Cooperative marriage is a heterosexual marriage negotiated and performed by a lala (a woman with same-sex desire) and a gay man. Building on growing debates on cooperative marriage within the tongzhi community and on intensifying media and academic attention, this thesis presents an empirical investigation of how gay men and lalas understand their experiences while in cooperative marriage. The study is based on in-depth interviews, participant observation and focus group interviews of twenty-two gay men and lalas in cooperative marriage distributed across five cities in China: Beijing, Shenyang, Hangzhou, Guangzhou and Foshan. Among the questions addressed are: Why do gay men and lalas opt for this particular type of marriage? What are the lived experiences of sexual minorities facing cultural and institutional discrimination in China? What are the main living strategies and styles they adopt to cope with such discrimination? The study also explores different ways of relating to others and some novel intimate practices emerging. It is shown that, in general, these are not in harmony with the heteronormative values that are dominating society today. The new ways and practices are therefore challenging criticism from liberal rights activists, particularly with regard to issues such as coming out. I identify four types of orientations of gay men and lalas towards cooperative marriage: familial, individual, pragmatic, and idealistic. These reveal how gay men and lalas understand their relations to other main players in their lives and strategize accordingly. Among the characteristics playing key roles in their decision making are gender, being the single child of the family and co-residence with the parents in the same city (local vs. non-local). It is shown that the lives of gay men and lalas in cooperative marriage are being complicated by the need to negotiate multiple relationships, e.g., with the marital partner, the same-sex partner, the marital partner’s partner, the natal family, the in-laws, and the gay community around. I also theorize on the major types of politics of intimate relationships engaged in by gay men and lalas as they craft their living spaces while in cooperative marriage. Finally, I demonstrate that cooperative marriage has led to a new sub-cultural tongzhi movement where gay men and lalas build on the rapport they have developed with each other; e.g., they share information and experiences while participating in semi-open public discussions and matchmaking events. This is leading to emergent types of new ethics within the community which have critically challenged the stereo types and dominant narratives on tongzhi strategizing. / published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy

Background A dramatic increasing trend of HIV prevalence among men who have sex with men (MSM) was observed in China from 2000. Most previous investigations were based on convenience sampling and none of them differentiated money boys (MB) from other MSMs. The objectives of this study was to determine the prevalence of HIV infection and its risk factors among MSMs in Shenzhen, China, using approximate probability sampling methods; and to interpret HIV transmission pattern among MSMs with both phylogenetical and epidemiological information. / Conclusions The prevalence of MV infection in Shenzhen MSMs was similar to the national rate in MSMs. HIV infection and related characteristics in Mf3s and other MSMs were different, indicating that a separate analysis was necessary. TLS could provide information on venue comparisons for venue-based MSMs and RDS could recruit more hidden subjects. Results from this study suggest that venue-specific intervention approaches should be developed and provided to different venues. / Results HIV prevalence was 5.5% among MSMs in Shenzhen. A significantly lower HIV infection was observed in MBs (4.5%) compared with other MSMs (7.0%). The HIV infection rate among MSMs was 5.7% by TLS and 4.6% by RDS, which were not significantly different. Factors related to HIV infection in MSMs included syphilis infection, occupation, sexual orientation, venue for recruitment and hometown HIV prevalence. HIV rate and social-behavioral characteristics were found to vary with venues, with significantly higher rates in family clubs, parks and saunas, than entertainment venue. Molecular phylogenetical analysis showed that genetic clusters were related to receptive anal intercourse, short stay in Shenzhen, early age of first sex, and high hometown HIV prevalence. Venue-specific transmission chains were observed in 60% of the subjects. / Subjects and Methods A total of 2143 MSMs were recruited in Shenzhen from 2008 to 2009, including 1651 persons from time-location sampling (TLS) and 492 from respondent-driven sampling (RDS). A separate recruitment of MBs and other MSMs was applied in TLS surveys and a mixed sample of MSMs was applied in RDS. All subjects were interviewed and had blood tests for HIV and syphilis. HIV positive samples were further used for phylogenetic analysis. / Zhao, Jin / Adviser: Mingliang He. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 161-177). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

