Mental Health Problems and Associated Socio-Ecological Factors Among HIV-Positive Young Migrant Men Who Have Sex with Men in China

  • Haochu (Howard) LiEmail author
  • Joseph T. F. Lau
  • Eleanor Holroyd
  • Xiaoming Li
Part of the Cross-Cultural Research in Health, Illness and Well-Being book series (CCRHIWB)


We examined the mental health status among HIV-positive young migrant men who have sex with men (MSM) residing in a city in Southern China through an ethnographic study. Nineteen HIV-positive young MSM aged from 18 to 25 were included in the current analysis. Most HIV-positive young MSM (14/19) self-reported depressive symptoms, almost half (8/19) had experienced anxiety, and about one third (6/19) had experienced both symptoms. The HIV diagnosis brought on such testified stressors including frightening images of HIV/AIDS, side-effects of antiretroviral treatment (ART), and social restrictions due to the disease, serving to make the men feel disabled and worthless. Participants’ life history accounts provided evidence of their problems being embedded in social ecological contexts, such as social adversity in the process of migration, social suffering as MSM, cultural trauma, stigma and discrimination. We theorize that HIV/AIDS is a trigger that amplifies pre-existing stress and conflicts that are deeply embedded at different socio-ecological levels among young migrant MSM.


HIV-positive Depression Anxiety Mental health Socio-ecological model Young people Migrant Men who have sex with men Ethnography China 



This research obtained funding from the Center for Health Behaviors Research of the Jockey Club School of Public Health and Primary Care (JCSPHPC), The Chinese University of Hong Kong (CUHK), a postgraduate study grant in JCSPHPC, and the Global Scholarship Programme for Research Excellence – CNOOC Grants 2010–2011 in CUHK. Authors wish to thank all participants who shared their life histories and experiences, Shenzhen 258 Rainbow Workgroup and Shenzhen CDC who helped significantly in the fieldwork and access to the populations. Dr. Conall O’Cleirigh from Harvard Medical School provided significant assistance in coding depression and anxiety symptoms.


  1. Alexander, J. C. (2004). Toward a theory of cultural trauma. In J. C. Alexender, R. Eyerman, B. Giesen, N. J. Smelser, & P. Sztompka (Eds.), Cultural trauma and collective identity (pp. 1–30). Berkeley: University of California Press.CrossRefGoogle Scholar
  2. Baer, H. A., Singer, M., & Susser, I. (Eds.). (2003). Medical anthropology and the world system. Westport: Praeger.Google Scholar
  3. Behringer, K. (2008). HIV/AIDS prevention: Factors affecting risky sexual behaviors among MSM in Shenzhen, China. UCHC Graduate School masters theses 2003–2010. Paper 144. Retrieved from
  4. Berg, M. B., Mimiaga, M., & Safren, S. A. (2004). Mental health concerns of HIV-infected gay and bisexual men seeking mental health services: An observational study. AIDS Patient Care and STDs, 18(11), 635–643.CrossRefGoogle Scholar
  5. Bhatia, R., Hartman, C., Kallen, M. A., Graham, J., & Giordano, T. P. (2011). Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: Results from the steps study. AIDS and Behavior, 15, 1161–1170.CrossRefGoogle Scholar
  6. Bourdieu, P. (1984). Distinction: A social critique of the judgement of taste (Trans: Nice, R.). Cambridge, MA: Harvard University Press.Google Scholar
  7. Campos, L. N., Guimaraes, M. D., & Remien, R. H. (2008). Anxiety and depression symptoms as risk factors for non-adherence to antiretroviral therapy in Brazil. AIDS and Behavior, 14, 289–299.CrossRefGoogle Scholar
