Chinese culture, HIV- and homosexuality-related stigma, social support, and safer sex: a path analytic model
H. Liu1, T. Ha1, H. Liu2, T. Feng3
1Virginia Commonwealth University, Epidemiology, Richmond, VA, United States, 2China Center for HIV/STD Control and Prevention, Beijing, China, 3Shenzhen Centre for Chronic Disease Control and Prevention, Shenzhen, China
Background: The objective of this study was to examine the interrelationships among Chinese culture, HIV- related stigma, and homosexuality-related stigma, social support and safer sex among Chinese among men who had sex with men (MSM).
Methods: A cross-sectional study using the respondent-driven sampling was conducted among MSM in Shenzhen, China in 2007. The study assessed the levels horizontal individualism, vertical individualism, vertical collectivism, horizontal collectivism, HIV stigma, public and self homosexual stigma, social support and condom use. Path analysis was performed to estimate the strength of the interrelationships.
Results: A total 351 MSM were recruited and interviewed. The mean age of the respondents was 27 years. The proportion of MSM who engaged in safer sex was 61%. The results of path analysis document that the following relationships were found to be statistically significant: (1) vertical collectivism was positively associated with public homosexual stigma [β (standardized coefficient) = 0.12] and self homosexual stigma (β = 0.12); (2) vertical individualism was positively associated with self homosexual stigma (β = 0.18); (3) horizontal individualism had a positive association with public homosexual stigma (β = 0.12) ; (4) self homosexual stigma had a positive relation with social support from sexual partners (β = 0.12); (5) public homosexual stigma was inversely associated with safer sex (β = 0.19). Goodness fit indices indicated the final model fitted the data well (X2 = 8.3, p = 0.59); TLI = 0.91; CFI =0.95; RMSEA = 0.045).
Conclusions: Given the potential influence of cultural dimensions on stigma and safer sex, the development of HIV intervention for MSM should take the characteristics of Chine collectivist culture into consideration and the prevention of homosexuality-related stigma should be an important component of the intervention program.