Advertisement

Archives of Sexual Behavior

, Volume 47, Issue 7, pp 2061–2069 | Cite as

Overcoming HIV Stigma? A Qualitative Analysis of HIV Cure Research and Stigma Among Men Who Have Sex with Men Living with HIV

  • Feng Wu
  • Alice Zhang
  • Andrew Babbitt
  • Qingyan Ma
  • Nir Eyal
  • Xin Pan
  • Weiping Cai
  • Fengyu Hu
  • Yu Cheng
  • Joseph D. Tucker
Original Paper

Abstract

Despite global progress in HIV stigma reduction, persistent HIV stigma thwarts effective HIV service delivery. Advances in HIV biomedical research toward a cure may shift perceptions of people living with HIV and HIV stigma. The purpose of this study was to examine how men who have sex with men (MSM) living with HIV in Guangzhou, China perceive HIV cure research and its potential impact on MSM and HIV stigma. We conducted in-depth interviews with 26 MSM living with HIV about their perceptions of HIV cure research and the potential impact of an HIV cure on their lives. Thematic coding was used to identify themes and structure the analysis. Two overarching themes emerged. First, participants stated that an HIV cure may have a limited impact on MSM-related stigma. Men noted that most stigma toward MSM was linked to stereotypes of promiscuity and high rates of sexual transmitted diseases in the MSM community and might persist even after a cure. Second, participants believed that an HIV cure could substantially reduce enacted, anticipated, and internalized stigma associated with HIV. These findings suggest that a biomedical cure alone would not remove the layered stigma facing MSM living with HIV. Comprehensive measures to reduce stigma are needed.

Keywords

HIV cure HIV-related stigma MSM China Sexual orientation 

Notes

Acknowledgements

The authors would like to thank Guangzhou Eighth People’s Hospital and UNC Project-China for their administrative support, and Gail E. Henderson and Yang Zhao for their research assistance and advice.

