Stigma and Discrimination Linked to Increasing HIV in Hong Kong

Jason Hung

Over the past decade, HIV rates have increased exponentially in Hong Kong. The number of individuals diagnosed has doubled every year between 2006 and 2017, although the rapid increase in HIV diagnosis may be ascribed to the increasing number of individuals seeking HIV testing in Hong Kong. Specifically, the uptake of voluntary counselling and HIV testing (VCT) services among MSM has increased from 43.4% in 2006 to 66.1% in 2011.[1] The annual government expenditure on HIV prevention policies has also increased significantly with the spend reaching $51 million US by 2020.

In Hong Kong, 60.5% of HIV cases occur in men who have sex with men (MSM). Dr Tim Brown, HIV epidemiologist from the East West Center of Hawaii, describes HIV in Hong Kong as an MSM epidemic. Andrew Chidgey, Chief Executive of AIDS Concern Hong Kong, says the entrenched cultural taboo in Hong Kong Chinese families against homosexuality is a major contributing cause of the rapid growth of HIV infection rates.[2] Men are unwilling to disclose a gay identity which delays prompt medical and social support when they become HIV positive.

Studies have found that Chinese populations discriminate against gay sexuality and people with HIV because of the cultural expectation that the younger generation has filial responsibilities to continue the family lineage.[3] The same pressure to conform to a heterosexual identity is found in Hong Kong Chinese culture–-again to raise children and fulfil the obligations of filial piety.

Despite the decriminalisation of homosexuality in the 1991 Crimes (Amendment) Bill, Hong Kong lacks legislation prohibiting sexual discrimination which results in anti-LGBTQ policies and practices. For example, the Section 124 of Crimes Ordinance sets the legal age of consent for gay sex at 21 years, compared to 16 years for heterosexual sex.[4] Equal Opportunity Ordinances aims to combat discrimination on all grounds except sexual orientation. As a result, same-sex marriage remains illegal in Hong Kong. Studies report that the more sexual discrimination and exclusion gay communities experience, the more stress and emotional distress they suffer.[5] This is also a denial of their human rights to equality and non-discrimination.

The former United Nations Secretary Ban Ki-moon described stigma as one of the biggest obstacles to prevention of HIV, regular HIV testing, and prompt medical care for HIV positive people. The frequency with which HIV-positive gay individuals experience marginalisation and other forms of discrimination has a significant impact on their practices, including the practice of safe sex.[6]

In 2012, the Hong Kong LGBT Climate Study found that only 28% of gay people were open about their sexuality with parents, indicating some degree of fear or reluctance surrounding disclosure of their sexuality to families. Globally HIV-positive gay people are often concerned that the disclosure of a HIV-positive and gay status results in increased stigmatisation.[7] However, the more time that lapses before individuals declare a gay identity, the greater the perceived stigma they experience due to their increasing concerns about being identified as gay.[8] Stigma can also result in psychological and emotional struggles with shame, fear and even depression, all of which may discourage individuals from practicing safe sex. In contrast, a healthy self-image among gay people is positively associated with HIV-preventive behaviour, including using condoms during sex and seeking regular HIV testing.[9] Studies by Hong-jie Liu et al., and Chi-yan Wong and Caterthine So-kum Tang in mainland Chinese and Hong Kong contexts support these findings.[10] Fear of the stigma that will be experienced by HIV-positive and gay men once they disclose their status to their families, reinforces their negative self-image.

This direct link between stigma and discrimination and the right to health is evident in Hong Kong with the prevalence of HIV in MSM. Urgent policy action is needed to start changing the negative consequences of government and cultural practices.

Jason Hung is a MSc Sociology candidate at London School of Economics (LSE) who will be an incoming intern at United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) and incoming researcher at Stanford University.

[1] Wong, H. et al. Usage and Acceptability of HIV Self-testing in Men who have Sex with Men in Hong Kong. AIDS and Behavior 2015; 19 (3): 505-15.

[2] Leung, H. Undercurrents Queer Culture and Postcolonial Hong Kong. University of British Columbia Press; 2008.

[3] Kang, E. and Rapkin, B. Why Tell? Serostatus Disclosure and HIV Stigma among HIV Seropositive Asians and Pacific Islander Men who have Sex with Men in New York City. Health Issues Confronting Minority Men Who Have Sex with Men. New York: Springer; 2008.

[4] Kong, T. A Fading Tongzhi Heterotopia: Hong Kong Older Gay Men’s Use of Spaces. Sexualities 2012; 15 (8): 896-916.

[5] Ho, W. et al. The Seven-Year Struggle: Injustices at Home for Chinese Immigrant Women in Hong Kong. Inter-Asia Cultural Studies 2014; 15 (1): 154-63.

[6] Parker, R. and Aggleton, P. HIV and AIDS-Related Stigma and Discrimination: A Conceptual Framework and Implications for Action. Social Science & Medicine 2003; 57 (1): 13-24.

[7] Keogh, P. et al. Ethnic Minority Gay Men: Redefining Community Restoring Identity. Research Report; 2004. London: Sigma Research.

[8] Liu, J. and Choi, K. Emerging Gay Identities in China: The Prevalence and Predictors of Social Discrimination Against Men Who Have Sex with Men. Edited by Pranee Liamputtong. In Stigma, Discrimination and Living with HIV/AIDS; 2013. Dordrecht, New York: Springer.

[9] Choi, K. et al. Risk and Protective Factors Affecting Sexual behavior Among Young Asian and Pacific Islander Men Who Have Sex With Men: Implications for HIV Prevention. Journal of Sex Education and Therapy 1999; 24 (1–2): 47-55.

[10] Liu, H. et al. Stigma, Delayed Treatment, and Spousal Notification Among Male Patients With Sexually Transmitted Disease in China. Sexually Transmitted Diseases 2002; 29 (6): 335-43.