Gender Identity and Sexual Orientation in Chinese Men Who Have Sex with Men: A Latent Class Analysis

  • M. Kumi SmithEmail author
  • Chongyi Wei
  • Chuncheng Liu
  • Stephen W. Pan
  • Jason J. Ong
  • Joseph D. Tucker
Original Paper


Men who have sex with men (MSM) are a diverse population yet are often treated as a monolithic risk group. In China, MSM have long been characterized as a “bridge population” of closeted men who are married to (or will marry) women due to sociocultural expectations. Latent class models can inform a more nuanced yet empirical characterization of this population. In total, 1424 eligible respondents recruited online provided self-reported behavioral data. Nine items related to constructs including sexual behaviors, sexual orientation, and gender identity informed the latent class model. Logistic regression was used to measure associations between latent class membership and HIV-related sexual and health-seeking behaviors. Model fit indicated a population structure made up of four classes that we characterized as “Gender nonconforming” (4.3%), “Closeted–unmarried” (29.9%), “Closeted–married” (24.6%), and “Out” (41.2%). Members of the “gender nonconforming” class were more likely to report HIV-related risk behaviors, and “Closeted–unmarried” class members were less likely to report health-seeking behaviors, both relative to “Out” members. The largest latent class was made up of members of the “Out” class, an enlightening revision of a population traditionally viewed as largely closeted men. Two types of “closeted” classes emerged, distinguished by divergent tendencies regarding marriage and health seeking. Findings suggest that current understandings of Chinese MSM are simplistic (regarding closeted behaviors) and too narrow (in its definition of MSM as cisgender men). A more nuanced understanding of MSM subgroups and their heterogeneous risk behaviors will be critical for provision of more meaningful prevention services.


Men who have sex with men Latent class analysis HIV risk behaviors Gender identity Sexual orientation 



We thank all the study participants and staff members at SESH Global, Danlan, Jiangsu Tongzhi, Yunnan Tongzhi and the Guangdong Provincial Centers for Skin Diseases and STI Control who contributed. This work was supported by the National Institute of Allergy and Infectious Diseases, US National Institutes of Health (1R01AI114310-01); University of North Carolina (UNC)–South China STD Research Training Centre (Fogarty International Center Grant Number 1D43TW009532-01 to J. T.) and UNC Center for AIDS Research (5P30AI050410-13).

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

10508_2019_1481_MOESM1_ESM.docx (14 kb)
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Authors and Affiliations

  1. 1.Division of Epidemiology and Community HealthUniversity of Minnesota Twin CitiesMinneapolisUSA
  2. 2.University of North Carolina Project-ChinaGuangzhouChina
  3. 3.Center for Health, Identity, Behavior and Prevention StudiesRutgers UniversityNew BrunswickUSA
  4. 4.Department of SociologyUniversity of California San DiegoSan DiegoUSA
  5. 5.Xi’an Jiatong-Liverpool UniversitySuzhouChina
  6. 6.London School of Hygiene and Tropical MedicineLondonUK
  7. 7.Department of MedicineUniversity of North Carolina Chapel HillChapel HillUSA

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