The other day I was discussing infectious diseases with a group of doctors. The question was relatively simple, “How do diseases spread?” They quickly offered: through coughing, sharing chopsticks, touching, mother to infant, and even mosquitoes. I continued, “those are all correct, but how about viruses like HIV or hepatitis?” A few perked up with “Blood transfusions!” I waited another minute before giving in, and adding, “and sexual intercourse.” When I said those two words, everyone’s eyes dropped to the floor (keep in mind these are doctors in their 30’s and 40’s). I had mentioned a taboo topic.
The problem, as in most cultures, is that even though the topic is off limits, it doesn’t mean that Chinese youth are celibate. Chinese youth have a poor understanding of contraceptives and reproductive health. Attitudes in China’s younger generation towards sex seem to have shifted rapidly from the more puritanical morals of their parent’s generation, and no one seems willing to fill this knowledge gap.
When I worked in rural Guangxi, I was encouraged by former volunteers from VSO to teach a lesson on AIDS in connection with World AIDS Day. In the days leading up to the class, I was terrified of having to say words like “sexual intercourse” in front of 30+ mostly female students, but if I didn’t talk with them about HIV, nobody else was going to. I planned to spend the first 40 minutes of class explaining how HIV is transmitted and how to prevent transmission. The second half of class would be opened up for anonymous questions written on a slip of paper. It was one of the more surprising days of my life as a teacher.
I explained to them that a decade earlier I would have been able to focus on the danger of intravenous drug use and blood transfusions, but for a woman in Guangxi, the highest risk for transmission is through sexual activity (as of 2007). This is due to the fact that AIDS has spread beyond drug users, and has moved into the more general public. An AIDS activist in Nanning told me AIDS was most prevalent in the cities along the freeways between Vietnam and Guangdong. AIDS infected long-distance truckers were having unprotected sex with prostitutes in towns along their route. These prostitutes than spread the disease to local men, who communicated it to their wives.
At this time AIDS had become a growing problem in China, and since little action had been taken in the first years of infection, a strong stigma against AIDS infected patients was almost encouraged. At first the official attitude was that it was a foreign problem. An OB/GYN nurse told a foreign guest at the hospital that she didn’t need to be careful about fluids in the delivery room because “Chinese women don’t have as many STD’s as foreigners”. Then it was acknowledged as a problem for those living at the margins of society. Finally it was admitted that there were a large number of people infected through tainted blood, poor hospital sanitation, and marital relationships (~2003, when Wen Jiabao became the first Chinese premier to shake hands with an AIDS patient). But the damage had already been done. In 2009 I visited a small town in Guangxi that had a large number of AIDS patients. Many of them had been forced to live in tents outside of their family homes due to an irrational fear of the disease.
After I carefully explained the planned material in class, I started answering questions. At least one person in every class asked if AIDS could be spread by mosquitoes or handshakes, which made it clear how limited their knowledge of AIDS really was. What surprised me most though was that the most common question in every class was, “My boyfriend wants to have sex, how do I say no?” The second most common was, “How do I tell my boyfriend to use a condom?”
Even in the countryside, where traditional culture still supposedly reigned, it appeared that many of the ~20 year old students were already engaging in sexual activity. In urban areas the age for beginning sexual activity is even younger, as I was informed by teachers and students at a middle school in Chengdu.
While China is making progress in the diagnosis and treatment of AIDS patients and the stigma is gradually fading (the recent increase in AIDS patients could actually signify a greater number of people being diagnosed who in the past would have suffered silently due to social pressure and lack of treatment options), health education for prevention is still lacking. Until medical professionals are willing to discuss this disease with their patients, it is doubtful that teachers or even parents will.
Note: When I asked a roomful of doctors what the most common means of transmission for AIDS in China was they said: #1 Intravenous drugs #2 Tainted blood transfusions #3 Sexual intercourse #4 Mother to infant. This outdated knowledge leads people to create programs that do not effectively address the problem at the source. In actuality it is #1 Sexual intercourse (Heterosexual sex 42% of new cases, Homosexual sex 32% of new cases, totally 74%) #2 Intravenous drugs #3 mother to infant and tainted blood (both have improved dramatically in the past few years) Source: UNAIDS