Kyung-Hee Choi, Ph
D, MPH, Jay Paul, Ph
D, George Ayala, Psy
D, Ross Boylan, Ph
D, and Steven E. Gregorich, Ph
D
Kyung-Hee Choi, Jay Paul, Ross Boylan, and Steven E. Gregorich are with the Center for sida Prevention Studies, University of California, San Francisco. George Ayala is with The Global forum on MSM & HIV, Oakland, CA.

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Corresponding author.
Correspondence should be sent lớn Kyung-Hee Choi, Ph
D, MPH at the University of California, San Francisco, Center for aids Prevention Studies, 50 Beale Street, Suite 1300, San Francisco, CA, 94105 (e-mail: ude.fscu
iohc.eeh-gnuyk). Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.
Contributors

K. Choi developed the research questions, participated in the data analysis & interpretation, and wrote the draft of the article. J. Paul, R. Boylan, and S. E. Gregorich participated in the data analysis & interpretation, and contributed to the writing of the article. G. Ayala reviewed and provided feedback on the draft article.


Objectives. We examined the associations between specific types & sources of discrimination & mental health outcomes among US racial/ethnic minority men who have sex with men (MSM) & how these associations varied by race/ethnicity.

Methods. A chain-referral sample of 403 African American, 393 Asian & Pacific Islander (API), & 400 Latino MSM recruited in Los Angeles County, California completed a standardized questionnaire. Data were obtained from the Ethnic Minority Men’s Health Study from May 2008 khổng lồ October 2009.

Results. Past-year experiences of racism within the general community & perceived homophobia among heterosexual friends were positively associated with depression and anxiety. Past-year homophobia experienced within the general community was also positively associated with anxiety. These statistically significant associations did not vary across racial/ethnic groups. The positive association of perceived racism within the gay community with anxiety differed by race/ethnicity, & was statistically significant only for APIs. Perceived homophobia within the family was not associated with either depression or anxiety.

Conclusions. Higher levels of experiences of discrimination were associated with psychological distress among MSM of color. However, specific types and sources of discrimination were differentially linked khổng lồ negative mental health outcomes among African American, API, and Latino MSM.


Accumulating data indicate that mental health problems are more prevalent among sexual minorities than among heterosexuals.1,2 A recent meta-analysis of 25 epidemiological studies revealed that the lifetime prevalence of depression & anxiety disorders was at least 1.5 times higher among lesbians, gays, and bisexuals, whereas the lifetime risk for suicide attempts was 2.47 times greater in sexual minority groups.2 Research linked a wide range of mental health outcomes among sexual minorities—including depression,3–10 anxiety,6,9,10 panic disorder,6 psychological distress,11–16 suicide attempts,11 & suicidal ideation11,17—to the effects of discrimination. Furthermore, studies showed widespread experiences of discrimination among sexual minorities.6,8,16,18,19 One population-based survey of US adults found that more than three quarters (76%) of gay or bisexual respondents reported a lifetime experience of discrimination.6 In another population-based survey of US adults, close lớn one quarter (21.4%) of lesbian, gay, or bisexual respondents reported experiencing discrimination in the past year.18

Although the disproportionate prevalence of mental health difficulties & experiences of social discrimination among lesbian, gay, và bisexual people are well documented, the association between discrimination và mental health outcomes is not well understood. Among the gaps in our understanding are the following 2 points. First, it is unclear which types and sources of discrimination have an adverse effect on mental health among sexual minorities. Three of the 15 existing studies on the impact of discrimination on mental health outcomes utilized composite measures of overall perceived discrimination that combined various forms of discrimination experiences.6,10,15 Eleven studies examined specific types of discrimination, such as antigay violence,5,9,11,12,14,17 racism,8,16 and homophobia,3,4,8,12,13,16 but made no specific references khổng lồ their sources (e.g., family, heterosexual friends, a mainstream gay community, a larger general community). One study specified only a single source (i.e., trắng gay men) for one particular khung of discrimination (i.e., perceived devaluation of Asian gay men7).

Second, it remains unknown whether previous study findings on the association between discrimination and poor mental health outcomes among sexual minorities are generalizable across racial/ethnic groups, because few studies of sexual minorities have directly compared the effects of discrimination on mental health outcomes among various racial/ethnic minority groups. Studies of discrimination và mental health among sexual minorities have either aggregated multiple racial and ethnic groups,3–6,9,11–14,17 or been limited khổng lồ 1 (i.e., African Americans,10 Asians,8 Latinos16) or 2 groups (i.e., Asians và Latinos15).

The present study addressed these gaps in the literature by examining the associations of specific types và sources of discrimination with mental health outcomes in a sample of African American, Asian or Pacific Islander (API), & Latino men who have sex with men (MSM). First, we examined the prevalence of discrimination based on race/ethnicity & sexual orientation. Second, we determined which types và sources of discrimination were associated with mental health outcomes. Finally, we assessed whether these associations varied by race/ethnicity.


METHODS

Data came from the Ethnic Minority Men’s Health Study, which was designed khổng lồ examine the impact of experiences of social discrimination, social networks, và sexual partnerships on sexual risk for HIV among African American, API, and Latino MSM in Los Angeles, California. Study participants were recruited from May 2008 to October 2009, utilizing a chain-referral sampling methodology. Initial “seed” respondents were recruited through referrals from project staff at sida Project Los Angeles và outreach activities at MSM venues such as bars, dance clubs, & coffee shops. Men were eligible khổng lồ participate in the study if they


After providing written informed consent, eligible seed participants completed a 1-hour, standardized questionnaire using audio computer-assisted self-interview technology. After this, each seed participant received $50 for compensation and was invited khổng lồ recruit up lớn 3 other MSM friends or acquaintances. He was given 3 “recruitment coupons” to pass out to these contacts as an invitation khổng lồ participate in the study. For every redeemed coupon, the referring participant received $10.

Once accepting the coupon from their seed participant, potential recruits contacted the study staff by telephone. During this telephone call, they were screened for eligibility and, if eligible, were scheduled to complete the study protocol at our project site. All potential participants had to come khổng lồ their appointment with a recruitment coupon. On the completion of the audio computer-assisted self-interview based survey, enrolled participants (wave 1 recruits) were given 3 recruitment coupons each & instructed to lớn give these coupons khổng lồ their MSM friends or acquaintances (wave 2 recruits). This recruitment and enrollment process continued until we reached our target sample kích thước of approximately 400 men for each ethnic group.


