Domestic Violence Victimization Among Men Who Have Sex with Men in China During the COVID-19 Lockdown

Abstract

Many countries worldwide have implemented dedicated measures, such as shelter at home, to contain the spread of the COVID-19 virus. However, those mitigation measures may have major implications for individuals living with someone abusive or controlling. Domestic violence (DV) may be one of the unintended consequences of public health measures due to increased various stressors and reduced access to support and services. There has been a lack of empirical research on DV victimization among gender and sexual minorities, a population vulnerable to interpersonal violence and its associated adverse health outcomes. This study investigates the prevalence of DV victimization among men who have sex with men (MSM) in Jiangsu Province, China, during the COVID-19 lockdown and its correlates with COVID-19–related psychosocial and health stressors. A total of 413 MSM were recruited via snowball sampling, venue-based, and internet-based sampling from four cities in Jiangsu Province. After providing informed consent, all participants completed study questionnaires, followed by HIV testing. Over a quarter of the participants (27.4%) reported DV victimization during the COVID-19 lockdown, including experience of verbal, physical, or sexual abuse. After adjusting sociodemographic factors, DV victimization was associated with various adverse experiences during the COVID-19 lockdown, including increased stress or anxiety level, increased alcohol use, and housing instability. Study findings underscore the prevalence of DV victimization among MSM during the COVID-19 pandemic in China. The results can inform public health efforts to raise awareness and address DV victimization among MSM in the low- and middle-income country context during the COVID-19 pandemic. Adequate health and social services and economic resources are also critical to address the needs of MSM experiencing DV victimization.

Keywords

domestic violence men who have sex with men China COVID-19

Introduction

Domestic violence (DV), including intimate partner violence (IPV), among sexual and gender minorities is a significant public health issue worldwide (Kimmes et al., 2019). In China, the world’s most populous country, gay, bisexual, and other men who have sex with men (MSM) largely remain hidden and often experience strong familial and cultural pressure to perform heterosexual marriage and procreate (Liu et al., 2018). In this high-stigma context, Chinese MSM are at risk for mental health issues and STI/HIV (Dong et al., 2019; Sun et al., 2020b, 2020c). For example, four studies with Chinese MSM found a lifetime prevalence of IPV between 23.7% and 35.5% (Davis et al., 2015; Liu et al., 2018; Wang et al., 2020; Wei et al., 2019). Further, MSM who experienced DV victimization were more likely to engage in sexual risk behaviors (Davis et al., 2015; Wei et al., 2019), to report a diagnosis of STI/HIV (Davis et al., 2015; Liu et al., 2018), suicidality (Wei et al., 2020), or depression (Peng et al., 2020).

During the COVID-19 pandemic, many countries have been adopting dedicated measures to contain the spread of the virus. While the mitigation measures, such as shelter at home, can effectively reduce the transmission of the infectious disease, they may also have major implications for individuals living with someone abusive or controlling (Bradbury-Jones & Isham, 2020). Economic distress due to unemployment or reduced income and other psychosocial stressors as well as a potential increase in negative coping mechanisms (e.g., excessive alcohol use) during a pandemic can lead to DV (Benson et al., 2003; Usher et al., 2020). Stringent restrictions on movement and widespread organizational closure related to COVID-19 can limit the opportunity to escape and seek help for DV victims. Emerging evidence suggests an upsurge in DV during the COVID-19 pandemic globally (Allen-Ebrahimian, 2020; Bradbury-Jones & Isham, 2020; Mahase, 2020). For example, hotline calls of DV against women in Hubei province, China, a hotspot for COVID-19, tripled during the shelter-in-place mandate in February 2020 compared to the same period in 2019 (Allen-Ebrahimian, 2020).

Although high DV during the pandemic among women in heterosexual relationships has been reported (Allen-Ebrahimian, 2020; Bradbury-Jones & Isham, 2020; Peterman et al., 2020), less is known regarding the DV victimization among sexual and gender minorities. A recent study found a high prevalence of IPV victimization (12.6%) during the COVID-19 lockdown period from an online sample of MSM in the United States (Stephenson et al., 2021). The state-enforced stay-at-home order in China was strictly enforced during the Chinese New Year holidays, a time when many people returned to their hometown and reunited with family members. Anecdotal reports have described interpersonal and emotional conflicts that sexual minorities in China experienced during the COVID-19 lockdown with their families (Lakshmi & Yu, 2020). It can be attributed to family members' stigma against homosexuality, strong cultural values promoting filial piety and heterosexual marriage, and reduced social connectedness with the LGBTQ community during the pandemic (Sun et al., 2020a, 2020b, 2020c). Therefore, the risk of DV victimization among the Chinese MSM may be exacerbated due to the state-enforced stay-at-home order during the COVID-19 pandemic.

