"The clan carries us": kinship, honor, and the collective enactment of family resilience among Yi households living with HIV in rural Southwest China.

BACKGROUND

While antiretroviral therapy has transformed HIV into a manageable chronic condition, prevailing family resilience frameworks, often grounded in Western individualism, may fail to fully capture how families in lineage-based societies negotiate illness and stigma. In the Yi communities of rural Southwest China, kinship and collective honor (, to jia zhi) structure the moral world of everyday life, yet their role in shaping family resilience remains underexplored. This study examined how Yi families in Liangshan experience and enact family resilience, with particular attention to the interplay between kinship obligations, moral meanings of care, and HIV-related stigma.

METHODS

A descriptive phenomenological design was employed. Semi-structured, in-depth interviews were conducted with 35 adults from HIV-affected Yi households between January and June 2024. Data were analyzed using Colaizzi’s method to elucidate the essential structure of lived family resilience, utilizing Hill’s ABC-X model and Walsh’s family resilience framework as sensitizing frameworks.

RESULTS

Family resilience emerged not as a fixed individual capacity, but as a relational and morally infused practice of “collective endurance”. Two interrelated experiential domains were identified: (1) Resilience woven within the family, sustained through shared presence, reciprocal care, and intergenerational responsibility; and (2) Resilience negotiated beyond the household, characterized by cautious engagement with healthcare resources while managing community surveillance. Central to both domains was jia zhi (lineage-based family identity), which functioned as a double-edged sword: simultaneously sustaining essential belonging while intensifying pressures to conceal HIV to protect collective honor.

CONCLUSIONS

Family resilience in Yi households is a collective moral practice anchored in the jia zhi system. HIV is perceived as a “genealogical rupture.” While “strategic silence” safeguards lineage honor, it imposes significant costs on individual members, especially women. Nursing and public health interventions should adopt lineage-sensitive models that engage clan elders and reframe treatment as “family protection” to ensure cultural alignment.