Sociocultural facilitators and barriers to condom use during anal sex among men who have sex with men in Guangzhou, China: an ethnographic study

Abstract

This ethnographic study explored how cultural belief systems shaped sexual risk practices among men who have sex with men (MSM) in Guangzhou, China. A specific focus was on how these men's sexual practices varied across sexual venues and among different partners in order to better understand sociocultural facilitators and barriers to condom use in the Guangzhou community. Qualitative data were obtained through semi-structured in-depth interviews with MSM and ethnographic observations in MSM sexual venues in the city. The thematic analysis focused specifically on the accounts of unprotected sex occasions. We found that an erotic idea of “rouyu” (desire of physical flesh) embedded in a subculture of MSM and a metaphor for condom use as being inferior and promoting distance posed a considerable barrier to condom use among these MSM. Some men reported gaining a positive self-concept related to same-sex identity through unprotected sex. These MSM's subjective evaluations of HIV risk were closely tied to the perceived characteristics of sex partners and sexual venues. We conclude by advocating specific sociocultural interventions in emerging risk venues, such as saunas/bathhouses, to better meet the needs of the MSM community in Guangzhou.

Keywords:

• HIV/STD
• unprotected sex
• sexual venues
• men who have sex with men
• China
• ethnography

Acknowledgements

The authors would like to thank the participants for sharing their life histories and the Chi Heng Foundation and Aibai.cn for helping the study fieldwork. We especially express gratitude to Drs Pimpawun Boonmongkon, Arayan Trangarn, and Philip Guest at Mahidol University. We also would like to thank anonymous referees for their critical comments on this paper. This study was made possible with funding from the Ford Foundation. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Ford Foundation. We also appreciate Drs David Wilmshurst and Jessica Lin for proofreading.