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

Abstract

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.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Abu-Raddad, L. J., Akala, F. A., Semini, I., Riedner, G., Wilson, D. P., & Tawil, O. (2010). Characterizing the HIV/AIDS epidemic in the Middle East and North Africa: Time for strategic action. Washington, DC: World Bank. Retrieved June 12, 2018, from http://documents.worldbank.org/curated/en/473151468052141714/pdf/548890PUB0EPI11C10Dislosed061312010.pdf.

  2. Afridi, F., Li, S. X., & Ren, Y. (2015). Social identity and inequality: The impact of China’s hukou system. Journal of Public Economics,123, 17–29. https://doi.org/10.1016/J.JPUBECO.2014.12.011.

    Article  Google Scholar 

  3. Altenburger, R. (2005). Is it clothes that make the man? Cross-dressing, gender, and sex in pre-twentieth-century Zhu Yingtai Lore. Asian Folklore Studies,64, 165–205. https://doi.org/10.2307/30030419.

    Article  Google Scholar 

  4. Arreola, S., Santos, G. M., Beck, J., Sundararaj, M., Wilson, P. A., Hebert, P., … Ayala, G. (2015). Sexual stigma, criminalization, investment, and access to HIV services among men who have sex with men worldwide. AIDS and Behavior,19(2), 227–234. https://doi.org/10.1007/s10461-014-0869-x.

    Article  PubMed  Google Scholar 

  5. Baeten, J. M., Haberer, J. E., Liu, A. Y., & Sista, N. (2014). Pre-exposure prophylaxis for HIV prevention: Where have we been and where are we going? Journal of Acquired Immune Deficiency Syndrome,63(Suppl 2), S122–S129. https://doi.org/10.1097/qai.0b013e3182986f69.

    Article  Google Scholar 

  6. Baral, S. D., Poteat, T., Strömdahl, S., Wirtz, A. L., Guadamuz, T. E., & Beyrer, C. (2013). Worldwide burden of HIV in transgender women: A systematic review and meta-analysis. The Lancet Infectious Diseases,13(3), 214–222. https://doi.org/10.1016/S1473-3099(12)70315-8.

    Article  PubMed  Google Scholar 

  7. Beijing LGBT Center & Department of Sociology of Peking University. (2017). China transgender population general survey report: Transgender and gender nonconforming people. Retrieved July 23, 2018, from http://image.cdb.org.cn/editor/20171121/files/2017 报告中国跨性别群体生存现状调研可视化.pdf

  8. Best, J., Tang, W., Zhang, Y., Han, L., Liu, F., Huang, S., … Tucker, J. D. (2015). Sexual behaviors and HIV/syphilis testing among transgender individuals in China. Sexually Transmitted Diseases,42(5), 281–285. https://doi.org/10.1097/OLQ.0000000000000269.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Beyrer, C., Baral, S. D., Van Griensven, F., Goodreau, S. M., Chariyalertsak, S., Wirtz, A. L., & Brookmeyer, R. (2012). Global epidemiology of HIV infection in men who have sex with men. The Lancet,380(9839), 367–377. https://doi.org/10.1016/S0140-6736(12)60821-6.

    Article  Google Scholar 

  10. Beyrer, C., Diouf, D., Drame, F., Ndaw, M., & Traore, C. (2014). Pushback: The current wave of anti-homosexuality laws and impacts on health. PLoS Medicine,11(6), e1001658. https://doi.org/10.1371/journal.pmed.1001658.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chan, P. A., Rose, J., Maher, J., Benben, S., Pfeiffer, K., Almonte, A., … Nunn, A. S. (2015). A latent class analysis of risk factors for acquiring HIV among men who have sex with men: Implications for implementing pre-exposure prophylaxis programs. AIDS Patient Care and STDs,29(11), 597–605. https://doi.org/10.1089/apc.2015.0113.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Chen, X., Li, X., Zheng, J., Zhao, J., He, J., Zhang, G., & Tang, X. (2015a). Club drugs and HIV/STD infection: An exploratory analysis among men who have sex with men in Changsha, China. PLOS ONE,10(5), e0126320. https://doi.org/10.1371/journal.pone.0126320.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Chen, X., Yu, B., Zhou, D., Zhou, W., Gong, J., Li, S., & Stanton, B. (2015b). A comparison of the number of men who have sex with men among rural-to-urban migrants with non-migrant rural and urban residents in Wuhan, China: A GIS/GPSAssisted random sample survey study. PLoS ONE,10(8), 1–18. https://doi.org/10.1371/journal.pone.0134712.