Funding

This work was supported by the National Institute of Health NIAID under Grant Nos. 1R01A108366-01 and 1R01AI114617-01A1.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Aggleton, P. (2007). “Just a snip”?: A social history of male circumcision. Reproductive Health Matters, 15, 15–21.CrossRefPubMedGoogle Scholar
  2. Aggleton, P., Wood, K., Malcolm, A., & Parker, R. (2005). HIV-related stigma discrimination and human rights violations: Case studies of successful programmes. Geneva: UNAIDS.Google Scholar
  3. Bernard, H. R. (2011). Research methods in anthropology: Qualitative and quantitative approaches. Lanham, MD: Rowman Altamira.Google Scholar
  4. Brooks, V. R. (1981). Minority stress and lesbian women. New York, NY: Free Press.Google Scholar
  5. Buell, K. G., Chung, C., Chaudhry, Z., Puri, A., Nawab, K., & Ravindran, R. P. (2016). Lifelong antiretroviral therapy or HIV cure: The benefits for the individual patient. AIDS Care, 28, 242–246.CrossRefPubMedGoogle Scholar
  6. Chambers, L. A., Rueda, S., Baker, D. N., Wilson, M. G., Deutsch, R., Raeifar, E., & Rourke, S. B. (2015). Stigma, HIV and health: A qualitative synthesis. BMC Public Health, 15, 848.  https://doi.org/10.1186/s12889-015-2197-0.CrossRefPubMedPubMedCentralGoogle Scholar
  7. Choi, K. H., Steward, W. T., Miege, P., Hudes, E., & Gregorich, S. E. (2016). Sexual stigma, coping styles, and psychological distress: A longitudinal study of men who have sex with men in Beijing, China. Archives of Sexual Behavior, 45, 1483–1491.  https://doi.org/10.1007/s10508-015-0640-z.CrossRefPubMedGoogle Scholar
  8. Chong, E. S., Mak, W. W., Tam, T. C., Zhu, C., & Chung, R. W. (2017). Impact of perceived HIV stigma within men who have sex with men community on mental health of seropositive MSM. AIDS Care, 29, 118–124.CrossRefPubMedGoogle Scholar
  9. Chu, C. E., Wu, F., He, X., Ma, Q., Cheng, Y., Cai, W., & Tucker, J. D. (2015). Exploring the social meaning of curing HIV: A qualitative study of people who inject drugs in Guangzhou, China. AIDS Research and Human Retroviruses, 31, 78–84.  https://doi.org/10.1089/AID.2014.0200.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Deeks, S. G., Lewin, S. R., Ross, A. L., Ananworanich, J., Benkirane, M., Cannon, P., & Zack, J. (2016). International AIDS Society global scientific strategy: Towards an HIV cure. Nature Medicine, 22, 839–850.  https://doi.org/10.1038/nm.4108.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Earnshaw, V. A., Bogart, L. M., Dovidio, J. F., & Williams, D. R. (2013). Stigma and racial/ethnic HIV disparities: Moving toward resilience. American Psychologist, 68, 225–236.CrossRefPubMedGoogle Scholar
  12. Earnshaw, V. A., & Chaudior, S. R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13, 1160–1177.CrossRefPubMedPubMedCentralGoogle Scholar
  13. General Office of the State Council of the People’s Republic of China. (2006). Regulations on AIDS prevention and treatment. Beijing: General Office of the State Council of the People’s Republic of China.Google Scholar
  14. Glaser, B. G. (1992). Basics of grounded theory analysis. Mill Valley, CA: Sociology Press.Google Scholar
  15. Goffman, E. (1963). Behavior in public place. New York, NY: Free Press.Google Scholar
  16. He, H., Lv, F., Zhang, N. N., Wu, Z., Liao, Q., Chang, Z., & Huan, X. (2017). Look into the HIV epidemic of gay community with a socio-cultural perspective: A qualitative study in China, 2015–2016. PLoS ONE, 12, e0170457.  https://doi.org/10.1371/journal.pone.0170457.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Herek, G. M., & Capitanio, J. P. (1993). Public reactions to AIDS in the United States: A second decade of stigma. American Journal of Public Health, 83, 574–577.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Herek, G. M., & Glunt, E. K. (1991). AIDS-related attitudes in the United States: A preliminary conceptualization. Journal of Sex Research, 28, 99–123.CrossRefGoogle Scholar
  19. Herek, G. M., & McLemore, K. A. (2013). Sexual prejudice. Annual Review of Psychology, 64, 309–333.CrossRefPubMedGoogle Scholar
  20. Hua, J., Emrick, C. B., Golin, C. E., Liu, K., Pan, J., Wang, M., & Jiang, N. (2014). HIV and stigma in Liuzhou, China. AIDS and Behavior, 18, 203–211.CrossRefPubMedCentralGoogle Scholar
  21. Hütter, G., Nowak, D., Mossner, M., Ganepola, S., Müßig, A., Allers, K., & Blau, O. (2009). Long-term control of HIV by CCR5 Delta32/Delta32 stem-cell transplantation. New England Journal of Medicine, 360, 692–698.CrossRefPubMedGoogle Scholar
