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Ye R, Lai Y, Gu J. New sexually transmitted HIV infections from 2016 to 2050 in Guangdong Province, China: a study based on a dynamic compartmental model. BMC Public Health 2024; 24:1307. [PMID: 38745217 PMCID: PMC11092022 DOI: 10.1186/s12889-024-18735-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND In Guangdong Province, China, there is lack of information on the HIV epidemic among high-risk groups and the general population, particularly in relation to sexual transmission, which is a predominant route. The new HIV infections each year is also uncertain owing to HIV transmission from men who have sex with men (MSM) to women, as a substantial proportion of MSM also have female sexual partnerships to comply with social demands in China. METHODS A deterministic compartmental model was developed to predict new HIV infections in four risk groups, including heterosexual men and women and low- and high-risk MSM, in Guangdong Province from 2016 to 2050, considering HIV transmission from MSM to women. The new HIV infections and its 95% credible interval (CrI) were predicted. An adaptive sequential Monte Carlo method for approximate Bayesian computation (ABC-SMC) was used to estimate the unknown parameter, a mixing index. We calibrated our results based on new HIV diagnoses and proportions of late diagnoses. The Morris and Sobol methods were applied in the sensitivity analysis. RESULTS New HIV infections increased during and 2 years after the COVID-19 pandemic, then declined until 2050. New infections rose from 8,828 [95% credible interval (CrI): 6,435-10,451] in 2016 to 9,652 (95% CrI: 7,027-11,434) in 2019, peaking at 11,152 (95% CrI: 8,337-13,062) in 2024 before declining to 7,084 (95% CrI: 5,165-8,385) in 2035 and 4,849 (95% CrI: 3,524-5,747) in 2050. Women accounted for approximately 25.0% of new HIV infections, MSM accounted for 40.0% (approximately 55.0% of men), and high-risk MSM accounted for approximately 25.0% of the total. The ABC-SMC mixing index was 0.504 (95% CrI: 0.239-0.894). CONCLUSIONS Given that new HIV infections and the proportion of women were relatively high in our calibrated model, to some extent, the HIV epidemic in Guangdong Province remains serious, and services for HIV prevention and control are urgently needed to return to the levels before the COVID-19 epidemic, especially in promoting condom-based safe sex and increasing awareness of HIV prevention to general population.
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Affiliation(s)
- Rong Ye
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, 510080, China
| | - Yingsi Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, 510080, China
- Sun Yat-sen Global Health institute, Sun Yat-sen University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan 2nd Road, Guangzhou, 510080, China.
- Sun Yat-sen Global Health institute, Sun Yat-sen University, Guangzhou, China.
- Research Center of Health Informatics, Sun Yat-sen University, Guangzhou, China.
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Pu Y, Xu W. Parenting Desire Among Sexual Minority Women in China: From the Stigma Perspective. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:293-306. [PMID: 37620669 DOI: 10.1007/s10508-023-02682-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023]
Abstract
In China, women who are childless or have children outside of heterosexual marriage are generally stigmatized. Consequently, Chinese sexual minority women are challenged for their willingness to have children. This study explored how multiple (structural-interpersonal-individual) levels of sexual minority stigma are related to parenting desire among Chinese sexual minority women. Furthermore, it examined the mediation mechanism of individual stigma and the moderation effect of outness to one's family in the link between structural/interpersonal stigma and parenting desire. Participants (265 lesbian and 193 bisexual women) completed online measures of structural stigma (adherence to Confucianism), interpersonal stigma (discrimination events), individual stigma (internalized homophobia and rejection sensitivity), outness to one's family, and parenting desire. Lesbian women reported lower structural and individual stigma and parenting desire levels than bisexual women. Sexual minority women's high adherence to Confucianism, internalized homophobia, and rejection sensitivity were positively associated with their increased parenting desires. Notably, adherence to Confucianism and discrimination events were associated with parenting desire through internalized homophobia, but not rejection sensitivity; moreover, outness to one's family buffered the direct link between adherence to Confucianism and parenting desire and strengthened the direct link between discrimination events and internalized homophobia and the indirect link between discrimination events and parenting desire. This study contributes to a robust understanding of how sexual minority stigma is connected to parenting desire among sexual minority women in Chinese sociocultural contexts, providing cultural-specific evidence to support theories of stigma and minority stress.
