HIV testing as prevention among MSM in China: The business of scaling-up

Abstract

In this paper, I examine the emergence of goumai fuwu, or contracting with social organisations to provide social services, in the HIV/AIDS sector in China. In particular, I interrogate the outsourcing of HIV testing to community-based organisations (CBOs) serving men who have sex with men (MSM) as a means of scaling-up testing in this population, and how the commodification of testing enables new forms of surveillance and citizenship to emerge. In turn, I tie the scaling-up of testing and its commodification to the sustainability of CBOs as they struggle to survive. In recent years, the HIV/AIDS response in China has shifted to expanding testing among MSM in order to reduce new infections. This response has been catalysed by the transition to sexual contact as the primary transmission route for HIV and the rising rates of infection among MSM, leading government institutions and international donors to mobilise CBOs to expand testing. These efforts to scale-up are as much about testing as they are about making visible this hidden population. CBOs, in facilitating testing, come to rely on outsourcing as a long-term funding base and in doing so, unintentionally extend the reach of the state into the everyday lives of MSM.

Keywords:

• HIV/AIDS
• China
• MSM
• HIV testing
• outsourcing

Acknowledgements

The author wishes to thank Britt Halvorson, Denielle Elliott and David Strohl for reviewing earlier drafts of this article. Additional thanks are extended to the anonymous reviewers for their careful reading and constructive feedback.

Notes

1. All references made to donors in this paper refer to international donors.

2. For more on outsourcing in China, see Irish, Salamon, and Simon (2009), Jing (2008), Jing and Bin (2012), and Teets (2012).

3. Funding came from a special AIDS fund administered by the Changsha Finance Department.

4. All names are pseudonyms.

5. For more on the commodification of blood in this context, see Erwin (2006) and Shao (2006).

6. The ‘Four Frees and One Care’ policy provides free ART to rural residents or those with financial hardship in urban areas, free voluntary counselling and testing services, free drugs to HIV-infected pregnant women and free testing for newborns, and free schooling for AIDS orphans. In 2010, the Chinese government added the ‘Five Expands, Six Strengthens’ policy for more extensive coverage and regulation of the epidemic.

7. In 2010, a case was publicised involving a man who was fired from his job due to his HIV status (Jacobs, 2010).

8. The more recent campaigns advocated by international health organisations promote treatment as prevention for people found to be seropositive. For a critical perspective on these models, see Nguyen, Bajos, Dubois-Arber, O'Malley, and Pirkle (2011) and Patton (2011).