In China, an emerging social issue involves a subset of rural women who, because of family and culture, become inadvertently matched up with and married to closeted men who have sex with men (MSM). These women—referred to as Tongqi—often discover they are in a loveless marriage, but any effort to change their situation results in intense backlash, discrimination, and stigma from families, village communities, and even government and healthcare institutions. This study explores the experiences of Tongqi, examining the influence of social interaction, community relationships, and macrostructural factors that coalesce to create an environment of chronic enacted stigma. In-depth interviews were conducted with 59 rural Tongqi, 11 of whom contracted human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) from their spouses. The findings reveal the significant role of extended kinship networks and macrostructural elements, such as hukou (household registration) and government officers, as well as village-level lineage structures. Informant data highlights how lineage relationships, interwoven with gender practices, contribute to the enacted stigma impacting the physical and psychological health of Tongqi. Tongqi report psychological effects such as an array of symptoms reflecting post-traumatic stress, chronic depression, and attempted suicide. Tongqi also report adverse physical health concerns involving reproductive health, unwanted pregnancies, sexually transmitted infections (STIs), and pregnancy complications. These findings helped produce possible policy recommendations to address the most pressing issues faced by Tongqi.

Background: Suicide and self-injury are serious public health concerns, especially in young populations, owing to multiple social, cultural, and gender determinants. Qualitative evidence exploring narratives regarding the factors behind suicide among young women is rare in Pakistan. Objective: The present study aims to explore the complex dimensions of suicide or self-injury among young women of Southern Punjab. Methods: Semi-structured interviews were conducted in a marginalized district in South Punjab, with participants consenting to in-person meetings at their homes or phone interviews. We collected detailed accounts of fifteen deceased girls or self-harm survivors, with insights provided by close relatives of the victims. Results: Our findings identified several conducive factors to suicidality, including receiving insults in front of others, low self-esteem, household pressures, work burdens, unfulfilled romantic desires, feelings of worthlessness, cheating in love, marriage without choice, and engagement in risky behaviors. These causes could be categorized into personal (such as an inferiority complex), social (a lack of family support and frequent conflicts), and cultural factors (forced marriages). Conclusions: Our study advocates for empowering women through education and restricting access to suicide means, such as pesticides or Paraphenylenediamine (PPD). Moreover, the government should take strict measures to discourage the forced marriage of young females in rural contexts. This study highlights the importance of integrating suicide prevention initiatives with research efforts within Pakistan’s healthcare system.

Tongqi - women married to men who have sex with men (MSM) – from rural China encountered multi stigma with their male partners, family, community, local bureaucracies, and national laws, such as the hukou system, form a complex tapestry of life. The analysis navigates through various dimensions of stigma, reflecting systematically on their mutual implications. Social structures, including class and gender, shape societal norms and behaviors. This study explores the under-researched influence of social interaction, community relationships, and macrostructural factors contributing to the enacted stigma experienced by Tongqi Data collected from 59 rural Tongqi, 11 of whom contracted human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDs), reveals the significant role of extended kinship networks and macrostructural elements, such as hukou (household registration) and government officers, in shaping the stigma faced by Tongqi. The importance of village-level lineage structures and dynamics highlights how these lineage relationships, interwoven with gender practices, contribute to the enacted stigma, physical and psychological health, and well-being of Tongqi. These include mental health, post-traumatic stress, depression, functional impairment, and permanent disability. Others include reproductive health, unwanted pregnancies, sexually transmitted infections (STIs), and pregnancy complications.