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    Why It’s Time to Take the Fight Against HIV Online

    The internet is a rare sanctuary for queer men in China. It’s also one of the best places for outreach.

    The apps Blued, Aloha, Jack’d, and Grindr are a key part of life for queer men across China — not just for hook-ups, but also as means of finding and building communities. To quote one of my research participants, “There are not many (other) channels for making friends, after all.”

    Stigma and discrimination mean that queer men — including gay, bisexual, and other men who have sex with men — have drastically fewer options for building offline communities in China than their heterosexual peers. The few gay-friendly offline spaces that do exist, including bathhouses, clubs, and certain bars, are often hidden and typically sexual in nature.

    For queer men, the lack of safe offline spaces can leave them more vulnerable to HIV and other sexually transmitted infections. A recent editorial published in the journal The Lancet Regional Health – Western Pacific, penned by five health experts, including professor Li Jinghua of Sun Yat-sen University, highlighted how treating and eventually eliminating HIV in China is made more challenging by the prevalence of discrimination, social stigmas, and shame.

    Indeed, stigma and discrimination can discourage queer men from accessing HIV prevention and treatment services. They are also a major barrier to testing for HIV, as many queer men opt not to test in the hope of avoiding exposing their sexual identities and sexual practices.

    Take Adam, for example. (To protect the identities of my research participants, I have given them all pseudonyms.) Adam knows about the existence of HIV testing services, but he is afraid going to a public hospital for testing will result in discrimination from his healthcare provider. He is also unwilling to go to a clinic associated with the LGBT community out of concern that he might be publicly identified as being gay or someone who has sex with other men.

    Although homosexuality was decriminalized in 1997, multiple Chinese scholars have pointed out that protections for queer men remain inadequate and that further efforts are needed at the civil and political levels to remove the social and structural barriers to accessing HIV-related services. This is especially important as HIV prevalence among queer men in China continues to rise, from an estimated 0.9% in 2003 to 5.4% in 2021.

    One potential solution is to reach out to queer men where they already are: online. Digital health services could leverage China’s strong digital infrastructure and massive data ecosystem to provide care to marginalized communities. In the right conditions, these services could empower individuals typically underserved by traditional, offline health services, including individuals with disabilities and individuals who face disproportionate levels of stigma and discrimination, such as people living with HIV.

    Studies have found that online spaces are safe havens for sexual minorities — and that these spaces can be modified to integrate sexual health services. My own team’s research suggests that queer men in China find the anonymity of online spaces valuable when seeking out sexual healthcare.

    Many of our research participants said they purchased HIV self-testing kits from online e-commerce platforms like Taobao. Today, growing numbers of queer men order these kits from LGBT organizations. The benefits of this new arrangement are varied. As one participant, Kane, put it: “First of all, it is sometimes free and can be couriered to you directly … Second, the tests can be done privately. Third, I trust the quality of the testing kits promoted by these organizations more than the ones you can buy on Taobao or (e-commerce platform)”

    Apart from testing, digital spaces have the potential to help prevent the spread of HIV. For example, the popular Chinese app Blued — sometimes referred to as the Chinese Grindr — has a built-in online health portal that allows individuals to obtain HIV pre-exposure and post-exposure prophylaxis, HIV self-testing kits, HIV treatment, and information on health services. This differentiates the app from rivals like Grindr or Hornet, which do not have these services built in.

    Some queer men find that online spaces help them connect with others in ways that offline spaces do not. Another research participant, William, shared with our research team that he finds online apps useful not only for dating or hooking up, but also because of the opportunity they offer him to connect with others and build friendships and communities online: “Personally, I think there is a lot of social interaction. After all, as a gay man, there are many things in my life I can’t tell my colleagues and friends. I can only talk to someone on the platform about my concerns.”

    Research has shown that better mental well-being is associated with better sexual health, and these are the kind of connections that can both improve queer men’s mental well-being and reduce self-stigmatization.

    Chinese scholars and experts, including Li of Sun Yat-sen University, have called for the establishment of a network of anonymous and LGBT-friendly sexual health clinics, together with sensitivity training and education for healthcare workers, to ensure that queer men receive better treatment. These are necessary interventions that will help stimulate the creation of holistically safe spaces for sexual minorities. But they shouldn’t distract us from the opportunities presented by China’s digital environment. Digital health services should be a part of any plan to end HIV, especially for key marginalized populations like queer men.

    Dec. 1 is World AIDS Day. For more of Sixth Tone’s coverage on this issue, click here.

    Editors: Cai Yiwen and Kilian O’Donnell; portrait artist: Zhou Zhen. 

    (Header image: VCG)