{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:58:58Z","timestamp":1791583138903,"version":"4.3.4"},"reference-count":60,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>HIV\/AIDS stigma remains a major barrier to public health intervention and social inclusion. In China, short-video platforms, such as Douyin, have become important spaces where people living with HIV\/AIDS share daily-life narratives and receive public responses. However, little is known about how public responses to these narratives vary geographically, or how regional sociodemographic and epidemiological contexts are associated with digital stigma and support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to examine the thematic structure, spatial heterogeneity, and macro-level correlates of public responses to daily-life narratives shared by people living with HIV\/AIDS on Douyin in China, with a focus on spatially varying correlational patterns of digital HIV\/AIDS stigma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We constructed a corpus of 174,394 public comments from Douyin videos created by people living with HIV\/AIDS. DeepSeek R1 671B was used to classify comments into 9 substantive themes and 1 residual \u201cothers\u201d category. Provincial topic indices were calculated by normalizing thematic comment counts by mobile internet access users. We then combined the least absolute shrinkage and selection operator feature selection, ordinary least squares, and spatial econometric models, residual spatial autocorrelation diagnostics, false discovery rate correction, and Shapley Additive Explanations (SHAP)\u2013geographic information system (GIS) interpretation to examine global associations and localized variable contributions across 31 provincial-level units in mainland China.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Moral judgment and attribution of blame were the most prevalent substantive theme (41,663\/174,394, 23.89%), followed by disease knowledge and transmission discussion (23,344\/174,394, 13.39%), and support, encouragement, and humanitarian care (18,101\/174,394, 10.38%). Spatial analysis showed pronounced geographic heterogeneity in both stigma- and support-oriented public responses. HIV incidence was positively associated with disease knowledge, social impact discussion, moral judgment, and support, while gender ratio was significantly associated with moral judgment and related evaluative themes. SHAP-GIS further revealed stronger positive contributions of HIV incidence to moralizing discourse in several southwestern provinces and a marked north-south pattern in the contribution of gender ratio.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Digital public responses to daily-life narratives shared by people living with HIV\/AIDS in China are geographically uneven and associated with place-based sociodemographic and epidemiological contexts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/93007","type":"journal-article","created":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:45:46Z","timestamp":1791582346000},"page":"e93007-e93007","source":"Crossref","is-referenced-by-count":0,"title":["Spatial Heterogeneity of Digital HIV\/AIDS Stigma in China: Cross-Sectional Ecological Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7501-2124","authenticated-orcid":false,"given":"Pu","family":"Zhang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3768-0639","authenticated-orcid":false,"given":"Yiliang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7444-2547","authenticated-orcid":false,"given":"Zheng","family":"Wei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9161-8954","authenticated-orcid":false,"given":"Na","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6026-1083","authenticated-orcid":false,"given":"Pan","family":"Hui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,9]]},"reference":[{"issue":"2","key":"R1","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.clindermatol.2024.02.001","article-title":"The global burden of HIV","volume":"42","author":"Payagala","journal-title":"Clin Dermatol"},{"issue":"23","key":"R2","doi-asserted-by":"publisher","first-page":"2799","DOI":"10.1097\/CM9.0000000000001842","article-title":"Prevention and control of HIV\/AIDS in China: lessons from the past three decades","volume":"134","author":"Xu","journal-title":"Chin Med J (Engl)"},{"key":"R3","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2023.103076","article-title":"\u201cFor my safety and wellbeing, I always travel to seek health care in a distant facility\u201d\u2014the role of place and stigma in HIV testing decisions among GBMSM \u2013 BSGH 002","volume":"83","author":"Zigah","journal-title":"Health & Place"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2025.103592","article-title":"Negotiating risk and resilience: HIV prevention practices among hill tribe communities in northern Thailand","volume":"97","author":"Laingoen","journal-title":"Health & Place"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.26408","article-title":"The impact of the National Syphilis Prevention Program on the prevalence of syphilis among people living with HIV in China: a systematic review and meta-analysis","volume":"28","author":"Zeng","journal-title":"J Int AIDS Soc"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2023.115868","article-title":"The