Politics of Public Health

Feel free to email me (chchliu@ucsd.edu) if you cannot access or want to discuss my articles.

Politics of the Covid-19

It’s (not) the flu: Expertise and the Covid-19 Pandemic in China, Hong Kong, and the United States. in progress. (with Larry Au and Zheng Fu) |introductory essay on Items|

HIV/AIDS and Socio-political structures

“Red is not the only color of a rainbow”: The making and resistance of the “MSM” subject among gay men in China. Social Science & Medicine. 2020. Winner of the Martin Levine Paper Award (American Sociological Association). |download| |abstract|

Public health scholars classify gay men as “men who have sex with men (MSM)” in their studies and interventions. Debates have been raised about the MSM classification for decades. However, we know little about how people who are classified as MSM perceive and respond to this classification, particularly in the authoritarian context where the biopower interacts with the repressive state power. Drawing upon Ian Hacking’s dynamic nominalism theory, this study tries to fill these gaps with interviews of 40 gay men in three Chinese cities about their interactions with public health education materials. I examined their perceptions of MSM knowledge and discourses associated with the classification, as well as their identifications to the MSM subject. I found that, on the one hand, many gay men had internalized the MSM subjectivity and considered themselves essentially at high risk of HIV infection. This compliance was constructed through various biopower techniques with the support of the state’s repressive power, as the Chinese state censored almost all public representations of gay men except the HIV/AIDS subject MSM. On the other hand, some of my interviewees were resistant to be part of the MSM classification. I showed how this failure is an unintended consequence of the hegemonic MSM discourse and the authoritarian regime’s institutional exclusion of the gay men’s community’s engagement in the expertise network that develops intervention materials and strategies. At last, I proposed to move beyond the debate around the name and representational character of the MSM by moving toward a more reflexive public health.

Beyond Clinical Trials: Social Outcomes of Structured Stakeholder Engagement in Biomedical HIV Prevention Trials in China. Culture, Health & Sexuality. 2019. |download| - |abstract|

Stakeholder engagement is increasingly recognized and institutionalized as an essential component of HIV-related biomedical research. However, we know little about stakeholder engagement’s social outcomes, i.e. its influence on the community it engages with, particularly in authoritarian regimes and outside high-income countries. This study evaluates a multi-site stakeholder engagement programme conducted in parallel with two HIV prevention trials among men who have sex with men (MSM) in China. We conducted a one-month ethnographic study and 41 semi-structured in-depth interviews with participants of a stakeholder engagement programme and/or clinical trials in six Chinese cities. We found that the stakeholder engagement programme offers MSM community stakeholders additional and flexible funding, networking opportunities, activities to increase clinical research literacy, and may strengthen their connections with the community. However, they may also generate negative unintended consequences. It may cost community stakeholders’ social capital, increase moral conflicts and tensions, and even create tension between their ‘community representative’ and ‘research assistant’ identities. Our findings suggest that structured stakeholder engagement practice could effectively mitigate negative outcomes generated by such engagement. The broader socio-political structure in which a trial is embedded requires more attention and consideration from trial funders and sponsors, particularly in stakeholder engagement programme design.

Transplantation or Rurality? Migration and HIV Risk among Chinese Men who have Sex with Men in the Urban Areas. Journal of International AIDS Society. 2018; 21(1): e25039. |download| - |abstract|

Introduction: Migration of men who have sex with men (MSM) from rural to urban areas is common across low‐ and middle‐income countries and is widely believed to contribute to elevated HIV risk among migrant MSM in urban areas. Little consensus exists on whether their risk is due to their transplantation or their being from resource‐constrained rural areas. This study seeks to clarify the relationship between migration and HIV risks by comparing differences in HIV‐related risky sexual behaviours and healthcare utilization across competing conceptualizations of migratory statuses.