BACKGROUND The coverage of HIV/AIDS behavioral surveillance among MSM in China falls far short of what is necessary as the current approach is expensive and time consuming. In addition MSM are difficult to reach in China. Internet-based behavioral surveys have demonstrated a number of advantages compared with the traditional paper-pen method. Chinese MSM are avid users of the Internet. Use of the internet provides an opportunity to access this hard-to-reach population and explore their use of the Internet for sexual purposes as well as to assess risk behaviors among MSM internet users. This thesis aimed to explore the trends in risk behaviors and HIV prevalence among MSM using traditional community-based surveys and Internet surveys, and to analyze the potential of web-based behavioral surveillance among MSM by comparing the differences between Internet and community-based MSM samples, and then to provide insights for the future HIV/AIDS behavioral surveillance, epidemic estimation and prediction as well as health intervention among the Chinese MSM population. METHODS This study has three components. The first focuses on trends in HIV risk behaviors and prevalence among MSM in Harbin in northeast China, based on community-based surveys. Eligible participants were approached by peer recruiters in traditional gay venues and then interviewed by health professionals with a standard questionnaire. Urine samples were collected to screen their HIV status. The second part presents two cross-sectional, Internet-based surveys among MSM in China in 2006 and 2007. The study website was advertised on three selected gay websites using a series of banners, pop-ups and text notifications. After providing consent to the survey, eligible participants were invited to complete an online questionnaire. The third component compares the demographic characteristics and risk behaviors of two samples of Chinese MSM. Participants living in Heilongjiang Province were extracted from the 2006 online survey dataset to compare with the community sample of MSM recruited in Harbin, the capital city of Heilongjiang Province in the same year. KEY FINDINGS Community-based behavioral surveillance Among MSM in Harbin, a trend was observed towards more self-identifying as homosexual (from 58% to 80%) and more living with a male partner (from 12% to 41%) over the study period 2002-06. Although there was a trend towards a reduction in the rate of never using a condom and an increase in the rate of always using condoms during anal sex in the past six months, the prevalence of unprotected anal intercourse (UAI) still remained at high level (from 90% in 2002 to 72% in 2006). Most respondents reported having multiple male sexual partners (≥ 2) in the past six months: 86.5% in 2002, 76.0% in 2004 and 91.6% in 2006. The HIV prevalence (2.2%, 15/674) among MSM in Harbin in 2006 was higher than that in previous survey years (1.3% in 2002 and 0.94% in 2004), but no statistically significant change was detected. Internet-based behavioral surveys Gay website users in China are young and well educated. The majority (85%) have used the Internet to seek sex and meeting sexual partners online, which is one of the most common reasons for visiting gay websites. Traditional gay venues still play an important role in the sex seeking process, especially for MSM who are older and less educated. Gay website users are vulnerable to HIV/AIDS given their high prevalence of UAI (56.6%) and multiple male sexual partners (66.5%). The type of partners plays an important role in determining consistent condom use. An increase in condom use was observed among MSM having sex between commercial partners relative to those having sex with non-regular partners and regular partners. Among the Internet sample, participants who have regular partners are less likely to have sex with females, less likely to have multiple partners and less likely to engage in commercial sex behaviors than those who do not. Comparisons between Internet and community samples There are significant differences in terms of demographic characteristics and risk behaviors between the Internet and community samples of MSM. The Internet sample was significantly younger, more educated and more likely to be students and self identify as homosexual. Among those who had anal sex in the past six months, the Internet sample tended to use condoms less consistently than the community sample. However, using the total sample size as the denominator to calculate the prevalence of UAI, no significant difference between the two samples was observed (AOR 1.02, CI 0.73-1.43, p = 0.905). After adjusting for differences in demographic characteristics, the community sample was more likely to have had sex with females (AOR 2.01, CI 1.22-3.30, p = 0.006) and have had ≥ 6 male partners in the previous six months than the Internet sample (46.1% vs. 20.2%; AOR 4.88, CI 3.51-6.80, p < 0.001). The mean number of male partners for the community sample was 13.5 ± 16.8, whereas it was 6.0 ± 12.2 for the Internet sample. CONCLUSIONS Although there is a trend towards an increase in condom use among MSM in China, they are vulnerable to HIV/AIDS infection given their high prevalence of UAI and multiple sexual partners. Public sector officials at all levels need to recognize this risk for HIV transmission. Health promotion and behavioral interventions should be enforced and scaled up to meet the need for controlling HIV transmission among MSM in China. Since the Internet has become a risk environment for MSM and the online MSM population is significantly different from the traditional community MSM group, online MSM should be included as a risk group in national HIV sentinel and behavioral surveillance and the coverage of surveillance for this specific group should be expanded to better understand the health promotion needs of this community as part of an HIV/AIDS strategy in China. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1339648 / Thesis (Ph.D.) - University of Adelaide, School of Population Health and Clinical Practice, 2008

"耽美"来源于日本，是以女性读者群为主要受众、描写男性与男性之间浪漫关系或性关系的文学或艺术作品，也被称为BL（Boy’s Love）。喜爱耽美的女性爱好者被称为"腐女"。耽美文化自1990 年代后期随着日本流行文化进入中国，至今已在中国网络空间中逐渐发展成为一个主要由女性网民所组成的，包含文本创作、阅读与交流的文化圈。与此同时，耽美文化的流行亦引发了中国当下种种对性与性别问题的思考。 / 本研究将耽美文化解译为"女性幻想男男之爱"的欲望结构，从精神分析幻想理论与酷儿理论的视角来考察中国网络中的耽美文化现象。论文所围绕的一个问题是，耽美文化与中国社会文化中的性/别话语产生了怎样的关系，以及如何从腐女的耽美幻想中搭建起与现实性/别政治的联系。研究首先分析了两类网络耽美小说文本，分别来看它们与1990年代以后的"男同性恋"身份话语，和2000年代以后对"中国古典文化"想象之间的吸收、挪用与再创造；其次以网络腐女圈的论坛讨论与配对狂欢为对象，研究网络耽美式恶搞对官方媒体、主流男性形象和异性恋规范的权威所潜在的颠覆性；最后以2011年一桩"腐女被抓案"新闻报道为契机，来观察耽美文化与网络淫秽色情审查的纠葛、冲突与可能的出路。 / 欲望幻想的流动性决定着它边界的模糊与开放，以及它承载、影响乃至侵扰"现实"秩序的功能。因此，作为一种女性的男性同性情欲幻想，本研究视耽美文化最引人注目的地方不在于其本身的出现与流行程度，而在于它与各种性/别话语的相互建构与矛盾冲突。此外，在对幻想文本、网络话语以及腐女群体的调查中，本研究也期待探索某种"酷儿"政治在中国网络文化中生产的可能性。 / Boy’s love (BL in short; danmei in Chinese) is a Japanese term for female-oriented fictional media, which focuses on love, sex and romance between beautiful androgynous boys or young men. Apart from the gay self-representations, BL is a genre of male homoeroticism by and for mostly heterosexual women. In China, the BL fans call themselves "Fu Nu", which means "rotten girl", to describe their enthusiasm for fantasizing male homosexuality. BL originated from Japanese amine, comic and game youth culture, and has since become a transnational phenomenon all over the world with a global fan base. As such, the phenomenon of boy’s love had already aroused a lot of discussions in relation to ideologies of gender and sexuality from different cultural and social perspectives. BL fandom in China’s culture context with its "Chinese characteristics" also deserves particular attention, when it opens up a fantastic space for Chinese woman to practice their sexuality beyond non-heterosexual norms. / However there is limited work that considers the queer sexuality of female BL fans in China, in relation to the queer texts and queer discourses they create. There is also little research that explores the capacity of boy’s love netizens to resist the on-going internet surveillance by the Chinese government of information deemed ‘sexually inappropriate’ and outside the heterosexual norm. Therefore there remains a paucity of studies that examine the political potentialities of anti-homophobic and queer discourses of sexuality as manoeuvred by the Chinese BL fan base that continue to populate online communities. Based on previous studies about the phenomenon of boy’s Love in China, this paper analyses the queer politics of the online BL fandom in terms of the interactions between BL and the other gender and sexuality discourses on the Chinese Internet. It will be argued that the online BL fandom opens up a virtual space for girls and young women to author practice their male homosexual fantasies. Moreover, it will be maintained that boy’s love appropriates the queerness from the different sides of cyber culture into its narrative fantasies, thus forming a queer continuum made up with the conflicts, complicities and political potentialities of the gender and sexuality on the Chinese internet. This paper concludes with an analysis of the ambiguous relation of BL with Chinese Internet censorship, and traces the capacities of boy’s love netizens in subverting and resisting government surveillance of what it terms ‘obscene’ information. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 周舒燕. / Thesis (Ph.D.) Chinese University of Hong Kong, 2014. / Includes bibliographical references (leaves 151-162). / Abstracts also in English. / Zhou Shuyan.