roles of social norms and leadership in health communication in the context of COVID-19","volume":"323","author":"Akf\u0131rat","journal-title":"Soc Sci Med"},{"issue":"1","key":"R7","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1007\/s13753-026-00693-2","article-title":"Reconfiguring responsibility: an empirical analysis of crisis discourse and situational crisis communication on Douyin","volume":"17","author":"Zhang","journal-title":"Int J Disaster Risk Sci"},{"issue":"3-4","key":"R8","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1007\/s40636-022-00259-z","article-title":"Douyin, storytelling, and national discourse","volume":"9","author":"Fung","journal-title":"Int Commun Chin Cult"},{"key":"R9","doi-asserted-by":"publisher","DOI":"10.2196\/76745","article-title":"Decoding HIV discourse on social media: large-scale analysis of 191,972 tweets using machine learning, topic modeling, and temporal analysis","volume":"27","author":"Zhan","journal-title":"J Med Internet Res"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114539","article-title":"Opportunities for technologically driven dialogical health communication for participatory interventions: perspectives from male peer navigators in rural South Africa","volume":"292","author":"Gibbs","journal-title":"Soc Sci Med"},{"key":"R11","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2024.116748","article-title":"Health communication on social media at the early stage of the pandemic: examining health professionals\u2019 COVID-19 related tweets","volume":"347","author":"Li","journal-title":"Social Science & Medicine"},{"key":"R12","doi-asserted-by":"publisher","DOI":"10.2196\/72490","article-title":"Navigating visibility on Weibo among people living with HIV: qualitative study","volume":"27","author":"Zeng","journal-title":"J Med Internet Res"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.2196\/69696","article-title":"Stigma attitudes toward HIV\/AIDS from 2011 through 2023 in Japan: retrospective study in Japan","volume":"27","author":"Piao","journal-title":"J Med Internet Res"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.2196\/63110","article-title":"Evidence on digital HIV self-testing from accuracy to impact: updated systematic review","volume":"27","author":"Beecroft","journal-title":"J Med Internet Res"},{"key":"R15","doi-asserted-by":"publisher","DOI":"10.1177\/20552076231216547","article-title":"Using web analytics data to identify platforms and content that best engage high-priority HIV populations in online and social media marketing advertisements","volume":"9","author":"Wray","journal-title":"Digit HEALTH"},{"issue":"1","key":"R16","doi-asserted-by":"publisher","DOI":"10.1080\/20008198.2021.1990527","article-title":"HIV\/AIDS stigma and psychological well-being after 40 years of HIV\/AIDS: a systematic review and meta-analysis","volume":"12","author":"Rzeszutek","journal-title":"Eur J Psychotraumatol"},{"issue":"sup1","key":"R17","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1080\/10810730050019528","article-title":"A critical assessment of theories\/models used in health communication for HIV\/AIDS","volume":"5","author":"Obregon","journal-title":"J Health Commun"},{"key":"R18","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2018.06.016","article-title":"Weibo friends with benefits for people live with HIV\/AIDS? The implications of Weibo use for enacted social support, perceived social support and health outcomes","volume":"211","author":"Han","journal-title":"Social Science & Medicine"},{"issue":"8","key":"R19","doi-asserted-by":"publisher","first-page":"e574","DOI":"10.1016\/S2352-3018(22)00076-5","article-title":"Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men","volume":"9","author":"Operario","journal-title":"Lancet HIV"},{"issue":"4","key":"R20","doi-asserted-by":"publisher","first-page":"356","DOI":"10.4085\/1062-6050-173-18","article-title":"The socioecological framework: a multifaceted approach to preventing sport-related deaths in high school sports","volume":"54","author":"Scarneo","journal-title":"J Athl Train"},{"key":"R21","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2026.103621","article-title":"Cross-linking geotagged social media data with public health registries for spatial health research","volume":"98","author":"Yin","journal-title":"Health Place"},{"issue":"9","key":"R22","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1016\/0277-9536(95)00220-0","article-title":"A regional comparison of socioeconomic and health indices in a Canadian province","volume":"42","author":"Frohlich","journal-title":"Social Science & Medicine"},{"issue":"3","key":"R23","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1007\/s11205-024-03354-3","article-title":"The impact of socio-economic conditions on individuals\u2019 health: development of an index and examination of its association with three of the most frequently registered diseases in Lazio region of Italy","volume":"173","author":"Valentini","journal-title":"Soc Indic Res"},{"issue":"1","key":"R24","doi-asserted-by":"publisher","DOI":"10.1186\/s12939-017-0670-3","article-title":"Different indicators of socioeconomic status and their relative importance as determinants of health in old age","volume":"16","author":"Darin-Mattsson","journal-title":"Int J Equity