Measures

We developed a culturally sensitive và psychometrically valid quantitative survey instrument by utilizing qualitative data collected from 6 focus groups (n = 50) & 35 individual in-depth interviews for the previous phase of this study, và through extensive pretesting with a sample of 168 MSM of color (56 African Americans, 56 APIs, & 56 Latinos). First, we modified existing measures (e.g., racism, homophobia)16 based on qualitative interview transcript data khổng lồ ensure that measures used were consistent with our target population’s subjective experiences and phraseology. Initial drafts of the measures were then pretested on 18 participants (6 per ethnic group), using experimentally validated pretest procedures.20 After revising the draft measures based on respondent feedback, the revised measures were administered via audio computer-assisted self-interview khổng lồ 150 participants (50 per ethnic group) lớn assess their psychometric properties. Data collected from these 150 participants were analyzed & used khổng lồ make final refinements lớn the instrument.


Demographic characteristics.

Respondents were asked about their race/ethnicity, age, level of education, nativity, sexual orientation, marital status, any lifetime history of incarceration (juvenile or adult), và HIV serostatus.


Experiences of racism and homophobia.

We assessed subjective experiences of racism from 2 different sources: the general and gay communities. Past-year experiences of racism within the general community were measured using a 4-item summative index, on which respondents indicated the number of different ways they were mistreated because of their race/ethnicity within the general community in the past year (e.g., stopped or harassed by the police; physically threatened). Perceived racism within the gay community was measured with a 4-item scale (e.g., “I’ve felt white gay men have acted as if they’re better than me because of my race or ethnicity”; “I’ve felt ignored or invisible where trắng gay men hang out because of my race or ethnicity”; Cronbach α = 0.86). Response to lớn each tòa tháp was scored on a 4-point Likert scale (1 = strongly disagree, 2 = somewhat disagree, 3 = somewhat agree, 4 = strongly agree). Response scores were averaged lớn create the perceived racism within the gay community scale.

We assessed subjective experiences of homophobia from 3 different sources: the general community, heterosexual friends, và family. Past-year experiences of homophobia within the general community were measured with a 4-item summative index that represented the number of ways respondents had experienced various forms of such mistreatment (e.g., stopped or harassed by the police; physically threatened). Perceived homophobia among heterosexual friends & perceived homophobia within the family were measured with, respectively, a 3-item scale (e.g., “I have lost heterosexual friends because of my sexual orientation”; Cronbach α = 0.87), and a 4-item scale (e.g., “Family members have pressured me at different times khổng lồ get married to lớn a woman”; Cronbach α = 0.82), respectively. Each cửa nhà used a 4-point Likert scale ranging from 1 (strongly disagree) to lớn 4 (strongly agree). Scores were averaged across each phối of items to size the perceived homophobia among heterosexual friends và homophobia within the family scales.


Mental health outcomes.

We assessed 2 mental health outcomes: depression & anxiety. Depression was measured by using the 7-item, short-form version of the Center for Epidemiological Studies Depression Scale.21 This scale asked about the number of days respondents experienced each of the 7 depressive symptoms in the previous week (e.g., feeling lonely, feeling sad; Cronbach α = 0.91) on a 4-point response set (1 = less than 1 day; 2 = 1–2 days; 3 = 3–4 days; 4 = 5–7 days). Anxiety was measured with the 6-item Anxiety subscale of the Brief Symptom Inventory.22 This scale asked about the màn chơi of discomfort respondents felt about each of 6 anxious states in the previous week (e.g., feeling fearful, spells of terror or panic; Cronbach α = 0.93) on a 5-point response set (0 = no discomfort; 1 = a little bit of discomfort; 2 = moderate discomfort; 3 = quite a bit of discomfort; and 4 = extreme discomfort). Response scores were averaged lớn create the depression & anxiety scales.


Statistical Analysis

Descriptive analyses included means and proportions of demographic, discrimination, & mental health variables, both in the overall sample và within each racial/ethnic group. Multivariate analyses of mental health began with the full phối of demographic and discrimination variables listed in Tables 1 và ​and2,2, and the interactions between each discrimination variable & race/ethnicity. Backward elimination removed all main effects with P > .2 & interaction terms with P > .05. To trương mục for clustering of respondents in the same referral chain, we used the generalized estimating equations modeling framework23 for the multivariate analyses and to obtain the P values for the descriptive statistics.


Sample Characteristics, by Race/Ethnicity: Ethnic Minority Men’s Health Study; Los Angeles, CA; 2008–2009


CharacteristicsAfrican American (n = 403), Mean or %API (n = 393), Mean or %Latino (n = 400), Mean or %Overall (n = 1196), Mean or %
Age,*** y (range = 18–83)41333536
Education***
1442213
 High school diploma or GED37132726
 Some college education35232929
 College graduate14602132
Nativity***
 US-born94436166
 Foreign-born6573934
Sexual orientation***
 Gay60867774
 Bisexual27111719
 Other13367
Marital status***
 Never married to a woman74918583
 Currently married to lớn a woman3333
 Separated/divorced/widowed2361214
Lifetime incarceration history***41133529
Self-reported HIV serotatus***
 Positive51144336
 Negative/unknown49865764
Depression scale score (range = 1–4)1.671.681.751.70
Anxiety scale score (range = 0–4)**0.540.650.770.65

Discrimination MeasuresAfrican American (n = 403)API (n = 393)Latino (n = 400)Overall (n = 1196)
Past-year experiences of racism within the general community,** %60506357
 Mean index score (range: 0–4)1.230.871.281.13
Perceived racism in the gay community,* %69756670
 Mean scale score (range: 1–4)2.332.462.232.34
Past-year experiences of homophobia within the general community,** %49455951
 Mean index score (range: 0–4)0.960.841.281.03
Perceived homophobia among heterosexual friends, %40505046
 Mean scale score (range: 1–4)1.892.052.031.99
Perceived homophobia within the family, %71827877
 Mean scale score (range: 1–4)2.272.642.432.44

RESULTS

We enrolled a total of 1196 participants. Of these participants, 453 were seeds, 722 were recruited by seeds (170 in wave 1, 126 in wave 2, 105 in wave 3, 61 in wave 4, 56 in wave 5, 49 in wave 6, 40 in wave 7, 38 in wave 8, 39 in wave 9, 14 in wave 10, và 24 in waves 11–14), and 21 had no information about their recruitment status. The mean, median, minimum, and maximum number of participants recruited by the seeds was 1, 0, 0, và 125, respectively.

