Minority stress and health: A grounded theory exploration among men who have sex with men in China and implications for health research and interventions
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…
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The Chinese social environment is collectivistic and emphasizes conformity to social norms and traditional family values including heterosexual marriage and procreation.
“The social environment in China can be characterized as a collectivistic culture with an emphasis on conforming to social norms and traditional family values including heterosexual marriage and procreation (Sun, Budge, et al., 2020; Sun et al., 2021).”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Sun, Budge, et al., 2020
The Chinese traditional value of filial piety emphasizes marriage and passing on family lineage.
“Moreover, the Chinese traditional value of ‘filial piety’, based on Confucian philosophy, emphasizes the importance of marriage and passing on one’s family lineage (Steward et al., 2013; Sun, Budge, et al., 2020).”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Sun, Budge, et al., 2020
China's collectivistic cultural norms may increase pressures from family and community to conceal sexual identity.
“China’s collectivistic cultural norms might therefore exacerbate pressures emerging from one’s own family and community to conceal one’s sexual identity (Steward et al., 2013; Sun, Budge, et al., 2020; Sun et al., 2021).”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Sun, Budge, et al., 2020
Interpersonal minority stress reactions, especially concerns about social acceptance, are most strongly related to minority stress exposures and poor mental health among Chinese sexual minority individuals, more so than identity concealment.
“For this reason, interpersonal minority stress reactions, most notably concerns about social acceptance, appear to be the most strongly related to both minority stress exposures (e.g., lack of family support) and poor mental health among Chinese sexual minority individuals (Sun, Budge, et al., 2020; Sun, Pachankis, et al., 2020), even more so than identity concealment.”
From Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China (2024) · cites this paper as Sun, Budge, et al., 2020
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Addressing Minority Stress and Mental Health among Men Who Have Sex with Men (MSM) in China
Sun, S., Pachankis, J. E., Li, X., & Operario, D. (2020) · Current HIV/AIDS Reports · doi:10.1007/s11904-019-00479-w · Cited by 169 · see citing works
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Self-citationCultural context matters: Testing the minority stress model among Chinese sexual minority men
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Self-citation
- Authors
- Sun, S., Budge, S., Shen, W., Xu, G., Liu, M., & Feng, S.
- Affiliations
- Brown University (US)
- University of Wisconsin–Madison (US)
- Eastern Michigan University (US)
- Boston College (US)
- Purdue University West Lafayette (US)
- University of Illinois Urbana-Champaign (US)
- Corresponding author
- Sun, Shufang
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 252
- Pages
- 112917
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W3012404455
- Cited by
- 74
- References
- 8
- Citations by year
- 2026: 19 · 2025: 15 · 2024: 10 · 2023: 6 · 2022: 10 · 2021: 10 · 2020: 4
- FWCI
- 8.47
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- University of Wisconsin-Madison
- Topics
- Social Sciences › Psychology › Social Psychology › LGBTQ Health, Identity, and Policy
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- minority stress, men who have sex with men, sexual minority health, HIV prevention, self-stigma, discrimination, heteronormativity, coping strategies, mental health, family rejection, marginalization, China
- MeSH terms
- Sexual and Gender Minorities, China, Health Status, Humans, Male, Stress, Psychological, HIV Infections, Homosexuality, Male, Social Stigma, Grounded Theory
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