Abstract
IntroductionStigma constitutes a critical challenge to the rising rates of HIV among Chinese men who have sex with men (MSM). It reduces willingness to disclose one’s sexual orientation and can lead to concurrent sexual partnerships. Disclosure decisions are also affected by cultural norms that place pressures on sons to marry. In this manuscript, we characterize how stigma and cultural factors influenced Chinese MSM’s decisions around disclosure and marriage. We seek to show that MSM’s actions were motivated by moral considerations, even when those choices posed HIV transmission risks.MethodsWe conducted qualitative interviews with 30 MSM in Beijing, China. Interviews were audio-recorded, transcribed, and translated into English for analysis. Transcripts were coded using a procedure that allowed for themes to emerge organically.ResultsParticipants struggled with feelings of shame and believed that others possessed stigmatizing attitudes about homosexuality. They had experienced relatively little discrimination because they infrequently disclosed their MSM status. In response to marital pressures, participant had to reconcile same-sex attractions with filial expectations. Their choices included: not being involved with women; putting on the appearance of a heterosexual relationship by marrying a lesbian; or fulfilling family expectations by marrying a heterosexual woman. Regardless of the decision, many rooted the justifications for their choices in the considerations they had given to others’ needs.ConclusionThe growing epidemic among MSM in China requires action from the public health community. As programs are scaled up to serve these men, it is critical to remember that MSM, who often fear social sanction if they were to reveal their sexual orientation, continue to face the same pressures from culturally normative social duties as heterosexual men. Interventions must find ways to help men navigate a balance between their own needs and the responsibilities they feel toward their parents and others.
Highlights
Stigma constitutes a critical challenge to the rising rates of HIV among Chinese men who have sex with men (MSM)
Participants struggled with feelings of shame and believed that others possessed stigmatizing attitudes about homosexuality
Regardless of the decision, many rooted the justifications for their choices in the considerations they had given to others’ needs
Summary
Stigma constitutes a critical challenge to the rising rates of HIV among Chinese men who have sex with men (MSM). Disclosure decisions are affected by cultural norms that place pressures on sons to marry In this manuscript, we characterize how stigma and cultural factors influenced Chinese MSM’s decisions around disclosure and marriage. Stigma is a socially shared process by which a society discourages specific behaviors and conditions [11] Such behavioral regulation is accomplished both through actions between people and through thought processes internal to any one individual. Enacted stigma refers to interpersonal acts of discrimination against individuals who have or are perceived to have socially scorned conditions, like same-sex attraction [12,13]. If that person possesses the stigmatized condition, internalized stigma is effectively a form of self-stigma [13,14,15]
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