Population Health

April 4, 2023

Pilot project seeks to destigmatize HIV, mental health in China through a mHealth intervention

Person writes a text message on a cell phoneDeath caused by HIV/AIDS has increased in China since 1990, with more than one million new infections occurring in 2020. People newly diagnosed with HIV often face mental health challenges such as depression, suicidal ideation and anxiety. Yet, because of discriminatory laws and attitudes towards the LGBTQIA+ community in China, newly diagnosed HIV-positive Men Who Have Sex With Men (MSM) are especially vulnerable to mental health complications. As a result, the state of their mental health can inhibit engagement with HIV-related care and medication adherence.

Liying Wang, a University of Washington Ph.D. student in Clinical Psychology, and her team seek to address these urgent mental health needs and health disparities among MSM in China. Awardees of a Population Health Initiative Tier 1 Pilot Grant, the team is developing a mHealth intervention through in-depth interviews with MSM in the community, staff members at the community-based organization and healthcare providers.

“I wanted to draw from my clinical training and see if I can meet the needs of people who are newly diagnosed with HIV, and typically in China, because of a lack of resources for mental health,” explained Wang. The team is developing an intervention that is delivered on WeChat in order to aid the coping process after an HIV-positive diagnosis. With this intervention, they hope to reduce the long-term risks for serious mental health conditions and increase medication adherence and linkage to care.

The official policy towards LGBTQIA+ people in China can be described as “don’t encourage, don’t discourage, don’t promote.” China’s Cybersecurity Law bans the dissemination of information that disrupts the “social order” and this includes the criminalization of the distribution of information for and about the LGBTQIA+ community. Due to these restrictions, it has been highly challenging for LGBTQIA+ groups to organize.

Wang described one case with a participant, who in the middle of virtual interviews had a private discussion with his partner. After a few minutes on mute, he told Wang he could no longer continue with the study and withdrew.

“Of course, I was hurt for one second,” Wang says, “And I was like, ‘Okay, this is not about me, or him, it’s about the structural discrimination that’s going on here’. It’s trust. He doesn’t trust because he has had or his partner has had experience with this.”

This interaction, among others, showed the research team how discrimination against MSM in China was directly affecting their participants and their mental health. Wang explained, “As a researcher that shows me how much work we have to do going forward, not to keep reinforcing this stigma, [but] how can we present ourselves in the research in a way that sets the narrative around HIV?”

To conduct interviews with the MSM community in China while keeping in mind the participants’ safety, Wang partnered with SCMC, an organization in Shanghai that collaborates with the Shanghai CDC to offer holistic HIV-related services to the community including HIV prevention, outreach and linkage to care. The SCMC staff have established a strong relationship with sexual and gender minority members in the community over the years, so were able to promote the research project through their WeChat group. People interested in the study contacted the organization and took a survey to give permission to be contacted.

During interviews, Wang did not want to force western ideas of health on participants, as they were less interested in cognitive strategies and more interested in practical strategies. “They want to know more about how to get treatment for HIV, how to get medication, and how to make an appointment with a doctor versus taking care of their mental well-being,” she said.

To navigate this cultural difference, while still learning the best ways to treat mental health for the MSM population, Wang focused on giving them very specific strategies. “What do you do when you feel down? What do you do when you feel anxious? What do you do when you want to isolate yourself?” If participants agreed their mental health was being negatively impacted, then Wang presented strategies and asked participants to rate the perceived importance and feasibility of those strategies. The project’s community-based participatory approach was essential to navigating cultural differences.

Wang and her team launched a mini program on WeChat in February 2023. One feature of the mini program allows users to fill out a medication tracking card, a more private reminder to take daily medication rather than a phone alarm.

The development team and designers have worked on this mini-program for about three years. “Thanks to the Tier 1 grant [from the Population Health Initiative],” Wang says, “I was able to provide some funding for my wonderful developers and designers, to compensate for their time and their contribution.”

Looking ahead, the team will continue developing their WeChat intervention and have already applied for the Initiative’s Winter Quarter 2023 Tier 2 grant. Wang explained how the Tier 2 grant could help her research, “Through this Tier 2 grant, I’m hoping to support our pilot testing of this intervention to see if it’s actually effective in terms of improving the coping and mental health outcomes for some of our community members.” Wang also plans to train the staff at the community partner organization on basic psychological support and therapeutic strategies to enable them to provide mental health support for those in need.