    Article  Google Scholar 

  14. Choi, K.-H., Diehl, E., Yaqi, G., Qu, S., & Mandel, J. (2002). High HIV risk but inadequate prevention services for men in China who have sex with men: An ethnographic study. AIDS and Behavior,6(3), 255–266. https://doi.org/10.1023/A:1019895909291.

    Article  Google Scholar 

  15. Choi, K.-H., Ning, Z., Gregorich, S., & Pan, Q.-C. (2007). The influence of social and sexual networks in the spread of HIV and syphilis among men who have sex with men in Shanghai, China. Journal of Acquired Immune Deficiency Syndromes,45(1), 77–84.

    Article  Google Scholar 

  16. Dilley, P. (2005). Which way out? A typology of non-heterosexual male collegiate identities. Journal of Higher Education,76(1), 56–88. https://doi.org/10.1353/jhe.2005.0004.

    Article  Google Scholar 

  17. Egan, J. E., Frye, V., Kurtz, S. P., Latkin, C., Chen, M., Tobin, K., … Koblin, B. A. (2011). Migration, neighborhoods, and networks: Approaches to understanding how urban environmental conditions affect syndemic adverse health outcomes among gay, bisexual and other men who have sex with men. AIDS and Behavior,15(S1), 35–50. https://doi.org/10.1007/s10461-011-9902-5.

    Article  Google Scholar 

  18. Fonner, V. A., Armstrong, K. S., Kennedy, C. E., O’Reilly, K. R., & Sweat, M. D. (2014). School based sex education and hiv prevention in low- and middle-income countries: A systematic review and meta-analysis. PLoS ONE,9(3), e89692. https://doi.org/10.1371/journal.pone.0089692.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Gao, Y., Lu, Z. Z., Shi, R., Sun, X. Y., & Cai, Y. (2001). AIDS and sex education for young people in China. Reproduction, Fertility, and Development,13(7–8), 729–737.

    Article  Google Scholar 

  20. He, Q., Wang, Y., Lin, P., Raymond, H. F., Li, Y., Yang, F., … McFarland, W. (2009). High prevalence of risk behaviour concurrent with links to other high-risk populations: A potentially explosive HIV epidemic among men who have sex with men in Guangzhou, China. Sexually Transmitted Infections,85(5), 383–390. https://doi.org/10.1136/sti.2009.035808.

    Article  PubMed  Google Scholar 

  21. Hu, J., Gu, X., Tao, X., Qian, Y., Babu, G. R., Wang, G., … Tang, W. (2017). Prevalence and trends of HIV, syphilis, and HCV in migrant and resident men who have sex with men in Shandong, China: Results from a serial cross-sectional study. PLoS ONE,12(1), e0170443. https://doi.org/10.1371/journal.pone.0170443.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Janulis, P., Feinstein, B. A., Phillips, G., Newcomb, M. E., Birkett, M., & Mustanski, B. (2018). Sexual partner typologies and the association between drug use and sexual risk behavior among young men who have sex with men. Archives of Sexual Behavior, 47, 259–271. https://doi.org/10.1007/s10508-016-0909-x.

    Article  PubMed  Google Scholar 

  23. Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J. (2012). Butch tops and femme bottoms? Sexual positioning, sexual decision making, and gender roles among young gay men. American Journal of Men’s Health,6(6), 505–518. https://doi.org/10.1177/1557988312455214.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Key Laboratory for AIDS Immunology at China Medical University. (2018). A multicenter, real-world study on two oral Truvada approaches to prevent HIV infection among men who have sex with men (ChiCTR-IIN-17013762). Retrieved July 31, 2018, from http://www.chictr.org.cn/hvshowproject.aspx?id=12652.

  25. Lanza, S. T., Rhoades, B. L., Greenberg, M. T., & Cox, M. (2011). Modeling multiple risks during infancy to predict quality of the caregiving environment: Contributions of a person-centered approach. Infant Behavior and Development,34(3), 390–406. https://doi.org/10.1016/j.infbeh.2011.02.002.

