MSM Health: Social Determinants Compared in Australia and China

This report compares the impact of social determinants of health, specifically living environment and discrimination/stigma, on the health and wellbeing of men who have sex with men (MSM) in Australia and China. It highlights that while both countries exhibit discrimination and stigma towards homosexuals, the societal adaptation and overall health outcomes differ. Australia has made significant progress in healthcare and social acceptance, leading to a reduction in HIV/AIDS incidence, while China, with its conservative culture, faces challenges in addressing stigma and improving healthcare access for MSM populations. The report concludes that despite similar challenges, the living environment and societal attitudes play a crucial role in shaping the health and wellbeing of MSM individuals in both countries.

Running head: HEALTHCARE
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Name of the Student
Name of the University
Author Note

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Introduction:
Acquired Immune Deficiency Syndrome or AIDS is a communicable disease caused
by the virus Human Immunodeficiency Virus (HIV). The virus causes an immune deficiency
among the patients and thereby increases their risks of fatal infections. The disease can be
spread by several means such as unprotected sex, blood transfusions and hypodermic needles
(Fauci, 2016). AIDS is considered to be one of the most significant health concerns across the
world and an estimated 1 million deaths have occurred in 2016 due to AIDS. According to
UNAIDS, as of 2017, approximately 36.9 million people were living with AIDS which
includes 1.8 million new diagnosis (Horner & Gopal, 2018; Katz et al., 2018). Moreover, the
risks of AIDS was found to be 27 times higher for men who have sex with other men (MSM)
groups and higher than people injecting drugs, transgender women and female sex workers
(Mimiaga et al., 2018).
Studies by Konda et al. (2017), Hoff et al. (2016) and Stephenson et al. (2015)
explored the patterns of transmission of AIDS among the MSM group and found that a
statistical relation exists between HIV infection and duration of the partnership. According to
the authors, the incidence of HIV decreases in long duration partnerships and shorter duration
of partners have been found to be associated with a higher chance of HIV infection (Hoff et
al., 2016). The relation is also influenced by the concurrency of the relationships, with the
fraction of HIV infection increasing with increase in concurrent relations and shorter duration
of partnerships while a reduced concurrency and longer average duration of relation is
associated with reduced fraction of HIV infections (Stephenson et al., 2015).
Social determinants of heath are factors which can impact the health and wellbeing of
people by affecting their behavior and access to healthcare services. Several social
determinants have been associated with HIV AIDS such as living environment,

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discrimination & stigma, gender & sexuality, healthcare systems and socioeconomic status
(Coleman et al., 2016; Zeglin&Stein, 2015). The aim of this study is to explore the impact of
two social determinants such as loving environment and discrimination & stigma on the
health and wellbeing of MSM group in Australia and China and understand how the society
have adapted to it.
Discussion:
-Discrimination, stigma and social justice in Australia:
According to Lyons et al., (2015), the Australian society generally considers
heterosexuality as an acceptable form of sexual orientation as a result of which homosexuals
and bisexuals often face discrimination and stigmatization. Studies show that almost one out
of seven people from Lesbian, Gay, Bisexual, Transgender and Queer communities fear
homophobic violence and discrimination against them. Violence and discrimination was also
found to be common stressors faced by the MSM groups of LGBTQ communities. Moreover,
the studies also show that 61% of MSM people experience verbal abuse, 18% suffered
physical assaults and 69% experienced some form of homophobia like social exclusion and
anti-homosexual propaganda (Perales & Todd, 2018).This shows how discrimination and
stigmatization against homosexuality is still prevalent in Australia which causes a social
injustice towards them.
Plöderl and Tremblay (2015) pointed out that the risks of mental health conditions as
well as other conditions such as obesity, smoking, alcoholism; drug use and self-harming
behavior are higher among gay and lesbians compared to others. The higher risks are due to
several factors such as rejection from family and friends, bullying and taunting from
schoolmates, homophobic jokes and harassment, threats from others, rejection and
marginalization by the society and a feeling of shame or guilt about their own sexualities due

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to the negative messages about homosexuality (Mundle et al., 2015; O’Donoghue&Guerin,
2017; Kolbert et al., 2018).
- Discrimination, stigma and social justice in China
The problems of discrimination and stigmatization of homosexual people is also
prevalent in China. According to Xie and Peng (2018), one the biggest concerns of people
living with HIV is the exposure of their condition to others without their consent. Studies
have shown that 79.4% of people living with HIV are afraid of gossips, while 52.3% fear
insults and threats against them, 30% fear harassment, and 24.2% fear physical attacks and
26.8% fear exclusion from educational and training opportunities (Choi et al., 2016). The
studies also show that homosexual people are often avoided by people, experience social
isolation, exclusion and injustice and also face judgment about their lifestyles. Such
experiences often affect their health seeking behaviors and can be significant emotional
stressors for them (Zhu et al., 2018). This factor additionally impacts their health and
wellbeing and thus causes a higher incidence of different health conditions among them
(Xie&Peng, 2018).
-Living Environment in Australia
Australia is a culturally diverse country with a huge diversity in terms of language,
religion, culture, history and art and the society is a heterogeneous mix of various cultures
which includes the indigenous and non-indigenous Australians, international students and
immigrants who study or work in Australia (Lyons et al., 2015). Thus Australia has a diverse
socio-cultural environment. The economy of the country is also very strong and has a
significant GDP that is compared to many developed countries. The strong
socioeconomicstatus has enabled a better distribution and accessibility of healthcare services
compared to developing countries (Perales&Todd, 2018).

