Social Studies of Public Health

 We trace the crafting of expert narratives during the initial months of the COVID-19 pandemic in Mainland China, Hong Kong, and the United States. By expert narratives, we refer to how experts drew different lessons from past disease experiences to guide policymakers and the public amidst uncertainty. These expert narratives were mobilized in different sociopolitical contexts, resulting in varying configurations of expertise networks and allies that helped contain and mitigate COVID-19. In Mainland China, experts carefully advanced a managed narrative, emphasizing the new pandemic akin to the 2003 SARS outbreak can be managed while destressing the similar mistakes the government made during the two crises. In Hong Kong, experts invoked a distrust narrative, pointing to a potential coverup of COVID-19 similar to SARS, activating allies in civil society to pressure policymakers to act. In the United States, experts were mired in a contested narrative and COVID-19 was compared to different diseases; varying interpretations of COVID-19’s consequences was exacerbated by political polarization. In expert narratives, the resonance of the past is emergent: the past becomes a site of struggle and a cultural object that is presented as potentially useful in solving problems of the present. 

Surveillance is never only about surveillance but is embedded in the broader social context, both domestically and internationally. During the COVID-19 pandemic, the surveillance practices of non-Western countries have often been analyzed from the perspective of the West, impacting domestic surveillance policymaking and public perception. However, we rarely know how Western societies’ surveillance practices and discourses may impact how people in non-Western societies understand their own domestic surveillance. Combining data from varied sources, this article examines domestic surveillance during COVID-19 in China and explores how Chinese residents perceive it, with a focus on perceptions that are in relation to the West.

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.

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.