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Suicidal Ideation, Resilience, and Healthcare Implications for Newly Diagnosed HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study

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Abstract

Globally, suicidal ideation and behavior have been widely reported among people living with human immunodeficiency virus (HIV). Knowledge gaps exist regarding the longer life and resilience-related experiences of people living with HIV (PLWH). Specifically, there is a dearth of data about the interaction of perceived risk and resilient factors resulting in a wide spectrum of intentional suicidal ideation outcomes in a Chinese cultural context. This qualitative research drew from a larger ethnographic study of newly diagnosed HIV-positive men who have sex with men (MSM) in Mainland China. Interviews were conducted with 31 MSM within 6 months of diagnosis of HIV infection. Initial suicidal ideation was commonly reported with participants subsequently feeling more resilient to these thoughts through gaining a greater understanding of their prognosis and treatment. Post-HIV diagnosis, some participants reported forming new relationships and receiving increased support from their partners, friends, peers, families, and community-based organizations. At follow-up, these participants generally reported suicidal ideation had declined. However, participants who continued to express suicidal ideation perceived extended pressure from their families’ expectations for them to engage in heterosexual marriages and parenthood. Furthermore, these men reported ongoing hardships in their daily life, unemployment, lack of social support, and isolation. Among this Mainland Chinese cohort of HIV-positive MSM, suicidal ideation may be a transient phenomenon experienced initially following HIV diagnosis that resolves with increased and specific familial, social, and service-based support. It is crucial to identify the causes of stress and social suffering associated with HIV diagnosis in order to reduce suicidal ideation. In China, action is needed to develop routine mental health screening and to increase services that support PLWH. Important services mechanism to accomplish this are promoting resilience through intentional activities as well as continued public health campaigns to reduce stigma toward HIV-positive MSM.

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Acknowledgements

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. Joseph T. F. Lau from The Chinese University of Hong Kong provided advice in the original ethnographic study. Dr. Conall O’Cleirigh from Harvard Medical School provided significant assistance in coding mental health symptoms. The publication’s contents are solely the responsibility of the authors and do not necessarily represent the official view of the centers or the schools.

Funding

This research was funded by 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.

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Authors and Affiliations

  1. School of Public Health, Shandong University, No. 44 Wen Hua Xi Road, Jinan, 250012, China

    Haochu Li, Jie Zhang & Baofa Jiang

  2. UNC Project-China, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Haochu Li & Joseph Tucker

  3. School of Clinical Sciences, Auckland University of Technology, Northcote, Auckland, New Zealand

    Eleanor Holroyd

  4. School of Global and Population Health, The University of Melbourne, Melbourne, Australia

    Eleanor Holroyd

  5. Department of Sociology, State University of New York College at Buffalo, Buffalo, NY, USA

    Jie Zhang

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  1. Haochu Li
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Correspondence to Haochu Li.

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Ethics approval was granted by the Survey and Behavioral Research Ethics Committee at the Chinese University of Hong Kong.

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Li, H., Tucker, J., Holroyd, E. et al. Suicidal Ideation, Resilience, and Healthcare Implications for Newly Diagnosed HIV-Positive Men Who Have Sex with Men in China: A Qualitative Study. Arch Sex Behav 46, 1025–1034 (2017). https://doi.org/10.1007/s10508-016-0894-0

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