of PTG after trauma exposure. Specifically, individuals experience fewer psychological symptoms and better mental health when adaptive coping strategies align with stressors; however, little research is available on the relationship and the mediating effect of coping strategies on the link of PTSD symptoms and PTG among HIV-infected men who have sex with men (MSM) in China. The aims of the current study were to investigate the relationship between PTSD symptoms and PTG as well as the potential mediating effects of coping strategies through which PTSD symptoms contributes to PTG among this vulnerable population. One hundred and forty HIV-positive MSM were recruited from the Beijing Center for Disease Prevention and Control and were asked to complete a battery of self-administered questionnaires, covering sociodemographic and HIV-related characteristics, coping strategies (i.e., problem-solving, seeking social support, self-blame, and wishful thinking), PTSD symptoms, and PTG. Results showed that, after controlling for sociodemographic and HIV-related variables, a negative linear relationship was found between PTSD symptoms and PTG. In addition, problem-solving and self-blame played significant mediating roles in the association between PTSD symptoms and PTG. The mediating effects of seeking social support and engaging in wishful thinking on the PTSD symptoms and PTD link were, however, non-significant. The present study contributes to an understanding of the association between PTSD symptoms and PTG and underscores the mediators through which individuals gain growth from traumatic experience in the context of HIV infection in Beijing, China. Given these findings, the future efforts at psychological intervention should differentiate and target various types of coping strategies, especially focusing on enhancing problem-solving skills and decreasing self-blame, in response to the promotion of positive growth among HIV-infected MSM.
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Affiliation(s)
- Zhi Ye
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Lihua Chen
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Danhua Lin
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
- Faculty of Psychology, Beijing Normal University, Beijing, China
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