每當提及中國古代男色關係時，閱史不深者 ，或未能打破「異性戀常規」的刻板印象，以為男色關係不曾存在於強調傳宗接代、褒揚孝道文化的中國傳統社會中；或習慣援引現代西方病理化同性戀的論述，將男色污名化，視之為少數人的反常嗜好。稍識其事者，能不致於偏聽權力知識所傳播的一種論述，知悉歷史上男色關係曾流行成風，卻僅憑表象，而無太多實證的情況下，論斷中國社會曾寬容對待男色關係，未察這種歸納委實過度簡單化，未能理解環繞男色所建立的關係複雜性。以本文所述的陳維崧及徐紫雲二人關係為例，即使能微觀男色關係的研究者亦多以陳維崧的文字為憑，復以情感層面的框架定位出男色關係，使其對男色關係的解讀不免流於主觀，亦欠卻對徐紫雲的主體性的關懷。 / 本文對應上述三種對男色關係的理解，回饋三種層次的知識：知從前所未知；對往昔一知半解者，豐富其所知；對已知者，復稽其所知。前緣部份，吐露筆者建基於在地性及人文關懷的研究動機。第一章解釋以男色命名關係的原由，及在前現代──現代─後現代、西方──東方的脈絡中，略陳前人研究的語境，並綜述其研究內容。第二章則透過彙整史料，呈示明末清初的男色生態，並探討造就該現象的時代因素。第三章講述陳維崧的生平故事。第四章除整理陳、徐二人的生平和交往，更討論「異性戀常規」如何令男色關係陷於失語的狀態。並關懷二人各自的主體性，更具深度地考量這段男色關係的性質及其操作。針對今日學界的論述如「冒襄笑遣雲郎乃完成了佔有權轉移」及「好男色者皆為雙性戀者」提出質疑。第五章聚焦於《九青圖詠》，以陳維崧與題詠者的交誼為觀察窗口，對題詠內容再作解讀，透析一種鮮有學者提及的客套之情，以豐富學界對箇中題詠立意的解釋，從而對時人對男色大都抱有欣賞之意的看法作出反思。第六章總結並歸納全文要點。 / When it comes to the nanse relationship in ancient Chinese society, people who hardly comprehend the context of history may well judge that there was no breeding ground for such relationship since Chinese culture places much emphasis on the continuation of one’s ancestral line and attaches much importance to filial piety. Meanwhile some people may tend to perceive such homosexual relationship as an abnormal behavior for the minority on the basis of modern western discourse of pathologized homosexuality, thus turning a blind eye to this stigmatized aspect. To those who somewhat understand the past, they might be able to extend their vision beyond what has been produced by the power knowledge, and thus would realize that there were various kinds of nanse relationships among different classes. They however might merely emphasize the popularity of the phenomena and conclude that such relationship was commonly tolerated. Such oversimplified argumentation would contribute to a kind of biased comprehension in which the nature of nanse relationship can by no means be concretely captured. Even to those who conduct micro study of nanse relationship, take my case of Chen Weisong and Xu Ziyun as an example, they usually capitalize on Chen’s literary works in discussing nanse relationship in terms of emotion regardless of the limitation of such subjective interpretation. And Less attention has been paid to the issue of Xu Ziyun’s subjectivity. / To remedy the above problem, this thesis is to produce three kinds of knowledge according to the aforementioned different levels of comprehension of nanse relationship, using the Chen-Xu relationship as a case to tell those without the knowledge of the history the neglected story, to inform those having half-baked knowledge, and to enrich the existing scholarship by reviewing the issue. To begin the thesis with a foreword, I declear my research motive which is related to a kind of local and humanistic concern. The first chapter explains the reasons for using nanse to name the male-male relationship in ancient Chinese society and reviews the previous studies in the Pre-Modern─Modern─Post-Modern and the West－East context. The second chapter shows the phenomenon of nanse relationship during late Ming and early Qing period and explicates its popularity. The third chapter introduces Chen Weisong’s life. The fourth chapter not only describes how Chen and Xu interacted, but also analyses how nanse relationship was misplaced owing to the operation of heteronormativity. In so doing, I provide the scholarship with an insight into Chen-Xu’s nanse relationship with emphasis on their subjectivities. In the midst of my argumentation, existing scholarly observations such as "Mao Xiang sent Ziyun to Chen to indicate the completion of shifting possession", "those immersing in Nanse are all bisexual," and so forth are challenged. The fifth chapter focuses on the picture Jiuqing tuyong and interprets the pomes on it by explicating the relationship between the poets and Chen, thus detecting a kind of civilities that existed among them. This discovery can enrich the existing scholarship concerning the poests’ objectives of writing the poems so as to respond to the question about their appreciation of nanse relationship. The sixth chapter concludes the thesis by highlighting the vital points mentioned in the previous chapters. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 李俊威. / Thesis (M.Phil.) Chinese University of Hong Kong, 2015. / Includes bibliographical references (leaves 257-273). / Abstracts in English and Chinese. / Li Junwei.

