Negotiating Intimacy and Silence: Family Disclosure Strategies Among Young Chinese Men Who Have Sex with Men Living with HIV

Background and Purpose: In China’s family-centered cultural context, young men who have sex with men (MSM) living with HIV must navigate the intersecting stigma associated with sexual minority identity and HIV within relationships shaped by filial obligation, family reputation, and expectations of heterosexual marriage. Existing disclosure research has largely been grounded in Western contexts and has often treated sexual identity and HIV status as separate domains. Less is known about how these stigmatized identities are negotiated together within Chinese families, or how disclosure and concealment reshape family relationships over time. This study addresses this gap by examining how young Chinese MSM living with HIV disclose, partially disclose, or withhold their sexual orientation and HIV status within family contexts, and how these processes reconfigure intimacy, obligation, and care.

Methods: This study employed Charmaz’s constructivist grounded theory approach. Data were drawn from in-depth, semi-structured online interviews with 24 Chinese MSM living with HIV, aged 18 to 30, recruited from a community-based online survey conducted in 2020. Interviews lasted approximately two hours and explored participants’ experiences of disclosing or concealing their sexual orientation and HIV status within family relationships. All interviews were conducted in Mandarin, transcribed, and analyzed through initial, focused, and theoretical coding, supported by NVivo. The analysis emphasized participants’ lived experiences and the relational and cultural contexts in which disclosure decisions were made.

Findings: Analysis identified five primary disclosure strategies: (1) prior disclosure of sexual orientation followed by HIV disclosure, (2) prior disclosure of sexual orientation with withheld HIV disclosure, (3) simultaneous disclosure of both identities, (4) non-disclosure of both identities, and (5) disclosure of HIV status while withholding sexual orientation. These strategies were fluid, relational, and shaped by participants’ efforts to manage stigma, preserve family ties, and navigate moral expectations. Findings show that disclosure is not a one-time act of identity revelation, but an ongoing relational process. Participants often mobilized the unequal moral meanings attached to HIV and sexual minority identity. While same-sex sexuality was frequently viewed as morally disruptive to family continuity, HIV could sometimes be interpreted through a discourse of illness and caregiving, allowing participants to access care while deflecting attention from sexual identity. To capture these dynamics, the study develops the concept of relational reconfiguration, referring to how family relationships are reorganized through boundary management, moral recalibration, and role redistribution. The findings also point to an ethics of ambiguity, in which partial disclosure, silence, and strategic opacity function as culturally grounded practices for sustaining intimacy under intersecting stigma.

Conclusion and Implications: This study challenges individualistic and binary models of disclosure by showing that family disclosure among young Chinese MSM living with HIV is relational, iterative, and culturally embedded. For social work practice, the findings suggest that disclosure support should move beyond encouraging full openness as a universal goal and instead attend to partial, staged, and family-sensitive strategies. More broadly, the study highlights the need for culturally grounded interventions and family-informed stigma reduction efforts that recognize how care, silence, and moral obligation coexist within Chinese family life.