'Unqueer' kinship? Critical reflections on 'marriage fraud' in mainland China

Betrayed, Beaten, Banished: The Stigma of Being a Rural Tongqi in China

In China, an emerging social issue involves a subset of rural women who, because of family and culture, become inadvertently matched up with and married to closeted men who have sex with men (MSM). These women-referred to as Tongqi-often discover they are in a loveless marriage, but any effort to change their situation results in intense backlash, discrimination, and stigma from families, village communities, and even government and healthcare institutions. This study explores the experiences of Tongqi, examining the influence of social interaction, community relationships, and macrostructural factors that coalesce to create an environment of chronic enacted stigma. In-depth interviews were conducted with 59 rural Tongqi, 11 of whom contracted human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) from their spouses. The findings reveal the significant role of extended kinship networks and macrostructural elements, such as hukou (household registration) and government officers, as well as village-level lineage structures. Informant data highlights how lineage relationships, interwoven with gender practices, contribute to the enacted stigma impacting the physical and psychological health of Tongqi. Tongqi report psychological effects such as an array of symptoms reflecting post-traumatic stress, chronic depression, and attempted suicide. Tongqi also report adverse physical health concerns involving reproductive health, unwanted pregnancies, sexually transmitted infections (STIs), and pregnancy complications. These findings helped produce possible policy recommendations to address the most pressing issues faced by Tongqi.

Sustaining Heteronormativity in Marriage: How Chinese Newspapers Frame Heterosexual Marriage Undertaken by Chinese Queer People

Family members often cite broader societal discourses and norms when forcing Chinese queer people to engage in heterosexual marriage (referred to as HMQ; heterosexual marriage undertaken by Chinese queer people). It is unclear what these social norms entail and how the norms are maintained. This paper examines 89 Chinese newspaper articles to uncover the societal discourses driving families to pressure queer people into heterosexual marriage. We identified three framings: (1) Highlighting problems of formality marriage (the marriage between two queer people) and gay's wife marriage (the marriage between a queer man and a heterosexual woman); (2) portraying people involved in formality marriage and gay's wife marriage as suffering from heteronormative pressure to engage in marriage; and (3) presenting formality marriage in a collaboration frame and gay's wife marriage in a deception frame. These framings suggest heteronormativity in marriage is upheld in societal discourses about HMQ and sustained by two hierarchies created in Chinese newspaper articles: one degrading queer marriage practices, which made heterosexual marriage undertaken by queer people inferior to ideal heterosexual marriage; another stratifying queer marriage practices, which made the marriage between a queer man and a heterosexual woman less acceptable than the marriage between two queer people.

Are All Gay Men at Risk of Developing HIV/AIDS? Why China's Mass HIV Testing Has Majorly Targeted Gay Men in the Era of Biomedicalization

Global HIV/AIDS responses have been increasingly biomedically dominated over the past years. In line with this shifting paradigm, China has prioritized mass HIV testing as a practical approach to controlling its HIV/AIDS epidemics among at-risk populations, especially gay men and other men who have sex with men (MSM). This study analyzed why China's mass HIV testing mainly targeted gay men by understanding the perspectives of public health professionals, community-based organization (CBO) workers, and gay men. In addition, this study revealed the tensions and unintended consequences of HIV/AIDS prevention and the representation of gay men in China. The study involved fieldwork conducted in a major city in Eastern China from 2015 to 2019. Semi-structured interviews were held with participants from the three abovementioned groups (N = 25). The study identified four processes concerning why gay men are mainly targeted for HIV testing. Some public health professionals believe that being a gay man is equivalent to having HIV/AIDS risks. In addition, this study particularly noted tensions between public health professionals and gay men, including gay men-identified CBO workers, over whether mass HIV testing should target gay men or anyone who engaged in sexual risk behaviors. This study argued that a particular focus on gay men due to pursuing biomedical advances in HIV/AIDS prevention seems to have unintendedly stereotyped gay men based on the presumptions that they are at risk of developing HIV/AIDS. In addition, this study corresponded to the broader social scientific discussion concerning whether HIV/AIDS intervention should target specific sexual risk practices or sexual identity/population.

