The impact of China-to-US immigration on structural and cultural determinants of HIV-related stigma: implications for HIV care of Chinese immigrants

ABSTRACT

Objectives: Asian Americans have poor HIV-related outcomes, yet culturally salient barriers to care remain unclear, limiting development of targeted interventions for this group. We applied the ‘what matters most’ theory of stigma to identify structural and cultural factors that shape the nature of stigma before and after immigration from China to the US.

Design: Semi-structured interviews were conducted with 16 immigrants to New York from China, recruited from an HIV clinic and community centers. Deductive followed by focal inductive qualitative analyses examined how Chinese cultural values (lian, guanxi, renqing) and structural factors influenced stigma before and after immigration.

Results: In China, HIV stigma was felt through the loss of lian (moral status) and limited guanxi (social network) opportunities. A social structure characterized by limited HIV knowledge, discriminatory treatment from healthcare systems, and human rights violations impinged on the ability of people living with HIV to fulfill culturally valued goals. Upon moving to the US, positions of structural vulnerability shifted to enable maintenance of lian and formation of new guanxi, thus ameliorating aspects of stigma.

Conclusions: HIV prevention and stigma reduction interventions among Chinese immigrants may be most effective by both addressing structural constraints and facilitating achievement of cultural values through clinical, peer, and group interventions.

KEYWORDS:

• HIV
• Chinese Americans
• China
• stigma
• immigrants
• structural vulnerability

Acknowledgements

Thanks to Venus Vacharakitja and Timithy Au for their aid in recruiting participants at APICHA.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the Robert Wood Johnson Foundation Health and Society Scholars program and the National Institute of Mental Health under grant T32 MH013043 to Debbie Huang. Ohemaa Poku is supported by the T32 Global Mental Health Training Program at the Bloomberg School of Public Health, Department of Mental Health (5T32MH103210-05; PI: Judith Bass).