介紹.與確診多年的HIV陽性男男性接觸者（MSM）相比，新確診的HIV陽性男男性接觸者（N-MSM）傳播HIV的危險性更高，承受更多的心理健康問題，但愛滋病相關知識相對缺乏。目前的研究已經描述了N-MSM的心理健康和危險行為情況，但關於二者影響因素的調查卻甚少，且暫無關於N-MSM獨特相關因素，如疾病認知，安全套使用認知，安全使用的社會道德等的研究报告。目前，中國只有少量關於HIV陽性MSM的研究，無關於N-MSM的研究。 / 目的.本研究的目的包括： 1）描述中國N-MSM的心理健康和危險行為情況；2）驗證疾病認知量表在N-MSM人群的適應性；3）探討N-MSM疾病認知與心理健康（自殺意念，抑鬱，自我歧視和創傷後成長）的關係，並進一步研究在認知表徵與心理健康結果關係中，情感表徵的仲介作用與交互作用； 4）探索疾病認知與心理因素（抑鬱、自我歧視和創傷後成長）對自殺意念的獨立作用與交互作用；和5）研究愛滋病傳播相關危險行為的多方面因素。 / 對象與方法：本研究採用橫斷面研究設計，對中國成都共225名N-MSM進行了面對面訪談和電腦輔助移動電話訪談。根據Moss-Morris的方法，驗證疾病認知問卷的信度及效度； 使用單變量、多變量及分層的logistic和線性回歸等方法進行資料分析。 / 結果.在225名研究對象中，48%有自殺意念和抑鬱表現，35%自我歧視得分較高，17%有積極的創傷後成長。N-MSM的危險行為普遍存在：31%在確診感染後發生過非保護肛交性行為，40%認為在未來6個月意願與HIV陰性男性發生非保護肛交性行為，20%在感染後想過故意將HIV傳染給別人。經驗證，疾病認知問卷在N-MSM中具有良好的心理測量特徵。疾病認知的多個維度，如情感反應和治療控制等，與心理健康結果顯著相關。在認知表徵與心理健康結果的關係中，情感表徵表現出強烈的仲介作用。兩個疾病認知維度（情感反應與治療控制）和兩個心理因素（抑鬱和創傷後成長）對自殺意念有獨立作用，但無交互作用。影響N-MSM危險行為的多方面因素包括安全套相關認知，情感因素，心理健康和社會道德。 / 結論.本研究結果顯示中國N-MSM心理健康問題和危險行為是普遍存在的。疾病認知與心理健康結果的顯著聯繫，提示了可以通過改善N-MSM的疾病認知從而減少該人群的心理健康問題；在HIV領域中，這是一個新的研究方向。在對N-MSM危險行為的幹預研究中，需考慮影響N-MSM的獨特因素，如安全套相關認知，情感反應和社會責任等。 / Introduction.Newly diagnosed HIV positive men who have sex with men (N-MSM) comprise a special subgroup of HIV positive MSM, as they have higher risks of transmission via anal sex, suffer from more mental health problems, and possess less knowledge of HIV/AIDS than those who have been diagnosed for many years. Previous studies have investigated the prevalence of mental health and risk behaviours among N-MSMs, while few studies have explored the risk factors associated with these health-related outcomes, particularly the factors unique to N-MSMs, like illness perception, cognitions regarding condom use, social morality of condom use, etc. China provides only limited data about HIV positive MSM, and no such data is about N-MSMs. / Objectives.The aims of the study were to 1) investigate the characteristics of mental health and risk behaviours among N-MSMs in China; 2) validate the revised illness perception questionnaire (IPQ-R) modified for N-MSMs; 3) examine the effects of patients’ illness perception on their mental health outcomes and determine the mediating or moderating effects of emotional representation on the associations between cognitive representation and mental health outcomes; 4) examine the main effects and interaction effects of illness perception and psychological variables on suicidal ideation; and 5) investigate the multidimensional factors associated with risk behaviours related to HIV transmission. / Subjects and Methods.A cross-sectional study was conducted in Chengdu, China. A total of 225 N-MSMs participated in this study. Both face-to-face and computer-assisted mobile phone interviews were applied. The methodology by Moss-Morris was used to validate IPQ-R among N-MSMs. Univariate, multivariate, hierarchical logistic, and linear regression methods were used for data analysis. / Results.Of all participants, 48% had suicidal ideation and depression, and 36% reported self-stigma, but only 17% experienced posttraumatic growth (PTG). Risk behaviours were prevalent: 32% had had unprotected anal intercourse (UAI) since HIV diagnosis, 40% had the intention to have UAI with HIV negative men in the coming 6 months, and 20% had had thoughts of transmitting HIV to others purposely since HIV diagnosis. The modified IPQ-R for N-MSMs was validated and found to have acceptable psychometric properties. Most dimensions of illness perception (such as emotional response, treatment control and consequences) were significantly associated with mental health outcomes. Emotional representation had strong mediation effects rather than moderator effects on the associations between cognitive representation and mental health outcomes. Two illness perception dimensions (emotional response and treatment control) and two psychological variables (depression and PTG) showed independent effects on suicidal ideation, but not interaction effects on suicidal ideation. Multidimensional factors, such as variables related to cognitions of condom use, emotional affect (feelings of guilt regarding HIV transmission to others), mental health, and social morality (perceptions regarding responsibility for condom use), were associated with risk behaviours among N-MSMs. / Conclusions.The results show that mental health problems and risk behaviours are prevalent among Chinese N-MSM. Illness perception has a strong influence on mental health outcomes, indicating a new direction for the reduction of mental health problems via the modification of patients’ illness perception. Multidimensional factors are associated with risk behaviours related to HIV transmission, such as cognitions of condom use, emotional affection and social morality, which are unique to HIV infectors and should be considered in the development of intervention programs among N-MSMs. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Wu, Xiaobing. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 257-276). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / Abstract (English) --- p.i / Abstract (Chinese) --- p.i / Acknowledgements --- p.iii / List of Contents --- p.v / List of Tables --- p.xi / List of Figures --- p.xv / Abbreviations --- p.xvii / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Background --- p.1 / Chapter 1.2.1 --- The importance of HIV positive men who have sex with men as a source of HIV transmission --- p.1 / Chapter 1.2.2 --- The importance of newly diagnosed HIV positive MSM (N-MSM) --- p.3 / Chapter 1.2.3 --- Knowledge gaps about N-MSM --- p.4 / Chapter 1.2.4 --- Illness perception as a relative new perceptive in HIV research --- p.5 / Chapter 1.2 --- Aims --- p.7 / Chapter 1.3 --- Structure of the thesis --- p.10 / Chapter 1.4 --- Summary --- p.15 / Chapter Chapter 2 --- Literature review --- p.16 / Chapter 2.1 --- HIV epidemic --- p.16 / Chapter 2.1.1 --- Global HIV/AIDS epidemic --- p.16 / Chapter 2.1.2 --- HIV/AIDS in China --- p.17 / Chapter 2.2 --- MSM and HIV --- p.22 / Chapter 2.2.1 --- HIV epidemic among MSM worldwide --- p.22 / Chapter 2.2.2 --- HIV prevalence and incidence among MSM in China --- p.24 / Chapter 2.2.3 --- Risk sexual behavior among HIV positive MSM and its determinants --- p.25 / Chapter 2.2.4 --- Mental health problems faced by HIV positive MSM --- p.31 / Chapter 2.2.5 --- Studies of PLWH in China --- p.38 / Chapter 2.3 --- Newly diagnosed HIV positive MSM (N-MSM) --- p.43 / Chapter 2.3.1 --- HIV transmission risk varies at different stages of HIV infection --- p.43 / Chapter 2.3.2 --- More risky sexual behavior among N-MSM --- p.45 / Chapter 2.3.3 --- More stress and lack of knowledge among N-MSM --- p.46 / Chapter 2.3.4 --- Definition of N-MSM --- p.47 / Chapter 2.3.5 --- Studies about N-MSM --- p.47 / Chapter 2.4 --- Self-regulation model and illness representation --- p.51 / Chapter 2.4.1 --- Self-regulation model --- p.51 / Chapter 2.4.2 --- Illness representation --- p.52 / Chapter 2.4.3 --- Application of illness representation in HIV research --- p.60 / Chapter 2.5 --- Audio computer-assisted self-interviewing (ACASI) --- p.61 / Chapter 2.5.1 --- Types of questionnaire deliver modes --- p.61 / Chapter 2.5.2 --- Comparisons of sexual behavior reporting between ACASI and other delivery modes --- p.63 / Chapter 2.5.3 --- Limitations of ACASI --- p.65 / Chapter Chapter 3 --- Subjects and Methods --- p.67 / Chapter 3.1 --- The study site --- p.67 / Chapter 3.2 --- Study population --- p.68 / Chapter 3.3 --- Recruitment of study participants --- p.68 / Chapter 3.4 --- Data collection procedure --- p.69 / Chapter 3.4.1 --- Face-to-face interview --- p.70 / Chapter 3.4.2 --- Computer-assisted mobile phone interview --- p.70 / Chapter 3.4.3 --- Service provision and incentives --- p.71 / Chapter 3.4.4 --- Sample size and the representativeness --- p.71 / Chapter 3.5 --- Quality control --- p.71 / Chapter 3.6 --- Establishment of the CAMP system --- p.72 / Chapter 3.7 --- Collaborator --- p.73 / Chapter 3.8 --- Measurements --- p.74 / Chapter 3.9 --- Statistical analysis --- p.83 / Chapter 3.10 --- Ethical approval --- p.85 / Chapter Chapter 4 --- Participant profiles --- p.86 / Chapter 4.1 --- Background --- p.86 / Chapter 4.2 --- Objectives --- p.87 / Chapter 4.3 --- Statistical analysis --- p.87 / Chapter 4.4 --- Results --- p.87 / Chapter 4.4.1 --- Background information --- p.87 / Chapter 4.4.2 --- Mental health outcomes --- p.88 / Chapter 4.4.3 --- HIV secondary transmission related behaviours --- p.90 / Chapter 4.4.4 --- Service utilization and quality of life --- p.94 / Chapter 4.5 --- Discussion --- p.95 / Chapter Chapter 5 --- Validation of the revised illness perception questionnaire among newly diagnosed HIV positive MSMs --- p.111 / Chapter 5.1 --- Background --- p.111 / Chapter 5.2 --- Objectives --- p.112 / Chapter 