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.