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Affiliation(s)
- Yaxin Pu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, China
- Institute of Psychology, Sichuan University, Chengdu, China
| | - Wenjian Xu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, 610065, China.
- Institute of Psychology, Sichuan University, Chengdu, China.
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3
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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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Li M, Li N. A study of the factors influencing HIV-preventive intentions among "hookup" application users. Front Psychol 2023; 13:1048226. [PMID: 36687841 PMCID: PMC9846252 DOI: 10.3389/fpsyg.2022.1048226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023] Open
Abstract
"Hooking up" refers to the act of experiencing sexual intimacy with strangers without committing to a romantic relationship. Social media provide more convenient conditions for hooking up; however, it also poses a greater risk for HIV infection. Therefore, it is necessary to study the factors influencing the HIV-preventive intentions of those who engage in online dating to devise effective strategies for preventing the spread of HIV. This study consisted of a questionnaire that was distributed to 520 users of the Hello Group application. The survey results revealed that structural equation modeling is a useful framework for understanding the risk of HIV transmission in casual hookup encounters. In addition, combining the health belief model with the theory of planned behavior can provide recommendations for enhancing HIV-preventive intentions among users of dating applications. The results showed that mindfulness, the Chinese cultural context, perceived benefits, and self-efficacy were the main predictors of users' HIV-preventive intentions when using online dating applications. Among the perceived HIV risks, only perceived barriers had a negative effect on users' HIV-preventive intentions. In addition, attitude, subjective norms, and behavior control served as mediating variables between independent variables and HIV-preventive intentions; however, the mediating effect of attitude on perceived benefits and intentions was not significant. According to our study, some users misunderstand the risks and make incorrect assessments of the cultural risks of hooking up. Therefore, it is necessary to pay attention to the research on the psychological tendencies of users and risk intervention when studying the concept of hooking up.
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Affiliation(s)
- Mengyu Li
- College of Humanities and Development Studies, China Agricultural University, Beijing, China
- Faculty of Modern Languages and Communication, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
- School of Journalism and Communication, Zhengzhou University, Zhengzhou, China
| | - Ning Li
- Department of Media and Communication, Kangwon National University, Chuncheon-si, South Korea
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5
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He A, Bu H, Liao A, Mu W. What triggers depressive symptoms among gay and bisexual men? A sequential mediation model of sexual minority-related stigma and self-criticism. BRITISH JOURNAL OF SOCIAL PSYCHOLOGY 2023; 62:1097-1113. [PMID: 36594229 DOI: 10.1111/bjso.12621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023]
Abstract
A growing number of studies has shown that gay and bisexual men are more likely to experience adverse mental health status than their heterosexual counterparts. Stigma-related stress and self-criticism are believed likely to exacerbate depressive symptoms among gay and bisexual men. This research used cross-sectional findings to illustrate the mediating role of internalized self-stigma and self-criticism in the association between perceived public stigma and depressive symptoms. A total of 317 Chinese gay and bisexual men (267 gays and 50 bisexuals with a mean age of 25.29) were invited to participate in this study from October to November 2021. Sociodemographic characteristics, perceived public stigma, internalized self-stigma, self-criticism and depressive symptoms were measured through self-reported online questionnaires. The results indicated that the association between perceived public stigma and depressive symptoms was sequentially mediated by internalized self-stigma and self-criticism. The findings indicated that public stigma, as a distal stressor, was perceived and internalized as self-stigma by gay and bisexual men. This self-stigma may pose a risk for depressive symptoms via self-criticism (a maladaptive consequence of their attempts to reduce cognitive dissonance). These results highlight the necessity of reducing sexual minority-related stigma and self-criticism to reduce depressive symptoms. Our findings appeal to society to further decrease prejudice and stigma, increase tolerance, and focus on the negative mental health status of gay and bisexual men.
