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UBC Theses and Dissertations

Sociocultural determinants of HIV vulnerabilities among ethnic and religious minority men who have sex with men in North China Pan, Stephen Warren


BACKGROUND: In China, 29% of new HIV cases are among men who have sex with men (MSM). Sociocultural factors may be influencing the HIV vulnerabilities of certain ethnic and religious minority MSM, but little such research exists in China. This dissertation seeks to understand how ethnicity and religion are shaping HIV vulnerabilities and testing among MSM in China. METHODS: Data were collected in three phases in Beijing and Tianjin, China from January 2013 – April 2014. Participants were self-identified MSM over 18 years old. In phase one, in-depth qualitative interviews were conducted with MSM of various ethnic and religious affiliations (n=41). Interview transcripts were analysed using an interpretive thematic approach. In phase two, findings from phase one informed the design of a structured questionnaire, which was pilot tested in two feedback sessions (n=8). In phase three, the structured questionnaire was used in a clinic-based cross-sectional survey (n=400). Statistical tests were conducted to assess if HIV infection, vulnerability, and testing were correlated with: ethnic and religious affiliation, acculturation, religiosity, and ethnic and religious discrimination. Inter-ethnic and inter-religious sexual partnerships were also assessed. Homonegativity was also assessed as a possible mediating variable between: (a) ethnicity and religion and (b) HIV-related outcomes. RESULTS: Ethnic and religious affiliations profoundly influenced individuals’ social reference groups. Religious social norms, codes of sexual morality, and beliefs in supernatural interventions appear to be inhibiting same-sex sexual behaviours among religious MSM, especially Muslims. Buddhists and ethnic minorities of South China had higher odds of various HIV vulnerabilities. Religiosity appears to have both positive and deleterious influences on HIV vulnerability. Sexual minority religious organisations can provide unique social support. Buddhists, Muslims, and ethnic Hui were more likely to report sex with their own religious and ethnic peers. Homonegativity did not account for any associations between ethnicity and religion and HIV-related outcomes. CONCLUSION: This dissertation is the first study to explicitly explore the intersectionality of ethnicity, religion, sexuality, and HIV vulnerability in China. Findings highlight the ethnic and religious diversity among MSM in China and its salience for HIV prevention. Public health models of conceptualizing ethnocultural difference in China should be re-examined.

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