Methods: In July 2016, MSM ≥16 years old currently residing in one of eight urban cities in China were recruited for an online cross‐sectional survey, which collected information on socio‐demographics, sexual behaviours, HIV care‐seeking behaviours, and healthcare utilization. Based on a question about residency status, each participant was classified as an urban local resident, urban transplant, or rural transplant. Multivariable multinomial logistic regression was used to examine the associations between risky behaviours and healthcare utilization among these three groups.

Results: Among 2007 MSM, the proportion of local, urban transplant and rural transplant were 32% (648/2007), 24% (478/2007), and 44% (881/2007), respectively. Compared with urban local resident MSM, urban transplant MSM were more likely to have ever tested for HIV (adjusted odds ratio (aOR) = 1.39, 95% confidence interval (CI): 1.08 to 1.80). Compared with urban transplant MSM, rural transplant MSM were less likely to have utilized any governmental sexual health services in the past three months (aOR = 0.75, 95% CI: 0.60 to 0.93), ever tested for HIV (aOR = 0.77, 95% CI: 0.61 to 0.96), ever initiated antiretroviral therapy (ART) (aOR = 0.16, 95% CI: 0.05 to 0.52), and ever purchased sex (aOR = 0.57, 95% CI: 0.38 to 0.85). No other significant differences were found in sexual behaviours among three groups.

Conclusions: The widely used local/migrant categorization obscures important differences in HIV risk present between urban/rural subgroups among them. Previous studies of HIV risks in Chinese “migrant” may have failed to consider the role of structural factors such as discrimination or barriers to healthcare when interpreting their findings of higher HIV prevalence in this population. Low ART uptake among rural transplant MSM in this study is particularly concerning and underscore the need for HIV‐related interventions tailored for this group.

Community Engagement in Sexual Health and Uptake of HIV Testing and Syphilis Testing among MSM in China: A Cross-sectional Online SurveyJournal of the International AIDS Society. 2017; 20(1):21372. |download| - |abstract|

Introduction: HIV and syphilis testing rates remain low among men who have sex with men (MSM) in low‐ and middle‐income countries (LMICs). Community engagement has been increasingly used to promote HIV testing among key populations in high‐income countries, often in settings with stronger civil society. This study aimed to assess socio‐demographic, behavioural, and community engagement factors associated with HIV and syphilis testing among MSM in China.

Methods: MSM ≥16 years old who had condomless sex in the past three months were recruited nationwide to complete a cross‐sectional online survey in November 2015. Data were collected on socio‐demographics, sexual behaviours, HIV testing, syphilis testing, and community engagement in sexual health. We defined community engagement in sexual health using six items assessing awareness and advocacy of sexual health programmes. The underlying factor structure of a 6‐item community engagement scale was determined through exploratory factor analysis. Univariate and multivariable logistic regressions identified correlates of HIV and syphilis testing.

Results: 1189 MSM were recruited. 54% (647/1189) of men had ever tested for HIV and 30% (354/1189) had ever tested for syphilis. Factor analysis suggested three levels of community engagement (minimal, moderate, and substantial) and this model explained 79.5% of observed variance. A quarter (26%, 312/1189) reported none to minimal engagement, over one half (54%, 644/1189) reported moderate engagement, and a fifth (20%, 233/1189) reported substantial engagement. Multivariable logistic regression showed that MSM with greater community engagement in sexual health were more likely to have ever tested for HIV (substantial vs. no engagement: aOR 7.91, 95% CI 4.98–12.57) and for syphilis (substantial vs. no engagement: aOR 5.35, 95% CI 3.16–9.04).

Conclusions: HIV and syphilis testing are suboptimal among MSM in China. Community engagement may be useful for promoting testing in China and should be considered in intervention development and delivery. Further research is needed to better understand the role of LMIC community engagement in HIV interventions.