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Affiliation(s)
- Along He
- School of Journalism & Communication, Nanjing University, Nanjing, China
| | - He Bu
- Department of Social and Behavioural Sciences, City University of Hong Kong, Hong Kong, China
| | - Ankang Liao
- School of Foreign Studies, Nanjing University, Nanjing, China
| | - Wenlong Mu
- School of Journalism and Communication, Wuhan University, Wuhan, China
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Xu W, Huang Y, Tang W, Kaufman MR. Heterosexual Marital Intention: The Influences of Confucianism and Stigma Among Chinese Sexual Minority Women and Men. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:3529-3540. [PMID: 35900678 DOI: 10.1007/s10508-021-02229-9] [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: 03/13/2021] [Revised: 11/06/2021] [Accepted: 11/09/2021] [Indexed: 06/15/2023]
Abstract
In traditional Confucianist culture in China, marriage and offspring are highly valued, placing sexual minority adults under tremendous pressure to marry an opposite sex partner. This study explored how Confucianism and stigma were associated with the intention to pursue a heterosexual marriage among Chinese sexual minority individuals as well as the moderating mechanisms of gender and age. Cross-sectional data were collected from 747 participants via online social networks from March to June 2020. Items assessed Confucianism values (communalism, filial piety, traditional gender roles); stigma (rejection sensitivity, social discrimination); and heterosexual marital intention (HMI). A total of 1.7% (n = 12) participants had ever been married, 11.6% (n = 87) planned to marry a different-sex partner, 60.4% (n = 451) had no intention to pursue a heterosexual marriage, and 26.4% (n = 197) had no specific marital plan. Bisexual participants scored significantly higher than homosexual individuals in HMI. Sexual minority adults with high levels of Confucianism and stigma were more likely to intend to marry. Importantly, both individual stigma (rejection sensitivity) and interpersonal stigma (social discrimination) partially mediated the relationship between Confucianism and HMI. Confucianism had a stronger impact on HMI for men than women, and age moderated the influence of Confucianism (including communalism and filial piety) on HMI, with a stronger impact for younger than older generations. This study contributes to a better understanding of how Confucianism and stigma may be connected to the intention to pursue a heterosexual marriage, suggesting culture-modified theories of stigma and sexual minority stress are needed to explain the experiences of sexual minority people in contemporary China.
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Affiliation(s)
- Wenjian Xu
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Yuxia Huang
- Department of Sociology and Psychology, School of Public Administration, Sichuan University, Chengdu, China
| | - Wanjie Tang
- Center for Educational and Health Psychology, Sichuan University, Chengdu, 610065, China.
| | - Michelle R Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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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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Huynh A, Yu N, Zhang J, Chevrier C, Lazarus L, Blanchard J, Lorway R. Money boys in Chengdu, China: migration, entrepreneurial precarity and health service access. CULTURE, HEALTH & SEXUALITY 2020; 22:1333-1348. [PMID: 31661667 DOI: 10.1080/13691058.2019.1679393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/08/2019] [Indexed: 06/10/2023]
Abstract
This qualitative study highlights the complex interplay between the social and structural conditions in Chengdu, China that shape the possibilities and vulnerabilities of money boys' sexual health. Within the context of China's liberalised market economy, we explore (1) how money boys' enter the sex trade market and navigate their sexual networks; (2) how their lives are enmeshed in fields of sexual desire, stigma and coercion; and (3) how the illicit and stigmatising nature of their work poses barriers to health service access. Findings reveal how the sex trade market and clinic are precarious spaces in which entrepreneurial ethics of the self and stigma-related coercive relations simultaneously enable and constrain money boys' sexual freedom and safer sex practices. By understanding this entrepreneurial precarity through the co-articulation of clinical and organisational work spaces, public health and social service providers can have a stronger sense of how various vulnerabilities configure to affect safer sex practices.
