China Grapples With HIV Cases Among Gay Men, but Stigma Runs Deep

Surge in infections worries health authorities and prompts soul-searching in conservative society

Beijing—A health report from a southeastern corner of China has brought a disturbing truth into the open: HIV infections are growing rapidly among young, gay Chinese men.

The trend is worrying health authorities—and prompting criticism of their efforts to respond—in a country that until 2001 classified homosexuality as a mental illness and where there is almost no public discussion of gay issues or rights.

The report this month from health authorities in Nanchang, a city of five million, said the HIV infection rate among students at the city’s colleges grew by 43% annually in the past five years. More than 80% of the new cases were the result of male same-sex encounters.

It was a small sample—135 HIV infections and seven deaths across 37 colleges—but its effect was one of shock.

“The society is changing so fast, I’m all confused. These miserable college students are detestable,” said one user on the Weibo social-media platform.

In the 1980s and ‘90s, Beijing depicted AIDS as only existing in the West, the result of decadent, capitalist lifestyles. After an explosion of AIDS cases in Henan province among farmers who had sold blood to unlicensed blood banks, the government began acknowledging the seriousness of the disease.

In the early days of China’s AIDS epidemic, drug users and sex workers were the main victims. A decade ago, men who have sex with men accounted for less than 1% of new HIV infections in China, according to government data. In 2015, they made up 27%. In the U.S. gay and bisexual men account for about 67% of new HIV diagnoses, according to the U.S. Centers for Disease Control and Prevention.

More alarmingly, while the total number of people living with HIV in China is still smaller than that of the U.S.—at around 575,000 compared with 1.2 million—it is growing faster, at a rate of around 100,000 a year compared with around 40,000 in the U.S., government data from both countries show. The rate of new infections has plateaued in the U.S., which health officials attribute to effective prevention and testing.

A nurse checks on a patient in the HIV/AIDS ward of a Beijing hospital. HIV infections in China are growing at a rate of around 100,000 a year, according to government data. PHOTO: DAVID GRAY/REUTERS
China has become more transparent in its handling of epidemics since it was criticized for its tight control on information during the 2003 outbreak of severe acute respiratory syndrome. Since that year, China has provided free antiretroviral medications to those who test HIV-positive. That doesn’t mean homosexuality or sexually transmitted diseases are comfortable topics here.

Liu Jiulong, a 37-year-old AIDS activist who grew up in rural Jiangxi province, of which Nanchang is the capital, said he didn’t encounter the notion of homosexuality until he was 26 years old and read about it online. Two years later, he attempted suicide after being diagnosed with HIV. The Beijing advertising company where he worked let him go after finding out about his status, saying other employees were scared to come to work.

“The government emphasizes the morality of sex rather than the safety of sex. If they continue to use this mentality to make public-health policies, China will pay the price one day,” he said.

World Health Organization officials have urged China to crack down on discrimination against people with HIV or at risk for the disease, saying stigmatization makes prevention efforts more difficult.

“While HIV testing is widely available, we know that many people are hesitant about getting tested for HIV—because of fears of testing positive, the stress of waiting for results, inconvenience of going to a facility for testing…and the fear of stigma and discrimination,” said Dr. Bernhard Schwartländer, WHO’s representative in China.

Chinese health officials say the rise of gay men in the HIV statistics partly reflects success in reducing infections among intravenous drug users—a trend mirrored in the U.S.—as well as among sex workers and from the illegal blood trade.

But it is nevertheless making them worried. Last year, authorities said they would release information on infected students so that colleges could warn the rest of the student body. Authorities inform colleges of how many HIV-positive students are attending a school, and who they are, but schools aren’t supposed to publicly identify those students.

For the gay community, it is one more assault. People infected with HIV are banned from government jobs, and students whose college learns of their HIV status have sometimes been expelled or pressured to leave.

“The intention [of the health authorities] is good, but it’s easy to cause panic because in the Chinese context, there is little knowledge of homosexuality and a lot of misunderstanding,” said Allen Chen, founder of Friend Public Welfare, a Guangzhou-based advocacy group focusing on sex education of students. “As a result, the gay students are depicted as high-risk and thus are further stigmatized,” he said.

Wang Ning, an AIDS specialist from the Chinese Center for Disease Control and Prevention, said there should be no reason to worry that the privacy of those with HIV infections will be violated as awareness of the disease grows. He said one reason for the rapid growth of infections was that some people with HIV withhold their status from sexual partners. “The understanding of privacy varies in different cultures. In China, some people think privacy means they don’t need to tell anybody,” he said.

Both officials and academics say that gay-dating sites and apps such as Blued have made casual campus sex more easily accessible. A student “can find a partner right from his dorm,” said Wei Wei, an associate professor of sociology from East China Normal University who is openly gay.

Zhai Zhihao, a senior at Huazhong University of Science and Technology in Wuhan, whose parents know he is gay, said the health authorities’ disclosure policy makes him uncomfortable. “It’s always about warning and intimidation, and how horrible sex is,” he said.

Mr Zhai said many parents, including his mother, forwarded news of the Nanchang report to their children in college, and he fears the new measures might compromise students’ privacy. “HIV-positive students would feel very insecure if they get a call from the school, even if it is just to remind them to take their medications regularly,” he said.

Chinese health officials have defended the decision to inform colleges of the number of HIV-infected students on campus. “No country in the world has discovered an effective way to curb the epidemic among gay men,” said Wu Zunyou, director of China CDC’s AIDS-prevention center on state broadcaster CCTV last year. “Most students know what AIDS is and how to prevent it, but the change of behavior remains a big challenge,” he said.

But Prof. Wei worries that health authorities are alienating the very group of people they need to reach. “How could these students trust the doctors? Going to see doctors is just asking for further humiliation,” he said.

by Fanfan Wang
Source – WSJ