The sample consisted of an approximately equal number of African American (n = 403), API (n = 393), and Latino men (n = 400). As Table 1 shows, sample characteristics differed by race/ethnicity. African Americans tended to lớn be older than APIs và Latinos. APIs were more likely khổng lồ have a college degree than were African Americans & Latinos. APIs & Latinos were more likely to lớn be foreign-born than were African Americans. African Americans were more likely to self-identify as bisexual than were APIs and Latinos. African Americans were more likely khổng lồ have ever been married to lớn a woman than were APIs & Latinos. African Americans and Latinos were more likely lớn have a lifetime history of incarceration than were APIs. African Americans had the highest HIV infection rate, followed by Latinos và APIs. The màn chơi of depression was similar across 3 racial/ethnic groups. However, the màn chơi of anxiety was the highest among Latinos, followed by APIs và African Americans.

There were significant racial/ethnic group differences in experiences of racism and homophobia (Table 2). African American & Latino MSM were more likely khổng lồ report past-year experiences of racism within the general community than were API men who have sex with men. In contrast, API men who have sex with men were more likely khổng lồ report racism within the gay community than were African American and Latino MSM. Past-year experiences of homophobia within the general community were most commonly reported by Latino MSM, followed by African American and API men who have sex with men. We found no statistically significant racial/ethnic differences in perceived homophobia among heterosexual friends & within the family.

Table 3 reports results of bivariate and multivariate regression analyses of the associations between discrimination experiences và depression & anxiety. Bivariate results showed that all 5 discrimination measures were associated with depression & anxiety. However, in multivariate analysis using backward elimination, only past-year experiences of racism within the general community và perceived homophobia among heterosexual friends remained as significant factors associated with depression. Depression was positively associated with past-year experiences of racism within the general community (b = 0.11; 95% confidence interval  = 0.07, 0.16; P < .001) và perceived homophobia among heterosexual friends (b = 0.11; 95% CI = 0.06, 0.16; P < .01). None of the interaction terms between race/ethnicity & the 5 discrimination measures was retained in the final multivariate model.


Associations between Racism & Homophobia & Depression & Anxiety: Results of Bivariate và Multivariate Regression Analyses: Ethnic Minority Men’s Health Study; Los Angeles, CA; 2008–2009


DepressionAnxiety
CharacteristicsBivariate, b (95% CI)Multivariate, b (95% CI)Bivariate, b (95% CI)Multivariate, b (95% CI)
Race/ethnicity
 API vs African American0.00 (−0.10, 0.11)0.12 (−0.00, 0.24)0.08 (−0.02, 0.17)−0.37* (−0.72, −0.02)
 Latino vs African American0.07 (−0.03, 0.17)0.04 (−0.05, 0.13)0.22*** (0.12, 0.31)0.14 (−0.22, 0.50)
 Latino vs API0.07 (−0.03, 0.16)−0.08 (−0.19, 0.04)0.14* (0.03, 0.24)0.51** (0.18, 0.85)
Age−0.01 (−0.01, 0.00)−0.01** (−0.01, −0.00)−0.01* (−0.01, −0.00)−0.01** (−0.01, −0.00)
US-born (Ref = foreign-born)0.04 (−0.05, 0.12)…a−0.13** (−0.22, −0.03)−0.11* (−0.20, −0.01)
Ever married (Ref = never married)0.09 (−0.04, 0.21)0.10 (−0.01, 0.21)0.13 (−0.00, 0.27)0.18* (0.05, 0.31)
Self-reported sexual orientation (Ref = other)…a…a
 Gay0.02 (−0.18, 0.22)0.13 (−0.06, 0.32)
 Bisexual0.15 (−0.07, 0.36)0.25 (−0.01, 0.51)
Education (Ref = college graduate)…a
 ≤ high school education0.26*** (0.12, 0.40)0.15 (−0.00, 0.31)0.20** (0.06, 0.35)
 High school diploma0.06 (-0.04, 0.16)0.02 (−0.09, 0.12)0.03 (−0.11, 0.16)
 Some college education0.15 (−0.01, 0.32)0.14 (−0.02, 0.31)0.09 (−0.05, 0.22)
Self-reported HIV positive (Ref = negative/unknown)0.08 (−0.01, 0.17)0.10 (0.01, 0.20)0.11* (0.01, 0.21)0.18* (0.07, 0.28)
Lifetime history of incarceration: yes (Ref = no)0.28*** (0.17, 0.40)0.26*** (0.15, 0.37)0.28*** (0.18, 0.38)0.27*** (0.16, 0.38)
Past-year experiences of racism within the general community0.12*** (0.08, 0.15)0.11*** (0.07, 0.16)0.15*** (0.10, 0.20)0.08** (0.02, 0.13)
Perceived racism within the gay community0.08** (0.02, 0.15)…a0.11*** (0.05, 0.17)…b
Interaction between perceived racism within the gay community and race/ethnicityNA…aNA
 API0.19*** (0.08, 0.30)
 African American−0.02 (−0.10, 0.06)
 Latino−0.02 (-0.13, 0.09)
Past-year experiences of homophobia within the general community0.07*** (0.03, 0.10)−0.03 (-0.07, 0.01)0.15*** (0.10, 0.20)0.06* (0.01, 0.11)
Perceived homophobia among heterosexual friends0.13*** (0.08, 0.19)0.11*** (0.06, 0.16)0.18*** (0.12, 0.24)0.11*** (0.06, 0.17)
Perceived homophobia within the family0.08** (0.03, 0.13)…a0.08*** (0.03, 0.13)…a

The multivariate model of the anxiety outcome suggested significant, positive main effects of past-year experiences of racism within the general community, past-year experiences of homophobia within the general community, và perceived homophobia among heterosexual friends (b = 0.08; 95% CI = 0.02, 0.13; P < .01; b = 0.06; 95% CI = 0.01, 0.11; P < .05; and b = 0.11; 95% CI = 0.06, 0.17; P < .001, respectively). In addition, the interaction of race/ethnicity with perceived racism within the mainstream gay community was statistically significant (P < .01). The positive association between anxiety và perceived racism within the gay community was found among APIs (b = 0.19; 95% CI = 0.08, 0.30; P < .001), but not among African Americans (b = −0.02; 95% CI = −0.10, 0.06; P = .587) or Latinos (b = −0.02; 95% CI = −0.13, 0.09; P = .724).


