This is the third in a series of blog posts on
HIV/AIDS in China, in preparation for the first China AIDS Walk. Click here for
the first and second posts of the series. China AIDS Walk aims to raise
awareness for HIV/AIDS in Mainland China; to abate discrimination and stigma
against people living with HIV/AIDS; and to raise funds for projects related to
HIV/AIDS.
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| Infographic used in a BBC News report in 2001. Statistical information is difficult to get, and numbers remain crude estimates. Source: http://news.bbc.co.uk/1/hi/world/asia-pacific/1481542.stm |
In the West HIV/AIDS is often perceived as a
‘gay disease’, even when it affects many more heterosexual people around the
world. Such association between homosexuality and HIV/AIDS is relatively new in
China. Until fairly recently most transmissions occurred through intravenous
drug use, sex work and blood plasma donations (see last blog post). But
transmission patterns are changing. A growing concern is the sexual
transmission of HIV/AIDS. As China is undergoing something akin to a sexual
revolution, risky behavior is increasing, catalyzed by a lack of awareness of
HIV/AIDS and other STDs. In 2003 sexually
transmitted HIV/AIDS cases accounted for 30.9% of total transmissions (Zhang and Chu 2005). A rapidly growing
problem is HIV/AIDS among
men who have sex with men (MSM). In 2001 only 0.2% of reported cases of
HIV/AIDS concerned MSM, by 2003 11.1% of new cases were among MSM (id.) Since
1992 homosexuality is legal in China. However, traditional stigma’s persist,
for instance the Confucian idea that not having children is a great evil.
Therefore many gay people lead double lives; having same-sex contact while
being married with one child; while their spouses are equally exposed to
HIV/AIDS. According to Zhang and Chu, a ‘particular situation for China is that MSM in China are more prone to spread
HIV to women’.
There have been only a few studies on awareness
and attitudes towards HIV/AIDS. A 2002 survey by the State Family Planning
Commission showed that 20% of Chinese adults have not heard of HIV/AIDS. Awareness
is much lower in rural areas (Chen 2002). A 2005 study surveying including
1326 undergraduate students between the ages of 17 and 28 found that 40% of sexually active students never uses
condoms. Condom-use does not seem to relate to personal perceptions of the risk
to contract HIV/AIDS (Huang et al. 2005). The possibility of transmission
through risky
behavior, including anal sex and needle sharing were poorly understood by most
students. Moreover, a
third of the students thought that HIV could be transmitted by casual contact. The
study also included questions about their attitudes towards people living with
HIV/AIDS. Respondents had rather low empathy for people who got HIV/AIDS,
especially through sexual promiscuity and drug use. Also 35% of the surveyed
would stop being a friend with someone if they would discover he/she is
homosexual.
The popular perception of HIV/AIDS in China is
influenced by transmission patterns. As many transmission cases occur in
criminalized environments (drug trade, sex industry), or in socially stigmatized
settings (homosexuality). HIV/AIDS has become to be seen as an “indecent
disease”.
This has practical implications. The
criminalized and stigmatized environments of HIV/AIDS makes it especially
difficult to address. For instance, how to start education and prevention programs
when the beneficiaries of such programs risk being jailed. Instead, official
policy emphasizes detection and treatment, rather than prevention and awareness
raising. In the face of criminalization, stigmatization and moralization of
HIV/AIDS, it is also difficult to gather social support, e.g. from family and
friends. Not only do people hesitate to associate with people living with
HIV/AIDS, also, people with HIV/AIDS are often inhibited by feelings of guilt
and shame. Moreover, stigmatization also leads to blindness and dangerous
unawareness of the nature of HIV/AIDS. According to Rachel Zhou Yanqiu (Zhou 2007) “moralized discourses of HIV/AIDS
have given the public a false sense of security: people from outside “high-risk
groups” tend to be blind to their possible exposure to HIV”.
The lack of
knowledge has contributed to discrimination and general misunderstanding leads
to stigmatizing and discrimination. Discrimination is also institutionalized,
as people with HIV/AIDS are labeled. Anonymous testing is not available. When
HIV/AIDS is diagnosed it will be reported to relevant authorities. This has
major repercussions for people’s job prospects, livelihoods and their social
environment. People who might carry HIV avoid real name testing, and unknowingly
continue to spread HIV.
Social
stigma, criminalization and real name testing are also some of the most
important reasons why statistics on the occurrence of HIV/AIDS in China are
difficult to come by. There Is no incentive for people to get tested, and there
is also no incentive for local governments to report high occurrence of
HIV/AIDS. Instead, the local governments carry out short-term campaigns, where
people are rounded up and forced to undergo testing. In Beijing, for instance,
the largest gay venue has been targeted occasionally. Police seal off the area
and people have to stand in line to give blood.[1]
[1] Foreigners are usually exempt
and can leave the premises. The advice is to carry your passport with you when
you’re foreigner and going out in gay venues.
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