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Affiliation(s)
- Anthony Huynh
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nancy Yu
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Juying Zhang
- West China School of Public Health, Sichuan University, Chengdu, China
| | - Claudyne Chevrier
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Lisa Lazarus
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - James Blanchard
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Robert Lorway
- Center for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
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He L, Pan X, Yang J, Ma Q, Jiang J, Wang W, Qiu J, Zou Y, Wang P, Zhao D, Wang H, Jiang T. HIV risk behavior and HIV testing among rural and urban men who have sex with men in Zhejiang Province, China: A respondent-driven sampling study. PLoS One 2020; 15:e0231026. [PMID: 32240244 PMCID: PMC7117739 DOI: 10.1371/journal.pone.0231026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Currently, human immunodeficiency virus (HIV) sentinel surveillance among men who have sex with men (MSM) in China conducted in large and medium-sized cities, and no HIV sentinel surveillance conducted in rural areas. HIV testing and intervention is predominantly conducted in urban areas, there have been a limited number of studies in rural areas MSM, it is necessary to conduct the investigation of HIV risk sexual behavior, HIV testing among rural and urban MSM. METHOD Between December 2013 and August 2015, a cross-sectional study was conducted in rural and urban areas in Zhejiang Province using respondent-driven sampling (RDS). Participants completed face-to-face interviewer-administered questionnaire surveys and were tested for HIV. RESULTS A total of 710 MSM participants were recruited, of whom 36.1% were from rural areas. The overall HIV prevalence was 16.6%, and was considerably lower among MSM living in rural areas (3.9%) than those living in urban areas (24.2%). 61.1% participants had not condom use with male sexual behavior in the past 6 months (86.7% in rural areas and 46.7% in urban areas). The social demographic and behavioral characteristics had significance difference among rural and urban MSM. Multivariate logistic regression revealed that, compared to men living in urban areas, MSM living in rural areas MSM were more likely to use dating apps to find sexual partners, were more likely to engage in bisexual behavior, and had lower condom use. 43.0% participants had been tested for HIV in the past year (41.8% in rural areas and 43.6% in urban areas). Multivariate logistic regression also revealed that among participants living in rural areas, having rural health insurance and not accepting HIV intervention were associated with lower HIV testing rates, while a higher monthly income and through use of internet to find sexual partner were associated with higher rates of HIV testing. CONCLUSION High risk behavior was prevalent, and HIV testing rates were low among MSM living in rural areas compare to urban areas in Zhejiang Province, therefore, preventative intervention measures should be immediately among rural MSM urgently to reduce HIV transmission and to promote HIV testing.
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Affiliation(s)
- Lin He
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xiaohong Pan
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (XP); (QM)
| | - Jiezhe Yang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Qiaoqin Ma
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
- * E-mail: (XP); (QM)
| | - Jun Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Wei Wang
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Jiaquan Qiu
- Kaihua county Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Yazhou Zou
- Quzhou Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Ping Wang
- Jiangshan Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Dongshe Zhao
- Lucheng district Center for Disease Control and Prevention, Quzhou, Zhejiang, China
| | - Hui Wang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Tingting Jiang
- Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
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Zhang Y, Worth H, Jun J, McMillan K, Chunyan S, Xiaoxing F, Zhang Y, Rui Z, Kelly-Hanku A, Jia C. 'I loved him all my life': love, duty and homosexuality in post-liberation China. CULTURE, HEALTH & SEXUALITY 2019; 21:591-604. [PMID: 30328772 DOI: 10.1080/13691058.2018.1501514] [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: 12/18/2017] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
This article is born out of an oral history study of 31 elderly homosexual men in four cities in China. It shows the ways in which major events of Chinese history since the birth of the People's Republic in 1949 intervene in personal lives and, in turn, how personal lives are drawn into larger historical events. One of the major themes running through these life narratives is that of love and duty. The interrelationship, as well as the tensions, between duty and love is a central part of the experiences of elderly Chinese homosexual men; their lives have been beset by hardships and duty, as well as by the joys of love, and these have an impact on their health and wellbeing. The experience of one individual, Mr Peng, illustrates the important yet shifting ways in which love and duty have been twinned throughout key life events. His narrative indicates an intricate interweaving of love for family, love for Deng, his male partner of 20 years, and love for his wife, as well as duty to family and to a patron. The inseparable couplet of love and duty served as the source of hardship and pain, but also of protection and great joy.