DISCUSSION

Experiences of discrimination based upon race/ethnicity và sexual orientation were highly prevalent in our sample of MSM of màu sắc in Los Angeles, California. We also found similarities & differences in experiences of discrimination by race/ethnicity. The report of experiencing homophobia among heterosexual friends & within the family was similar among African American, API, và Latino MSM. However, the report of experiencing racism within the general community was more common among African Americans và Latinos than among APIs, whereas the reverse trend was observed with more APIs reporting experiences of racism within the mainstream gay community compared with African Americans và Latinos. The report of experiencing homophobia within the general community was highest among Latinos.

Previous studies documented the significant association between racism & mental health outcomes among United States API & Latino MSM.7,8,15,16 Our data indicated that experienced racism within the general community might have generalized adverse effects on psychological well-being among not only API & Latino MSM but also African American MSM. Our multivariate analysis found that past-year experiences of racism within the general community were positively associated with both depression and anxiety, but these associations were not moderated by race/ethnicity. Regardless of their race/ethnicity, those who were more likely lớn experience racism within the general community reported more symptoms of both depression & anxiety.

By contrast, racism within the mainstream gay community appeared to lớn have negative psychological consequences in our sample only for API men who have sex with men. Our multivariate analysis found a significant positive association between perceived racism within the gay community và symptoms of anxiety, but this association was moderated by race/ethnicity. Perceived racism within the gay community was positively associated with anxiety among API men who have sex with men, but not among African American and Latino MSM. This finding was not surprising, given that a previous study of US Asian gay men found higher levels of depression among those who were more likely khổng lồ perceive devaluation of Asian gay men by white gay men.7 One explanation for the racial/ethnic difference with respect to the impact of racism within the gay community on psychological well-being might be related lớn a way in which racism manifests itself within the gay community. Our previous qualitative study of MSM of color in Los Angeles found that there were differential values placed on various racial/ethnic groups as potential sexual partners. In this tacit race/ethnicity-based sexual hierarchy, Whites were most preferred, followed by Latino and African American men, with API men the least preferred.24 Although all 3 groups of MSM of color experienced some size of racism within the gay community, & some forms of race-based sexual objectification, APIs might face particular difficulties in finding sexual partners among those men whom they find desirable.25–27 These specific experiences of rejection or being devalued might lead khổng lồ psychological distress.

In this study, we examined whether 3 different sources of homophobia—the general community, heterosexual friends, và the family—all affected psychological well-being among MSM of color. Our multivariate analyses found that past-year experiences of homophobia within the general community were positively associated with anxiety symptoms, whereas perceived homophobia among heterosexual friends was positively associated with both depressive and anxiety symptoms. By contrast, homophobia within the family was not associated with either depression or anxiety. We also examined whether race/ethnicity moderated the significant associations of homophobia within the general community & among heterosexual friends with mental health outcomes. We found no moderation by race/ethnicity. Taken together, our data indicated that homophobia experienced within the general community and among heterosexual friends both appeared to have a negative effect on psychological well-being of all African American, API, and Latino MSM, but homophobia within the family seemed to have little influence on their mental health. The reason why we found no effects for homophobia within the family might be that the psychological distress caused by family rejection of homosexuality was compensated by the benefits offered by the family, such as emotional & financial support around matters not related khổng lồ sexuality. Another possible explanation might be that those experiencing the greatest levels of family rejection ceased contacts with their family, thus reducing its impact. These hypotheses should be examined in future studies.

Antigay stigma, harassment, và violence were shown to lớn have a variety of deleterious mental health consequences among sexual minorities.5,9,11,12,14,17 Consistent with these findings, our bivariate analyses found the significant positive association of past-year experiences of homophobia within the general community with depression & anxiety. However, when the multivariate mã sản phẩm adjusted for demographic characteristics and included all measures of racism & homophobia, our measure of homophobia within the general community (assessing antigay harassment và threats) was significantly associated with anxiety but not with depression. In this model, the significance level for the association between past-year experiences of homophobia within the general community and anxiety was reduced from P < .001 to P < .05. By comparison, the significant association of perceived homophobia among heterosexual friends with depression và anxiety found in bivariate analyses remained unchanged in multivariate models. The magnitude of the association of perceived homophobia among heterosexual friends with depression và anxiety was greater than that of the association of past-year experiences of homophobia within the general community with depression and anxiety. These results suggested that for MSM of color, perceived homophobic disapproval và rejection by an immediate circle of heterosexual friends was more detrimental to psychological well-being than experiences of sexual orientation-related harassment & threats by members of the general community.

We noted 3 study limitations. First, the study results had limited generalizability. Participant recruitment took place in Los Angeles County, which has a relative high concentration of API and Latino residents as well as an established mainstream gay community. The experiences of MSM of color might differ in other areas without such large racial/ethnic and sexual minority communities. Also, the sample was overrepresented by men who were HIV positive because many of the initial seeds used for recruitment were HIV-positive men who used services of our collaborating agency (i.e., sida Project Los Angeles). HIV infection rates reported by our study participants were higher than those estimated by the Los Angeles County Department of Public Health, HIV Epidemiology Program.28 More studies with MSM of color are needed to lớn validate our study findings. Second, self-report measures had limitations with respect to lớn accuracy. In particular, we might have underestimated the prevalence of past-year experiences of racism and homophobia within the general community because some participants might have had difficulty in accurately recalling all the events that had happened during a 1-year period. Third, the cross-sectional nature of our study did not enable us to draw causal inferences for the effects of experienced discrimination on mental health outcomes. Because we were uncertain about the temporal order of our measures, it was possible that depressed or anxious individuals were more likely to report experiences of discrimination. Future studies should use a longitudinal design lớn examine the causal links between experienced discrimination & negative psychological consequences.

Despite these limitations, our data had several implications for further research và intervention development with respect to lớn specific types & sources of discrimination differentially linked khổng lồ negative mental health outcomes among African American, API, & Latino MSM.

