Differences in risk behaviours, HIV/STI testing and HIV/STI prevalence between men who have sex with men and men who have sex with both men and women in China

A newly emergent literature suggest that bisexual men and women face profound health disparities in comparison to both heterosexual and homosexual individuals. Additionally, bisexual individuals often experience prejudice, stigma, and discrimination from both gay/lesbian and straight communities, termed "biphobia." However, only limited research exists that empirically tests the extent and predictors of this double discrimination. The Bisexualities: Indiana Attitudes Survey (BIAS) was developed to test associations between biphobia and sexual identity.

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.

To understand the stigma and discrimination experienced by men who have sex with men (MSM) in Chengdu, and to evaluate their impact on effective HIV prevention. Focus group discussions and individual in-depth interviews were conducted from June to September 2006. Stigma and social pressure for MSM were reported to mainly arise from their families to get married and have children to protect family reputation and lineage. Few participants reported experiencing stigma and discrimination from friends, colleagues, or general society. Nevertheless, fear of being ostracized because of their sexual orientation was frequently expressed, and was a major barrier for participating in HIV/AIDS prevention programs. Fear of stigma and discrimination related to HIV infection from inside the MSM community was also identified as a major reason for MSM reluctance to seek HIV testing and treatment. Stigma and discrimination related to homosexual activities and HIV/sexually transmitted disease infection have been major barriers for MSM seeking health services. HIV/AIDS programs must be sensitive to issues of stigma both from outside and inside the MSM community.