Mapping Online Community Spaces Through Online Focus Group Discussions Among Gay, Bisexual, and Other Men Who Have Sex With Men in Guangdong, China: Implications for Human Immunodeficiency Virus/Sexually Transmitted Disease Prevention Services

A study in China among gay, bisexual, and other men who have sex with men explored the use of online spaces for sexually transmitted disease engagement, with implications for differentiated health promotion messaging. Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5.Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM.5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet. 11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services.14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5. Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM.5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services.14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5.Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM.5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services. 14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5.Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM. 5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services.14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5.Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM.5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services.14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services. 1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5.Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM.5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact. 11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services.14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5. Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM.5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services.14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5.Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM.5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services. 14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.Background Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services.We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis.Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were Chinese platforms (vs. non-Chinese) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces.Although broad-based, GBMSM-specific messaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces.For further references, please see "Supplemental References," http://links.lww.com/OLQ/B5.Gay, bisexual, and other men who have sex with men (GBMSM) in China have integrated online websites and smartphone apps into their everyday lives,1 but nevertheless continue to face substantial barriers to accessing health services due to stigma associated with their sexual orientation.2 Such stigma manifests in several ways, including stigmatizing attitudes by the public and health care workers toward GBMSM, as well as internalized stigma among GBMSM.3,4 The fear of disclosure as well as measures of internalized and perceived stigma have been found to be barriers to the uptake of HIV testing, as well as associated with sexual behaviors that increase the risk of HIV among Chinese GBMSM. 5-7 These dynamics therefore place key populations like Chinese GBMSM at a greater risk of HIV acquisition compared with the general population.8Online spaces, which we define as Internet spaces and platforms where individuals may interact or seek information, have become more common in many countries. Online spaces provide GBMSM an opportunity to remain anonymous in the face of prevailing stigma.9 For Chinese GBMSM, online spaces have contributed to community building, extending public spaces, and promoting the online visibility of sexual minorities.10 Since the advent of the Internet and smartphones, Internet technologies and realities have profoundly impacted the ways in which GBMSM interact.11 Online spaces are also instrumental in reaching some subpopulations of GBMSM. Specifically, GBMSM who are younger, less likely to identify as gay, and reported lower levels of community connectedness may be more likely to use the Internet.11Given the salience of online spaces for GBMSM, online interventions have the potential to positively benefit GBMSM, especially in the context of stigma from society. Online interventions have also been effective in engaging Chinese GBMSM, including in the context of antiretroviral therapy adherence for GBMSM living with HIV12 and mobile phone interventions to promote HIV testing13 as well as for crowdsourcing to develop relevant HIV/sexually transmitted disease (STD) prevention services.14,15 More importantly, such online interventions have the potential to reach Chinese GBMSM who may not disclose their sexual orientation to doctors or seek sexual health services.Although online interventions may be useful for sexual health, most online sexual health research focuses on high-income countries. Fewer studies have examined sexual minorities in low- to middle-income countries. The limited literature has focused on describing relevant spaces for sexual health among sexual minorities, such as the dating practices of GBMSM on dating and hook-up apps,16 but not articulating the implications of such findings for HIV/STD services.1,17,18 This is important to help ensure that sexual health programming and prevention messaging are culturally tailored to varying online spaces. The purpose of this study was to examine online GBMSM community spaces in China and implications for HIV/STD prevention and sexual health services.