Abstract
Previous research has documented the deleterious impact of homosexuality stigma on HIV sexual risk behavior among men who have sex with men (MSM) and the vulnerability of this group in China for HIV acquisition. Factor analysis of 10 survey items from 477 MSM from Shanghai yielded two factors: Perceived stigma assessed participants’ impressions of the degree of societal stigmatization of homosexuals whereas enacted stigma measured direct personal experiences of stigmatizing behaviors. Enacted stigma exhibited satisfactory internal reliability and was associated with HIV sexual risk behavior. Further research is needed to refine perceived and other stigma constructs for Chinese MSM.
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Anderson, V. N. (1992). For whom is this world just? Sexual orientation and AIDS. Journal of Applied Social Psychology, 22, 248–259.
Bentler, P. M., & Bonnett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88, 588–606.
Bharat, S., Aggleton, P., & Tyrer, P. (2001). HIV and AIDS-related discrimination, stigma and denial. Geneva: UNAIDS.
Bogart, L. M., Collins, R. L., Cunningham, W., Beckman, R., Golinelli, D., Eisenman, D., et al. (2005). The association of partner abuse with risky sexual behaviors among women and men with HIV/AIDS. AIDS and Behavior, 9, 325–333.
Browne, M. W., & Cudek, R. (1993). Alternative ways of assessing model fit. In K. A. Bollen & J. S. Long (Eds.), Testing structural equation models (pp. 136–162). Newbury Park, CA: Sage Publications.
China Ministry of Health. (2006). 2005 Update on the HIV/AIDS epidemic response in China. Beijing, China: National Center for AIDS/STD Prevention and Control, China CDC.
Choi, K., Gibson, D. R., Han, L., & Guo, Y. (2004). High levels of unprotected sex with men and women among men who have sex with men: A potential bridge of HIV transmission in Beijing, China. AIDS Education and Prevention, 16, 19–30.
Choi, K., Lui, H., Guo, Y., Han, L., & Mandel, J. S. (2006). Lack of HIV testing and awareness of HIV infection among men who have sex with men, Beijing, China. AIDS Education and Prevention, 18, 33–43.
Choi, K., 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.
Choi, K., Ning, Z., Gregorich, S. E., & Pan, Q. (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, 77–84.
Chu, H. (2001, March 6). Chinese psychiatrists decide homosexuality isn’t abnormal. Los Angeles Times, A1.
Crocker, J., Major, B., & Steele, C. (1998). Social stigma. In D. T. Gilbert, S. T. Fiske, & G. Lindzey (Eds.), The handbook of social psychology (4th ed., Vol. II, pp. 504–553). Boston: McGraw-Hill.
Cronbach L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334.
Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: Findings from 3 US cities. American Journal of Public Health, 91, 927–932.
Farmer, P. (2005). Pathologies of power: Health, human rights, and the new war on the poor. Berkeley, CA: University of California Press.
Field, C. A., & Welsh, A. H. (2007). Bootstrapping clustered data. Journal of the Royal Statistical Society, Series B, 63, 369–390.
Fish, T. A., & Rye, B. J. (1991). Attitudes toward a homosexual or heterosexual person with AIDS. Journal of Applied Social Psychology, 21, 651–667.
Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491.
Gill, B. (2002, September 9). China’s HIV/AIDS crisis: Implications for human rights, the Rule of Law and U.S.–China relations. Testimony before the Congressional-Executive Commission on China, Roundtable on HIV/AIDS.
Herek, G. M., & Capitanio, J. P. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 1130–1147.
Herek, G. M., Gillis, J. R., & Cogan, J. C. (1999). Psychological sequelae of hate-crime victimization among lesbian, gay, and bisexual adults. Journal of Consulting and Clinical Psychology, 67, 945–951.
Hershberger, S. L., & D’Augelli, A. R. (1995). The impact of victimization on the mental health and suicidality of lesbian, gay, and bisexual youth. Journal of Consulting and Clinical Psychology, 67, 945–951.
Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.
Huebner, D. M., Davis, M. C., Nemeroff, C. J., & Aiken, L. S. (2002). The impact of internalized homophobia on HIV preventive interventions. American Journal of Community Psychology, 30, 327–348.
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.
