Supernatural Explanatory Models of Health and Illness and HIV Antiretroviral Therapy Use Among Young Men Who Have Sex with Men in China

Stephen W. Pan, M. Kumi Smith, Richard M. Carpiano, Hongyun Fu, Jason J. Ong, Wenting Huang, Weiming Tang, Joseph D. Tucker

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: In China, men who have sex with men (MSM) shoulder a disproportionate HIV burden. Early initiation and adherence to HIV antiretroviral therapy (ART) will be critical to reversing the HIV epidemic in China, but ART usage remains suboptimal among MSM diagnosed with HIV. One understudied but potentially important factor underpinning suboptimal ART usage is personal belief in supernatural explanatory models of health and illness (supernatural explanatory models). This study examines associations between beliefs in supernatural explanatory models and ART usage among MSM in China. Method: In 2017, an online survey was distributed nationwide throughout China by gay community–based organizations. Eligible study participants were self-identified MSM between 16 and 30 years old who had tested positive for HIV and who had seen a doctor in the last 2 years. Beliefs in supernatural explanatory models were measured using a three-item scale developed specifically for the Chinese population (range, 3–15). Results: Of 73 participants, the majority were currently using ART (83.6%) and 42.5% expressed some endorsement of belief in supernatural explanatory models. However, among 21 participants with the strongest belief in supernatural explanatory models, prevalence of current ART usage was 61.9%. Stronger belief in supernatural explanatory models was significantly associated with lower likelihood of current ART usage (adjusted odds ratio = 0.52; 95% confidence interval = 0.13–0.75). Conclusion: Belief in supernatural explanatory models may be a powerful predictor of ART usage among MSM living with HIV in China. Further studies are needed to corroborate these findings and elucidate mechanisms of association.

Original languageEnglish (US)
Pages (from-to)602-608
Number of pages7
JournalInternational Journal of Behavioral Medicine
Issue number5
StatePublished - Oct 1 2020

Bibliographical note

Funding Information:
This study was funded by the National Institutes of Allergy and Infectious Diseases (grant numbers NIAD1R01AI114310 and NIAID K24AI143471), Fogarty International Center (grant numbers 1D43TW009532 and R25TW009340), and Shenzhen Chronic Disease Hospital. Funders had no role in the study design; collection, analysis, or interpretation of data; writing of the articles; or decision to submit for publication.

Publisher Copyright:
© 2020, International Society of Behavioral Medicine.


  • Gay men
  • HIV
  • Religion
  • Sexual and gender minorities
  • Spirituality


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