Further research can tell us much more about both mediating và moderating factors between such stresses and mental health outcomes. For example, how do different sources of racism influence internalized racism for racial/ethnic minority MSM? How vị different sources of sexual orientation-based discrimination influence internalized homophobia for racial/ethnic minority MSM? vị different patterns of internalized stigmatization by racial/ethnic minority MSM differentially affect their awareness of sources of social & institutional support? bởi they affect the utilization of those sources of support? How might the capacity lớn tap various sources of tư vấn or affirmation influence self-esteem and resilience? Are there resources within the communities of racial/ethnic minority MSM that could be developed or expanded to lớn enhance the resilience of racial/ethnic minority MSM to address this problem on a larger institutional or community level (e.g., Davis et al. 200529)?

Although the present study did not focus on specific clinical dynamics, it suggested some practical considerations with respect lớn the evaluation of và scope of services for racial/ethnic minority MSM reporting emotional distress to lớn health providers. It suggested the value of expanding the exploration of potential sources of áp lực to encompass an examination of issues of race-based and sexual orientation-based discrimination và victimization. It would appear khổng lồ be helpful khổng lồ assess such experiences not only on a general level, but with respect to family, friendship networks, và contacts within the mainstream gay community. Sources of tư vấn in managing such stressors would also be part of such an assessment. Moving from assessment of the individual’s history khổng lồ his understanding of these experiences, và the links between these experiences and his own particular symptoms might be a first step of an intervention. As noted in the previous discussion on research needs, it might be valuable lớn explore and address the ways in which these forms of stigmatization might result in internalized racism & homophobia. In this regard, assessment might be said to be shaped by systemic psychotherapy theory in broader respects,30 & consistent with minority găng theory.1,12 Further research will help to shape specific intervention strategies that might draw upon existing intrapersonal, social, & community resources.

Mental health services still carry a certain stigma31; thus, it might potentially be helpful lớn consider offering services not explicitly identified as psychological in nature (such as group discussions) for those who have experienced discrimination or victimization because of race or sexual orientation. Providing the opportunity khổng lồ talk about these matters with others who have undergone comparable experiences provides the opportunity to lớn gain support, examine the impact of such experiences, & potentially seek out further support services if necessary.

In addition, community-based organizations that serve gay, lesbian, bisexual, và transgender populations might wish to lớn consider the value of interventions that both raise awareness about the damaging effects of discrimination on racial/ethnic minority MSM và work to shift social norms. Educational và social marketing campaigns have heightened awareness about homophobia, not only in the general community but in communities of color (e.g., the thành phố new york State đen Gay Network’s “We Are Part of You” campaign; see http://www.wearepartofyou.org). Creating comparable campaigns that target racism within the mainstream gay community and foster a sense of inclusiveness have the potential for significant impact on the well-being of gay and bisexual racial/ethnic minority men.

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If you"re not watching Korean dramas,better known as K-dramas,then you"re missing out in several ways. First, there"s the big-picture, cultural impact khổng lồ consider: K-dramas and K-movies have becomea worldwide phenomenon, and if you"re going khổng lồ be a pop culture connoisseur/productive denizen of the entertainment-loving internet—and you"re here, so you obviously are both of those things—then you need lớn be versed inall things K-drama.And then there"s the more important reason to watch Korean dramas: They are addictive and amazing, and you"ll thank yourself for adding them lớn your pop culture diet.


Known for their interesting storylines và intense (if sometimes predictable) plot twists, Korean dramas can go from super sappy to lớn incredibly heartbreaking lớn "WTF, what was that?" in a heartbeat. That variety is exactly what keeps viewers coming back for more. Here, we"ve listed the best-ever K-dramas lớn watch, grouped by the most popular genres—and if you"re well versed in the more established K-dramas, consult our các mục of the best new Korean shows on Netflix in 2023. (And if you"re looking specifically for the all-time best K-dramas on Netflix or best Korean dramas on Hulu? We"ve got you covered there too.)

Action/Thriller Korean Dramas

If your Korean entertainment knowledge doesn"t expand beyond Squid Game & Train lớn Busan, here"s where to start. These thrilling K-dramas are filled with kích hoạt and intrigue, with some selections touching on societal issues in a similar vein to Parasite. (Also, so many zombies!) Your next stop: the best Korean thriller movies.


If you haven"t yet checked outSquid Game, which is set to become Netflix"s most-watched show ever, then here"s one more recommendation: This edge-of-your-seat
Korean thriller on Netflix is definitely worth a look. In the viral hit, agroup of charactersin serious debt sign up khổng lồ play a series of children"s games for a chance at 45.6 billion won (about $38 million). The catch? If the players loose at Tug of War or Red Light, Green Light, they die.

watch it on netflix


This remix of the international Netflix hit La Casa de Papel (Money Heist) takes the original"s thrilling plot và deftly weaves in Korean culture. The series takes place in a fictional timeline where North and South Korea are on the brink of reunification, & have made a Joint Economic Area, complete with a mint và a universal currency. However, the rich just keeps getting richer while the poor face inequality and discrimination. Enter a group of charismatic thieves who take over the Unified Mint with the goal of stealing four trillion won (roughly $3 billion USD).

watch it on netflix

"Vincenzo"


If you"re looking for something in the middle of the Venn Diagram of "K-Drama" và "Mafia Drama," thenVincenzois the show for you. In it, tuy vậy Joong-ki stars as a Korean man named Vincenzo who was adopted by an Italian mafia family và raised in the mob life in Italy. When his adoptive father dies, his adopted brother sets out lớn kill him, forcing Vincenzo to flee back khổng lồ Seoul.


If you enjoyed Korean movies likeThe Calland#Alive, you"ll be able lớn stomach and loveSweet Home. The show follows a guy who moves into a new apartment complex after the death of his family. Depressed & a loner, he starts witnessing frightening things in the building from some of his odd neighbors. If you"re a peek-over-the-blanket-type person when watching horror shows like I am, then I"d advise you to lớn tune into this during the day time. (I made the mistake of starting this show at night—never again.)

watch it on netflix

"Happiness"


This modern zombie drama is full of surprises at every turn, starting with being one of the only dramas khổng lồ acknowledge the COVID-19 pandemic. Officer Yoon Sae-bom (Han Hyo-joo) has been dreaming of having her own apartment when she gets the chance lớn move into a high-rise with her high-school friend, Detective Jung Yi-hyun (Park Hyung-sik). Soon after they move in, an infectious disease sweeps the country, with those infected getting a craving of human blood. The apartment building ends up quarantined, with Sae-bom and Yi-hyun trying to lớn keep the peace amoung the eccentric tenants.

