Navigating intersectional stigma and post-traumatic growth among heterosexually married men who have sex with men living with HIV in China.

BACKGROUND

Heterosexually married men who have sex with men living with HIV (MSMW-HIV+) in China occupy a uniquely marginalized position shaped by intersecting stigmas related to HIV, same-sex behavior, and marital norms. Existing research has largely emphasized risk, pathology, and moral failure, with limited attention to how individuals navigate, reinterpret, and potentially transform these experiences under structural constraint. Drawing on post-traumatic growth (PTG) theory and an intersectionality framework, this study examined how growth and adaptation unfold within a collectivist sociocultural context.

METHODS

We conducted semi-structured interviews with 23 MSMW-HIV+ in China. Data were collected in 2023 and analyzed using reflexive thematic analysis. Analysis focused on lived experiences of stigma, meaning-making processes, and post-disclosure life trajectories.

RESULTS

Three interrelated themes emerged: Living in the Intersections, Cognitive Reframing, and Navigating Post-Disclosure Life. First, respondents described living at the intersection of multiple stigmas that produced "impossible choices," shaping disclosure strategies, marital power dynamics, and institutional exclusion. Some respondents engaged in cognitive reframing that shifted self-blame toward structural consciousness and expanded empathy, while others experienced intensified internalized stigma. Post-disclosure lives followed divergent pathways, including negotiated internal coherence, constrained accommodation prioritizing family stability, and marital dissolution as a route to authenticity.

CONCLUSIONS

Growth, where present, coexisted with ongoing distress and was contingent on relational support, community resources, and material security. These findings identify culturally specific forms of growth grounded in relational reconfiguration rather than individual self-actualization, highlighting the need for interventions addressing relational, community, and institutional conditions shaping wellbeing among MSMW-HIV+.