HIV/AIDS first appeared in The New York Times in 1982, originally referred to as Gay-Related Immune Deficiency (GRID). [i] Although GRID was later renamed to Acquired Immune Deficiency Syndrome (AIDS) as an attempt to clarify that HIV was not, in fact, “a gay plague,” the misconception of HIV/AIDS as a “gay disease” remains entrenched in some Chinese communities, including in the Greater China Region. [ii] The misconception bars  the HIV-positive gay community in Hong Kong from disclosing their sexual and health status, and the stigma around the disease denies this vulnerable group the ability to access vital medical treatment.

In the past decades, HIV cases have increased exponentially in Hong Kong, with the number of individuals diagnosed annually doubling between 2006 to 2017. [iii] In line with HIV cases, the annual government expenditure on HIV prevention policies has also achieved exponential growth; the projected costs in 2020 alone will reach 400 million HKD (approximately 51 million USD).[iv]

In Hong Kong, 60.5 percent of HIV cases are attributed to men who have sex with men (MSM). [v] In HIV in Hong Kong: Living on the Edge, Dr Tim Brown, the Director of UNAIDS Collaborating Center at the East-West Center, frames the HIV epidemic in Hong Kong as an MSM epidemic. [vi] Andrew Chidgey, the Chief Executive of AIDS Concern Hong Kong, argues that one of the most prominent causes of the rapid growth of HIV infection in Hong Kong is an entrenched cultural taboo among Hong Kong Chinese families, meaning that individuals are unwilling to disclose their identity as MSM with their HIV-positive status, and they are consequently unlikely to receive prompt or effective medical and social support. [vii]

Ezer Kang and Bruce Rapkin argue that Chinese populations adopt uniquely critical cultural proscriptions regarding the link between homosexuality and HIV, because the younger generation is expected to fulfill their filial responsibilities by passing on the family lineage, something that HIV-positive men are often believed to be prevented from doing.[viii] Globally, former United Nations Secretary Ban-Ki moon commented that stigma is one of the biggest hurdles for HIV responses which included practicing safe sex and undertaking regular HIV testing. [ix] [x] Richard G. Parker and Peter Aggleton, and Erin McCarthy (2016: 222) adopt a sociological perspective when examining stigmatization, arguing that HIV-positive gay people are often socially marginalised and devalued.[xi] [xii] John de Wit et al. and Peter Keogh et al. argue the HIV-positive gay individuals are concerned that disclosure of their HIV-positive and homosexual status would result in greater stigma.[xiii] Thus, HIV-positive gay individuals might be reluctant, whether partially or wholly, to disclose their sexual and health status to any parties. The more they conceal their HIV-positive and homosexual status, however, the more likely they would accumulate perceived stigma. [xiv] [xv]

Jenny Liu and Kyung-Hee Choi argue stigma could result in psychological and emotional struggles with shame, fear, and even depression, and the presence of such symptoms could discourage individuals from practicing safe-sex precautions.[xvi] In contrast, a study by Choi et al. found that the more positive the self-image gay people have, the more likely Asian American men were to engage in HIV-preventive sexual behaviours, including using condoms during anal sex and regularly seeking HIV testing.[xvii] Similar research conclusions are drawn by Hong-jie Liu et al., Chi-yan Wong and Catherine So-kum Tang in the mainland Chinese and Hong Kong contexts.[xviii] [xix] However, for those individuals who have a desire to protect themselves from sexual and health stigmatization would in usual withhold or delay disclosure of HIV positive and homosexual status within family and social network. Their negative self-image, therefore, remains deadlocked.[xx]

From a domestic level, while homosexuality was decriminalised in 1991 as part of the Crimes (Amendment) Bill, Hong Kong lacks comprehensive legislation that prohibits discrimination on the grounds of sexuality and being MSM.[xxi] [xxii] From an international level, the United Nations Convention on the Rights of Persons with Disabilities mandates that ratifying countries eradicate disability-based discrimination. However, the convention does not explicitly include HIV-infection within its definition of “disability.” [xxiii] The deficient legal protection for Hong Kong gay individuals, especially those HIV-positive, facilitates sexual and health stigmatization, in which these insecure cohorts would rather remain “in the closet” than publicly seek medical and social assistance. While Article 25 of the Basic Law states all Hong Kong residents are equal before the law, HIV-positive gay individuals are often invisible from the ill-defined “equality.”[xxiv] Judicial review should be underwent as soon as possible to help broaden the legal protection for sexual and health rights, and combat discrimination on the grounds of sexual orientation and HIV infection in Hong Kong.

About the Author

Jason Hung is an incoming visiting student researcher at Stanford University and UC Berkeley. He was also a visiting student researcher at UCLA. His research interests include international migration studies, ethnic studies (especially Chinese and Muslim diaspora living in English speaking countries), and women’s studies in China.

Endnotes

[i] Altman, Lawrence. “New Homosexual Disorder Worries Health Officials”. New York Times. Retrieved May 11, 2017. (http://www.nytimes.com/1982/05/11/science/new-homosexual-disorder-worries-health-officials.html?pagewanted=all).

[ii] Dowsett, Gary. “The “Gay Plague” Revisited: AIDS and Its Enduring Moral Panic”. In Gilbert Herdt, Moral Panic, Sex Panic: Fear and the Fight over Sexual Rights, New York and London: New York University Press, 2009, p. 130.

