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.
|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.
Chen, Sheng Li. 2002. HIV/AIDS in China : survey provides guidelines for improving awareness . In Asia-Pacific population & policy. Honolulu: East-West Center.
Huang, Jin , Carol Bova, Kristopher P. Fennie, Angela Rogers, and Ann B. Williams. 2005. "Knowledge, attitudes, behaviors, and perceptions of risk related to HIV/AIDS among Chinese university students in Hunan, China." AIDS Patient Care and STDS no. 19 (11):769-77.
Zhang, Bei Chuan, and Quan Sheng Chu. 2005. "MSM and HIV/AIDS in China." Cell Res no. 15 (11-12):858-864.
Zhou, Yanqiu Rachel. 2007. "“If you get AIDS… You have to endure it alone”: Understanding the social constructions of HIV/AIDS in China." Social Science & Medicine no. 65 (2):284-295. doi: 10.1016/j.socscimed.2007.03.031.