"Watering-Down" Strict HIV Testing Quotas on Chinese Men Who Have Sex with Men Community-Based Organizations

The Chinese Center for Disease Control employs Community-Based Organizations (CBO) to conduct mass testing on "hidden" Men who have Sex with Men (MSM). Testing MSMs is intended to make risky bodies legible to the state and discipline the CBOs around narrow health goals. However, detailed ethnographic fieldwork with MSM CBOs in southwest China demonstrates that pressures to achieve HIV testing quotas produce the need to "water-down" or manipulate data. This distorts the identities and practices of MSMs from state surveillance and builds collusive partnerships between CBOs and low-level government officials to mitigate the disciplinary impacts of strict audits.

Molecular networks reveal complex interactions with MSM in heterosexual women living with HIV-1 who play peripheral roles in Guangzhou, China

BACKGROUND

With the number of newly diagnosed HIV-positive heterosexual women increasing yearly, it is urgent to understand HIV-1 transmission among heterosexual women in Guangzhou, China.

METHODS

HIV-1 pol sequences were obtained from people living with HIV-1 during 2008 to 2017 in Guangzhou, China. A molecular network was constructed using HIV-1 TRAnsmission Cluster Engine with 1.5% genetic distance. Potential linkage and centrality metric were measured with Cytoscape. Transmission pathways between heterosexual women and men who have sex with men (MSM) were determined using Bayesian phylogenetic analysis.

RESULTS

In the network, 1799 (62.6%) MSM, 692 (24.1%) heterosexual men and 141 (4.9%) heterosexual women formed 259 clusters. Molecular clusters including MSM and heterosexuals were more likely to form larger networks (P<0.001). Nearly half of the heterosexual women (45.4%) were linked to heterosexual men and 17.7% to MSM, but only 0.9% of MSM were linked to heterosexual women. Thirty-three (23.4%) heterosexual women linked to at least one MSM node and were in peripheral role. Compared to general heterosexual women, the proportion of heterosexual women linked to MSM infected with CRF55_01B (P<0.001) and CRF07_BC (P<0.001) was higher than that of other subtypes, and the proportion diagnosed between 2012-2017 (P=0.001) was higher than that in 2008-2012. In MCC trees, 63.6% (21/33) of the heterosexual women differentiated from the heterosexual evolutionary branch, while 36.4% (12/33) differentiated from the MSM evolutionary branch.

CONCLUSION

Heterosexual women living with HIV-1 were mainly linked to heterosexual men and were in peripheral positions in the molecular network. The role of heterosexual women in HIV-1 transmission was limited, but the interaction between MSM and heterosexual women were complex. Awareness of the HIV-1 infection status of sexual partners and active HIV-1 detection are needed for women.

Sex life and sexuality among tongqi: doing gender and heterosexuality

The term tongqi refers to cisgender, heterosexual women who unwittingly marry non-straight men. In mainland China, their adverse social position and health have been the subject of concern. This study aims to broaden and diversify perceptions of the lived experiences of tongqi by focusing on sex and sexualities in mixed-orientation marriages. Four themes (lack of sexuality-related exploration before marriage, the unsatisfactory nature of marital sex life, the exercise of sexual agency, and increased self-awakening) were developed from observations of a tongqi online support group and 12 semi-structured interviews with members. Using inductive thematic analysis, findings reveal how heteronormativity oppresses and punishes both tongqi and their non-straight husbands. In most cases, husbands not 'doing heterosexuality' as expected were still found to be 'doing gender' in patriarchal ways, with wives' subordinate status thereby being reinforced, making them more vulnerable. However, despite women's sexual autonomy and agency being constrained by normative forces, some were able to navigate their conjugal relationships by practising sexual autonomy and agency within and outside their marriage.