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Affiliation(s)
- Youchun Zhang
- a Institute of Anthropology , Renmin University of China , Beijing , China
| | - Heather Worth
- b School of Public Health and Community Medicine , UNSW Sydney , Australia
| | - Jing Jun
- c Public Health Research Center , Tsinghua University , Beijing , China
| | - Karen McMillan
- b School of Public Health and Community Medicine , UNSW Sydney , Australia
| | - Su Chunyan
- d Journalism and Communication , China Youth University for Politicial Sciences , Beijing , China
| | - Fu Xiaoxing
- e School of Sociology and Politics , Renmin University of China , Bejing , China
| | - Yuping Zhang
- f School of Sociology , Tsinghua University , Beijing , China
| | - Zhao Rui
- f School of Sociology , Tsinghua University , Beijing , China
| | - Angela Kelly-Hanku
- g Papua New Guinea Institute for Medical Research , Goroka , Papua New Guinea
| | - Cui Jia
- f School of Sociology , Tsinghua University , Beijing , China
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11
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Than PQT, Tran BX, Nguyen CT, Truong NT, Thai TPT, Latkin CA, Ho CSH, Ho RCM. Stigma against patients with HIV/AIDS in the rapid expansion of antiretroviral treatment in large drug injection-driven HIV epidemics of Vietnam. Harm Reduct J 2019; 16:6. [PMID: 30654814 PMCID: PMC6337792 DOI: 10.1186/s12954-019-0277-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 01/04/2019] [Indexed: 02/01/2023] Open
Abstract
Background Despite existing efforts to provide antiretroviral treatment (ART) for all HIV-diagnosed people, stigma deprives them of the highest attainable health status and challenges the effectiveness of ART program in Vietnam. This study aimed to assess five dimensions of HIV-related stigma and explore its associated factors among ART patients in a multisite survey. Implications of this study support the development of HIV policies to improve patients’ access, utilization, and outcomes of ART program toward the 90-90-90 goal in Vietnam. Methods A total of 1133 ART patients who were recruited by convenience sampling method from 8 ART clinics in Hanoi and Nam Dinh in a cross-sectional study from January to August 2013. Multivariate logistic regression was employed to identify factors associated with stigmatization. Results The majority of participants reported experiencing stigmatization due to shame (36.9%), blame/judge (21.6%), and discrimination (23.4%). Further, 91.5% of participants disclosed their HIV status with others. The likelihood of experiencing stigmatization did not only associate with the patients’ socioeconomic status (e.g., age, occupation, education) and HIV status disclosure, but also their health problems. Those with anxiety or depression and perceived lower quality of life were more likely to experience stigma. Conclusions To maximize the efficiency of the ART program, it is essential to develop interventions that reduce stigma involving individuals, families, and communities, and recognize and address complex health problems especially those patients showing depressive symptoms. Increasing quality of life of HIV-positive patients by providing vocational training, financial, family, and peer support will reduce the likelihood of experiencing stigma.
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Affiliation(s)
- Phung Quoc Tat Than
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Nu Thi Truong
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Thao Phuong Thi Thai
- Department of General Planning and Department of Cardiology, Friendship Hospital, Hanoi, Vietnam
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Lim SH, Brown SE, Shaw SA, Kamarulzaman A, Altice FL, Beyrer C. "You Have to Keep Yourself Hidden": Perspectives From Malaysian Malay-Muslim Men Who Have Sex With Men on Policy, Network, Community, and Individual Influences on HIV Risk. JOURNAL OF HOMOSEXUALITY 2018; 67:104-126. [PMID: 30307803 DOI: 10.1080/00918369.2018.1525946] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.
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Affiliation(s)
- Sin How Lim
- Centre of Excellence for Research in AIDS (CERiA), Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Stacey A Shaw
- Department of Social Work, Brigham Young University, Provo, Utah, USA
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Frederick L Altice
- Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, Connecticut, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Huang H, Ding Y, Wang H, Khoshnood K, Yang M. The Ethical Sensitivity of Health Care Professionals Who Care For Patients Living With HIV Infection in Hunan, China: A Qualitative Study. J Assoc Nurses AIDS Care 2017; 29:266-274. [PMID: 28967489 DOI: 10.1016/j.jana.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
The level of ethical sensitivity of health care professionals who care for patients with HIV may shed light on ethical behaviors in HIV care. However, little research has determined how such professionals view ethical issues in clinical practice in China. The purpose of our qualitative descriptive study was to explore the ethical sensitivity of health care professionals in Hunan Province, China, and to discuss the existing deficiencies. We used purposive sampling to recruit 17 health care professionals who provided direct care to patients with HIV and conducted interviews with them. Interview transcripts were analyzed by thematic analysis. Informants showed certain sensitivities to ethical issues, but the majority also held stigmatizing attitudes toward patients with HIV, and exhibited ethics driven by HIV-related laws and regulations rather than ethical principles. There is room to improve the ethical sensitivity of health care professionals who care for patients with HIV in China.
