Anticipated HIV stigma among men who have sex with men and transgender individuals in China: a cross-sectional study

Abstract

BackgroundHIV-related stigma has been positively associated with low health-care utilisation and risky sexual behaviours in people living with HIV. However, the relationship between HIV-related stigma and the use of new technologies such as gay mobile applications and HIV self-testing is still not clear. We aimed to examine factors associated with HIV-anticipated stigma among men who have sex with men (MSM) and transgender individuals in China. MethodsDuring July 28–31, 2016, MSM and transgender individuals aged 16 years or older who self-reported as HIV negative were recruited for an online cross-sectional survey on China's biggest MSM mobile application BlueD. Information regarding sociodemographics, sexual behaviours, sexual health service use, and anticipated HIV stigma (measured by a seven-item Likert scale, ranging from one to four) were collected. The mean values of the seven items were calculated to create an overall score, with a higher score indicating a higher level of anticipated HIV stigma. Univariate and multivariable linear regressions were conducted to examine the factors associated with anticipated HIV stigma, while age, education, income, sexual orientation, and marital status were adjusted in the multivariable models. Findings2006 participants were recruited; most were MSM (1904 of 2006, 95%). The mean score for anticipated HIV stigma was 2·98 (SD 0·64). Having used social media platforms to seek sexual partners within in the past 3 months (adjusted β 0·11, 95% CI 0·05–0·17) was associated with increased anticipated HIV stigma, whereas having self-tested for HIV (adjusted β −0·07, 95% CI −0·13 to −0·01), and having disclosed one's sexuality to one's health-care provider (adjusted β −0·16, 95% CI −0·22 to −0·96) were associated with decreased anticipated HIV stigma. InterpretationCampaigns to combat HIV-related stigma are needed on gay mobile applications. Promotion of HIV self-testing and disclosure might be an effective method to reduce HIV-related stigma among MSM and transgender individuals in China. FundingNational Institutes of Health (National Institute of Allergy and Infectious Diseases [NIAID] 1R01AI114310; National Center for Advancing Translational Sciences [UL1TR001111]), University of North Carolina–South China STD Research Training Centre (Fogarty International Centre 1D43TW009532), University of North Carolina Center for AIDS Research (NIAID 5P30AI050410), University of California San Francisco Center for AIDS Research (NIAID P30 AI027763), and the Bill & Melinda Gates Foundation to the MeSH Consortium (BMGF-OPP1120138).