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"All of Us Are Dead"


This heart-racing zombie thriller offers another quality spin on the drama, following a group of high school students as the zombie apocalypse comes lớn their school. The kids are left on their own as their classmates quickly return, & we see how they handle the survival challenge while also getting storylines of parents và politicians handling the vi khuẩn outside the school. The most interesting part is how classic high school tropes (crushes, bullies, etc.) are twisted into thrilling plots.

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"My Name"


In this intense thriller, a young woman named Ji-woo (Han So-hee) sets out to lớn avenge the death of her father, who was involved in the criminal underworld. She takes up a new identity as a thành viên of the police force working with her father"s old partner, Choi Mu-jin (Park Hee-soon).

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"Signal"


This detective thriller takes place across two timelines, as detectives from different times khung a cold case squad, solving cases based on real-life crimes. Criminal profiler Park Hae-Young (Lee Je-hoon) & detective phụ vương Soo-hyn (Kim Hye-soo) work with Lee Jae-han (Choi Jin-woong), a detective living in 2000, to work through heart-wrenching mysteries with edge-of-your-seat thrills.

watch it on netflix

"Healer"


In this kích hoạt drama, Ji Chang-wook plays the "Healer," a night courier who messengers illegal items & does whatever the client needs—as long as it isn"t murder—with the help of a genius hacker. When he crosses paths with tabloid writer Chae Young Shin (Park Min-young) and successful reporter Kim Moon Ho (Yoo Ji-tae), all three learn that they"re connected in several ways. Come for the intricate plot, stay for some serious romance.

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"Flower of Evil"


Detective phụ vương Ji-won (Moon Chae-won) has a seemingly ideal family with a devoted husband and an adorable daughter. However, her loving spouse Baek Hee-sung (Lee Joon-gi) is hiding some dark secrets, as he assumed a new identity when he was young to escape a disturbing childhood. Ji-won"s perfect life comes crumbling down as her latest investigation into a serial killer intertwines with Hee-sung"s past, & she has khổng lồ question whether her husband is really a murderer.

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"D.P"


This brutally realistic drama stars Jung Hae-in as An Jun-ho, following the young man as he enlists in the South Korean army as part of his mandatory military service. After his basic service, during which he struggles with the ritualistic hazing and "survival of the fittest" culture of bullying, he lands a spot in the Deserter Pursuit unit, where he"s sent to catch soldiers who"ve gone AWOL. The stories of the deserters are intense, with the drama shining a light on mistreatment in the armed forces.

watch it on netflix

"Weak hero Class 1"


This brutal webcomic-based drama tackles school violence through a realistic lens, taking place at a boy"s high school where the richest students are the most powerful. Bullied student Yeon Si-eun (former Wanna One member Park Ji-hoon) sees his tormentors as an obstacle towards reaching academic success and getting a scholarship lớn Seoul National University. Though he doesn"t see much need for friends, he eventually finds allies in fellow class outcast Oh Beom-seok (Hong Kyung), & the school"s best fighter An Soo-ho (Twenty Five Twenty One"s Choi Hyun-wook). Fair warning, the eight-episode drama has major twists and a devestating ending.

watch it on viki

Romance Korean Dramas

These thắm thiết K-dramas are for the fans of intense, sweeping romances that can span from heart-fluttering lớn heart-wrenching in one episode. (Think Bridgerton, but even more swoon-worthy.) If you want to spend 16-20 hours invested in a serious slow burn, look here.

"Crash Landing on You"


A South Korean heiress, Yoon Se-ri, gets caught in a storm while paragliding & finds herself blown off course into North Korea. Se-ri then runs into Ri Jeong-hyeok, Captain of the North Korean Special Forces và a thành viên of the North Korean elite family. Captain Ri eventually hatches a plan lớn get Se-ri back khổng lồ South Korea with the help of his squad, but not before they all tackle the obstacles that come their way—and then some. This drama mixes romance with comedy và ultimately tells the tale of two star-crossed lovers. It"s currently the highest rated tv
N drama & the second-highest Korean drama in cable television history. (Also, stars Son Ye-jin và Hyun Bin have since gotten married và are expecting a baby!)

watch it on netflix

"Business Proposal"


This 2022 rom-com drama has become the year"s biggest hit so far thanks khổng lồ its hilarious romances (and a super-popular kissing clip). Shin Ha-ri (I.O.I. Và The Uncanny Counter"s Kim Se-jeong) is a food researcher at a company that just welcomed a new president, Kang Tae-moo (Ahn Hyo-seop). When her wealthy BFF (played by Seol In-ah) asks her lớn go on a blind date for her & ruin it, the date turns out to lớn be Tae-moo. The morning after the disastrous date, Ha-ri receives a call—Tae-moo wants lớn marry her!?! Their hilarious courtship, as well as the second lead romance, will definitely steal your heart.

watch it on netflix

"Descendants of the Sun"


If you"ve torn through Vincenzo and want lớn spend more time with tuy nhiên Joong-ki, check out the acclaimed drama that made him part of the Hallyu Wave. This acclaimed drama follows Captain
Yoo Si-jin (Song) of the Korean Special Forces as he falls in love with surgeon Kang Mo-yeon (Song Hye-ko).

watch it on hulu

"Hometown Cha-Cha-Cha"


This country-boy meets city-girl romance starts when Seoul dentist Yoon Hye-jin (Shin Min-ah) loses her shoe during a visit to lớn the seaside village of Gonjin. It"s found by Hong Doo-shik (Kim Seon-ho), a jack-of-all-trades who does odd jobs around town. Hye-jin ends up moving to lớn Gonjin, where Doo-shik helps her adapt lớn the new environment, và the couple slowly (and sweetly) grows feelings for each other.

watch it on netflix

"Coffee Prince"


This classic k-drama follows Choi Han-gyul (Goblin"s Gong Yoo), the irresponsible heir lớn a conglomerate with a popular chain of coffee shops. One day he meets Ko Eun-chan (Yoon Eun-hye), a tomboys who"s often mistaken for a man và has been the breadwinner of her family since she was 16. Not knowing Eun-chan is a girl, Han-gyul hires her to lớn be his gay lover to lớn get out of the blind dates his grandmother sets up. Han-gyul also takes over a derelict coffee shop, renamed Coffee Prince, to lớn prove khổng lồ his grandmother và ex-girlfriend that he is capable. As he"s only hiring good-looking male employees, Eun-chan decides khổng lồ keep up her gender charade khổng lồ get a job at his cafe.