This study aims to describe the prevalence of DV victimization during the COVID-19 lockdown among MSM in Jiangsu province, China, and explore its correlates with COVID-19-related psychosocial and health stressors. Using a cross-sectional survey, we investigated various types of DV (physical, verbal, and sexual) and relationships of the perpetrator(s) (e.g., intimate partner and family members) as well as various adverse impacts of COVID-19. While the study was primarily exploratory, we hypothesized that experiencing DV victimization was associated with experiencing other psychosocial and health stressors, such as worse mental health, during the COVID-19 lockdown. Findings can inform public health efforts to raise awareness and address DV victimization among MSM during the COVID-19 pandemic.

Methods

Recruitment and Study Procedure

Data were collected in four cities (Nanjing, Zhengjiang, Suzhou, Wuxi) in Jiangsu Province, China, as part of the annual National HIV Sentinel Surveillance data collection. Located in southeastern China, Jiangsu province has a population of over 80 million. Following the Chinese government’s recognition of the COVID-19 epidemic, Jiangsu Province enforced a “Level-1 Public Health Emergency Response” between January 24th, 2020 and March 28th, 2020 (Jiangsu government office, 2020b, 2020a).

Recruitment took place between June 26th, 2020 and August 19th, 2020. Participants were recruited via snowball sampling, venue-based, and internet-based sampling. Inclusion criteria were (a) ≥18 years old, (b) male at birth, (c) had anal or oral sex with men in the past year, and (d) reside in Jiangsu, China. All eligible participants were invited to one of the survey sites located in the local CDC to complete a face-to-face interview and provide a blood sample for HIV testing. Those who tested positive were then notified and linked to appropriate medical care. The local ethics committee approved the study.

Instruments

Dependent variable

The dependent variable was DV victimization during the COVID-19 lockdown. It was assessed by participants’ self-report of the frequency (“never,” “sometimes,” “fairly often,” and “very often”) of experiencing at least one type of DV, i.e., verbal, physical, or sexual violence victimization during the COVID-19 lockdown: (1) “Someone living in the same house yelled at you or said things to you that made you feel bad about yourself, embarrassed you in front of others, or frightened you”; (2) “Someone living in the same house did things like push, grab, hit, slap, kick, or throw things at you during an argument or because they were angry with you”; and (3) “Any unwanted or coerced physical contact, touching, kissing, fondling, rubbing, oral sex, anal sex.” A dichotomized variable DV victimization was constructed if participants reported any of these experiences “sometimes,” “fairly often,” or “very often” versus “never.” For those participants who reported any of these experiences “sometimes,” “fairly often,” or “very often,” they were asked to describe their relationship with the perpetrator(s) (e.g., same sex partner, opposite sex partner/wife/girlfriend, and family member).

Independent variables: Participants reported sociodemographic characteristics, including age, years of residence in their local city, and relationship status. HIV status was based on the HIV testing results. Participants reported various changes in their mental health (i.e., stress or anxiety level), illicit drug and alcohol use, access to social support and health care, and the number of paid work hours compared to the pre-pandemic period. Response options included “decreased due to the pandemic,” “not changed due to the pandemic,” and “increased due to the pandemic.” In addition, participants reported (yes/no) if they had become homeless or had to live with friends or relatives because of COVID.

Recent depressive symptoms were assessed via the Patient Health Questionnaire-2 (Kroenke et al., 2001), a brief screening tool for depression. Participants reported experiences of depressive symptoms (e.g., feeling down, depressed, or hopeless) in the past 2 weeks with response options “not at all,” “several days,” “more than half the days,” or “nearly every day.” A cutoff score of ≥ 3 indicates the presence of depressive symptoms (Gilbody et al., 2007).