  8. Chae, D. H., & Ayala, G. (2010). Sexual orientation and sexual behavior among Latino and Asian Americans: Implications for unfair treatment and psychological distress. Journal of Sex Research, 47(5), 451–459.CrossRefGoogle Scholar
  9. Chae, D. H., & Yoshikawa, H. (2008). Perceived group devaluation, depression, and HIV-risk behavior among Asian gay men. Health Psychology, 27(2), 140–148.CrossRefGoogle Scholar
  10. Chen, Q., Zhou, Z., Wen, Y., Lu, W., Huang, G., & Jia, M. (2004). Effects of mental health and psychosocial factors in individuals with HIV/AIDS. Chinese Mental Health Journal, 18, 850–853. Retrieved from Scholar
  11. Choi, K. H., Liu, H., Guo, Y., Han, L., Mandel, J. S., & Rutherford, G. W. (2003). Emerging HIV-1 epidemic in China in men who have sex with men. Lancet, 361, 2125–2126.CrossRefGoogle Scholar
  12. Cochran, S. D., Mays, V. M., Ortega, A. N., Alegria, M., & Takeuchi, D. (2007). Mental health and substance use disorders among Latino and Asian American lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 75(5), 785–794.CrossRefGoogle Scholar
  13. Cournos, F., McKinnon, K., & Wainberg, M. (2005). What can mental health interventions contribute to the global struggle against HIV/AIDS? World Psychiatry, 4(3), 135–141.Google Scholar
  14. Courtenay-Quirk, C., Wolitski, R. G., Parsons, J. T., & Gomez, C. A. (2006). Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men. AIDS Education and Prevention, 18(1), 56–67.CrossRefGoogle Scholar
  15. Fisher, J. D., Smith, L. R., & Lenz, E. M. (2010). Secondary prevention of HIV in the United States: Past, current, and future perspectives. Journal of Acquired Immune Deficiency Syndromes, 55(2), s106–s115.CrossRefGoogle Scholar
  16. Fleming, J., & Ledogar, R. J. (2008). Resilience, an evolving concept: A review of literature relevant to aboriginal research. Pimatisiwin, 6(2), 7–23.Google Scholar
  17. Goffman, E. (1963). Stigma—notes on the management of spoiled identity. New York: Simon and Schuster/Touchstone Books.Google Scholar
  18. Good, B. (1994). Medicine, rationality, and experience—an anthropological perspective. Cambridge: Cambridge University Press.Google Scholar
  19. Green, J., & Thorogood, N. (2009). Qualitative methods for health research (2nd ed.). London: Sage.Google Scholar
  20. Henkel, K. E., Brown, K., & Kalichman, S. C. (2008). AIDS-related stigma in individuals with other stigmatized identities in the USA: A review of layered stigmas. Social and Personality Psychology Compass, 2(4), 1586–1599.CrossRefGoogle Scholar
  21. Hirshfielda, S., Wolitskib, R. J., Chiassona, M. A., Remienc, R. H., Humberstonea, M., & Wong, T. (2008). Screening for depressive symptoms in an online sample of men who have sex with men. AIDS Care, 20(8), 904–910.CrossRefGoogle Scholar
  22. Hu, H. C. (1944). The Chinese concepts of “face”. American Anthropologist, 46(1), 45–64.CrossRefGoogle Scholar
  23. Huebner, D. M., Rebchook, G. M., & Kegeles, S. M. (2004). Experiences of harassment, discrimination, and physical violence among young gay and bisexual men. American Journal of Public Health, 94, 1200–1203.CrossRefGoogle Scholar
  24. Kleinman, A., & Kleinman, J. (1997). Moral transformations of health and suffering in Chinese society. In A. M. Brandt & P. Rozin (Eds.), Morality and health (pp. 101–118). New Yourk: Routledge.Google Scholar
