HIV-Positive, Heterosexually Married Men Who Have Sex with Men in China: HIV Status Disclosure and Sexual Behaviors

IntroductionThe emerging evidence reveals that men who have sex with men and women pose high secondary HIV transmission risks, but little is known about sexual behavior changes and HIV status disclosure among HIV-positive, heterosexually married men who have sex with men (HIV+MMSM) in China. This qualitative study aimed to (1) explore sex life among HIV+MMSM prior to HIV diagnosis, and (2) understand their life experiences of disclosing HIV status to their spouses and/or same-sex sexual partners from a public health perspective.MethodsEighteen semi-structured interviews were conducted online in China between March and May 2022. Among the HIV+MMSM respondents aged between 25 and 56 years, 77.8% identified as gay, 38.89% reported having lived with HIV for 5 years or above, and 55.6% reported were still in a heterosexual marriage at the interview point.ResultsThe thematic analysis generated two major themes including inconsistent condom use with same-sex sexual partners before HIV diagnosis, and HIV (non)disclosure and sexual behaviors with their wives and same-sex sexual partners. Those who had neither HIV disclosure nor protective sexual behaviors with their wives and same-sex sexual partners attempted to protect wives and same-sex sexual partners using various alternatives, such as treatment-as-prevention/undetectable = untransmittable (TasP/U = U).ConclusionsOur results reveal that HIV disclosure is difficult in taking into consideration of negative social climates (in general and in gay communities) towards HIV+MMSM and legal regulations surrounding HIV disclosure, stigma, and matrimony.Policy ImplicationsInterventions targeting acceptance and resilience, along with efforts to reduce HIV-related stigma, should be integrated into HIV care. Advocating for improvements in legal protections and regulations and raising awareness of the benefits of TasP/U = U could create an inclusive environment for this population, ultimately leading to better health outcomes and overall quality of life.