Data Analysis

Descriptive statistics were used to summarize sample characteristics, including frequencies of verbal, physical, and sexual violence victimization experienced during the COVID-19 lockdown and the perpetrator’s relationship (s) of each type of violence. We used bivariate analysis (t-statistics, Chi-square) to explore potential sociodemographic characteristics of DV victimization and identify correlations of experiencing at least one type of violence during the COVID-19 lockdown. Adverse experiences during the COVID-19 lockdown that was statistically significant (p < .05) in the bivariate analysis and sociodemographic characteristics were included in the final multivariate logistic regression model. All analyses were performed using Stata Version 15.0.

Results

Sample Characteristics

A total of 413 MSM in Jiangsu participated in the study. Table 1 presents the prevalence of three types of DV victimization during the COVID-19 lockdown: 21.6% reported verbal violence, 10.2% experienced physical violence, and 9.2% reported sexual violence. Over a quarter of the participants (27.4%) reported experiencing at least one type of DV victimization. Family members and friends were the most frequent sources of verbal violence; family members, friends, and sexual partners were the most frequent sources of physical violence; same sex partners were the most frequent sources of sexual violence.

Table 1.

Domestic violence victimization during the COVID-19 lockdown among men who have sex with men (MSM) in Jiangsu, China (N = 413).

Domestic Violence	N (%)
Verbal violence (yelled at you or said things to you that made you feel bad about yourself, embarrassed you in front of others, or frightened you)
Frequency of verbal violence during the lockdown
Very often	4 (1.0)
Fair often	4 (1.0)
Occasionally	81 (19.6)
Never	324 (78.4)
Verbal violence from	N = 89
Family member only	21 (23.6)
Friend only	18 (20.2)
Same sex partner only	16 (18.0)
Opposite sex partner/wife/girlfriend only	10 (11.2)
Opposite sex partner/wife/girlfriend and family member	4 (4.5)
Same sex partner and family member	4 (4.5)
Other with other kinds of relationships	4 (4.5)
Same sex partner, family member and friend	3 (3.4)
Family member and friend	2 (2.3)
Opposite sex partner/wife/girlfriend and friend	2 (2.3)
Same sex partner and friend	2 (2.3)
Friend and other	1 (1.1)
Opposite sex partner/wife/girlfriend, family member and friend	1 (1.1)
Same sex partner and opposite sex partner/wife/girlfriend	1 (1.1)
Physical violence (push, grab, hit, slap, kick, or throw things at you during an argument or because they were angry with you)
Frequency of physical violence during the lockdown
Very often	2 (0.5)
Fair often	1 (0.2)
Occasionally	39 (9.4)
Never	371 (89.8)
Physical violence from	N = 42
Family member only	9 (21.4)
Friend only	8 (19.0)
Same sex partner only	9 (21.4)
Opposite sex partner/wife/girlfriend only	7 (16.7)
Opposite sex partner/wife/girlfriend and family member	2 (4.8)
Same sex partner and friend	2 (4.8)
Same sex partner, family member and friend	2 (4.8)
Opposite sex partner/wife/girlfriend, family member and friend	1 (2.4)
Opposite sex partner/wife/girlfriend and friend	1 (2.4)
Same sex partner and opposite sex partner/wife/girlfriend	1 (2.4)
Sexual violence (unwanted or coerced physical contact, touching, kissing, fondling, rubbing, oral sex, anal sex)
Frequency of sexual violence during the lockdown
Very often	1 (0.2)
Fair often	2 (0.5)
Occasionally	35 (8.5)
Never	375 (90.8)
Sexual violence from	N = 38
Same sex partner only	17 (44.7)
Opposite sex partner/wife/girlfriend only	5 (13.2)
Friend only	9 (23.7)
Same sex partner and friend	3 (7.9)
People with other kinds of relationships only	2 (5.3)
Opposite sex partner/wife/girlfriend and friend	1 (2.6)
Same sex partner and opposite sex partner/wife/girlfriend	1 (2.6)

Correlates of DV during the COVID-19 lockdown

Table 2 presents the sample characteristics and correlates of DV victimization during the COVID-19 lockdown. Age, number of years of living in the local city (indication of migrant status), marital status, and HIV status were not significantly associated with DV victimization during the COVID-19 lockdown. Experiencing at least one type of DV victimization during the COVID-19 lockdown was associated with various adverse impacts from COVID-19 in the bivariate analyses (Table 2). Compared to those who did not experience DV, DV victims reported significant increased stress or anxiety level (69.0% vs. 47.3%, p < .001), increased alcohol use (27.4% vs. 15.0%, p = .004), increased difficulty accessing health care (34.5% vs. 16.3%, p <.001), decreased number of paid work hours (56.6% vs. 39.7%, p = .002), and increased housing instability (15.9% vs. 4.7%, p < .001). Participants with experience of DV victimization were more likely to exhibit depressive symptoms at the time of assessment than those who did not experience DV (20.4% vs. 6.7%, p < .001).