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"Boys Over Flowers"


Boys Over Flowersis an old-school teen drama, focused on a group of popular/privileged/not-so-nice boys at the prestigious Shinhwa High School. The group, known as F4, bully others khổng lồ get their way—until a working class girl named Geum Jan-di arrives at the school on scholarship & stands up to the boys.

watch it on netflix

"True Beauty"


If you want to follow a high-school love triangle, then this hilarious coming-of-age drama is for you. High schooler yên Ju-yeong (Moon Ga-young) has an inferiority complex after being bullied for years by students & family members for her looks. After learning makeup artistry from You
Tube, she is considered a "goddess" & becomes more popular at school. Soon she falls into a triangle between mysterious Lee Su-ho (Cha Eun-woo), who recognizes her through her makeup, and his former best friend Han Seo-jun (Hwang In-youp).

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"Weightlifting Fairy Kim Bok-joo"


This drama has one of the most likable protagonists và the cutest friends-to-lovers story. Kim Bok-joo (Lee Sung-kyung), a collegiate weightlifter training for the Olympics, meets Jung Joon-hyung (Nam Joo-hyuk) a swimmer at the same school recovering from a psychological problem. The two athletes start out as reluctant friends, but watching them fall in love makes for some hilarious, heart-warming moments.

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"Her Private Life"


This drama from rom-com queen Park Min-young is a sweet story of love & fangirling. Art gallery curator Sung Deok-mi (Park) has a secret life running a fan page for her idol Shi-an. She devotes her life khổng lồ her job và family, while keeping her fangirl activities secret out of disapproval. One day, Ryan (Kim Jae-Wook)becomes the art director of Deok-mi"s gallery, & he soon sets up a celebrity exhibit featuring Shi-an. As Deok-mi struggles to keep her private life secret, Ryan takes an interest in her.

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"Our Beloved Summer"


Ten years have passed since high schoolers Choi Ung (Parasite"s Choi Woo-sik) & Kook Yeon-su (Kim Da-mi) starred in a documentary together. Though they started out hating each other, the pair later began dating and stayed together for five years. Now, five years after the rough breakup, the two adults find each other back in their lives at the same time the documentary goes viral, with fans clamoring for an update. Will Ung và Da-mi fall in love again while filming the sequel? kiểm tra out this enemies-to-lovers drama to lớn find out.

watch it on netflix

"Run On"


The storyline: Ki Seon-gyeom, a popular sprinter turned sports agent, meets Oh Mi-joo, who writes subtitle translations for movies, and Mi-joo believes they were destined for each other. The story centers around their budding romance alongside some strong secondary characters. Mi-joo is played by actress Shin Se-Kyung (from
Rookie Historian) while Seon-gyeom is played by im Si-Wan (from
Strangers From Hell), so if you"re familiar with both famous faces then give this show a chance.

watch it on netflix

"Start-Up"


Bae Suzy & Nam Joo-hyuk stans will want lớn tune into this drama, which mixes comedy with romance. The show centers around a group of young individuals who are all eager to start their own businesses. When Bae and Nam"s characters, Seo Dal-mi và Nam Do-san respectively, are chosen to lớn join Sandbox (a tech accelerator for entrepreneurs), along with Seo"s sister Won In-jae, the three are pitted against one another in a contest khổng lồ be the best. Little does Dal-mi know, however, someone important from her past (Han Ji-pyeong, played by Kim Sun-ho) has her back throughout this start-up journey. Viewers will be rooting for Dal-Mi to over up with Do-San or Ji-pyeong. Personally, we are team Ji-pyeong.

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"Nevertheless"


K-dramas are known for being more chaste than Western romances, taking several episodes for couples lớn build their feelings before they become official or even kiss. If you"re looking for something steamier, Nevertheless follows the flirtation & eventual friends-with-benefits relationship between art students Yoo Na-bi (My Name"s Han So-hee) & Park Jae-eon (Love Alarm"s tuy vậy Kang). Their love story may be frustrating, but the actors" chemistry makes this drama worth the watch.

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"Touch Your Heart"


I"m somewhat biased because I am an unabashed Lee Dong-wook stan, but
Touch Your Heartis really, really fun lớn watch. Things take place in a high-powered law firm, where a washed-up actress works as a secretary for a cranky attorney. The two leads have great chemistry—they"ve played star-crossed lovers in Goblin—and they"re both extremely good-looking. Plus, it"s another workplace love story! Is the universe trying to lớn send me a sign?

watch it on netflix

"What"s Wrong With Secretary Kim"


This beloved rom-com stars Park Min-young as Kim Mi-so, the skilled secretary to lớn chaebol businessman Lee Young-joon (Park Seo-joon). The job is demanding & Young-joon is narcissistic & self-absorbed, và after nine years at her job, Mi-so has finally decided khổng lồ quit and start living her life for herself. However, Young-joon refuses khổng lồ let her go, and eventually he realizes that his feelings for Mi-so go beyond professional admiration. On Mi-so"s side, she begins to see her slowly-softening monster in a new life, leading to lớn a genuinely sweet love story (and some top-tier kissing scenes).

watch it on hulu

"Strong Woman bởi vì Bong Soon"


This drama has a bit of everything, cramming a compelling crime thriller, a charming love story, và a family legacy of super-strength all into 16 episodes. Tiny và mighty vày Bong-soon (Park Bo-young) has inherited a gift of monumental strength that runs through the women in her family. Her dream is lớn create a đoạn clip game, but she spends her days searching for permanent employment & using her power for good. One day, gaming CEO Min-Hyuk (Happiness" Park Hyung-sik) sees Bong-soon"s power & hires her as a bodyguard, since he"s been receiving threatening letters. Showroom in a serial killer threatening Bong-soon"s neighborhood và a longtime crush/cop (Ji-soo) to complete the love triangle, & you have a show that will suck you in.

watch it on viki

Fantasy Korean Dramas

These sci-fi/fantasy shows range from modern lớn historical, và the magical elements can either be hidden among day-to-day life or blown out lớn encompass tons of lore Game of Thrones-style (though minus the gore, most of the time). K-dramas also love a good fated romance, so expect some mystical love connections.

