[Psychological-behavioral-social adaptation mechanisms among HIV-positive men who have sex with men from the perspective of the social ecological model].

Objective: To analyze key issues and core barriers in psychological, behavioral, and social adaptation among HIV-positive men who have sex with men (MSM) based on the social ecological model, identify adaptation characteristics at different stages post-diagnosis. Methods: A qualitative research design was employed. Using purposive sampling, 18 HIV-positive MSM were recruited from Beijing You'an Hospital, Capital Medical University, between March and May 2025. Semi-structured in-depth interviews were conducted with all participants. Grounded theory methodology was applied within the Social-Ecological Model (SEM) framework, with three-level coding performed on interview data to construct an adaptation mechanism framework. Results: A total of 18 participants aged 22-60 years were included, with 9 diagnosed within 1 year and 9 diagnosed for more than 1 year prior to the study. Through the derivation of 62 initial concepts, 20 initial categories, and 6 major categories, a three-level adaptation mechanism framework encompassing the micro-, meso-, and macro-system levels was constructed, with the core category identified as the psychological-behavioral-social adaptation of HIV-positive MSM. At the micro-system level, individuals achieved internal adaptation through cognitive restructuring, emotion regulation, and health behavior management; however, sexual risk behaviors persisted within steady partnerships and under conditions of emotional impulsivity. At the meso-system level, individuals achieved interpersonal adaptation by weighing the timing of disclosure, selecting disclosure strategies, and relying on peer support networks, although disclosure decisions remained influenced by HIV-related stigma and intergenerational differences in disease awareness. At the macro-system level, individuals maintained social functioning through privacy management, utilization of medical security policies, and selective consumption of new media information, while still facing structural stigma and insufficient trust in services. The three levels interacted dynamically and jointly influenced post-diagnosis adaptation and health outcomes. Comparative analysis showed that newly diagnosed participants mainly focused on the early-stage process of crisis response-information seeking-behavioral initiation,whereas previously diagnosed participants had transitioned to the long-term stage of behavior maintenance-relationship reconstruction-structural resistance,indicating differences in adaptation priorities across diagnostic stages. Conclusion: The adaptation process among HIV-positive MSM is characterized by a multilevel mechanism spanning micro-, meso-, and macro-system dimensions, with differential emphases in psychological adjustment, behavior management, and social relationship reconstruction across diagnostic stages.