  22. Jeffries, W. L., IV, Townsend, E. S., Gelaude, D. J., Torrone, E. A., Gasiorowicz, M., & Bertolli, J. (2015). HIV stigma experienced by young men who have sex with men (MSM) living with HIV infection. AIDS Education and Prevention, 27, 58–71.CrossRefPubMedGoogle Scholar
  23. Jürgensen, M., Sandøy, I. F., Michelo, C., Fylkesnes, K., & ZAMACT Study Group. (2013). Effects of home-based voluntary counselling and testing on HIV-related stigma: Findings from a cluster-randomized trial in Zambia. Social Science and Medicine, 81, 18–25.CrossRefPubMedGoogle Scholar
  24. Kalichman, S. C., & Simbayi, L. C. (2003). HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sexually Transmitted Infections, 79, 442–447.CrossRefPubMedPubMedCentralGoogle Scholar
  25. Lewin, S. R. (2013). A cure for HIV: Where we’ve been, and where we’re headed. Lancet, 381, 2057–2058.  https://doi.org/10.1016/s0140-6736(13)61180-0.CrossRefPubMedPubMedCentralGoogle Scholar
  26. Li, H., Holroyd, E., & Lau, J. T. (2010). Negotiating homosexual identities: The experiences of men who have sex with men in Guangzhou. Culture, Health and Sexuality, 12, 401–414.CrossRefPubMedGoogle Scholar
  27. Liamputtong, P. (2013). Stigma, discrimination and living with HIV/AIDS. Dordrecht, Netherlands: Springer.CrossRefGoogle Scholar
  28. Lichtenstein, B. (2003). Stigma as a barrier to treatment of sexually transmitted infection in the American deep south: Issues of race, gender and poverty. Social Science and Medicine, 57, 2435–2445.CrossRefPubMedGoogle Scholar
  29. Liu, J. X., & Choi, K. (2006). Experiences of social discrimination among men who have sex with men in Shanghai, China. AIDS and Behavior, 10(4 Suppl.), S25–S33.  https://doi.org/10.1007/s10461-006-9123-5.CrossRefPubMedGoogle Scholar
  30. Liu, J. X., & Choi, K.-H. (2013). Emerging gay identities in China: The prevalence and predictors of social discrimination against men who have sex with men. In P. Liamputtong (Ed.), Stigma, discrimination and living with HIV/AIDS (pp. 271–287). Berlin: Springer.CrossRefGoogle Scholar
  31. Liu, H., Feng, T., Rhodes, A. G., & Liu, H. (2009). Assessment of the Chinese version of HIV and homosexuality related stigma scales. Sexually Transmitted Infections, 85, 65–69.  https://doi.org/10.1136/sti.2008.032714.CrossRefPubMedGoogle Scholar
  32. Liu, H., Yang, H., Li, X., Wang, N., Liu, H., Wang, B., & Stanton, B. (2006). Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sexually Transmitted Diseases, 33, 68–76.CrossRefPubMedGoogle Scholar
  33. Ma, Q., Wu, F., Handerson, G., Rennie, S., Rich, Z. C., Cheng, Y., & Tucker, J. D. (2016). ‘I can coexist with HIV’: A qualitative study of perceptions of HIV cure among people living with HIV in Guangzhou, China. Journal of Virus Eradication, 2, 170–174.PubMedPubMedCentralGoogle Scholar
  34. Mahajan, A. P., Sayles, J. N., Patel, V. A., Remien, R. H., Sawires, S. R., Ortiz, D. J., & Coates, T. J. (2008). Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS, 22(Suppl. 2), S67–S79.  https://doi.org/10.1097/01.aids.0000327438.13291.62.PubMedPubMedCentralGoogle Scholar
  35. Mall, S., Middelkoop, K., Mark, D., Wood, R., & Bekker, L.-G. (2013). Changing patterns in HIV/AIDS stigma and uptake of voluntary counselling and testing services: The results of two consecutive community surveys conducted in the Western Cape, South Africa. AIDS Care, 25, 194–201.CrossRefPubMedGoogle Scholar
  36. Maughan-Brown, B. (2010). Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa. Social Science and Medicine, 70, 368–374.CrossRefPubMedGoogle Scholar
  37. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36, 38–56.CrossRefPubMedGoogle Scholar
  38. Neilands, T. B., Steward, W. T., & Choi, K. H. (2008). Assessment of stigma towards homosexuality in China: A study of men who have sex with men. Archives of Sexual Behavior, 37, 838–844.  https://doi.org/10.1007/s10508-007-9305-x.CrossRefPubMedGoogle Scholar
  39. Parker, R., & Aggleton, P. (2003). HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action. Social Science and Medicine, 57, 13–24.CrossRefPubMedGoogle Scholar
  40. Passaes, C. P., & Sáez-Cirión, A. (2014). HIV cure research: Advances and prospects. Virology, 454, 340–352.CrossRefPubMedGoogle Scholar