Health"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.psych.49.1.65","article-title":"Intergroup contact theory","volume":"49","author":"Pettigrew","journal-title":"Annu Rev Psychol"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.20.1.21395","article-title":"Personal contact with HIV-positive persons is associated with reduced HIV-related stigma: cross-sectional analysis of general population surveys from 26 countries in sub-Saharan Africa","volume":"20","author":"Chan","journal-title":"J Int AIDS Soc"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2023.102968","article-title":"How the natural environment in downtown neighborhood affects physical activity and sentiment: using social media data and machine learning","volume":"79","author":"Sun","journal-title":"Health Place"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2024.103174","article-title":"Social media insights into spatio-temporal emotional responses to COVID-19 crisis","volume":"85","author":"Wang","journal-title":"Health Place"},{"key":"#cr-split#-R29.1","doi-asserted-by":"crossref","unstructured":"Wei Z Xie Y Xiao D Zhang S Hui P Zhou M . Social media discourses on interracial intimacy: tracking racism and sexism through Chinese geo-located social media data. Presented at: Proceedings of the ACM Web Conference 2024. Association for Computing Machinery. 2337-2346","DOI":"10.1145\/3589334.3645334"},{"key":"#cr-split#-R29.2","doi-asserted-by":"crossref","unstructured":"Singapore. May 13, 2024.URL: https:\/\/dl.acm.org\/doi\/proceedings\/10.1145\/3589334 [Accessed 26-02-2026] [doi: 10.1145\/3589334.3645334]","DOI":"10.1145\/3589334.3645334"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijdrr.2024.104422","article-title":"Research on online public opinion in the investigation of the \u201c7\u201320\u201d extraordinary rainstorm and flooding disaster in Zhengzhou, China","volume":"105","author":"Zhang","journal-title":"International Journal of Disaster Risk Reduction"},{"issue":"6","key":"R31","doi-asserted-by":"publisher","first-page":"653","DOI":"10.1109\/JPROC.2023.3279374","article-title":"Zero-shot and few-shot learning with knowledge graphs: a comprehensive survey","volume":"111","author":"Chen","journal-title":"Proc IEEE"},{"issue":"13s","key":"R32","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1145\/3582688","article-title":"A comprehensive survey of few-shot learning: evolution, applications, challenges, and opportunities","volume":"55","author":"Song","journal-title":"ACM Comput Surv"},{"issue":"8081","key":"R33","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1038\/s41586-025-09422-z","article-title":"DeepSeek-R1 incentivizes reasoning in LLMs through reinforcement learning","volume":"645","author":"Guo","journal-title":"Nature"},{"issue":"1","key":"R34","doi-asserted-by":"publisher","DOI":"10.1038\/s40494-025-01624-y","article-title":"Automatic recognition of cross-language classic entities based on large language models","volume":"13","author":"Xu","journal-title":"npj Herit Sci"},{"key":"R35","unstructured":"GitHub. URL: https:\/\/github.com\/cauzp\/JMIR93007 [Accessed 03-09-2026]"},{"issue":"3","key":"R36","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1177\/15586898241257546","article-title":"Qualitative thematic analysis in a mixed methods study: guidelines and considerations for integration","volume":"18","author":"DeJonckheere","journal-title":"J Mix Methods Res"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031","article-title":"Interrater reliability: the kappa statistic","volume":"2012","author":"McHugh","journal-title":"Biochem Med"},{"issue":"1","key":"R38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1145\/3790251","article-title":"Beyond aggregate feedback: a spatially-aware computational framework for understanding citizen-state interaction on social media","volume":"9","author":"Zhang","journal-title":"Trans Soc Comput"},{"key":"R39","doi-asserted-by":"crossref","unstructured":"Muthukrishnan R Rohini R . LASSO: a feature selection technique in predictive modeling for machine learning. Presented at: 2016 IEEE International Conference on Advances in Computer Applications (ICACA); Oct 24, 2016:18-20; Coimbatore, India. [doi: 10.1109\/ICACA.2016.7887916]","DOI":"10.1109\/ICACA.2016.7887916"},{"issue":"5","key":"R40","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1007\/s11135-006-9018-6","article-title":"A caution regarding rules of thumb for variance inflation factors","volume":"41","author":"O\u2019brien","journal-title":"Qual Quant"},{"issue":"1-3","key":"R41","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1016\/j.scitotenv.2008.03.011","article-title":"Use of local Moran\u2019s I and GIS to identify pollution hotspots of Pb in urban soils of Galway, Ireland","volume":"398","author":"Zhang","journal-title":"Science of The Total Environment"},{"key":"R42","doi-asserted-by":"publisher","DOI":"10.1016\/j.sbspro.2013.12.027","article-title":"A study on multiple linear regression analysis","volume":"106","author":"Uyan\u0131k","journal-title":"Procedia - Social and Behavioral Sciences"},{"issue":"4","key":"R43","doi-asserted-by":"publisher","first-page":"709","DOI":"10.3758\/bf03192961","article-title":"Using heteroskedasticity-consistent standard error estimators in OLS regression: an introduction and software implementation","volume":"39","author":"Hayes","journal-title":"Behav Res