We-ness Matters: Dyadic Coping in Chinese HIV Serodiscordant Same-Sex Male Couples Through a Convergent Mixed-Methods Approach

Abstract

In China, men who have sex with men represent a significant proportion of new HIV diagnoses. Within this group, serodiscordant same-sex male couples—where one partner is HIV-positive and the other is HIV-negative—face the challenges of HIV transmission as well as the dual stigmas associated with their sexual orientation and HIV status. Research to date has highlighted several critical gaps in understanding the dyadic coping mechanisms of these couples in HIV care and prevention. First, there is a lack of integrated theoretical frameworks capturing the dyadic experiences of serodiscordant same-sex male couples, particularly in non-Western contexts. Second, while dyadic coping has been recognised as important, its specific effects on HIV-related health outcomes among same-sex male couples remain underexplored. Third, the concept of we-ness—defined as couples’ shared sense of identity and mutual influence in facing challenges—is inadequately incorporated into existing models, particularly considering compounding couple-level minority stressors. Fourth, HIV-specific support as an outcome variable in HIV care and prevention among these couples has received insufficient attention. Finally, there is a notable scarcity of studies focusing on the experiences of serodiscordant same-sex male couples in China, where unique cultural factors may influence distinct dyadic coping processes.

This thesis integrates Bodenmann’s systemic transactional model of dyadic coping, the couple-level minority stress theory, and the concept of we-ness. It employs a convergent mixed-methods approach to explore the dyadic coping processes of Chinese serodiscordant same-sex male couples in HIV care and prevention. The study addresses four interconnected objectives: (a) examining the mediating role of we-ness between dyadic coping and HIV-specific support; (b) exploring the manifestation of we-ness in HIV care and prevention; (c) investigating couple-level and cultural factors influencing we-ness formation; and (d) synthesising quantitative and qualitative findings to provide an integrated perspective of the dyadic coping process.

Study 1 quantitatively examined role distinguishability and the association between dyadic coping and HIV-specific support mediated by we-ness. This involved a cross-sectional survey encompassing 234 pairs of Chinese serodiscordant same-sex male couples. Using the actor–partner interdependence mediation model, the findings revealed the following: (a) within Chinese serodiscordant same-sex male couples, roles in dyadic coping strategies and HIV-specific support were indistinguishable, (b) both positive and negative dyadic coping exhibited significant actor effects but nonsignificant partner effects on HIV-specific support within the couples, and (c) we-ness functioned as a mediator connecting dyadic coping to HIV-specific support, demonstrating significant actor–actor and partner–actor effects.

Building on finding (c) from Study 1, Study 2a qualitatively explored the manifestation of we-ness in HIV care and prevention among Chinese serodiscordant same-sex male couples. Twenty couples from Study 1 were interviewed separately in simultaneous face-to-face interviews, using a deductive approach that combined content, thematic, and dyadic interview analysis for data interpretation. The study identified four key themes: (a) a tug-of-war of power, (b) planning for a shared future, (c) a shield of mutual protection, and (d) the hidden words underneath sex.

Drawing upon insights from Study 1 and Study 2a, Study 2b qualitatively explored the couple-level and cultural factors that influence we-ness formation amidst HIV care and prevention efforts. The study revealed a distinctive cultural pattern of negotiated interdependence, where couples selectively engage in dependence and independence across different domains. In HIV care, couples demonstrate strategic independence through misaligned stigma perceptions and detached caregiving practices, representing adaptations to institutional constraints. In prevention, couples maintain adaptive interdependence through culturally congruent strategies, particularly evident in their indirect communication patterns and shared responsibility for sexual safety. Additionally, topic openness emerged as a significant couple-level facilitator, while topic avoidance functioned as a double-edged factor in shaping we-ness formation.

Integrating findings from all three studies through the pillar integration process yielded three key meta-inferences: (a) bilateral we-ness enhancement promotes effective HIV care and prevention, while unilateral enhancement yields mixed outcomes, demonstrating the paradoxical effects of power dynamics in these relationships; (b) couple-level factors significantly influence we-ness formation through complex pathways of reciprocal influence between partners; and (c) cultural patterns of negotiated interdependence fundamentally shape how couples reconstruct traditional practices when managing HIV.

This thesis examines we-ness in HIV care and prevention among Chinese serodiscordant same-sex male couples. Integrating the systemic transactional model of dyadic coping, couple-level minority stress theory, and the concept of we-ness offers novel insights into the complex dynamics shaping couples’ dyadic coping processes. Theoretically, these findings extend our understanding of we-ness formation by revealing how cultural adaptations intersect with healthcare accessibility and social marginalization. The identification of negotiated interdependence as a distinct cultural pattern offers a novel framework for understanding how marginalised couples navigate both relationship dynamics and healthcare systems. Practically, the thesis informs the design of couple-based interventions, suggesting a comprehensive approach that addresses both relationship processes and systemic barriers to healthcare access. This includes the incorporation of communication skills training, perspective-taking activities, and systemic changes in healthcare delivery to foster balanced we-ness development while promoting health equity. By illuminating the multifaceted nature of we-ness formation, this work provides a foundation for future research and interventions, contributing to a more inclusive and effective response to the HIV epidemic in China and beyond.

Date of Award	13 Jan 2025
Original language	English
Awarding Institution	City University of Hong Kong
Supervisor	Xiaonan Nancy YU (Supervisor)