  41. Peay, H. L., & Henderson, G. E. (2015). What motivates participation in HIV cure trials? A call for real-time assessment to improve informed consent. Journal of Virus Eradication, 1, 51–53.PubMedPubMedCentralGoogle Scholar
  42. Persaud, D., Gay, H., Ziemniak, C., Chen, Y. H., Piatak, M., Jr., Chun, T.-W., & Luzuriaga, K. (2013). Absence of detectable HIV-1 viremia after treatment cessation in an infant. New England Journal of Medicine, 369, 1828–1835.CrossRefPubMedGoogle Scholar
  43. Quinn, D. M., & Chaudoir, S. R. (2009). Living with a concealable stigmatized identity: The impact of anticipated stigma, centrality, salience, and cultural stigma on psychological distress and health. Journal of Personality and Social Psychology, 97, 634.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Roberts, E. T., & Matthews, D. D. (2012). HIV and chemoprophylaxis, the importance of considering social structures alongside biomedical and behavioral intervention. Social Science and Medicine, 75, 1555–1561.CrossRefPubMedGoogle Scholar
  45. Roura, M., Urassa, M., Busza, J., Mbata, D., Wringe, A., & Zaba, B. (2009). Scaling up stigma? The effects of antiretroviral roll-out on stigma and HIV testing: Early evidence from rural Tanzania. Sexually Transmitted Infections, 85, 308–312.CrossRefPubMedGoogle Scholar
  46. Sawires, S. R., Dworkin, S. L., Fiamma, A., Peacock, D., Szekeres, G., & Coates, T. J. (2007). Male circumcision and HIV/AIDS: Challenges and opportunities. Lancet, 369, 708.CrossRefPubMedPubMedCentralGoogle Scholar
  47. Steward, W. T., Miege, P., & Choi, K. H. (2013). Charting a moral life: The influence of stigma and filial duties on marital decisions among Chinese men who have sex with men. PLoS ONE, 8, e71778.  https://doi.org/10.1371/journal.pone.0071778.CrossRefPubMedPubMedCentralGoogle Scholar
  48. Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Procedures and techniques for developing grounded theory. Thousand Oaks, CA: Sage.Google Scholar
  49. Wang, Q. (2011). Well-identified but not coming out: Contemporary gay minority investigation. China Agricultural University Journal of Social Sciences, 4, 016.Google Scholar
  50. Wei, C., Yan, H., Yang, C., Raymond, H. F., Li, J., Yang, H., & Stall, R. (2014). Accessing HIV testing and treatment among men who have sex with men in China: A qualitative study. AIDS Care, 26, 372–378.  https://doi.org/10.1080/09540121.2013.824538.CrossRefPubMedGoogle Scholar
  51. Wei, H., & Zhong, Z. (2016). Inter-generational exchange, filial piety culture and structural constraints: An empirical analysis of offspring supporting behavior. Journal of Nanjing Agricultural University, 1, 144–155.Google Scholar
  52. Wolfe, W. R., Weiser, S. D., Leiter, K., Steward, W. T., Percy-de Korte, F., Phaladze, N., & Heisler, M. (2008). The impact of universal access to antiretroviral therapy on HIV stigma in Botswana. American Journal of Public Health, 98, 1865–1871.CrossRefPubMedPubMedCentralGoogle Scholar
  53. Wu, J. (2003). From “long yang” and “dui shi” to tongzhi: Homosexuality in China. Journal of Gay and Lesbian Psychotherapy, 7, 117–143.CrossRefGoogle Scholar
  54. Xu, X., Sheng, Y., Khoshnood, K., & Clark, K. (2017). Factors predicting internalized stigma among men who have sex with men living with HIV in Beijing, China. Journal of the Association of Nurses in AIDS Care, 28, 142–153.CrossRefPubMedGoogle Scholar
  55. United Nations Programme on HIV/AIDS. (2012). HIV in China: Facts and figures. Retrieved from http://unaids.org.cn/en/index/page.asp?id=197&class=2&classname=China+Epidemic+%26+Response.
  56. Zhou, Y. R. (2006). Homosexuality, seropositivity, and family obligations: Perspectives of HIV-infected men who have sex with men in China. Culture, Health and Sexuality, 8, 487–500.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Feng Wu
    • 1
  • Alice Zhang
    • 1
    • 2
  • Andrew Babbitt
    • 1
  • Qingyan Ma
    • 1
    • 3
  • Nir Eyal
    • 4
  • Xin Pan
    • 1
  • Weiping Cai
    • 5
  • Fengyu Hu
    • 5
  • Yu Cheng
    • 6
  • Joseph D. Tucker
    • 1
    • 3
  1. 1.University of North Carolina Project-ChinaGuangzhouChina
  2. 2.Department of Family MedicineUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillUSA
  4. 4.Harvard University Program in Ethics and HealthHarvard UniversityBostonUSA
  5. 5.Infectious Diseases InstituteGuangzhou Eighth People’s HospitalGuangzhouChina
  6. 6.School of Sociology and AnthropologySun Yat-Sen UniversityGuangzhouChina

Personalised recommendations