It was really interesting for me to read to Dr. Wong’s articles about HIV among MSM in China, because it is a geographic area that I am pretty unfamiliar with. As a public health student in the US, most of my studies on HIV have been focused on either the US or Africa, because of the high prevalence rates. But it is really interesting to consider how different an epidemic of the same disease looks in different countries and how it has transformed over the years. Whereas MSM are recognized as a high-risk group in the US, it is rarely discussed in the context of the Africa HIV epidemic. Conversely, mother to child transmission of HIV remains an issue in Africa and other low-income countries, whereas this form of transmission has virtually been eliminated in the US and other more developed countries. Russia is another example of a different picture of HIV because the percentage of people living with HIV who are intravenous drug users is very high compared to other areas of the world.
It is interesting to compare and contrast the issues surrounding HIV in China to other epidemics across the globe. Stigma associated with MSM and HIV is clearly an issue in China. As discussed in the article, “one must only engage in activities and behaviors that will not ‘shame’ the family” and that homosexual relations “will be tolerated by the family only to the extent that it does not interfere with the individual’s and the family’s duties and eventual marriage”. This attitude towards homosexuality seems to fall somewhere in between what it is in Africa, where it is viewed much more negatively and in the US, where same sex marriages are now legally in many places. While there may be some tolerance of these practices within families, clearly this sexual preference is still kept a secret from the larger community. Obviously, this stigma and these cultural expectations will have a large impact on the HIV epidemic. For example, MSM may be more reluctant to get tested for HIV or seek treatment for HIV, if they fear that they will be judged about their sexuality. Another large issue considering this cultural stigma is about partner notification and transmission. As we have learned in other classes, women make up the fastest growing group of persons newly infected with HIV, and in the case of China, we can see how the high prevalence rate of HIV among MSM can contribute to the growing incidence among women. Wong et al. make the comment that “considering that at least one third of Chinese MSM are also married, MSM might be acting as a bridge for infection among women in China”. I thought it was really interesting to learn about male sex workers in China who have sex with men and that one study found that “twenty percent of the sample self-identified as heterosexual and indicated that they traded sex for purely business reasons”. Clearly, these two dynamics can greatly increase in the spread of HIV throughout both the homosexual and heterosexual population of China.
In order to address these issues, a number of health interventions are needed (including promotion of condom use, scaling up of HIV services in hospitals, and campaigns to increase tolerance of homosexuality). However, it is concerning that “it is extremely difficult for outsiders (including Chinese academics) to gain free and unhindered access to such information” about HIV. What is first needed, most of all, is an increased commitment by the Chinese government (considering most health centers are governemtn-run) to address these issues surrounding HIV, if the incidence rate is ever going to be reduced.