Minority stress and health: A grounded theory exploration among men who have sex with men in China and implications for health research and interventions

Shufang Sun; Stephanie Budge; Wenxuan Shen; Ge Xu; Muqing Liu; Siqi Feng

doi:10.1016/j.socscimed.2020.112917

Minority stress and health: A grounded theory exploration among men who have sex with men in China and implications for health research and interventions

Soc Sci Med. 2020 May:252:112917. doi: 10.1016/j.socscimed.2020.112917. Epub 2020 Mar 17.

Authors

Shufang Sun¹, Stephanie Budge², Wenxuan Shen³, Ge Xu⁴, Muqing Liu⁵, Siqi Feng⁶

Affiliations

¹ Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, USA. Electronic address: shufang_sun@brown.edu.
² Department of Counseling Psychology, School of Education, University of Wisconsin-Madison, USA.
³ Eastern Michigan University, USA.
⁴ Department of Counseling, Developmental, and Educational Psychology, Lynch School of Education, Boston College, USA.
⁵ Department of Human Developments & Family Studies, College of Health and Human Sciences, Purdue University, USA.
⁶ Department of Psychology, University of Illinois at Urbana-Champaign, USA.

PMID: 32197142
DOI: 10.1016/j.socscimed.2020.112917

Abstract

Rationale: Men who have sex with men (MSM) in China are disproportionately affected by HIV and mental health issues. Although predominately western-based research suggests a minority stress perspective to explain health disparities, how Chinese MSM experience stress related to being a sexual minority and how such experiences affect their health have not been carefully examined.

Objective: This study was a qualitative investigation of how stress related to sexuality (e.g., stigma, discrimination, and oppression) are experienced among MSM in China and how these experiences affect their psychological and behavioral health.

Method: In-depth, semi-structured interviews were conducted with 24 MSM in China. Grounded theory was employed to guide data analysis.

Results: Six categories emerged, which included: A Family-Oriented, Heteronormative Culture, Interpersonal Rejections and Marginalization, Internalization of Stigma, the Psychological Impact of Minority Stress, Impact on HIV-related Behavioral Health, and Coping. A conceptual model was developed, which illustrated relationships among categories and described sources, processes, and impact of minority stress among MSM in China. Cultural, social, and internalized sources of minority stress were shown to have detrimental effects on participants' psychological health and HIV-related behavioral health. Various coping strategies shared the purpose of navigating well-being in one's direct environment and in the larger culture.

Conclusions: Findings demonstrate the relevance of minority stress in behavioral health among Chinese MSM as well as the need to conceptualize minority stress within MSM's sociocultural context. HIV prevention efforts may benefit from a contextualized understanding of minority stress and addressing minority stress in a culturally congruent, community-centered fashion.

Keywords: Behavioral health; China; HIV; Health; Men who have sex with men; Mental; Minority stress; Sexual minority men; Stigma.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Grounded Theory*
HIV Infections* / epidemiology
Health Status*
Homosexuality, Male*
Humans
Male
Sexual and Gender Minorities
Social Stigma
Stress, Psychological*

Abstract

Publication types

MeSH terms

Grants and funding