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He H, Lv F, Zhang NN, Wu Z, Liao Q, Chang Z, Li Y, Xu H, OuYang L, Huan X, Yang J. Look into the HIV Epidemic of Gay Community with a Socio-Cultural Perspective: A Qualitative Study in China, 2015-2016. PLoS One 2017; 12:e0170457. [PMID: 28107523 PMCID: PMC5249147 DOI: 10.1371/journal.pone.0170457] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/05/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current Chinese studies continue to view male homosexuality through a disease focused lens which pays limited attention to socio-cultural aspects of sexual behavior and HIV transmission. This qualitative study aimed to investigate how socio-cultural factors influence gay men's sexual beliefs and behaviors in contemporary China, and their implications for HIV epidemic. METHODS AND FINDINGS Qualitative methodology was used in this study. During 2015-2016, in-depth interviews were conducted with 61 self identified gay men in Jiangxi, Henan, Heilongjiang, Guangdong, Jiangsu provinces and Chongqing municipality of China. Our study revealed that: 1) influenced by Chinese traditional culture, gay men have conflicts on self-identity, which led to low self-acceptance and negative attitude on sex, and huge socio-psychological stress; 2) a generational differences within gay community was observed, reflected in varied sexual attitudes and practices as well as way for approaching new friends, both of which have implications and challenges on HIV control and prevention; 3) socio-cultural barriers, including open minds towards casual sex and nonmonogamous relationship, and low priority of health demands were widely observed and led to negative coping with AIDS among gay community. CONCLUSIONS It is essential to take a holistic view into gay men's HIV epidemic in China. Socio-cultural barriers for HIV control and prevention found in this study call for serious and imperative consideration on integrated measures, including targeted efforts towards effective sex education and further inclusion of socio-cultural perspectives in HIV/AIDS interventions for gay men.
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Affiliation(s)
- Huijing He
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fan Lv
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail:
| | - Nanci Nanyi Zhang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zunyou Wu
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qinghua Liao
- Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi Province, China
| | - Zhanjun Chang
- Zhengzhou Center for Disease Control and Prevention, Zhengzhou, Henan Province, China
| | - Yi Li
- Heilongjiang Provincial Center for Disease Control and Prevention, Harbin, Heilongjiang Province, China
| | - Huifang Xu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong Province, China
| | - Lin OuYang
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Xiping Huan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu Province, China
| | - Juan Yang
- The National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Abstract
Intolerant attitudes and sexual prejudice against sexual minorities (lesbian, gay, bisexual, and questioning/queer-LGBQ) has been a long-standing global concern. In this article, Chinese attitudes towards sexual minorities are examined with reference to the cultural context in Hong Kong, a place where the East has intermingled with the West for over a century. Chinese sexuality manifested in Hong Kong is a mix of Confucian ideology and Christian thought. Traditional Confucian values of xiao (filial piety) and conventional religious thoughts of Christianity together influence Chinese attitudes towards sexual minorities. Though many governmental policies have been put in place and numerous laws have been enacted to protect the human rights of underprivileged and disadvantaged groups over the past few decades, sexual minorities are frequently being excluded from most of these protections. In Hong Kong, sexual prejudice exists not only among the general public, but also among educators and mental health professionals. Thus, Chinese sexual minorities experience sexual prejudice and minority stress in Hong Kong under unique cultural circumstances. This calls for inclusive policies and an embracing attitude towards sexual minorities so their mental health will not suffer.