"I did not know I was gay": sexual identity development and fluidity among married tongzhi in China

This study aimed to analyse the life experiences of married tongzhi (defined here as men who are sexually attracted to men) in mixed-orientation marriages in mainland China. The study used a life course perspective to understand sexual identity development among tongzhi, born in the 1970s or thereabouts, in heterosexual marriage and rural China. The study focused on identifying the experiences of the 13 tongzhi participants. Using thematic analysis, we found sexual identity development was influenced by China's historical and social context and, in particular, internal (e.g. internalised heteronormativity), informational (e.g. Internet), and cultural (e.g. family-oriented) factors. Some tongzhi did not follow an identity development trajectory as "out and proud" since their identities were embedded in the complexity of family life and social pressure, the invisibility of "gay circles", and normative social roles. They chose instead to maintain their heteronormative marriages, while seeking to explore and fulfil their homoerotic desires. Implications are discussed for epistemology, methodology and advocacy.

Reciprocal/Authoritarian Filial Piety and Mental Well-Being in the Chinese LGB Population: The Roles of LGB-Specific and General Interpersonal Factors

Although filial piety is considered as a salient value in the Chinese culture, studies on the mental well-being of Chinese lesbian, gay, and bisexual (LGB) individuals rarely take filial piety into account or examine it in relation to other variables to clarify the mechanism between filial piety and mental well-being. A total of 1453 LGB participants from 30 provinces and regions in Mainland China completed the online survey. They provided demographic information and completed measures of filial piety, a general interpersonal factor (i.e., perceived burdensomeness and thwarted belongingness), an LGB-specific interpersonal factor (i.e., perceived parental support for sexual orientation), and mental well-being. Structural equation modelling results indicated that higher reciprocal filial piety was directly, and indirectly through lower thwarted belongingness, associated with better mental well-being. Lower authoritarian filial piety was indirectly associated with better mental well-being through higher perceived parental support for sexual orientation and lower thwarted belongingness. In addition, reciprocal filial piety had a stronger effect on perceived parental support for sexual orientation and perceived burdensomeness among lesbians and bisexual women than gay and bisexual men. These findings suggest that reciprocal filial piety is a protective factor, whereas authoritarian filial piety is a risk factor, for the mental well-being of Chinese LGB persons. Moreover, perceived parental support for sexual orientation and thwarted belongingness might be the mechanisms underlying the effect of reciprocal/authoritarian filial piety on mental well-being. Implications of findings for practice and research are discussed.

Correlates of Taiwanese Gay and Bisexual Men's Family-Building Preferences: A Mediation Analysis

This study investigated the role of filial piety, internalized homophobia, and desire for genetic relatedness with one's child in gay and bisexual men's family-building choice. A sample of 1,023 Taiwanese gay and bisexual men with a desire to have a child was recruited to complete an online survey that included the Contemporary Filial Piety Scale, the Chinese Internalized Homophobia Scale, and questions about desire for genetic relatedness with a child and acceptance of adoption and surrogacy. Mediation models, with desire for genetic relatedness as a mediator, were tested. The results show that those who chose surrogacy-only were older and had higher socio-economic status than those who selected adoption-only and both options. Filial piety and internalized homophobia were positively associated with the acceptance of surrogacy-only over adoption-only and both options. Desire for genetic relatedness mediated these relationships. This finding elucidates how sociocultural factors shape family-building preferences among gay and bisexual men.

Impacts of the COVID-19 pandemic on HIV testing utilization among men who have sex with men in China: a cross-sectional online survey

BACKGROUND

The COVID-19 pandemic creates disruptions on HIV prevention and sexual health services for men who have sex with men (MSM).

OBJECTIVE

This study compared HIV testing utilization in three different reference periods (Period 1: before COVID-19 outbreak [November 2019 to January 2020], Period 2: after the outbreak [February to April 2020], and Period 3: after the pandemic was under initial control [May to July 2020]). Factors associated with HIV testing utilization after COVID-19 outbreak (combine Period 2 & 3) were also investigated.

METHODS

Participants were MSM aged ≥18 years living in Shenzhen, China. Those self-reported as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August to September 2020. HIV testing uptake after COVID-19 outbreak was the dependent variable, and multivariate logistic regression models were fitted.

