Navigating Turbulent Waves of Emotions: Multi-Level Stress and Coping Among Chinese Men Who Have Sex with Men Living with HIV.

Men who have sex with men (MSM) bear a disproportionate burden of HIV in China and are particularly vulnerable to mental health challenges. This study is phase one of a multi-phase project that aimed to identify unmet needs of MSM living with HIV to inform the development of a multi-level intervention. We interviewed 24 stakeholders through videoconferencing, including 15 MSM living with HIV, five staff from a community-based organization serving gender and sexual minority individuals, and four staff from the Centers for Disease Control and Prevention in Shanghai, China. We conducted content analysis using inductive and deductive coding and identified the following themes: 1) Navigating Turbulent Waters: multi-level stress currents; 2) Mapping Anchors: multifaceted support network; 3) Staying Afloat: Daily strategies and functioning; and 4) Charting New Courses: paths for intervention. Examining the stress and coping process among MSM living with HIV from a socio-ecological lens is especially important in the collective cultural context. The interactive nature of the stress from multiple socio-ecological levels, lack of individual coping skills, and scarcity of psychosocial services highlighted the importance of community-based, multi-level interventions to meet the needs of MSM living with HIV in China.