Intersecting self-stigma of young Chinese men who have sex with men living with HIV/AIDS

Abstract

In China, social discrimination and stigma remain widespread, despite subtle differences in national policies toward HIV/AIDS and homosexuality. Furthermore, the disproportionate HIV/AIDS infection in young men who have sex with men (MSM) engendered the intersection of stigma against HIV/AIDS and sexual behavior between two same-sex individuals. Guided by the Corrigan’s “why try” effect model and the “cognitive-affective-behavioral” model, this study aims (1) to investigate the responses of young Chinese MSM living with HIV/AIDS to the public stigma associated with their MSM identity and HIV/AIDS identity; (2) to elucidate the meanings and experiences of living with MSM identity and HIV/AIDS identity; (3) to examine the impact of intersecting self-stigma at different levels. This study adopted a convergent mixed methods research design. Concerning quantitative research, an extensive community-based online survey was conducted with MSM living with HIV/AIDS in China aged 18-30 years. The target population is a hard-to-reach and hidden group, so non-probability purposive sampling was employed to recruit respondents. The final sample size of this study was 1,004. Informed by the constructivist grounded theory, semi-structured interviews were conducted with 24 interviewees for the qualitative research recruited from survey respondents who indicated their willingness to participate in the follow-up interview. According to the convergent design, qualitative and quantitative data were analyzed in parallel and interpreted in an integrative manner. The first study investigated the process of intersecting self-stigma from awareness and agreement to application based on Corrigan’s “three A’s” model. The findings suggested that this progressive linear pattern does not apply to all stigmatized identities. Besides, the intersection of self-stigma associated with MSM identity and HIV/AIDS identity occurs within and between each process step. The second study further explored the meanings and experiences of living with the intersecting stigmatized identities and depicted four profiles of their intersecting self-stigma. The first profile described participants self-stigmatizing their MSM identity more than their HIV/AIDS identity; the second profile captured those who reported stronger HIV/AIDS self-stigma. The third and fourth profiles were characterized by those who either self-stigmatized or accepted both intersecting identities, respectively. The third study used moderation analysis to investigate the impact of intersecting self-stigma at the intrapersonal, interpersonal, and community levels. The results show that participants’ homosexual self-stigma weakens the negative effect of HIV/AIDS self-stigma on their self-efficacy while enhancing the adverse impact of HIV/AIDS self-stigma on their HIV/AIDS community participation. Therefore, the intersecting self-stigma has different effects on individuals at different levels. This study provides a comprehensive analysis of intersecting self-stigma among young Chinese MSM living with HIV/AIDS regarding the process, experience, and impact. These three dimensions of intersecting self-stigma are also interrelated. Participants’ experiences of intersecting self-stigma resonate with the intersecting process of self-stigma and can explain the impact of intersecting self-stigma. Meanwhile, social and cultural factors need to be incorporated into the analysis of intersecting self-stigma. This study develops theories related to self-stigma and intersectionality. It has implications for policymaking to eliminate public stigma, social work practice about intervening in people with multiple stigmatized identities, and future self-stigma research.