Methods"},{"issue":"2","key":"R44","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1177\/0049124119882467","article-title":"Spatial regression models: a systematic comparison of different model specifications using Monte Carlo Experiments","volume":"51","author":"R\u00fcttenauer","journal-title":"Sociological Methods & Research"},{"issue":"1","key":"R45","doi-asserted-by":"publisher","first-page":"77","DOI":"10.3102\/10769986027001077","article-title":"Quick and easy implementation of the Benjamini-Hochberg procedure for controlling the false positive rate in multiple comparisons","volume":"27","author":"Thissen","journal-title":"Journal of Educational and Behavioral Statistics"},{"key":"R46","unstructured":"Lundberg SM Lee SI . A unified approach to interpreting model predictions. Presented at: Proceedings of the 31st International Conference on Neural Information Processing Systems; Dec 4-9, 2017:4768-4777; Long Beach, California, USA. URL: https:\/\/doi.org\/10.48550\/arXiv.1705.07874 [Accessed 24-02-2026]"},{"key":"R47","doi-asserted-by":"publisher","DOI":"10.1016\/j.jenvman.2023.117357","article-title":"Insights into geospatial heterogeneity of landslide susceptibility based on the SHAP-XGBoost model","volume":"332","author":"Zhang","journal-title":"J Environ Manage"},{"key":"R48","doi-asserted-by":"publisher","DOI":"10.1016\/j.eiar.2025.108227","article-title":"The geography of climate concern: a large-scale analysis of public discourse on extreme heat in China using social media and explainable AI","volume":"117","author":"Zhang","journal-title":"Environ Impact Assess Rev"},{"key":"R49","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclepro.2026.147517","article-title":"Leveraging large language models to explain provincial heterogeneity in online discussion of water pollution in China: a socioeconomic and environmental perspective","volume":"543","author":"Zhang","journal-title":"J Clean Prod"},{"issue":"Suppl 2","key":"R50","doi-asserted-by":"publisher","first-page":"S324","DOI":"10.2105\/AJPH.2009.162537","article-title":"Effective health risk communication about pandemic influenza for vulnerable populations","volume":"99 Suppl 2","author":"Vaughan","journal-title":"Am J Public Health"},{"issue":"1","key":"R51","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-025-07079-2","article-title":"Moral judgments influence emotional responses and comment lengths through the moderating role of linguistic style matching","volume":"15","author":"Tian","journal-title":"Sci Rep"},{"issue":"Suppl 1","key":"R52","doi-asserted-by":"publisher","DOI":"10.1002\/jia2.25934","article-title":"What will it take to get to the heart of stigma in the context of HIV?","volume":"25 Suppl 1","author":"Stackpool-Moore","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"R53","doi-asserted-by":"publisher","DOI":"10.1057\/s41599-024-03819-3","article-title":"Decoding the apple paradox: a critical discourse analysis of gender, technology, and nationalism in China\u2019s digital space","volume":"11","author":"Tian","journal-title":"Humanit Soc Sci Commun"},{"issue":"4","key":"R54","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1080\/15295036.2021.1934503","article-title":"\u201cThe world wants us dead\u201d:stigma and the social construction of health in","volume":"38","author":"Price","journal-title":"Critical Studies in Media Communication"},{"issue":"2","key":"R55","doi-asserted-by":"publisher","first-page":"286","DOI":"10.2105\/AJPH.2012.300854","article-title":"Reducing HIV-related stigma in health care settings: a randomized controlled trial in China","volume":"103","author":"Li","journal-title":"Am J Public Health"},{"issue":"3","key":"R56","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1016\/0277-9536(94)00384-6","article-title":"Stigma, HIV and AIDS: an exploration and elaboration of a stigma trajectory","volume":"41","author":"Alonzo","journal-title":"Soc Sci Med"},{"key":"R57","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2022.101056","article-title":"Social capital and HIV-serodiscordance: disparities in access to personal and professional resources for HIV-positive and HIV-negative partners","volume":"17","author":"Iveniuk","journal-title":"SSM Popul Health"},{"issue":"3","key":"R58","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1177\/1745691621997144","article-title":"A Social-Identity Theory of Information-Access Regulation (SITIAR): understanding the psychology of sharing and withholding","volume":"17","author":"Bingley","journal-title":"Perspect Psychol Sci"},{"issue":"3-4","key":"R59","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1002\/ajcp.12644","article-title":"Exploring the role of empowerment in Black women\u2019s HIV and AIDS activism in the United States: an integrative literature review","volume":"71","author":"Rutledge","journal-title":"Am J Community Psychol"}],"container-title":["Journal of Medical Internet Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:45:47Z","timestamp":1791582347000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.jmir.org\/2026\/1\/e93007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,9]]},"references-count":60,"URL":"https:\/\/doi.org\/10.2196\/93007","relation":{},"ISSN":["1438-8871"],"issn-type":[{"value":"1438-8871","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,9]]},"article-number":"v28i2e93007"}}