    Article  PubMed  Google Scholar 

  26. Lanza, S. T., Tan, X., & Bray, B. C. (2013). Latent class analysis with distal outcomes: A flexible model-based approach. Structural Equation Modeling: A Multidisciplinary Journal,20(1), 1–26. https://doi.org/10.1080/10705511.2013.742377.

    Article  Google Scholar 

  27. Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago, IL: University of Chicago Press. https://doi.org/10.1136/bmj.310.6978.540.

    Google Scholar 

  28. Li, S. L. (2003). Cross-dressing in Chinese opera. Hong Kong: Hong Kong University Press.

    Google Scholar 

  29. Lim, S., Cheung, D., Guadamuz, T. E., Wei, C., Koe, S., & Altice, F. L. (2015). Latent class analysis of substance use among men who have sex with men in Malaysia: Findings from the Asian Internet MSM Sex Survey. Drug and Alcohol Dependence,151, 31–37. https://doi.org/10.1016/j.drugalcdep.2015.02.040.

    Article  PubMed  Google Scholar 

  30. Lin, H., Ding, Y., Liu, X., Wu, Q., Shen, W., & He, N. (2015). High prevalence of HIV infection and bisexual networks among a sample of men who have sex with men in Eastern China. PLoS ONE,10(6), e0129300. https://doi.org/10.1371/journal.pone.0129300.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Liu, C., Fu, R., Tang, W., Cao, B., Pan, S. W., Wei, C., … Kumi Smith, M. (2018). Transplantation or rurality? Migration and HIV risk among Chinese men who have sex with men in the urban areas. Journal of the International AIDS Society,21(1), 1–8. https://doi.org/10.1002/jia2.25039.

    Article  Google Scholar 

  32. Liu, H., Feng, T., Liu, H., Feng, H., Cai, Y., Rhodes, A. G., & Grusky, O. (2009). Egocentric networks of Chinese Men who have sex with men: Network components, condom use norms, and safer sex. AIDS Patient Care and STDs. https://doi.org/10.1089/apc.2009.0043.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Mao, X., Wang, Z., Hu, Q., Huang, C., Yan, H., Wang, Z., … Xu, J. (2018). HIV incidence is rapidly increasing with age among young men who have sex with men in China: A multicentre cross-sectional survey. HIV Medicine. https://doi.org/10.1111/hiv.12623.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Mumtaz, G., Hilmi, N., McFarland, W., Kaplan, R. L., Akala, F. A., Semini, I., … Abu-Raddad, L. J. (2011). Are HIV epidemics among men who have sex with men emerging in the Middle East and North Africa?: A systematic review and data synthesis. PLoS Medicine,8(8), e1000444. https://doi.org/10.1371/journal.pmed.1000444.

    Article  PubMed Central  Google Scholar 

  35. National Bureau of Statistics of China. (2015). Average annual income of China in 2015. Retrieved May 2, 2018, from http://www.stats.gov.cn/.

  36. Noor, S. W., Ross, M. W., Lai, D., & Risser, J. M. (2014). Use of latent class analysis approach to describe drug and sexual HIV risk patterns among injection drug users in Houston, Texas. AIDS and Behavior,18(3), 276–283.

    Article  Google Scholar 

  37. Parker, R., Aggleton, P., & Perez-Brumer, A. G. (2016). The trouble with ‘Categories’: Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion. Global Public Health,11(7–8), 819–823. https://doi.org/10.1080/17441692.2016.1185138.

    Article  PubMed  Google Scholar 

  38. Patel, P., Borkowf, C. B., Brooks, J. T., Lasry, A., Lansky, A., & Mermin, J. (2014). Estimating per-act HIV transmission risk. AIDS,28(10), 1509–1519. https://doi.org/10.1097/QAD.0000000000000298.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Poteat, T., German, D., & Flynn, C. (2016). The conflation of gender and sex: Gaps and opportunities in HIV data among transgender women and MSM. Global Public Health,11(7–8), 835–848. https://doi.org/10.1080/17441692.2015.1134615.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Prestage, G., Brown, G., De Wit, J., Bavinton, B., Fairley, C., Maycock, B., … Zablotska, I. (2015). Understanding gay community subcultures: Implications for HIV prevention. AIDS and Behavior,19(12), 2224–2233. https://doi.org/10.1007/s10461-015-1027-9.

