Grant: Travel Awards - Institute Community Support

Background China's 56 ethnic groups (including the Han majority) represent diverse belief systems, cultural practices, and languages that can affect the sexual health and mental well-being of men who have sex with men (MSM). However, ethnocultural research among China's MSM remains scant. This study examines how ethnic affiliation, ethnic identity affirmation, and Mandarin proficiency may be impacting Chinese MSM's HIV vulnerability and psychological distress. Methods From 2013-2014, structured questionnaires were administered at MSM HIV testing clinics in a multi-ethnic Northern Chinese megalopolis (n=400). Correlations were assessed with logistic regression. Results Compared to ethnic Han, ethnic minorities from Southern China had greater odds of HIV infection [adjusted odds ratio (AOR): 7.40, 95% confidence interval (CI): 2.33-23.47] and forced sex (AOR: 3.27, 95% CI: 1.12-9.52). Ethnic Muslims had lower odds of unprotected anal intercourse (AOR: 0.41, 95% CI: 0.21-0.82), but greater odds of circumcision (AOR: 2.62, 95% CI: 1.24-5.51). Weak sense of ethnic belonging was marginally associated with anxiety (AOR: 1.54, 95% CI: 0.99-2.38). Weak ethnic peer socialization was marginally associated with never testing for HIV (1.63, 95% CI: 0.93-2.86) and HIV infection (AOR: 2.08, 95% CI: 0.87-5.00). Poorer Mandarin proficiency was associated with anxiety (AOR: 2.59, 95% CI: 1.19-5.63) and marginally associated with forced sex (AOR: 2.43, 95% CI: 0.99-6.00). Conclusion Heterogeneous HIV vulnerabilities between ethnic groups challenge current practices of aggregating all ethnic minorities into one 'non-Han' category. The health implications of co-occurring ethnocultural and sexual marginalization in China warrants further research.