[iii] Evidence to Action. “HIV/AIDS Statistics in Hong Kong 1984-2016”. Centre for Health Protection, Department of Health, Hong Kong, 2017. (http://www.aidsdatahub.org/sites/default/files/publication/HIVAIDS_Statistics_in_Hong_Kong_1984-2016.jpg).

[iv]  Brown, Tim. “HIV in Hong Kong: Living on the Edge: Centre for Health Protection”. Department of Health, Hong Kong, 2016, p. 3 (http://www.info.gov.hk/aids/pdf/g175.pdf).

[v]  Virtual AIDS Office of Hong Kong. “Hong Kong Surveillance Report – 2014”. Department of Health, Hong Kong, 2014. (http://www.info.gov.hk/aids/english/surveillance/sur_report/hiv14.pdf).

[vi] Brown, Tim. “HIV in Hong Kong: Living on the Edge: Centre for Health Protection”. Department of Health, Hong Kong, 2016, p. 9 (http://www.info.gov.hk/aids/pdf/g175.pdf).

[vii] South China Morning Post. “It’s not just a gay problem’: head of Aids Concern Hong Kong says growing number of HIV cases a concern for whole of society”. Accessed June 10, 2017. (http://www.scmp.com/news/hong-kong/education-community/article/2097488/its-not-just-gay-problem-head-aids-concern-hong).

[viii] Kang, Ezer and Bruce Rapkin. “Why Tell? Serostatus Disclosure and HIV Stigma among HIV Seropositive Asians and Pacific Islander Men who have Sex with Men in New York City”. Health Issues Confronting Minority Men Who Have Sex with Men, New York: Springer, 2008, p. 197.

[ix] Ki-moon, Ban (2008) “The stigma factor”. The Washington Times. Retrieved September 6, 2011 (http://www.washingtontimes.com/news/2008/aug/06/the-stigma-factor/).

[x] Wit, John B.F. de et al.. “Strange Bedfellows: HIV-Related Stigma Among Gay Men in Australia”, Stigma. In Pranee Liamputtong, Discrimination and Living with HIV/AIDS, Dordrecht; New York: Springer, 2013, p. 289.

[xi] Parker, Richard and Peter Aggleton. “HIV and AIDS-related stigma and discrimination: A conceptual framework and implications for action”. Social Science & Medicine 57 (1), 2003.

[xii] Wit, John B.F. de et al.. “Strange Bedfellows: HIV-Related Stigma Among Gay Men in Australia”, Stigma. In Pranee Liamputtong, Discrimination and Living with HIV/AIDS, Dordrecht; New York: Springer, 2013, p. 291.

[xiii] Keogh, Peter et al.. Ethnic minority gay men: Redefining community restoring identity. London: Sigma Research, 2004.

[xiv] Meyer, Ilan H.. “Minority stress and mental health in gay men”, Journal of Health and Social Behavior 36 (March), 1995.

[xv] Liu, Jenny X. and Choi, Kyung-Hee. “Emerging Gay Identities in China: The Prevalence and Predictors of Social Discrimination Against Men Who Have Sex with Men”. In Pranee Liamputtong, Stigma, Discrimination and Living with HIV/AIDS. Dordrecht; New York: Springer, 2013, p. 280.

[xvi] Choi, Kyung-Hee et al.. “Risk and protective factors affecting sexual behaviour among young Asian and Pacific Islander men who have sex with men: Implications for HIV prevention”. Journal of Sex Education and Therapy 24 (1–2), 1999, p. 274.

[xvii] Choi, Kyung-Hee et al.. “Risk and protective factors affecting sexual behaviour among young Asian and Pacific Islander men who have sex with men: Implications for HIV prevention”. Journal of Sex Education and Therapy 24 (1–2), pp. 48–55.

[xviii] Liu, Hong-jie et al.. “Stigma, delayed treatment, and spousal notification among male patients with sexually transmitted disease in China”. Sexually Transmitted Diseases 29 (6), 2002.

[xix] Wong, Chi-yan and Catherine So-kum Tang. “Coming out experiences and psychosocial distress of Chinese homosexual men in Hong Kong”. Archives of Sexual Behaviour 33 (2), 2004.

[xx] Kang, Ezer and Rapkin, Bruce. “Why Tell? Serostatus Disclosure and HIV Stigma among HIV Seropositive Asians and Pacific Islander Men who have Sex with Men in New York City”. Health Issues Confronting Minority Men Who Have Sex with Men, New York: Springer, 2008, p. 212.

[xxi] S.A.R. Stonewall. Acceptance Without Exception. Stonewall Equality Ltd, Hong Kong, 2016. (http://www.stonewall.org.uk/sites/default/files/gwb_hong_kong_2016_final.pdf).

[xxii] Cheo, John. “Gay and Lesbian Rights in Confucian Asia: The Cases of Hong Kong, Singapore, and Taiwan”. College Undergraduate Research Electronic Journal. University of Pennsylvania, 2014. (http://repository.upenn.edu/cgi/viewcontent.cgi?article=1204&context=curej)

[xxiii] Elliott, Richard. “HIV, disability and discrimination: making the links in international and domestic human rights law”. Journal of the International AIDS Society 12(1), 2009.

[xxiv] S.A.R. Stonewall. Acceptance Without Exception. Stonewall Equality Ltd, Hong Kong, 2016. (http://www.stonewall.org.uk/sites/default/files/gwb_hong_kong_2016_final.pdf).