Sexuality and Subjectivity

Light and Shadow: Gay Bar as a Space of Consumption. West Journal. 2016; (2): 70-74. (in Chinese: “明”与“暗”:作为消费空间的同性恋酒吧) |download| - |abstract|

中文摘要:基于对广州市两家同性恋酒吧的参与式观察及其消费者的深入访谈,本文分析了同性恋酒吧中的空间消费,尤其是消费的"明面"与"暗面"问题。我们发现,"暗面"的消费是同性恋酒吧在城市同性恋群体中广受欢迎的最主要原因。这种暗面消费为消费空间设置了门槛,由此保证了空间内同性恋者的"纯度"与"质量",同时以较为密集的消费与互动满足了同性恋者对社交的需要以及认同的建构,缓解了社会污名的压力。消费主义所带来的炫耀性、符号性的新消费模式也使同性恋酒吧成为最为重要的城市同性恋空间之一。

Stereotype and Masculinity: A Gender Perspective to Review the Male Nurse. Sexuality Research in China. 2016; 2(1): 362-374. (in Chinese: 刻板印象与男性气质——性别视角下的男护士) |download| - |abstract|

中文摘要: 随着社会和护理行业的发展,男护士逐渐活跃在这个曾经被视作只有女性才会从事的行业之中。本文从社会学和性别研究的理论视角出发,在对两家医院两个月的参与式观察与26位相关人士的深度访谈后,通过对与男护士相关的最明显的一优一缺点——“力气大”与“不细心”进行了细致的梳理与批判,对目前男护士的学术研究和现实管理中存在的过分偏重于生物性别解释与性别本质主义的问题进行了再讨论。本文发现,这种基于生物性别的刻板印象似的优缺点虽然突出了男护士在特殊科室的重要作用,但无益于其护士身份自我认同的稳固和发展,亦使得其陷入了更深的自我与外界规训之中,并对改善护理质量的要求可能会产生一定的误导。本文也会以男护士为主体,分析他们是如何通过对信息的裁剪和展演对自我身份与其男性气质进行重新的建构与展示的。

English Abstract: With the development of the society and the nursing profession, male nurses are gradually becoming active in the profession that was once considered to be only women. From the theoretical perspective of sociology and gender studies, this paper, after two months of participatory observations of two hospitals and in-depth interviews with 26 relevant individuals, thoroughly examine the most stereotypical advantages and disadvantages associated with male nurses - The "great strength" and "not careful enough." This paper finds that the advantages and disadvantages of this kind of gender-based stereotypes highlight the important role of male nurses in special departments, but they are not conducive to the stability and development of their identity as a nurse, which also makes them fall into deeper self-doubt and discipline. This article also examines how male nurses reconstruct and display their identity and masculinity through the strategical display/hide information.

Meaning World and Subjective Construction of an Anti-Masturbation Community: A Sociological Investigation (in Chinese: 戒色者的意义世界与主体建构——对一个网络社群的社会学研究).  |abstract|

中文摘要: 适度自慰的无害性早已从“生物科学”的层面得以证实。但近年来,反自慰(“戒色”)的话语却在国内巨大影响,追随者已达百万。对此,中文文献对此缺少关注,而西方的相关研究在其历史和宗教的背景下的讨论,亦无法解释中国“戒色”社群中的个体化、世俗化导向。本文通过对多名“戒色”实践者的深度访谈及其所在网络社群的话语分析,探讨该社群如何在当下社会语境下挪用传统、宗教、国族等元素对“性”及“自慰”的话语进行主体建构;个体又是如何反思性地重塑自我认同及生活轨迹,进而践行另类的意义世界的。

English Abstract: The harmlessness of moderate masturbation has long been confirmed from the perspective of “biological science”. However, in recent years, the discourse of "anti-masturbation" have been greatly affected in China, and its followers have reached more than one million. However, current literature lacks attention to this very strange issue. Through in-depth interviews with several “anti-masturbation” practitioners and discourse analysis of the online community, this paper explores how the community uses traditional, religious, nationalism and other elements to frame the issue of masturbation and the social relations associated with it. The discourse of masturbation carries out the subject construction. While practitioners reflexively reshapes their self-identity and life trajectory, and then practices the alternative meaning world.

Scroll to top