    Article  PubMed  Google Scholar 

  41. Reisner, S. L., Poteat, T., Keatley, J., Cabral, M., Mothopeng, T., Dunham, E., … Baral, S. D. (2016). Global health burden and needs of transgender populations: A review. The Lancet,388(10042), 412–436. https://doi.org/10.1016/S0140-6736(16)00684-X.

    Article  Google Scholar 

  42. Rice, C. E., Turner, A. N., & Lanza, S. T. (2016). Sexual behavior latent classes among men who have sex with men: Associations with sexually transmitted infections. Journal of Sex Research,00(00), 1–8. https://doi.org/10.1080/00224499.2016.1211599.

    Article  Google Scholar 

  43. Ruan, Y., Pan, S. W., Chamot, E., Qian, H.-Z., Li, D., Li, Q.-C., … Kristensen, S. (2011). Sexual mixing patterns among social networks of HIV-positive and HIV-negative Beijing men who have sex with men: A multilevel comparison using roundtable network mapping. AIDS Care,23(8), 1014–1025. https://doi.org/10.1080/09540121.2010.542127.

    Article  PubMed  Google Scholar 

  44. Schwartz, A. (2016). A multi-group latent class analysis of chronic medical conditions among men who have sex with men. AIDS and Behavior,20(10), 2418–2432. https://doi.org/10.1007/s10461-016-1381-2.

    Article  Google Scholar 

  45. Sexual and Gender Minority. (2018). Retrieved from https://www.edi.nih.gov/people/sep/lgbti/resources/terminology.

  46. Smith, M. K., Stein, G., Cheng, W., Miller, W. C., & Tucker, J. D. (2019). Identifying high risk subgroups of MSM: A latent class analysis using two samples. BMC Infectious Diseases,19(1), 213. https://doi.org/10.1186/s12879-019-3700-5.

    Article  PubMed  Google Scholar 

  47. Song, D., Zhang, H., Wang, J., Han, D., Dai, L., Liu, Q., … Zaller, N. (2013). Sexual risk behaviours and their correlates among gay and non-gay identified men who have sex with men and women in Chengdu and Guangzhou, China. International Journal of STD and AIDS,24(10), 780–790. https://doi.org/10.1177/0956462413482425.

    Article  PubMed  Google Scholar 

  48. Stahlman, S. A., Lyons, C. A., Sullivan, P. S., Mayer, K. H., Hosein, S. E., Beyrer, C. A., & Baral, S. D. (2017). HIV incidence among gay men and other men who have sex with men in 2020: Where is the epidemic heading? Sexual Health,14(1), 5–17. https://doi.org/10.1071/sh16070.

    Article  PubMed  Google Scholar 

  49. Tang, W., Han, L., Best, J. M., Zhang, Y., Mollan, K., Kim, J., … Tucker, J. D. (2016). Crowdsourcing HIV test promotion videos: A noninferiority randomized controlled trial in China. Clinical Infectious Diseases,62(11), 1436–1442. https://doi.org/10.1093/cid/ciw171.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Tang, W., Mahapatra, T., Liu, F., Fu, G., Yang, B., Tucker, J. D., … Detels, R. (2015). Burden of HIV and syphilis: A comparative evaluation between male sex workers and non-sex-worker men who have sex with men in urban China. PLoS ONE,10(5), e0126604. https://doi.org/10.1371/journal.pone.0126604.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Tao, J., Ruan, Y., Yin, L., Vermund, S. H., Shepherd, B. E., Shao, Y., & Qian, H.-Z. (2013). Sex with women among men who have sex with men in China: Prevalence and sexual practices. AIDS Patient Care and STDs,27(9), 524–528. https://doi.org/10.1089/apc.2013.0161.

    Article  PubMed  PubMed Central  Google Scholar 

  52. The UN Theme Group on HIV/AIDS in China. (2002). China’s titanic peril: 2001 update of the AIDS situation and needs assessment report. Retrieved May 31, 2018, from www.hivpolicy.org/Library/HPP000056.pdf.

  53. Viiv Healthcare. (2018). A safety, tolerability, acceptability, and pharmacokinetic (PK) study of cabotegravir (CAB) in healthy human immunodeficiency virus (HIV)-uninfected Chinese men (NCT03422172). https://clinicaltrials.gov/ct2/show/NCT03422172.

