May I have the next dance? Chinese gay men exploring selves and practices through the tradition of dance in public spaces.

This study explores the way in which some Chinese gay men negotiate dance performances in parks and other public spaces in an attempt to invent and experiment with 'possible selves'. In most circumstances, these same men conceal their sexual orientation for fear of stigma and discrimination, experiencing in the process something of a 'divided self'. Little attention has been given to understanding the way such individuals negotiate and construct same-sex experiences, especially through the negotiation of specific and restricted social interactions and performances. Based on participant observation with a group of dancers practising in a Chinese public park, this paper analyses how these men explore same-sex relations and lifestyles through the circumscribed performance of collective public dance.

Unpacking the Influence of Sexual Stigma on HIV Risk: Results From a Prospective Study of Men Who Have Sex With Men in Beijing, China.

OBJECTIVE: We examined the mediating roles of coping, depression, anxiety, and encountering difficult sexual situations in explaining the association between stigma against men who have sex with men (MSM) and HIV risk. METHODS: We conducted path analyses using longitudinal data collected from 493 Chinese MSM in Beijing at baseline, 6 months, and 12 months from 2011 to 2013. RESULTS: MSM stigma, specifically anticipations of stigma, had a marginally significant, protective total effect on unprotected anal intercourse at 12 months. This overall association, however, was the byproduct of 5 significant, indirect associations (3 risk enhancing, 2 protective) that routed through coping, anxiety, and difficult sexual situations. Of note, heavier use of avoidant coping principally had a protective effect on risk behavior by decreasing difficult sexual situations. CONCLUSIONS: Interventions to reduce avoidant coping would be an important tool for improving the emotional well-being of Chinese MSM. Such interventions, however, must be paired with biomedical or behavioral HIV prevention strategies to ensure that their benefit is not undermined by unintended increased HIV transmission risk in response to reduced social isolation among MSM.

Sexual Stigma, Coping Styles, and Psychological Distress: A Longitudinal Study of Men Who Have Sex With Men in Beijing, China.

The direct link between stigma against sexual minorities and psychological distress is well established. However, few studies have examined the potential mediating roles of avoidant and social support coping in the relationships between internalized and anticipated stigma associated with homosexuality and depressive symptoms and anxiety among Chinese men who have sex with men (MSM). We recruited a longitudinal sample of 493 MSM in Beijing, China from 2011 to 2012. Participants completed computer-based questionnaires at baseline, 6, and 12 months. We found significant indirect effects of anticipated MSM stigma on symptoms of both depression and anxiety via avoidant coping: anticipated MSM stigma at baseline was significantly associated with avoidant coping (B = 0.523, p < 0.001) at 6 months and, conditional on anticipated MSM stigma, avoidant coping had a significant positive effect on depressive symptoms and anxiety at 12 months (B = 0.069, p = 0.001 and B = 0.071, p = 0.014). In contrast, no significant indirect effects of anticipated MSM stigma on either psychological distress outcome via social support coping were found. No significant indirect effects of internalized MSM stigma via either avoidant or social support coping were found. These results underscore the need for interventions that address anticipations of stigma and the use of avoidant coping techniques to manage such anticipations.

Charting a moral life: the influence of stigma and filial duties on marital decisions among Chinese men who have sex with men.

INTRODUCTION: Stigma 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. METHODS: We 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. RESULTS: Participants 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. CONCLUSION: The 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.

Decentralization of the provision of health services to people living with HIV/AIDS in rural China: the case of three counties.

This study is based on a large-scale household survey and in-depth interviews of key informants that was conducted in villages in three counties of two provinces in China. We assess the new decentralized service provision system for people living with HIV/AIDS in rural populations in China. Since 2003, new social assistance schemes, and, more importantly, decentralization of routine treatment and care to community health stations, were progressively implemented in rural areas most affected by the HIV/AIDS epidemic. Though some problems remain, such as persistent discrimination towards infected patients and the lack of sufficient training of medical staff, the new decentralized pattern of service provision has lowered barriers to health access and alleviated economic pressure on affected households.

National and subnational HIV/AIDS coordination: are global health initiatives closing the gap between intent and practice?

BACKGROUND: A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing policymakers today. Global health initiatives (GHIs) have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's HIV/AIDS programmes including the Multi-country AIDS Programme (MAP). METHODS: In-depth interviews were conducted at national and subnational levels (179 and 218 respectively) in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and subnational HIV coordination structures, and the extent to which coordination efforts around HIV/AIDS are aligned with and strengthen country health systems. RESULTS: Positive effects of GHIs included the creation of opportunities for multisectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the subnational level, weakening their effectiveness. CONCLUSIONS: The paper identifies residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address.