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Affiliation(s)
- Diana K Kwok
- a Department of Special Education and Counselling , Hong Kong Institute of Education
| | - Joseph Wu
- b Department of Applied Social Science , City University of Hong Kong
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Mi G, Ma B, Kleinman N, Li Z, Fuller S, Bulterys M, Hladik W, Wu Z. Hidden and Mobile: A Web-based Study of Migration Patterns of Men Who Have Sex With Men in China. Clin Infect Dis 2016; 62:1443-7. [PMID: 27129466 DOI: 10.1093/cid/ciw167] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 01/11/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are highly vulnerable to human immunodeficiency virus (HIV) infection and more likely to migrate due to widespread stigma and discrimination in China. Their mobility complicates estimation of local MSM population sizes and the provision of HIV services, and may also contribute to the spread of HIV. METHODS Between 1 January 2008 and 31 December 2012, the visits of all individuals to the largest Chinese MSM dating website were recorded. After a predesigned de-identification procedure by the website, we analyzed Internet Protocol addresses for migration patterns. Migrants were defined as individuals who were away from their registered residence for >6 months in the last 12 months. RESULTS The website contained data on 794 912 MSM eligible for the study, of which 34.5% were migrants. The median age was 26 years (range, 18-61 years), and 85.5% were unmarried. Compared with nonmigrant MSM, migrants were less likely to be married to a woman (8.6% vs 13.5%; P < .001). The 5 provinces with the highest migrant inflow ratios were Guangdong, Shanghai, Beijing, Tianjin, and Zhejiang. Eastern coastal cities were the primary destination of MSM from southwestern China. CONCLUSIONS Preferential MSM migration may influence MSM population sizes in both originating and destination provinces, particularly for provinces with uneven inflow and outflow. MSM migration from southwestern China, which has the highest HIV prevalence in this population, to coastal cities with lower prevalence may have implications for the spread of the HIV epidemic as well as HIV care services.
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Affiliation(s)
- Guodong Mi
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention
| | | | - Nora Kleinman
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) Association of Schools of Public Health, Washington D.C
| | - Zhijun Li
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC)
| | - Serena Fuller
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) Association of Schools of Public Health, Washington D.C
| | - Marc Bulterys
- Global AIDS Program, China Office, US Centers for Disease Control and Prevention (CDC) Naval Health Research Center, San Diego, California
| | - Wolfgang Hladik
- Division of Global HIV and TB, Center for Global Health, CDC, Atlanta, Georgia
| | - Zunyou Wu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention
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Chow EP, Gao L, Chen L, Jing J, Zhang L. Shifting Patterns of the HIV Epidemic in Southwest China: A Case Study Based on Sentinel Surveillance, 1995-2012. AIDS Patient Care STDS 2015; 29:314-20. [PMID: 25928866 DOI: 10.1089/apc.2014.0307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The HIV epidemic is experiencing a rapid shift in transmission profile in China. This study aims to examine the changes in magnitude, transmission pattern, and trend of the HIV epidemic in a typical Southwest Chinese prefecture over the period of 1995-2012. HIV surveillance data from the web-based reporting system were analyzed during this period. We investigated the temporal trends in the changing characteristics of HIV transmission, the HIV disease burden in key affected populations, and assessed the impacts on HIV disease progression due to scale-up of antiretroviral treatment. A total of 3556 HIV/AIDS cases were reported in Yuxi prefecture, Yunnan, over the study period. The number of HIV tests conducted has dramatically increased from 1041 in 1995 to 247,859 in 2012, resulting in a substantial increase in HIV diagnoses from 11 cases to 327 cases over the same period. Since 2005, cumulatively 1250 eligible people living with HIV (PLHIV) have received combination antiretroviral therapy which reduced AIDS disease progression from 9.0% (95% CI: 6.7-11.4%) in 1995 to 0.1% (0-0.3%) in 2012 (ptrend=0.0002). The primary mode of HIV transmission has been shifted from injection sharing (71.9% diagnoses in 1995-2004) to unsafe sexual contacts (82.6% diagnoses in 2012). Yuxi prefecture is experiencing a concentrated but shifting HIV epidemic. Scale-up of HIV testing is essential to effective sentinel surveillance and enhancing early diagnosis and treatment in PLHIV.
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Affiliation(s)
- Eric P.F. Chow
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
| | - Liangmin Gao
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Liang Chen
- Division of HIV/AIDS and STI Control, Centers for Disease Control and Prevention, Yuxi Prefecture, Yunnan, China
| | - Jun Jing
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
- The Kirby Institute, University of New South Wales Australia, Sydney, New South Wales, Australia
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