5.3 --- Modification and translation --- p.113 / Chapter 5.4 --- Statistical analysis --- p.114 / Chapter 5.5 --- Results --- p.116 / Chapter 5.5.1 --- Items of the main cognitive representation subscales --- p.116 / Chapter 5.5.2 --- Items of the emotional response subscale --- p.117 / Chapter 5.5.3 --- Items of the causal attribution subscale --- p.118 / Chapter 5.5.4 --- Examination of the identity subscale --- p.118 / Chapter 5.5.5 --- Descriptions of the derived subscales --- p.119 / Chapter 5.5.6 --- Inter-correlations among subscales --- p.119 / Chapter 5.5.7 --- External validity --- p.120 / Chapter 5.5.8 --- Associations between background variables and illness perception --- p.120 / Chapter 5.6 --- Discussion --- p.121 / Chapter Chapter 6 --- Relationships between illness perception and mental health outcomes among N-MSM --- p.132 / Chapter 6.1 --- Background --- p.132 / Chapter 6.2 --- Objectives --- p.134 / Chapter 6.3 --- Statistical analysis --- p.136 / Chapter 6.3.1 --- Analysis of the associations between illness perception and mental health outcomes --- p.136 / Chapter 6.3.2 --- Analysis of the mediation effects of emotional response on the associations between cognitive representation and health related outcomes --- p.137 / Chapter 6.3.3 --- Analysis of moderating effects of emotional response on the associations between cognitive representation and mental health outcomes --- p.139 / Chapter 6.4 --- Results --- p.140 / Chapter 6.4.1 --- Suicidal ideation --- p.140 / Chapter 6.4.2 --- Depression --- p.142 / Chapter 6.4.3 --- Self-stigma --- p.145 / Chapter 6.4.4 --- Posttraumatic growth --- p.147 / Chapter 6.5 --- Summary --- p.149 / Chapter 6.5.1 --- Associations between illness perception and health related outcomes --- p.149 / Chapter 6.5.2 --- Summary of the mediation effects of emotional response on the association between cognitive representation and health related outcomes --- p.150 / Chapter 6.5.3 --- Summary of the moderating effects of emotional response on the association between cognitive representation and health related outcomes --- p.150 / Chapter 6.6 --- Discussion --- p.151 / Chapter Chapter 7 --- The main and interaction effects of illness perception and other psychological variables on suicidal ideation among N-MSM --- p.177 / Chapter 7.1 --- Background --- p.177 / Chapter 7.2 --- Objectives and hypothesis --- p.179 / Chapter 7.3 --- Data analysis and results --- p.180 / Chapter 7.3.1 --- Associated factors of suicidal ideation in univariate analysis --- p.180 / Chapter 7.3.2 --- The associations between illness perception / psychological variables and suicidal ideation --- p.180 / Chapter 7.3.3 --- The independent effects of emotional response/treatment control and psychological variables on suicidal ideation --- p.182 / Chapter 7.3.4 --- Analysis of the interaction effects between illness perception and psychological variables onto suicidal ideation --- p.184 / Chapter 7.4 --- Discussion --- p.184 / Chapter Chapter 8 --- Risk behaviours related to HIV transmission and associated factors --- p.197 / Chapter 8.1 --- Background --- p.197 / Chapter 8.2 --- Objectives --- p.199 / Chapter 8.3 --- Statistical analysis --- p.202 / Chapter 8.4 --- Results --- p.203 / Chapter 8.4.1 --- Factors associated with having had UAI with men since HIV diagnosis --- p.203 / Chapter 8.4.2 --- Factors associated with intention to have UAI with HIV negative men in the coming 6 months --- p.205 / Chapter 8.4.3 --- Factors associated with having the thoughts of transmitting HIV to others purposively since HIV diagnosis --- p.206 / Chapter 8.5 --- Discussion --- p.207 / Chapter Chapter 9 --- Conclusions --- p.225 / Chapter 9.1 --- Summaries and interpretations of findings related to mental health --- p.225 / Chapter 9.1.1 --- Poor mental health status --- p.225 / Chapter 9.1.2 --- A validated revised illness perception questionnaire (IPQ-R) among N-MSM --- p.226 / Chapter 9.1.3 --- Strong associations between illness perception and mental health outcomes --- p.226 / Chapter 9.1.4 --- Significant associations between illness perception / other psychological variables and suicidal ideation --- p.227 / Chapter 9.2 --- Summaries and interpretations of findings related to risk behaviours --- p.228 / Chapter 9.2.1 --- Prevalent risk behaviours --- p.228 / Chapter 9.2.2 --- Factors affecting the risk behaviours related to HIV