Jinich, S., Paul, J. P., Stall, R., Acree, M., Kegeles, S., Hoff, C., et al. (1998). Childhood sexual abuse and HIV risk-taking behavior among gay and bisexual men. AIDS and Behavior, 2, 41–51.
Kessler, R. C., Mickelson, K. D., & Williams, D. R. (1999). The prevalence, distribution, and mental health correlates of perceived discrimination in the United States. Journal of Health and Social Behavior, 40, 208–230.
Landrine, H., Klonoff, E. A., Gibbs, J., Manning, V., Lund, M. (1995). Physical and psychiatric correlates of gender discrimination: An application of the Schedule of Sexist Events. Psychology of Women Quarterly, 19, 473–492.
Liu, H., Yang, H., Li, X., Wang, N., Liu, H., Wang, B., et al. (2006). Men who have sex with men and human immunodeficiency virus/sexually transmitted disease control in China. Sexually Transmitted Diseases, 33, 68–76.
Ma, X., Zhang, Q., He, X., Sun, W., Yue, H., Chen, S., et al. (2007). Trends in prevalence of HIV, syphilis, hepatitis C, hepatitis B, and sexual risk behavior among men who have sex with men: Results of 3 consecutive respondent-driven sampling surveys in Beijing, 2004 through 2006. Journal of Acquired Immune Deficiency Syndromes, 45, 581–587.
Macovei, M., & Coman, A. (1999). Implications for HIV/AIDS of laws affecting men who have sex with men in Romania. ACCEPT (The Bucharest Acceptance Group). Medicine and Law, 18, 335–349.
Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health, 91, 1869–1876.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129, 674–697.
Murphy-Bermann, V. A., & Berman, J. J. (1993). Effects of responsibility for illness and social acceptability on reactions to people with AIDS: A cross-cultural comparison. Basic and Applied Social Psychology, 14, 215–229.
Muthén, L. K., & Muthén, B. (2006). Mplus user’s guide. Los Angeles, CA: Muthén and Muthén, Inc.
Niang, C. I., Diagne, M., Niang, Y., Moreau, A. M., Gomis, D., & Diouf, M., et al. (2002). Meeting the sexual health needs of men who have sex with men in Senegal. Horizons Final Report. Washington, DC: Population Council.
Onyango-Ouma, W., Birungi, H., & Geibel, S. (2005). Understanding the HIV/STI risks and prevention needs of men who have sex with men in Nairobi, Kenya. Horizons Final Report. Washington, DC: Population Council.
Paul, J. P., Catania, J., Pollack, L., & Stall, R. (2001). Understanding childhood sexual abuse as a predictor of sexual risk-taking among men who have sex with men: The Urban Men’s Health Study. Child Abuse and Neglect, 25, 557–584.
SAS Institute. (2002). SAS on-line doc, version 9.0. Cary, NC: SAS Institute, Inc.
Scambler, G. (1989). Epilepsy. London: Routledge.
Shilts, R. (1987). And the band played on. New York: St. Martin’s Press.
Smedley, B. D., Stith, A. Y., & Nelson, A. R. (Eds.). (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.
Stata Corporation. (2005). Stata 9 user’s guide. College Station, TX: Stata Corporation.
Yu, C. Y. (2002). Evaluating cutoff criteria of model fit indices for latent variable models with binary and continuous outcomes. Unpublished doctoral dissertation, University of California, Los Angles, CA.
Zhang, B., Liu, D., Li, X., & Hu, T. (2000). A survey of men who have sex with men: Mainland China. American Journal of Public Health, 90, 1949–1950.
Acknowledgements
This study was funded by NIH/Fogarty D43 TW00003-13S1 and the Japanese Foundation for AIDS Prevention. Dr. Neilands was supported by a Center grant from the National Institute of Mental Health (P30 MH62246-05). During the course of article preparation, the authors received helpful comments and suggestions for improvement from Nelson Varas Diaz, Tri Do, David Huebner, and Starley Shade. We are also grateful to the Editor and two anonymous reviewers for their helpful comments that lead to an improved version of this article.
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Neilands, T.B., Steward, W.T. & Choi, KH. Assessment of Stigma Towards Homosexuality in China: A Study of Men Who Have Sex with Men. Arch Sex Behav 37, 838–844 (2008). https://doi.org/10.1007/s10508-007-9305-x
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DOI: https://doi.org/10.1007/s10508-007-9305-x