  54. Wang, J., Zhou, Y., & Liu, S. (2017). China labor-force dynamics survey. Chinese Sociological Dialogue,2(3–4), 83–97. https://doi.org/10.1177/2397200917735796.

    Article  Google Scholar 

  55. Wang, S., Song, D., Huang, W., He, H., Wang, M., Manning, D., … Operario, D. (2015). Heterosexual partnerships and the need for HIV prevention and testing for men who have sex with men and women in China: A qualitative study. AIDS Education and Prevention,27(2), 126–138. https://doi.org/10.1521/aeap.2015.27.2.126.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Wei, C., & Raymond, H. F. (2018). Pre-exposure prophylaxis for men who have sex with men in China: Challenges for routine implementation. Journal of the International AIDS Society,21(7), e25166. https://doi.org/10.1002/jia2.25166.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Wilkinson, A. L., El-Hayek, C., Fairley, C. K., Roth, N., Tee, B. K., McBryde, E., … Stoové, M. (2017). Measuring transitions in sexual risk among men who have sex with men: The novel use of latent class and latent transition analysis in HIV sentinel surveillance. American Journal of Epidemiology,185(8), 627–635. https://doi.org/10.1093/aje/kww239.

    Article  PubMed  Google Scholar 

  58. Winter, S., Diamond, M., Green, J., Karasic, D., Reed, T., Whittle, S., & Wylie, K. (2016). Transgender people: Health at the margins of society. The Lancet,388(10042), 390–400. https://doi.org/10.1016/S0140-6736(16)00683-8.

    Article  Google Scholar 

  59. Wolitski, R. J., & Fenton, K. A. (2011). Sexual health, HIV, and sexually transmitted infections among gay, bisexual, and other men who have sex with men in the United States. AIDS and Behavior,15(S1), 9–17. https://doi.org/10.1007/s10461-011-9901-6.

    Article  Google Scholar 

  60. Wu, C.-J. (2012). Performing transgender desire: Male cross-dressing shows in Taiwan. In H. Chiang (Ed.), Transgender China (pp. 225–262). New York: Palgrave Macmillan. https://doi.org/10.1057/9781137082503_9.

    Google Scholar 

  61. Wu, Z., Sullivan, S., Wang, Y., Rotheram-Borus, M., & Detels, R. (2007). Evolution of China’s response to HIV/AIDS. Lancet,369(9562), 679–690. https://doi.org/10.1016/S0140-6736(07)60315-8.

    Article  PubMed  Google Scholar 

  62. Wu, Z., & Wang, Y. (2010). Introduction: China meets new AIDS challenges. Journal of Acquired Immune Deficiency Syndromes,53, S1–S3. https://doi.org/10.1097/QAI.0b013e3181c7d379.

    Article  PubMed  Google Scholar 

  63. Wu, J., Wu, H., Li, P., & Lu, C. (2016). HIV/STIs risks between migrant MSM and local MSM: A cross-sectional comparison study in China. PeerJ,4, e2169. https://doi.org/10.7717/peerj.2169.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Wylie, K., Knudson, G., Khan, S. I., Bonierbale, M., Watanyusakul, S., & Baral, S. (2016). Serving transgender people: Clinical care considerations and service delivery models in transgender health. Lancet,388(10042), 401–411. https://doi.org/10.1016/S0140-6736(16)00682-6.

    Article  PubMed  Google Scholar 

  65. Xu, J., Qian, H., Chu, Z., Zhang, J., Hu, Q., Jiang, Y., … Shang, H. (2014). Recreational drug use among Chinese men who have sex with men: A risky combination with unprotected sex for acquiring HIV infection. BioMed Research International,2014, 725361. https://doi.org/10.1155/2014/725361.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Xu, J. J., Tang, W. M., Zou, H. C., Mahapatra, T., Hu, Q. H., Fu, G. F., … Shang, H. (2016). High HIV incidence epidemic among men who have sex with men in china: Results from a multi-site cross-sectional study. Infectious Diseases of Poverty,5(1), 82. https://doi.org/10.1186/s40249-016-0178-x.

    Article  PubMed  PubMed Central  Google Scholar 

  67. Yang, X., Wang, L., Hao, C., Gu, Y., Song, W., Wang, J., … Zhao, Q. (2015). Sex partnership and self-efficacy influence depression in Chinese transgender women: A cross-sectional study. PLoS ONE,10(9), 1–13. https://doi.org/10.1371/journal.pone.0136975.