Table 2.

Correlates of domestic violence victimization among MSM during the COVID-19 lockdown in Jiangsu, in China (N = 413).

Characteristics	N (%)	Experience of DV Victimization (n = 113)	No Experience of DV Victimization (n = 300)	p-value
Age, mean (range)	32.4 (18–66)	33.4 (18–62)	32.0 (18–66)	0.23
Years living in local cities
≤2 years	118 (28.6)	33 (29.2)	85 (28.3)	0.86
>2 years	295 (71.4)	80 (70.8)	215 (71.7)
Marital status
Single	272 (65.9)	73 (64.6)	199 (66.3)	0.54
Married	110 (26.7)	34 (30.1)	76 (25.3)
Cohabitation	9 (2.2)	1 (0.9)	8 (2.7)
Divorced or widowed	22 (5.3)	5 (4.4)	17 (5.7)
HIV status
Negative	373 (90.3)	102 (90.3)	271 (90.3)	0.98
Positive	40 (9.7)	11 (9.7)	29 (9.7)
Stress or anxiety level has increased during the lockdown
No	193 (46.7)	35 (31.0)	158 (52.7)	<.001
Yes	220 (53.3)	78 (69.0)	142 (47.3)
No	407 (98.6)	111 (98.2)	296 (98.7)	0.74
Yes	6 (1.5)	2 (1.8)	4 (1.3)
No	337 (81.6)	82 (72.6)	255 (85.0)	0.004
Yes	76 (18.4)	31 (27.4)	45 (15.0)
Connection to friends has decreased during the lockdown
No	285 (69.0)	72 (63.7)	213 (71.0)	0.15
Yes	128 (31.)	41 (36.3)	87 (29.0)
No	325 (78.7)	74 (65.5)	251 (83.7)	<.001
Yes	88 (21.3)	39 (34.5)	49 (16.3)
Number of paid work hours has decreased during the lockdown
No	230 (55.7)	49 (43.4)	181 (60.3)	0.002
Yes	183 (44.3)	64 (56.6)	119 (39.7)
Become homeless or had to live with friends or relatives during the lockdown
No	381 (92.3)	95 (84.1)	286 (95.3)	<.001
Yes	32 (7.8)	18 (15.9)	14 (4.7)
Recent depression scoring by PHQ-2
No depressive symptoms	370 (89.6)	90 (79.6)	280 (93.3)	<.001
Having depressive symptoms	43 (10.4)	23 (20.4)	20 (6.7)

Table 3 presents the results of the multivariate logistic regression model of DV victimization during the COVID-19 lockdown. Participants who reported increased stress or anxiety level (AOR: 1.98, 95% CI: 1.20, 3.27), housing instability (AOR: 2.54, 95% CI: 1.08, 5.56), and recent depressive symptoms (AOR: 2.73, 95% CI: 1.33, 5.60) were significantly more likely to report DV victimization. Increased alcohol use during the COVID-19 lockdown was marginally significantly associated with DV victimization (AOR: 1.76, 95% CI: 0.97, 3.20). Variance inflation factor (VIF) analysis did not suggest multicollinearity (VIF values < 3).

Table 3.

Multivariate logistic regression of domestic violence victimization among MSM during the COVID-19 lockdown in Jiangsu, in China (N = 413).

Characteristics	OR^a (95% CI^b)
Age, mean (range)	1.02 (0.99,1.05)
Years living in local cities
≤2 years	Reference
>2 years	0.88 (0.50,1.53)
Marital status
Single	Reference
Married	0.99 (0.50,1.95)
Cohabitation	0.29 (0.04,2.77)
Divorced or widowed	0.50 (0.15,1.66)
HIV status
Negative	Reference
Positive	1.16 (0.15,1.66)
Stress or anxiety level has increased during the lockdown
No	Reference
Yes	1.98 (1.20,3.27) **
Alcohol use has increased during the lockdown
No	Reference
Yes	1.76 (0.97,3.20)+
Difficulty accessing health care has increased during the lockdown
No	Reference
Yes	1.46 (0.82,2.62)
Number of paid work hours has decreased during the lockdown
No	Reference
Yes	1.27 (0.78,2.09)
Become homeless or had to live with friends or relatives during the lockdown
No	Reference
Yes	2.45 (1.08,5.56)*
Recent depression scoring by PHQ-2
No depressive symptoms	Reference
Having depressive symptoms	2.73 (1.33,5.60)**

+p<.10, *p<.05, **p<.01.