  25. Lau, J. T. F., Wang, M., Wong, H. N., Tsui, H. Y., Jia, M., Cheng, F., Zhang, Y., Su, X., & Wang, N. (2008). Prevalence of bisexual behaviors among men who have sex with men (MSM) in China and associations between condom use in MSM and heterosexual behaviors. Sexually Transmitted Diseases, 35(4), 406–413.CrossRefGoogle Scholar
  26. Lau, J. T. F., Yu, X. N., Mak, W. W. S., Cheng, Y. M., Lv, Y. H., & Zhang, J. X. (2010). Suicidal ideation among HIV+ former blood and/or plasma donors in rural China. AIDS Care, 22(8), 946–954.CrossRefGoogle Scholar
  27. Lewis, M. A., Uhrig, J. D., Ayala, G., & Stryker, J. (2011). Reaching men who have sex with men for HIV prevention message with new media: Recommendations from an expert consultation. Annals of the Forum for Collaborative HIV Research, 13(3), 11–18.Google Scholar
  28. Li, L., Wang, H. M., Ye, X. J., Jiang, M. M., Lou, Q. Y., & Hesketh, T. (2007). The mental health status of Chinese rural-urban migrant workers: Comparison with permanent urban and rural dwellers. Social Psychiatry and Psychiatric Epidemiology, 42(9), 716–722.CrossRefGoogle Scholar
  29. Li, H. C., Holroyd, E., & Lau, J. T. F. (2010). Negotiating homosexual identities: The experiences of men who have sex with men in Guangzhou. Culture, Health & Sexuality, 12(4), 401–414.CrossRefGoogle Scholar
  30. Mao, L., Kidd, M., Rogers, G., Andrews, G., Newman, C. E., Booth, A., Saltman, D. C., & Kippax, S. C. (2009). Social factors associated with major depression disorder in homosexually active, gay men attending general practices in urban Australia. Australian and New Zealand Journal of Public Health, 33(1), 88–86.CrossRefGoogle Scholar
  31. McCance, T. V., McKenna, H. P., & Boore, J. R. P. (2001). Exploring caring using narrative methodology: An analysis of the approach. Journal of Advanced Nursing, 33(3), 350–356.CrossRefGoogle Scholar
  32. McLeroy, K. R., Bibeau, D., Steckler, A., & Glanz, K. (1988). An ecological perspective on health promotion programs. Health Education and Behavior, 15(4), 351–377.CrossRefGoogle Scholar
  33. O’Cleirigh, C., Mimiaga, M., Safren, S. A., Stall, R., & Mayer, K. H. (2010). Synergistic effects of psychosocial and substance use problems on increased sexual transmission risk among HIV-infected men who have sex with men. XVIII International AIDS Conference, Vienna [abstract WEPE0515].Google Scholar
  34. Parker, R. (2001). Sexuality, culture, and power in HIV/AIDS research. Annual Review of Anthropology, 30, 163–179.CrossRefGoogle Scholar
  35. Poundstone, K. E., Strathdee, S. A., & Celentano, D. D. (2004). The social epidemiology of human immunodeficiency virus/acquired immunodeficiency syndrome. Epidemiological Reviews, 26, 22–35. doi: 10.1093/epirev/mxh005.CrossRefGoogle Scholar
  36. Rogers, G., Curry, M., Oddy, J., Pratt, N., Beilby, J., & Wilkinson, D. (2003). Depressive disorders and unprotected casual anal sex among Australian homosexually active men in primary care. HIV Medicine, 4(3), 271–275.CrossRefGoogle Scholar
  37. Safren, S. A., Traeger, L., Skeer, M. R., O’Cleirigh, C., Meade, C. S., Covahey, C., & Mayer, K. H. (2010). Testing a social-cognitive model of HIV transmission risk behavior in HIV-infected MSM with and without depression. Health Psychology, 29(2), 215–221.CrossRefGoogle Scholar
  38. Sallis, J. F., Owen, N., & Fisher, E. B. (2008). Ecological models of health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior and health education: Theory, research, and practice (4th ed., pp. 465–485). San Francisco: Jossey-Bass.Google Scholar
  39. Savetsky, J. B., Sullivan, L. M., Clarke, J., Stein, M. D., & Samet, J. H. (2001). Evolution of depressive symptoms in human immunodeficiency virus-infected patients entering primary care. Journal of Nervous & Mental Disease, 189(2), 76–83.CrossRefGoogle Scholar
