Challenges in HIV prevention and treatment among men who have sex with men in China: structural exclusion, healthcare inequity, and testing avoidance.

Men who have sex with men (MSM) in China face a high burden of HIV infection. While biomedical interventions are crucial, technology alone cannot explain the challenges of AIDS prevention and treatment in this group; deeper social structural factors need urgent attention. This study analyzes the ways that structural barriers, through the national policy system and structural stigma, affect the HIV prevention and treatment behaviors of MSM in China. We reviewed central-level academic and policy documents and analyzed the data using NVivo 12. We then integrated the research results from these documents using cross-analysis, which revealed three interrelated structural obstacles. First, the conflict between a series of anti-discrimination laws and HIV being a disqualifying condition in the civil service recruitment physical examination has formed an exclusive employment structure. This conflict has normalized employment discrimination and weakened the social and economic foundations to prevent and treat HIV in MSM. Second, unequal medical resources, the cross-stigmatization of HIV-positive status and homosexual orientation, and the lack of legal recognition of same-sex sexual relations have resulted in the refusal of medical and differential treatment in medical institutions. Third, involuntary identity disclosure promotes HIV testing evasion. In social networks with strong rural characteristics in China, the risk of involuntary identity disclosure shifts detection from health-protective behavior to threat perception, amid weakened social support. This study holds that the AIDS epidemic among MSM is a major public health challenge facing China at present, and effective control requires a paradigm shift to promote health equity. We suggest taking advantage of the existing connections among the MSM group on localized social media to promote HIV prevention and health equity in this population.