^aOR: Odds Ratio.

^bCI: Confidence Interval.

Discussion

To our knowledge, this is one of the first empirical studies concerning the experience of DV among MSM during the COVID-19 lockdown. Due to stringent prevention efforts, China has successfully contained the COVID-19 outbreak (Salzberger et al., 2020). However, DV may be one of the negative consequences of China’s massive and strict stay-at-home efforts. Over a quarter (27.3%) of MSM in our sample reported DV victimization during the COVID-19 lockdown, which is much higher than the prevalence (12.6%) reported in a recent study of MSM in the United States (Stephenson et al., 2021). As previous research on DV among Chinese MSM has only assessed lifetime prevalence (Davis et al., 2015; Liu et al., 2018; Wang et al., 2020; Wei et al., 2019), we do not know if this represents an increasing trend of DV victimization in this population. Nonetheless, this concerning prevalence reflects a need to address DV victimization among a highly marginalized population during the pandemic.

We also identified several correlates of DV victimization during the COVID-19 lockdown, including increased stress or anxiety level, increased alcohol use, housing instability due to COVID-19, and recent depressive symptoms. Stringent stay-at-home orders may have led to a syndemic of worsened mental health, increased substance use, and DV victimization ((Stephenson et al., 2021)). It is also concerning that participants experiencing DV victimization were more than twice as likely to become homeless or have to stay with friends or relatives during the pandemic than those without experiencing DV victimization. Although we cannot draw any causal inference between housing instability and DV victimization, it is evident there is an urgency to address multiple social, economic, and health needs of MSM experiencing DV victimization during a pandemic. However, LGBTQ service agencies worldwide, particularly those in low- and middle-income countries, are often under-funded and have experienced the strain of an ever-increasing workload and diminishing resources during the COVID-19 pandemic (Salerno et al., 2020). Policymakers must raise awareness of DV among vulnerable populations in the context and aftermath of the pandemic and ensure equitable distribution of resources to mitigate its consequences.

Contrary to prior research (Davis et al., 2015; Liu et al., 2018), we did not find DV victims more likely to test positive for HIV. One possible explanation is the study’s methodology. Prior research inquired about lifetime DV and its relationship with HIV, compared to our focus on the experience of DV during the COVID-19 lockdown. Longitudinal follow-up of this sample may be needed to understand whether DV during the pandemic is prospectively associated with HIV risk after the COVID-19 lockdown.

Several study limitations should be noted. First, this sample of MSM was recruited from four cities in Jiangsu Province (northeast of China) and is not representative of MSM in other areas of China. Therefore, the findings may not be generalizable. Second, the cross-sectional method precludes any causal inferences. For instance, adverse impacts of COVID-19, such as housing instability, can be risk factors for DV victimization and also are the consequences of DV victimization. The lack of longitudinal data also prevents any inferences about a potential increasing trend of DV among MSM during the COVID-19 lockdown. Third, we assessed few demographic variables. For instance, lower socioeconomic status may be a key demographic characteristic for DV-experienced MSM, yet this was not assessed. Without a better understanding of the participants’ socioeconomic background, we are cautious of the generalizability of the findings. Fourth, this study includes individuals who are under the age of 21, though are old enough to provide written informed consent without parental permission. A separate, age-specific study of children under the age of 18 is warranted. Fifth, although the reported prevalence of depression in this sample was notably lower than previous research (D. Wei et al., 2020), we caution against the interpretation of improved mental health given potential issues with the measurement. PHQ-2 is a brief screening tool, and a more comprehensive measure would have provided a more accurate understanding of depression among Chinese MSM during the COVID-19 lockdown.

