Online survey
With assistance from a local community-based organization (CBO) and the Guangzhou Center for Diseases Control and Prevention (CDC), we conducted a cross-sectional online questionnaire survey with 777 MSM in Guangzhou, China in September 2018. The survey was distributed online to MSM through social media platforms of CBOs and the CDC. Eligibility criteria included: 1) being biologically male at birth, 2) being 16 years old or above, 3) reported ever having sex with men including oral or anal sex, and 4) residing in Guangzhou in the past six months. All survey data were anonymous and confidential, and online consent was obtained before the commencement of the survey. Either 7.5 USD (50 Chinese Yuan) or a free HIV self-test kit was provided to participants as an incentive to participate.
Survey instruments
We collected information about participants’ sociodemographic characteristics including age, residence permit, occupation, heterosexual marital status (never married, engaged or married, and divorced/separated/widowed), annual income, highest education obtained (high school or less, some college, university, and postgraduate), gender identity (male, female, transgender, and unsure), sexual orientation (gay, bisexual, heterosexual, and unsure) and sexual orientation disclosure to people other than their partner(s) (yes/no).
Homoprejudiced violence questionnaire
Twelve homoprejudiced violence items were designed based on previous literature (5, 21, 22). We selected 12 items to cover the four major domains – physical assaults, verbal aggression, psychological abuse, and cyber violence. We translated and adapted the 12 items into the Chinese setting. We used the questionnaire mainly to assess the magnitude of the problem rather than for scale validation. The 12-item homoprejudiced violence questionnaire asked whether a participant had ever experienced any of the following due to their sexual orientation: being gossiped about, name calling, deliberately alienated or isolated, threatened, maliciously called gay, spit on, personal belongings ever been damaged by someone, deprived of economic resources or personal belongings by someone (including family members), personal freedom ever been restricted by someone (including family members), physically harmed (such as being slapped, beaten or kicked), ever been harmed on social media (such as WeChat and Weibo, the Chinese substitutes of WhatsApp and Twitter), ever been harmed through phone calls or messages. The questionnaire was field tested with 10 participants and minor amendments were made for better clarity.
All 12 items used three responses: “yes”, “no” and “do not want to tell”. A new summative variable was generated by adding up the responses (yes coded as 1, no or do not want to tell were coded as 0) of the 12 items to assess the overall prevalence. The summed value 0 was recoded as 0 (no prior experiences of homoprejudiced violence), and the summed values 1 to 12 were recoded as 1 (prior experiences of homoprejudiced violence of any type) (outcome 1). Additionally, one follow-up item asked whether participants had ever committed any of the 12 violent behaviors aforementioned against others due to their sexual orientation (yes, no, do not want to tell) (outcome 2). The Cronbach alpha value was 0.89.
Data analysis
Descriptive analysis was used to describe sample characteristics, including sociodemographic backgrounds and frequencies of violence experiences. The two outcomes were dichotomized for further regression analyses, i.e., the responses “no” and “do not want to tell” were grouped as one category, while the “yes” responses constituted the other category. We conducted univariate and multivariable binary logistic regressions to examine sociodemographic factors associated with homoprejudiced violence. We reported odds ratios and 95% confidence intervals (CIs). Data were analyzed using SPSS, version 25.