Partner Violence Risk Higher for MSM With HIV in Convenience Marriages

Intimate partner violence (IPV) was more prevalent in men who have sex with men (MSM) who were diagnosed with HIV and were in a marriage of convenience, according to a study published in Family Process.¹ The risk of IPV increased when the MSM did not disclose their HIV status.

Marriages of convenience were defined as marriages between 2 individuals of the LGBTQ community who marry due to social, cultural, family, and political pressures. This type of marriage is present in modern-day China due to social stigmas around LGBTQ individuals. Further, MSM are at an increased risk of HIV in China but the disclosure of HIV to the partner of convenience is less common. Although HIV disclosure is a contributor to IPV in general,² this has not been evaluated in marriages of convenience or focused on MSM. This study aimed to assess the disclosure of HIV status between MSM and their lesbian partner, as well as assess the association between HIV disclosure and IPV.

Couple arguing | Image credit: vectorfusionart - stock.adobe.com

The study was conducted using WeChat, which is a Chinese social media platform that also offers HIV education. Participants were recruited between June and December 2020 and were included if they were diagnosed with HIV, were MSM, were in a marriage of convenience, and were willing to participate. People were excluded if they had severe mental or physical conditions or had an unregistered marriage ceremony to a lesbian.

Information about their HIV status and their demographic data were collected from all participants. The Patient Health Questionnaire for Depression (PHQ-2) and the Generalized Anxiety Disorder Scale (GAD-2) were used to evaluate the symptoms of anxiety or depression in all participants. The Beck Scale for Suicide Ideation – Chinese Version (BSI-CV) was used to evaluate the suicidal tendencies of all the participants. The Dating Violence Questionnaire was used to measure the experiences of IPV within the previous 12 months.

There were 232 MSM who completed the analysis who had a mean (SD) age of 41.1 (7.2) years and 65.1% identified as gay. A total of 55.6% lived in an urban area, 16.4% lived with their lesbian partner, 23.7% had children with their lesbian partner, and 44.8% had received their HIV diagnosis in the previous 2 years.

Fifty-seven percent of participants had told their lesbian partner about their HIV status, of whom 74.4% had a diagnosis of HIV and disclosed it after marriage. The likelihood of HIV disclosure was higher in bisexual men (adjusted OR [aOR], 4.47; 95% CI, 1.68-11.93) and in men who had a child with their spouse (aOR, 5.02; 95% CI, 1.49-16.87), a long-term gay partner outside of their convenience marriage (aOR, 4.55; 95% CI, 1.48-13.97), higher levels of social support (aOR, 3.73; 95% CI, 1.07-13.02), lower levels of self-stigma (aOR, 5.68; 95% CI, 1.96-16.46), and no suicidal ideation (aOR, 3.72; 95% CI, 1.43-9.71).

A total of 61.6% had experienced IPV within the previous 12 months, with 34.9% experiencing it from a gay partner and 44.4% experiencing it from a lesbian spouse. This included the threatening to disclose the status of HIV or MSM (34.5%), physical abuse (22.0%), use of control (26.7%), emotional abuse (19.0%), sexual abuse (10.8%), and security threats (17.2%). A total of 90.2% of the participants reporting IPV had never sought help.

IPV was found to have an increased likelihood if MSM had disclosed their HIV status to their lesbian partner (aOR, 4.27; 95% CI, 1.73-10.53) with the likelihood persisting in participants who had disclosed their HIV status to their gay partner (aOR, 2.38; 95% CI, 1.09-5.22).

There were some limitations to this study. Social support could have decreased and psychological distress and IPV increased due to the study taking place during the pandemic. Also, causal inferences could not be drawn due to the cross-sectional design of the study, and tere was a lack of consistency in the timing of assessed variables. In addition, all participants were enrolled through WeChat, which could exclude those who do not use the social media platform; details of the IPV incidence, such as timing and frequency, were not recorded; and measurement bias could have affected the measurement of depression and anxiety.

The researchers concluded that MSM who have a diagnosis of HIV and are in a marriage of convenience have a higher likelihood of experiencing IPV both in their marriage to their lesbian spouse and in their gay relationship when disclosing their HIV status.

References

1. Yu Y, Qin K, Xian Y, Cai H, Xiao F. HIV disclosure and intimate partner violence among HIV-infected men who have sex with men in marriage of convenience in China. Fam Process. Published online May 22, 2024. doi:10.1111/famp.13017
2. Sullivan T. The intersection of intimate partner violence and HIV: detection, disclosure, discussion, and implications for treatment adherence. Top Antivir Med. 2019;27(2):84-87.