HIV in China: Understanding the Social Aspects of the Epidemic

Jun, J. and H. Worth ( eds ) HIV in China: Understanding the Social Aspects of the Epidemic . Sydney : UNSW Press , 2010 240 pp (pbk) £32.84 . ISBN: 978-1-74223-169-3 During my early visits to China in the eighties, all anyone wanted to hear about was HIV/AIDS. The viral cause had only recently been identified and was disputed, but apparent social and behavioural correlatives had received much publicity. Chinese friends and colleagues displayed a keen, almost prurient, interest in the spread of the disease in Europe and the United States. I detected more than a little schadenfreude from my otherwise kindly hosts, that the West was getting its come-uppance. They did not know that an epidemic was also underway in China, still hidden but soon to emerge from the far borders of the south west in the province of Yunnan, spreading first in impoverished central provinces and finally becoming established nationally. It is generally acknowledged that health officials were slow off the mark. When the first case was identified in 1985 it was firmly described as being ‘of foreign origin’. A subsequent long-drawn out awakening over a period of about 15 years meant that many people died unrecognised and untreated and are lost to official statistics. Jolted by the scandals over the sale of infected blood and plasma, and scared by the SARS epidemic, the system went into overdrive, cracking down severely on drug addiction and prostitution and ordering public health departments to sort out identification and treatment plans. Like earlier approaches to infectious diseases, the solution was seen to lie in public education and treatment, carried out by health workers from local and regional bureaux. What was different this time was the involvement of the public security forces in the enforcement of harsh social controls. The above remarks are by way of background to this book which is one of a number of recent publications which discuss the social drivers of the AIDS epidemic in China. It represents the relative novelty of such research by Chinese social scientists. The book is largely the product of a new generation: these are papers from a capacity-building workshop for young scholars held in 2009 by Tsinghua, China’s leading university and the University of New South Wales. In a very useful overview, one of the editors, Jing Jun, outlines the ‘three trades’– those of blood, sex and narcotics – that have driven the epidemic, and which flourish under circumstances of poverty, gender inequality, corporate greed and economic expansion. Then follows a series of qualitative studies of gay men, female sex workers, young drug takers and officials and victims of the ‘red oil’ boom, the market trade in blood. In each case the authors outline the particular social features which stimulate and accompany the growth of disease. These include unemployment among minority peoples, migration to the cities of large numbers of young women and men in economic boom times, pressures on students to perform in a competitive academic market and the sheer entrepreneurial drive toward getting rich and spending money in consuming pleasures. In her study of female sex workers, Huang Yingying discusses the occupational concerns of ‘hair salon’ girls, who work in the lower end of the sex industry in thinly-disguised hairdressing shops and massage parlours and who have been a focus of the government’s drive for condom use. Fear is a way of life for them. As well as her insightful description of sex workers’ working practices, attitudes and dreams, she gives a useful account of the policy conflicts that impact upon them – police harassment and arrest on one hand and health departments attempts at HIV prevention on the other. She also describes the extent of commercial sex amongst young women migrant workers, which might range from taking presents and protection to sex for money. This shifting population experiences the freedoms and constraints of life in the factories of the Special Economic Zones where China’s wealth is created. Zhang Yuping contributes an important chapter on the fears of identity exposure among gay men living with HIV. Traditionally, there are many instances of same sex relationships both in history and Chinese classical literature; as long as these did not conflict with the Confucian ethic of marrying and producing a son to keep alive the ancestral line, they did not attract condemnation or comment. The modernising Republican and later Communist governments pathologised homosexuality as a psychological disease, a categorisation that was not lifted until 2001. A fairly high degree of stigmatisation and discrimination remains and the ethic of confidentiality is not deeply embedded in medical practice. The double exposure of sexual preference and HIV status militates against the official ‘Four Free and One Care’ policy which offers free testing and retroviral drugs, for these are available only on the basis of household registration and many do not wish to return to their home towns for treatment. This book attempts to do what all good sociology should do, to combine the intimacy of an approach which concentrates on beliefs, values and behaviour whilst highlighting inequality, market forces and state policies. It draws attention to the family as a central site where dynamic conflicts around sexual behaviour, obligation and HIV status are played out. In an excellent final chapter Huan Juanli discusses the two concepts that have guided Chinese social scientists in their research, ethnicity and gender inequality. Official statistics have obscured the degree to which minority peoples have been afflicted by the epidemic; for millions of poorer women the rhetoric of equality that they ‘hold up half the sky’ means little as they head from their village to the industrial kitchen of Shenzhen. As book chapters, the work here does not contain the methodological rigour that one might associate with qualitative research. Nevertheless it has the flavour of authenticity and the findings are broadly corroborated elsewhere. The careful reader might note the book’s cautious tone on issues of widespread discrimination, criminalisation and police and Party corruption. An otherwise hard-hitting chapter on ‘red oil’ fails to mention that no officials have been prosecuted while ‘whistle-blowers’ have been harassed. Our Chinese colleagues work within a narrower set of freedoms.