AB056. Fragile bubble of “positive living”: an ethnographic study of transitions of status and normalcy among men who have sex with men (MSM) living with HIV in urban Shanghai

Background: As global public health increasingly frames human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) as a manageable chronic disease, there remain gaps in understanding how this framing is adapted, experienced, and internalized by people living with HIV (PLHIV), particularly in non- Western sociocultural contexts. In China, although HIV/AIDS-related policies and treatment access have improved, stigma and stereotypes, especially toward men who have sex with men (MSM) with HIV, persist. These individuals remain largely marginalized and socially invisible. The objective of this study is to show that while “positive living”, a more upbeat and non-pathological view of HIV/AIDS, is possible, it is highly conditional and sustained only through specific support systems and environments.

Methods: This research draws on one year of ethnographic fieldwork at a Shanghai-based non-governmental organization (NGO) supporting PLHIV. It is based on approximately 530 hours of participant observation, including daily NGO activities, PLHIV tea-parties, art support group sessions, meetings with artists and counselors, and the HIVxART exhibition. It also includes 32 in-depth interviews with MSM living with HIV, NGO staff, and art support group team members. These data explore how young MSM with HIV perceive HIV/AIDS, navigate life after status transitions, and test the boundaries of visibility within a fragile yet reassuring “bubble” created by the NGO and its allies.

Results: This study finds that “positive living” emerges through collective labor. From full acceptance to strategic invisibility, participants express a spectrum of responses to their HIV status. The NGO fosters emotional resilience and a sense of normalcy by offering safe spaces for sharing, identity-building, and community bonding. Yet, this bubble is precarious: it can rupture when funding is threatened or when identity exposure risks emerge.

Conclusions: This study demonstrates how the chronic disease narrative of HIV/AIDS intersects with local moral worlds, PLHIV’s complex identities, and lived experiences. It calls for culturally responsive, socially embedded HIV care, which recognizes the conditions and labor required to build and sustain “normalcy” in stigmatized populations.

Keywords: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS); men who have sex with men (MSM); medical anthropology; stigma; urban China