Conclusions

DV victimization during the COVID-19 lockdown was prevalent among MSM in Jiangsu, China. DV victimization was associated with various social, economic, and health vulnerabilities during the COVID-19 pandemic. Findings of the current study raise concerns about the needs and experiences of DV victimization among a sample of MSM in China as a way of drawing attention to some of the unfortunate and troubling paradoxes of strict public health measures to control a pandemic, not in opposition to them. Public health actions, including multi-level interventions, are needed to address the consequences of DV victimization among MSM in China and potentially other global regions.

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research is supported by National Institute of Health (R21MH118945). Work by Shufang Sun is also supported by National Institute of Health (K23AT011173).

ORCID iDs

Don Operario

Cui Yang

Author Biographies

Shufang Sun, PhD is an Assistant Professor in the Department of Behavioral and Social Sciences at Brown University School of Public Health. Dr. Sun’s research focuses on understanding minority stress and mental health among marginalized populations including LGBTQ individuals, as well as minority health promotion through innovative, evidence-based methods including mHealth and mindfulness-based interventions.

Xiaoming Sun, MHS, was a student at the Johns Hopkins Bloomberg School of Public Health. Ms. Sun has extensive experience with social and behavioral research of marginalized populations in China.

Chongyi Wei, PhD, is an Associate Professor at Department of Health Behavior, Society, and Policy, Rutgers University School of Public Health. Dr. Wei’s main research interests focus on reducing disparities in HIV infection among sexual minority men, particularly in China and other parts of southeast Asia. His work has included conducting extensive HIV behavioral epidemiology, examining acceptability and feasibility of innovative prevention strategies, and developing and evaluating individual- and community-based intervention trials among sexual minority men in China/Asia.

Lingen Shi, MD, PHD, works at institute of STI and HIV/AIDS prevention and control, Jiangsu provincial center for disease control and prevention. Dr. Shi’s main research focuses on epidemiology on STI and HIV, surveillance on STI and HIV. Dr. Shi was one of the key investigators on improving HIV testing among sexual minority men using social marketing. He is conducting a large cohort study on social and psychological impacts among patients taking antiretroviral therapy.

Ying Zhang, MPH, is a student in the School of Public Health at Southeast University. Miss Zhang’s main research interests focus on epidemiological survey and acceptability and feasibility of biomedical prevention approach (e.g., pre-exposure prophylaxis) among MSM in Jiangsu province, China.

Don Operario, PhD, is Professor of Public Health in the Department of Behavior and Social Sciences in the School of Public Health. Dr. Operario’s research addresses the social psychological determinants of HIV, mental health, and related health issues (substance use, structural violence, access to services) in historically marginalized communities, with an emphasis on developing and evaluating theory-based social and behavioral interventions that are relevant for delivery in complex communities. His research area also concerns the lived experiences associated with social inequality, with an emphasis on understanding the perspectives of intersectional identities and addressing health and psychosocial disparities. His NIH-funded projects examine these public health issues among racial and ethnic minority populations as well as sexual and gender minority populations in the United States, the Philippines, China, South Korea, Kenya, and South Africa.

Hongjing Yan, MD, MPH, is a Professor at Institute of HIV/AIDS Prevention and Control, Jiangsu Provincial Center for Disease Control and Prevention. Dr. Yan’s main research interests focus on epidemiological survey and behavioral interventions among people at high risk of HIV such as men who have sex with men, commercial sex workers, people who use drugs and transgender women in Jiangsu province, China. Dr. Yan has collaborated with multiple research institutes in the United States to develop HIV prevention and care programs to control the HIV/AIDS epidemic driven by high-risk populations in China.

Nicholas Zaller, PhD, is a Professor in the College of Public Health, Department of Health Behavior and Health Education at the University of Arkansas for Medical Sciences. Dr. Zaller has more than a decade of experience working with individuals at high risk for HIV infection both domestically and internationally. In addition to his HIV prevention research in China, Dr. Zaller have led research on MSM populations in the United States.

Cui Yang, PhD, is an Associate Professor in the Department of Health, Behavior and Society at Johns Hopkins Bloomberg School of Public Health. Dr. Yang’s research incorporates innovative approaches to better understand and intervene the independent and combined influence of individual, network (sociometric and egocentric), and environmental (built and social) factors on disease transmission dynamics and risk behaviors among marginalized populations in both domestic and international settings. Dr. Yang is the Principal Investigator of multiple NIH-funded projects on sexual and gender minority health in Baltimore and in China.

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