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For MSM groups, the economic strength of Australia have helped to provide better
treatment and thereby improve their health and wellbeing. Lyons et al., (2015) suggested that
the education system, healthcare systems and employment sector in Australia have developed
significantly since 1990’s which have allowed more people from MSM groups to have access
to better healthcare services as well as education and employment opportunities which have
helped to reduce the incidence of HIV AIDS among them.
-Living Environment in China
China is a rapidly developing economy whit the GDP significantly rising and
healthcare affordability improving throughout the country (Zhu et al., 2018). According to
Choi et al. (2016), these factors have helped to improve the health and wellbeing of MSM
people in China. However, Xie and Peng (2018) also pointed out that a rapidindustrialization
and population explosion have significantly affected the healthcare distribution in the country
which impacts everyone. For people in MSM groups, the living environment has also been
shown to be stressful due to acts of discrimination and stigmatization in education healthcare
and employment sectors, causing their social isolation (Li et al., 2017).
Li et al. (2017) also suggested that a health gap exists between homosexual and
heterosexual people due to a higher prevalence of mental health conditions among them.
According to Zhu et al.(2018), LGBTQ people also have higher incidences of various health
conditions such as HPV infections, cancer, obesity and AIDS. Moreover, they also are less
likely to have health insurances, less likely to fill prescriptions, more likely to use emergency
health services and have higher risks of being refused healthcare services or harassed by
healthcare providers. This shows how the living environment can be significant stressors for
MSM people in China (O’Donoghue&Guerin, 2017; Kolbert et al., 2018).
-How the society has adapted and changed

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Australia: In Australia, the incidence of HIV AIDS has reduced significantly over the
years. This can be attributed to several factors such as developments in healthcare industry
and an increased acceptability towards homosexuality by the Australian people (Lyons et al.,
2015). Even though a biasness towards heterosexuality still exists in Australia, a significant
change have occurred over the years and people now are more acceptable of differences in
sexual preferences (Bretaña et al, 2018). According to Lyons et al., (2015), more Australians
are now comfortable to express their sexual preferencethan before and such change in
outlook can also be seen in popular media such as movies and television where
homosexuality is shows less and less as a taboo.Bretaña et al.(2018) however posits that the
Australian society still has a long way to go towards removing discrimination and
stigmatization.
China:China is a more conservative society than Australia, and the culture significantly
depends on traditional values and beliefs. Due to this, the society has poorly adapted to a
change in perspectives towards sexual orientations (Choi et al., 2016). Even though due to the
impact of globalization, China has more access to internet than ever before, the social
structure of the country has remained the same and cultural traditions still prevails in the
common practices. Due to this stigmatization and discrimination of homosexuals, especially
MSM groups is still common (Li et al., 2017).
Conclusion:
AIDS or Acquired Immunodeficiency Syndrome is a disease caused by the Human
Immunodeficiency Virus or HIV. The disease causes a failure of the immune system making
the body prone to fatal infections. The disease can be sexually transmitted during an
unprotected intercourse. The disease have caused deaths of millions of people. However, the
risks of HIV have been found to be higher among men who have sex with other men or MSM

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group of the LGBTQ community, who have 27 times higher risks of getting infected with
HIV than others. Other studies have shown that the risks of AIDS were also associated with
the length and concurrence of their sexual relationships. Additionally, social determinants of
health such as living environment and discrimination and stigmatization also has significant
impacts on the health of individuals from MSM groups and can also increase their risks of
HIV.
In Australia, stigmatization is still prevalent with one of every seven individual from
LGBTQ community face discrimination, stigmatization, social injustice, abuse, victimization
and social isolation. However the overall health and wellbeing of the LGBTQ communities,
MSM group included have improved over the years. On the other hand, the progress of China
in the same regard is seen to be slower, with the society still not being open minded towards
homosexuality and individuals from MSM groups still fear violence and abuse. Even though
the ill treatment experienced by individuals from MSM groups are almost identical n both
Australia and China, in China a larger proportion of MSM people (61-69%) face such
treatment.

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