  40. Semple, S. J., Strathdee, S. A., Zians, J., McQuaid, J., & Patterson, T. L. (2011). Psychosocial and behavioral correlates of anxiety symptoms in a sample of HIV-positive, methamphetamine-using men who have sex with men. AIDS Care, 23(5), 628–637.CrossRefGoogle Scholar
  41. Shen, Q., Lu, Y. W., Hu, C. Y., Deng, X. M., Gao, H., Huang, X. Q., & Niu, E. H. (1998). A preliminary study of the mental health of young migrant workers in Shenzhen. Psychiatry and Clinical Neurosciences, 52(suppl), 370–373.CrossRefGoogle Scholar
  42. Shenzhen City Government General Office. (2011, September 14). Shenzhen Shi Renkou Fazhan “shi er wu” Guihua [the 12th Five years Shenzhen City population development plan]. Retrieved from
  43. Steward, W., Herek, G., Ramakrishna, J., Bharatd, S., Chandye, S., Wrubelf, J., & Ekstranda, M. L. (2008). HIV-related stigma: Adapting a theoretical framework for use in India. Social Science and Medicine, 67(8), 1225–1235.CrossRefGoogle Scholar
  44. USCDC/Centers for Disease Control and Prevention. (2008). Syndemic prevention network: Spotlight on syndemics. Atlanta: Centers for Disease Control. Web page. Retrieved from Scholar
  45. Wang, J., Lin, X., Wu, H., & Qu, W. (2005). The mood state of paid blood donors with HIV and its relation to stress and cognitive appraisal. Acta Psychologica Sinica, 37, 106–112.Google Scholar
  46. Whetten, K., Reif, S., Whetten, R., & Murphy-McMillan, L. K. (2008). Trauma, mental health, distrust, and stigma among HIV-positive persons: Implications for effective care. Psychosomatic Medicine, 70, 531–538.CrossRefGoogle Scholar
  47. Wong, D. F. K. (2008). Differential impacts of stressful life events and social support on the mental health of mainland Chinese immigrant and local youth in Hong Kong: A resilience perspective. British Journal of Social Work, 38, 236–252.CrossRefGoogle Scholar
  48. Wong, D. F. K., Li, C. Y., & Song, H. X. (2007). Rural migrant workers in urban China: Living a marginalized life. International Journal of Social Welfare, 16, 32–40.CrossRefGoogle Scholar
  49. Wong, D. F. K., He, X. S., Leung, G., Lau, Y., & Chang, Y. L. (2008). Mental health of migrant workers in China: Prevalence and correlates. Social Psychiatry and Psychiatric Epidemiology, 43, 483–489.CrossRefGoogle Scholar
  50. Xie, W., Chen, L., Cai, W., Liu, G., Zhao, J., & Tan, J. (2010). Estimation of the population size of men who have sex with men in Shenzhen in 2010. Chinese Journal of AIDS & STDs, 17(4), 414–415. Retrieved from Scholar
  51. Yu, X. N., Lau, J. T. F., Mak, W. W. S., Cheng, Y. M., Lv, Y. H., & Zhang, J. X. (2009). Risk and protective factors in association with mental health problems among people living with HIV who were former plasma/blood donors in rural China. AIDS Care, 21(5), 645–654.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Haochu (Howard) Li
    • 1
    • 2
    Email author
  • Joseph T. F. Lau
    • 3
  • Eleanor Holroyd
    • 4
  • Xiaoming Li
    • 5
  1. 1.UNC Project-China, Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.School of Public HealthShandong UniversityJinanChina
  3. 3.Jockey Club School of Public Health and Primary CareThe Chinese University of Hong KongHong Kong SARChina
  4. 4.School of Clinical SciencesAuckland University of TechnologyNorthcoteAuckland
  5. 5.Department of Health Promotion, Education, and BehaviorArnold School of Public HealthColumbiaUSA

Personalised recommendations