"Goblin (Guardian: The Lonely & Great God)"


This series, written by Kim Eun-sook, is the fourth highest-rated Korean drama of all time. The fantasy romance is about a modern day goblin, Gong Yoo, who needs a human bride (Kim Go Eun) to end his cursed immortal life. His life then becomes intertwined with a grim reaper, Lee Dong-wook, who is unable khổng lồ remember his past. The story evolves as all these strangers" lives intertwine.

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"Hotel de Luna"


The hotel Del Luna is a refuge for the dead, a middle ground that helps souls pass into the afterlife. All souls pass on after dealing with their unfinished business in life, except Man-wol (IU), the owner who has been cursed lớn run the khách sạn for over a millennium, as penance for her sins. The hotel also needs a human manager to lớn help it run; the next fated human is Koo Chan-sung (Yeo Jin-goo), a Harvard grad who discovers that he can see ghosts. As they work together, Chan-sung begins to lớn unravel the secrets of Man-wol"s past.

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"The Uncanny Counter"


This show loosely reminds me of
Ghostbusters, but with an eclectic group of characters who each possesses special abilities. The five-person group, called "Counter," work at a noodle restaurant by day & at night, hunt down evil spirits who have escaped from the after life to lớn go after humans. (Their red tracksuits in the show are iconic and honestly would make for great group Halloween costume in 2022—just putting the idea out there.) This K-drama has been very well received by the audience & will have you binging all the episodes in one weekend.

watch it on netflix

"Tale of the Nine Tailed"


You might want lớn keep the lights turned on for Lee Dong-wook"s new show because it"s a little scary (think scenes with ghosts & a water well à laThe Ring). Aside from some minor scenes that make you shudder, however, the story largely revolves around his character Lee-yeon, a mythical fox known as gumiho, và a documentary filmmaker nam giới Ji-a (played by Jo Bo-ah) who were once lovers in the past. (The foxes adopt human appearances, but have special powers.) Circumstances in the present bring the two on a treacherous journey that involves solving Ji-a"s parents mysterious deaths and the two rediscovering their love for each other.

watch it on viki

"The King: Eternal Monarch"


This Korean drama has it all: parallel universes, time travel, a handsome king, a strong female detective, tragedy, và romance. The show tells the story of Lee Gon (played by one of South Korea"s most popular actors: Lee Min-ho), a Korean emperor who rules The Kingdom of Corea (the North và South are still unified in this world) và discovers a portal opening in the bamboo forest that leads him to lớn a parallel universe—the world that we know today. He meets, & falls in love, with detective Jung Tae-eul (played byGoblin"s Kim Go-eun) in this world & they have to lớn work together to lớn close this time portal before their two worlds collide và freeze in time forever. Will they succeed in their journey và will their love be able to lớn transcend time?

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"Mystic Pop-up Bar"


This show checks off the boxes for drama, fantasy, & mystery. The storyline centers on Ssanggab Cart Bar, which is only open at night on the rooftop of a building. Wol-Ju (played by Hwang Jung-eum) runs the mysterious food cart & customers who visit her consist of the living và dead. While drinking and eating, they converse with Wol-Ju about themselves and their internal struggles.

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"Memories of the Alhambra"


This fantasy drama is perfect for Hyun Bin and Park Shin-hye fans (you may remember her from the popular showThe Heirs). The two actors play each other"s lãng mạn interest inMemories of the Alhambra, which is phối between Spain & South Korea. (Fun fact: Park Shin-hye learned Spanish for the show, so her voice is not dubbed!) They encounter each other in Spain when Hyun Bin"s character, Yoo Jin-woo, arrives khổng lồ the hostel owned by Park Shin-hye"s character, Jung Hee-joo, because he wants her to sign over the rights to develop her brother"s augmented reality game. (The brother, meanwhile, has vanished into thin air). Jin-woo starts playing the game & eventually realizes it is causing those around him khổng lồ die. If he wants khổng lồ save himself and Jung Hee-joo"s missing brother, he has lớn complete the dangerous quests.

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"Legend of the blue Sea"


This fantasy romance show explores the relationship between a bé artist and a mermaid who meet và fall in love. The mermaid, Shim Cheong, (played by the talented and beautiful Jun Ji-hyun) follows her lover Heo Joon-jae (Lee Min-ho) to land unbeknownst lớn him that she is a mer person. Juxtaposed against present day, the storyline also focuses on the two"s Joseon-era incarnations, town head Kim Dam-ryeong & the mermaid Se-hwa. That pair met a tragic fate, so what does this mean for their current counterparts? Will Shim Cheong & Joon-jae meet the same bad fate?

watch it on hulu

"W"


If you"ve ever wished that the nhân vật of your favorite book could jump off the page & into your arms, this contemporary fantasy is just for you. Cardiothoracic resident Oh Yeon-joo (Happiness" Han Hyo-joo) is the daughter of Oh Sung-moo (Kim Eui-sung), the artist behind the popular 10-year webtoon W, who goes missing the day his final chapter is due. While looking in his office, Yeon-joo suddenly gets sucked into the comic itself, & saves the life of its hero Kang Chul (Lee Jong-suk), who her father is determined khổng lồ kill. She then emerges back in his office, with the webtoon chapter having finished itself, with her actions as the new plot.

watch it on viki

"My Love from the Star"


In this rom-com, bởi vì Min-joon (Kim Soo-hyun) is a handsome alien who landed on Earth 400 years ago during Korea"s Joseon era. He"s been waiting for a chance to return khổng lồ his home planet for centuries. When he has three months left on Earth, he gets a new neighbor, Hallyu star Cheon Song-yi (Jun Ji-hyun), who resembles a young woman from his past. Their romance will have you watching the skies hoping for an alien invasion (as long as they look lượt thích Min-joon).

watch on viki

"Alchemy of Souls"


Set in the fictional country of Daeho, this period fantasy takes place in the world of mages, who live as nobles và warriors among other mortals. Elite warrior Nak-su has evaded authorities by using a forbidden spell called "alchemy of souls," which allows her khổng lồ switch bodies. When she jumps into the weak body of Mu-deok (Jung So-min), she has to re-build enough strength khổng lồ wield her powerful sword. So she takes a position as a servant for Jang-uk (Lee Jae-wook), a noble who needs a teacher to help him unbind his magic.

watch it on netflix

"While You Were Sleeping"


Reporter phái nam Hong-joo (Bae Suzy) lives with an ability to dream about the future, and her visions are usually unfortunate events. Though she can warn the people involved, the dreams ha