Sobering Trends in China’s Fight against HIV

Source: South China Morning Post; students spelling out the word AIDS with HIV/AIDS awareness ribbons. 

Source: South China Morning Post; students spelling out the word AIDS with HIV/AIDS awareness ribbons. 

When it comes to HIV and AIDS prevention there is much progress to celebrate. But while organizations such as UNICEF and articles in TIME Magazine have announced the possibility of an AIDS-Free Generation, the trends in China are startlingly bleak. New cases of HIV among gay men, students, and elderly above 60 increased in the past five years, 420%, 410%, and 360%, respectively. Credit should be given to the Chinese CDC for tracking the statistics and issuing their new slogan, “Joining together to fight AIDS by taking extra precautions”. However, slogans for public moral will only go so far to solve this problem. The rise in HIV infection rates is rooted in the fabric of Chinese social culture. Indeed, China has been unable to address what 1980s New York City faced. What Dr. Oxiris Barbot describes as: “radicalized stigma around poverty, addiction, gender identity, and sexual orientation conspired to fuel HIV” at the apex of the epidemic in the United States. China’s inability to discuss in stark terms the issues that surround the causes of HIV is driving this epidemic.

The biggest barrier to frank conversations around this terrible disease is the social construct of “face.” Face cannot be translated because it is a way of life. It is self-worth derived from public perception. Everything that is said and done contributes to one’s face regardless of if it was purposeful or imposed. In Chinese society, as in many Asian countries, the battle to have or save face starts from day one. Under these circumstances, it is natural to be risk-averse to saying – or doing – anything that could compromise face.

By extension, admitting to anything shameful is automatically taboo. Any stigma against unsafe sexual practices, homosexuality, and disease contraction is simply magnified by the fact that no one talks about it, which creates a vicious cycle of ignorance. A Chinese proverb sums it nicely, “A family’s ugliness (misfortune) should never be publicly aired.” Rather than address that these issues exist, the Chinese impulse is to ignore them to disastrous effect.  

Taking extra precautions, as the Chinese CDC slogan suggests, is great in theory, except when the public does not understand sexual health as it falls into the category of things that are never discussed. While Japanese students are lucky to get a whopping three hours of education, their Chinese counterparts do not. Anecdotal stories indicate that the extent of sexual education takes place in seventh grade when Chinese students are asked to read a section of their anatomy textbooks and instructed not to ask questions about it. According to an interview published in The Economist with Fei Yunxia, a sex-educator from the Girls’ Protection Foundation, “No one tells…students about their bodies or how to protect themselves from harm.” In the rare instance that there is sex education, it never touches on more complex issues such as abuse, sexually transmitted diseases, and physical or emotional health. Indeed, lack of this vital education among students mean many are unaware of AIDS when they become infected. According to the Chinese Center for Disease Control and Prevention, 92% of the new cases reported in China were due to sexual interactions. Obviously the impact of this ignorance is taking its toll, and even worse the brunt of the epidemic is on China’s youth.  

Lastly, homosexuality is still a sensitive topic among the Chinese. “Chinese people can accept people being lesbian or gay. But not within their own family,” states Wu Zheng in a 2011 article published in The New York Times. The People’s Republic of China (PRC) banned homosexuality until 1997 and only removed it from the state-sanctioned list of mental illness fifteen years ago in 2001. While, historically, Chinese society has had less animosity towards homosexuality, as there was no moral baggage from religious beliefs as in Western countries, there is extreme pressure to marry and carry on the bloodline, so, it is still considered shameful to be gay. Many homosexual men and women are pressured into unhappy marriages and resort to affairs, which risks their own sexual health as well of that of their marital partners. As with the United States during the start of the AIDS crisis in the 1980s, this marginalized community is most at risk.

Admittedly, the closed-lipped nature of Chinese society may not be the sole reason for the spread of HIV, but it is certainly not helping. Solid understanding of sexual health and HIV prevention is the only way that these numbers will improve, and this will not be achieved without dissemination of the information. There is some encouraging progress recently with the publication of a sexual education textbook that details information about sexual intercourse and to some degree emotional health and well-being. However, this textbook remains extremely controversial and does not guarantee that instructors will take advantage of this resource. Furthermore, NGO and nonprofit organizations, which usually fill the gaps in society due to stigma, funding, or interest, are not as numerous nor well-funded in China as in other countries. Someone must take responsibility to open the topic to public discourse and take action. The time could not be better than now.

In fact, literally right now, consider donating to UN AIDS so you can contribute to the fight against this pressing epidemic.