Why China needs to talk a lot more about gay sex and HIV
New HIV diagnoses have doubled since 2008, yet ignorance about the virus is widespread; with parents, schools and health authorities saying little, it’s left to NGOs to spread safe sex message
Beijing (South China Morning Post) - Lin Hui, a student in China, thought condoms only served to prevent pregnancy. So when he had sex with another man, in high school, he didn’t think he was exposing himself to any risk.
Lin, who asked that his real name not be revealed, was diagnosed with HIV in 2014, a few months before turning 18. He is now a university student in Nanjing, keeping the virus in check with daily medication. He feels resentment, however, about contracting a disease society taught him little about.
“I never imagined it could happen to me,” Lin says. “There is very little sex or HIV-prevention education in schools or in society in general. People only talk about it around World Aids Day," on December 1, "and then we forget about it.”
Lin is one of a growing number of young people in China to have been diagnosed with HIV in recent years. While the country has managed to dramatically reduce HIV transmission through drug use and blood transfusions, the rate of new, sexually transmitted infections among young people has accelerated in the past five years, particularly among men who have had sex with other men.
Almost 17,000 people aged between 15 and 24 were diagnosed with HIV in 2015, according to China’s National Centre for Aids/STD Control and Prevention (NCAIDS). That was 10 per cent more than the number of new cases identified in 2014 in the same age group, and more than double the number of new cases reported in 2008.
Over the past decade, the number of HIV transmissions among young Chinese has increased by as much as 20 per cent annually. China’s health authorities have recognised the problem but have been slow to respond.
“The real challenge today is especially among young populations, especially among young gay men,” says Bernhard Schwartländer, the WHO representative in China. “There’s a real spread of HIV in these populations, and we don’t seem to reach them well. I think it’s a real challenge to Chinese society to deal with populations that are outside of social norms, that are different in some way.”
Almost 70 per cent of the people aged between 15 and 24 years who were diagnosed with HIV last year were infected through homosexual sex. Of the students in that age group, gay sex was the cause of infection in 82 per cent of cases, according to NCAIDS. About 3,200 students received HIV diagnoses last year, but four times as many newly infected young people were outside the school system.
This suggests that starting HIV prevention education in university might already be too late, because most young people at risk are outside of college campuses, says Catherine Sozi, UNAids country director for China.
“So if they don’t get the information while they’re in school ... then it’s a bit of a missed opportunity to help young people” gain the knowledge that will help protect them, she says.
The Ministry of Education and the National Health and Planning Commission have mandated six hours of sexual education for all middle school pupils and four hours for high school students.
But few schools offer any type of sex education, sexual health activists say. And when they do, classes are usually focused on biological changes during puberty, not on relationships or gender identity diversity.
Liu Shi, project manager at the non-profit Beijing Gender Health Education Institute, sees two barriers preventing young people from receiving sex education in schools. One is parents.
“So many parents want their children to stay away from any sex education before college because, especially if the sex education is in high school, they are worried that their kids may be encouraged to have sex earlier,” says Liu, who is HIV positive.
Many Chinese parents want their children to concentrate on studying for the national college entrance exams, wait until college to have personal relationships, and wait until they’re married to have sex, after graduating from university.
The reality, of course, is different. Technologically savvy, and increasingly free from the constraints of living with their families in small, rural communities, young people are exploring their sexuality earlier and more boldly than previous generations. At the same time, sex remains a taboo subject in schools, official discourses and pop culture.
“There’s not enough government and social publicity,” says Wang Long, founder of the non-profit Zhejiang Love Working Group. “Movies, TV series, talk shows, newspapers and radio all avoid talking about sex.”
The Ministry of Health has a condom distribution programme, but condoms adverts are banned from television.
Even though many universities have programmes, clubs or lectures that address HIV prevention, the message often goes astray, according to Martin Yang, China Aids Walk project manager at Beijing Gender Health Education Institute. The content fails to resonate with young people, or they merely ignore it, Yang says.
“I think the perception of a lot of people in this country is that [HIV] is far away,” says Sozi. “It’s a sex worker somewhere, and some gay man somewhere. It’s not here.”
Health workers are realising there needs to be a paradigm shift in the way they tackle HIV/Aids prevention, she says.
“We’re still doing what we did 20 years ago,” Sozi adds. “There’s been no shift in keeping up with the emerging populations and how they do things, how business is done. It’s done on the phone; it’s no longer posters and reading newspapers.”
At the Blued offices in Beijing’s Chaoyang district, employees are making last-minute preparations for World Aids Day events. Blued is China’s largest gay dating app, with 27 million users. Since 2008, its parent company, Danlan, has worked with government agencies on online and offline HIV prevention efforts.
The app has a section with information about HIV, and a feature that allows users to find the nearest testing centre and make an appointment. There are regular live-streaming events and photo contests. Its HIV-related information has logged 70 million views in 12 months, says Hank Chen, director of Danlan Public Welfare.
“Compared with the entertainment feature and the socialising feature, the HIV-prevention feature is not that popular,” Chen says, adding they are looking at new ways to get the message across.
Discussion on HIV prevention should not just involve medical terms, says Fabio Scano, a disease control coordinator at the WHO Beijing office. It should be tied to people’s lifestyles, and to combating stigma and discrimination by involving more NGOs and community groups. In particular, gay men should be involved in “the planning and implementation of services: from being merely service providers, to full partners in planning”.
The government has established a fund for NGOs to tap into for HIV testing. However, funds are not available for most advocacy or awareness-raising work.
Yang of China AIDS Walk wants students to become more involved in the search for efficient ways to get the HIV-prevention message across to other young people. The organisation is making available micro-grants for student groups at 100 universities around the country to conduct their own outreach experiments. The funds come from individual donations but should be enough to plant the seeds of community work among students.
“It can be anything from a board game to a radio show,” Yang says. “It will give them the opportunity to disseminate information and be creative.”
Additional reporting by Qu Chaonan