RESULTS

HIV testing uptake was significantly lower during Period 2 than Period 1 (44.0% versus 61.0%, p<.001). However, HIV testing uptake was not significantly higher in Period 3 than Period 2 (46.6% versus 44.0%, p=.21). The prevalence of HIV testing uptake after COVID-19 outbreak was 55.6%. After adjusting for significant background characteristics, condomless anal intercourse (CAI) with regular male sex partners (AOR: 2.15, 95%CI: 1.29, 3.57) and sexualized drug use (AOR: 2.94, 95%CI: 1.41, 6.06) both before and after COVID-19 outbreak, CAI with regular (AOR: 2.07, 95%CI: 1.06, 4.07) and non-regular male sex partners (AOR: 3.57, 95%CI: 1.43, 8.89) were positively associated with the dependent variable. Regarding HIV prevention service utilization, HIV testing uptake before COVID-19 outbreak (AOR: 10.75, 95%CI: 7.22, 16.02), and use of sexually transmitted infections (STI) testing (AOR: 7.02, 95%CI: 4.10, 12.02), other HIV/STI prevention (AOR: 3.15, 95%CI: 2.16, 4.60) and PrEP (AOR: 3.58, 95%CI: 1.54, 8.34) after COVID-19 outbreak were associated with higher HIV testing uptake. Perceived risk of HIV infection at present was higher than the time before COVID-19 outbreak (AOR: 1.15, 95%CI: 1.01, 1.30), perceived COVID-19 preventive measures taken up by HIV testing service providers to be effective (AOR: 1.52, 95%CI: 1.29, 1.78), and perceived higher behavioral control to take up HIV testing (AOR: 1.18, 95%CI: 1.00, 1.40) were positively associated with HIV testing uptake. Concerns about COVID-19 infection during HIV testing (AOR: 0.78, 95%CI: 0.68, 0.89), avoiding crowed places (AOR: 0.68, 95%CI: 0.48, 0.98) and HIV testing service providers reduced their working hours (AOR: 0.59, 95%CI: 0.48, 0.98) were negatively associated with the dependent variable.

CONCLUSIONS

HIV testing utilization among Chinese MSM declined after COVID-19 outbreak and did not increase after the pandemic received initial control. Removing structural barriers to access HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing might be useful strategies to improve HIV testing among MSM during the pandemic.

CLINICALTRIAL

Revisiting the dominant coming out discourses in China's LGBT activism and research: Lesbians' chugui experiences within the family

This article, by illustrating coming-out stories of lesbians and their families, inspired by and extending Amy Brainer's theorization of LGBT family of origin relationships based on her studies in Taiwan, critically revisits the dominant coming-out discourses in the LGBT activism and research in contemporary mainland China. I first argue that, although the belief that the Western-rooted idea of coming out and Chinese family traditions are incompatible is influential within China's LGBT activist circles, what is seldom recognized is that "chugui", the Chinese translation of "coming out", has already become a local term. However, grassroots but creative definitions of "chugui", such as "to cultivate a better parent-child relationship", is rejected by LGBT activist elites. I then point out an imbalance in China's LGBT research that mainly pays attention to strategies of not coming out to parents, which actually underestimates parents' agency and even otherizes parents in the name of "filial piety". Rather, the emerging liberalistic ideal of family relationships, especially mother-daughter relationships, enables coming-out practices to become intersubjective journeys for both LGBT children and their parents to rethink gender and sexuality. Finally, I criticize the narrowly defined "family", or "home", in China's dominant coming-out discourses, which disproportionately focuses on one's family of origin and presumes it as a heteronormative fortress. I call for studies that recognize queer empathy and solidarity in a family of origin and connects one's experiences in her family of origin with her later life in chosen families, which may be the family of origin of her child(ren).

Social support and coping style of Tongqi in China: A cross-sectional study

Tongqi (gays' wives) in China were under tremendous distress and social pressure due to their special identities and were not clearly known. A sample of 179 Chinese Tongqi were recruited through online social media groups in 2017-2018. Their hidden lives, social support, and coping styles were analyzed. The results showed that the majority of Tongqi concealed their identities, had negative responses to cope with their tremendous distress, and did not have sufficient social support. Their social support was mainly from family members. Hidden identities obstructed Tongqi's access to extrafamilial social support that could alleviate their distress. Tongqi need more social support and protection.