    Article  Google Scholar 

  68. Young, R. M., & Meyer, I. H. (2005). The trouble with “MSM” and “WSW”: Erasure of the sexual-minority person in public health discourse. American Journal of Public Health,95(7), 1144–1149. https://doi.org/10.2105/AJPH.2004.046714.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Yun, K., Xu, J. J., Reilly, K. H., Zhang, J., Jiang, Y. J., Wang, N., & Shang, H. (2011). Prevalence of bisexual behaviour among bridge population of men who have sex with men in China: A meta-analysis of observational studies. Sexually Transmitted Infections,87(7), 563–570. https://doi.org/10.1136/sextrans-2011-050079.

    Article  PubMed  Google Scholar 

  70. Zhang, B. (2000). AIDS epideimology of men who have sex with men. Journal of Chinese AIDS/STD Prevention and Control,6(2), 126.

    Google Scholar 

  71. Zhang, Y., Best, J., Tang, W., Tso, L. S., Liu, F., Huang, S., … Tucker, J. D. (2016). Transgender sexual health in China: A cross-sectional online survey in China. Sexually Transmitted Infections,92(7), 515–519. https://doi.org/10.1136/sextrans-2015-052350.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Zhang, B., Li, X., Hu, T., Liu, D., & Shi, T. (2000). HIV/AIDS interventions targeting men who have sex with men: Theory and practice. Journal of China AIDS/STD Prevention and Control,6(3), 155–157.

    Google Scholar 

  73. Zhang, B., Liu, D., Li, X., & Hu, T. (2001). AIDS-related high-risk behaviors and affecting factors of men who have sex with men in mainland China. Chinese Journal of Sexually Transmitted Infection,1(1), 7–16.

    Google Scholar 

  74. Zhang, L., Peng, P., Wu, Y., Ma, X., Soe, N. N., Huang, X., … Meyers, K. (2019). Modelling the epidemiological impact and cost-effectiveness of PrEP for HIV transmission in MSM in China. AIDS and Behavior, 23, 523–533. https://doi.org/10.1007/s10461-018-2205-3.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Zheng, L., Hart, T. A., & Zheng, Y. (2012). The relationship between intercourse preference positions and personality traits among gay men in China. Archives of Sexual Behavior,41(3), 683–689. https://doi.org/10.1007/s10508-011-9819-0.

    Article  PubMed  Google Scholar 

  76. Zheng, L., Hart, T. A., & Zheng, Y. (2015). Top/bottom sexual self-labels and empathizing-systemizing cognitive styles among gay men in China. Archives of Sexual Behavior,44(5), 1431–1438. https://doi.org/10.1007/s10508-014-0475-z.

    Article  PubMed  Google Scholar 

  77. Zheng, L., Lippa, R. A., & Zheng, Y. (2011). Sex and sexual orientation differences in personality in China. Archives of Sexual Behavior,40(3), 533–541. https://doi.org/10.1007/s10508-010-9700-6.

    Article  PubMed  Google Scholar 

  78. Zheng, C., Xu, J., Hu, Q., Yu, Y., Chu, Z., Zhang, J., … Shang, H. (2016). Commercial sex and risk of HIV, syphilis, and herpes simplex virus-2 among men who have sex with men in six Chinese cities. BMC Infectious Diseases,16(1), 765. https://doi.org/10.1186/s12879-016-2130-x.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Zou, H., Tucker, J. D., Fan, S., Xu, J., Yu, M., Luo, Z., … Grulich, A. E. (2018). Learning about HIV the hard way: HIV among Chinese MSM attending university. The Lancet Infectious Diseases,18(1), 16–18. https://doi.org/10.1016/S1473-3099(17)30711-9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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).

Author information

Affiliations

Authors

Corresponding author

Correspondence to M. Kumi Smith.

Ethics declarations

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 13 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Smith, M.K., Wei, C., Liu, C. et al. Gender Identity and Sexual Orientation in Chinese Men Who Have Sex with Men: A Latent Class Analysis. Arch Sex Behav 49, 721–731 (2020). https://doi.org/10.1007/s10508-019-01481-4

Download citation

Keywords

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