transmission and implications --- p.229 / Chapter 9.3 --- Service implications --- p.231 / Chapter 9.3.1 --- Intervention programs for reducing mental health problems --- p.231 / Chapter 9.3.2 --- Intervention programs for reducing risk behaviours related to HIV transmission --- p.233 / Chapter 9.3.3 --- Policy support in HIV prevention --- p.236 / Chapter 9.4 --- Study limitations --- p.238 / Chapter 9.5 --- Recommendations for future research --- p.239 / Chapter 9.5.1 --- Longitudinal studies --- p.239 / Chapter 9.5.2 --- Behavioural studies --- p.240 / Chapter 9.5.3 --- Intervention studies --- p.240 / Chapter 9.6 --- Conclusions --- p.241 / Chapter Appendix I --- Questionnaire for face-to-face interview --- p.243 / Chapter Appendix II --- Questionnaire for computer-assisted mobile phone interview --- p.254 / Reference --- p.257

The present thesis explored the experiences and correlates of victimization among Chinese gay men and lesbians in Hong Kong with the aim at reducing their victimization experiences in future. This thesis had two studies. Study One was a cross-sectional study to examine correlates of victimization experiences. Based on the stress and coping paradigm, an integrated model on victimization experiences was developed. The model composed of three predicting factors of victimization experiences: predispositional stressors including gender role atypicality and internalized homophobia, cognitive appraisal variables including perceived discrimination and gay/lesbian community involvement, and sexual identity management strategies including counterfeiting, integration, and confrontation. A total of 645 Chinese gay men and lesbians in Hong Kong participated in this study. Results of path analyses showed that sexual identity management strategy of confrontation was the immediate correlate of victimization. Cognitive appraisal variables, including perceived discrimination and gay/lesbian community involvement, were also directly related to victimization experiences. Predisposition stressors, including gender role atypicality and internalized homophobia, were related to cognitive appraisal variables and sexual identity management strategies, which in turn predicted victimization experiences. The cross-sectional model was examined with four types of victimization experiences, including verbal insults, physical attacks, sexual assaults, and unfair treatment; and with gay men and lesbians separately. Results showed that the model was more predictive of physical attacks and sexual assaults of gay men. Based on the final cross-sectional model, a longitudinal model on victimization experiences and a psychoeducational program on sexual identity management strategies were developed. Study Two was a three-month follow-up study to examine the longitudinal model and to evaluate the effectiveness of the psychoeducational program on reducing future victimization experiences. A random sample of 392 participants from Study One was recruited to Study Two. Results of path analyses showed that victimization experiences at T2 (Time Two) were predicted by three longitudinal paths. Confrontation at T1 (Time One) had direct impact on confrontation at T2, which was linked to victimization experiences at T2. Victimization experiences at T1 predicted confrontation at T2, which was related to victimization experiences at T2. Victimization experiences at T1 had direct effects on victimization experiences at T2. Similar to the cross-sectional model, the longitudinal model was more predictive of physical attacks and sexual assaults of gay men. Results also showed that the psychoeducational program was effective in reducing participants' victimization experiences in future. Compared with the control group, participants of the psychoeducational program used less confrontation strategy, more counterfeiting and integration strategies from T1 to T2. Participants showed greater reduction in victimization experiences than the control group from T1 to T2. Compared with lesbians, gay men demonstrated greater reduction in victimization experiences after the psychoeducational program. Limitations and service implications of the studies were discussed. / Wong Chi Yan. / "August 2005." / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0566. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 262-291). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.