A "Phoenix" rising from the ashes: China's Tongqi, marriage fraud, and resistance

There are significant numbers of women in China who have inadvertently married closeted gay men. Women in China who unwittingly marry closeted gay men are known as Tongqi (), and these women often discover their husband's secret only after giving birth to fulfill filial obligations. These women taken into this "marriage fraud" are initially unaware of their husbands' sexual orientation. Because China's divorce law favors men, even if the wife files for divorce, the husband often wins custody of children. The tendency to blame the woman who have unwittingly married gay men extends even to the woman's own immediate families. These women suffer heightened risk of not only physical death from AIDS and other diseases, but also psychological death through the loss of physical mobility, alienation of kin, and death of their heterosexual marriage identity. This article extends necropolitics to the social death situations of 12 educated and 47 low-educated Tongqi and reveals how they resist and overcome their circumstances. Tongqi are the women who have unwittingly married gay men of violations involving their own marriage, but they are not simply waiting for death. Taking an ethnographical approach, this work uses the social death concept of necropolitics to provide understanding of how marriage and gender laws perpetuate these dysfunctional unions.

"I'll Change His Sexual Orientation, I Don't Think About HIV": A Qualitative Study to Explore Attitudes, Behaviors, and Experiences Among Wives of Men Who Have Sex With Men in Mainland China

In mainland China, HIV prevalence among men who have sex with men (MSM) has risen sharply in the past decade. However, few HIV studies have directly addressed the female spouses' (tongqi) experiences, a population estimated at 14 million [Cheng, F. K. (2016). I want to come forward: Voices from Chinese tongqi. Cogent Social Sciences, 2(1), 1158343. doi:10.1080/23311886.2016.1158343; Zhu, J. (2018). "Unqueer" kinship? Critical reflections on "marriage fraud" in mainland China. Sexualities, 21(7), 1075-1091. doi:10.1177/1363460717719240]. We conducted this exploratory qualitative study to understand tongqi's attitudes toward same-sex sexuality and HIV risk as well as their sexual history. Semistructured interviews were conducted with 24 tongqi between October 2015 and September 2016. Data were coded and analyzed using thematic analysis. We identified four primary themes: (a) surprise, initial disbelief, and negative attitudes toward their husbands' same-sex sexuality; (b) maintenance of regular sexual contact, particularly before pregnancy; (c) unprotected sex with marital and extramarital partners; and (d) low perception of HIV risk. Strategies to increase HIV knowledge and testing uptake are urgently needed among these vulnerable women but must be implemented with caution to avoid exacerbating high levels of homophobia.

Behind the Rainbow, "Tongqi" Wives of Men Who Have Sex With Men in China: A Systematic Review

Background

Due to the restrictions and stigmatization of homosexuality in China, there has emerged the “Tongqi,” or the wives of men who have sex with men (MSM). There are around 14 million Tongqi wives whose needs for support are often overshadowed. This phenomenon has been largely under researched, this review is the first to address the current data on the Tongqi. The aim of this systematic review is to begin to provide insight into the pre-existing data and the further support that is needed for the wives of MSM.

Methods

The researchers searched PubMed, Web of Science, EMBASE, PsycINFO, CNKI, Sinomed and WangFang databases from their inception date until June 7, 2019. Handsearching was also completed to provide a rich data set.

Results

The articles were summarized and analyzed for thematic clusters. From the selected article, five themes emerged, including Sexual Health Issues, Intimate Partner Violence, Mental Health Status, Marriage Dissatisfaction, and Coping Strategies. These themes often intersected to provide a complex understanding of the current gaps in support provided to Tongqi.

Conclusion

Tongqi wives remain a hidden population in Chinese mainstream society, who deserves a sensitive approach to support. The study revealed that the MSM wives suffer severe mental, physical, health, and life related harms. However, instead of situating them into the victim roles, many women take on an identity of empowerment and are working together, aiming to make social changes. In order to address the Tongqi phenomenon, it is also essential to reduce the discrimination toward homosexuality. Tongqi are a special group of Chinese women, they require further intensive research attention.