Gendering China's Strategy against HIV/AIDS: Findings from a Research Project in Guangdong Province

Abstract

This analysis explores the potential influence of gender inequalities on the sex ratio of HIV/AIDS infections in China. The sex ratio is characterized by faster increases in sexually transmitted infections among women and includes the spread of HIV/AIDS from men to women. This contribution combines the findings of a research project in Guangdong Province, conducted between 2001 and 2002, with a range of government and academic sources to examine gender differences in sexuality and HIV/AIDS-related attitudes and behaviors, the impact of contradictory policies on women, and demands for services and social support. The study suggests priority areas for policy-makers and argues that, while China's action against HIV/AIDS has achieved remarkable results, there is still a need for further action. This includes a need to harmonize policies; increase services and social support, especially through civil society organizations and peer-help groups; and encourage men's involvement in the protection of women's rights.

Keywords:

• China
• HIV/AIDS
• sexuality
• gender inequality
• JEL Codes: N, N4, N45

Acknowledgments

I wish to thank the Giuangdong Women's Federation for supporting the project and Qiuxia Long and her team for their conscientious efforts throughout the project. I also thank the guest editors of the special issue and anonymous reviewers and editors of Feminist Economics for their helpful suggestions. Any mistakes in the final version lie with the author alone.

Notes

There has not been any comparative data on similar research questions from other areas of China, although bilateral organizations such as the Department for International Development (DFID) supported a study by Susie Jolly and Wang Ying (2003) and Aizhixing Institute undertook a study in 2007 on sex workers. Madu Bala Nath's 2000 compilation Gender, HIV and Human Rights: A Training Manual provides comparative data from other countries on individual experiences with HIV/AIDS and sexuality and on AIDS-related attitudes and behavior. The present volume offers another chance to compare data across countries.

Bai Xu details the cooperation between the 100 percent Condom Use Programme in Hubei and the local public security bureaus (law enforcement) on the promotion of condom use in recreational centers. “Peer educators” were trained by the program to help promote the use of condoms in 5,300 out of 5,600 recreational centers. As a result, today 95 percent of the prostitutes in Hubei report the use of condoms compared to 39 percent in random samples around the country (Bai Xu 2007).

See State Council Working Committee Office and the UN Theme Group on AIDS in China (2004); State Council AIDS Working Committee Office, China (2005); and Yan Wei (2006).

The Chinese government implemented the HIV/AIDS Sentinel Surveillance Plan in 1995 and China's Medium-and-Long-Term Program for the Prevention and Control of AIDS (1998–2010) in 1998. In 2001, it organized China's first National AIDS Conference and increased spending on a strategic plan, the Five-Year Action Plan to Control HIV/AIDS (2001–5). For an account of government policy on the prevention of HIV/AIDS, see the United Nations Theme Group on HIV/AIDS in China (2002), State Council AIDS Working Committee Office and the UN Theme Group on AIDS in China (2004).

In November 2003, the government publicly acknowledged the AIDS epidemic in China for the first time by broadcasting public advertising against AIDS. (This is included with thanks to a reviewer's comment).

For more on the notion of men as “gatekeepers,” see William Connell (2003). His paper suggests that men are still dominating policy-making processes.

See several UN collaborative publications including the Norwegian Working Group on HIV/AIDS and Gender (2001), Nath (2000), the World Health Organization (WHO 2003), and the Joint United Nations Programme on HIV/AIDS (UNAIDS) Interagency Task Team on Gender and HIV/AIDS (2005), as well as Lesley Doyal (2001), and Susie Jolly and Wang Ying (2003).

According to Nick Danforth:

• Male involvement seems to be the most comprehensive and useful term. Involvement can be of many kinds. Male participation is likewise quite broad, but implies participation in existing reproductive health activities, usually services for women. Male responsibility is less comprehensive than the first two terms. The term reflects the widespread belief that men have been “irresponsible” and now should take their fair share of responsibility for birth control and STD use. Many men may well be irresponsible, but this cannot form the basis for a positive reproductive health programme that seeks to involve men and women in a transformative way. (1995: 2)

The present analysis employs the three expressions in accordance with Danforth's delineation.

In their review of China's 4^th report on the implementation of CEDAW in 1999, the United Nations Committee on the Elimination of All Forms of Discrimination Against Women (CEDAW) raised concern about the absence of a legal definition of discrimination, arguing that it inhibits women's fight against discriminatory policies and practices.

This project started in 2001 as a collaborative initiative of the Women's Federation of Guangdong (a regional arm of the-All China Women's Federation, a national organization under the leadership of the Chinese Communist Party) and the United Nations Development Fund for Women (UNIFEM). Funding was also provided by the United Nations Children's Fund (UNICEF). This project received US$10,000 from UNICEF and US$15,000 from UNIFEM, an amount that represented an exceedingly trivial portion of the overall funding up to millions on HIV/AIDS prevention provided by international and bilateral organizations working in China at the time. It mobilized researchers from several organizations during a fact-finding trip in October 2001. In my previous capacity as the UNIFEM Gender Advisor in Northeast Asia, I conducted interviews with the Guangdong Centre for Disease Prevention and Control, the Guangdong Family Planning Association, Guangdong Association of Sexology, Guangdong Party School and the Department of Health of Guangdong. Concurrently, representatives of the Guangdong Women's Federation also interviewed these organizations. We collaborated on the assessment of the interviews.

Even after the project had begun, in November 2005, Guangdong was reported to have over 10,000 cumulative HIV cases. Similar high numbers were found in Guangxi and Xinjiang, while Henan and Yunnan each reported the highest number at over 30,000 cumulative HIV cases (State Council Working Committee Office, China 2005: 10).

This figure of STD cases was compiled based on data from STD clinics. The real number could be much higher than this because clinic doctors, as a result of stigma and biased medical practices, do not treat many STD infections.

The overwhelming majority of the project participants had no experience either with survey studies or interviews. Workshops were not only helpful for project participants to develop adequate questionnaires and interview questions but also for them to receive technical training on how to conduct interviews, especially on culturally sensitive issues, such as sex and sexuality in the Chinese context.

The groups usually had three to six members but occasionally had as many as ten.

There were also 28 percent of men and 15 percent of women who decided that both were to blame, 8 percent of men and 8 percent of women thought that neither were to blame, and 12 percent of men and 7 percent of women who indicated that they did not know who was to blame.

See similar discussions in Nath (2000) and the Joint United Nations Programme on HIV/AIDS, United Nations Population Fund, and United Nations Development Fund for Women (UNAIDS, UNFPA, and UNIFEM 2004).

My interview with Dr. Mingrui Qin, a member of research on HIV/AIDS in China in a joint China-Canada research project on anti-discrimination at the Centre for Human Rights Studies of the Law School of the Beijing University (Mingrui Qin and Lai Xiaole 2008), reveals that more women than men in some AIDS-affected villages in Henan sold blood and contracted HIV/AIDS in the 1990s, as more women were at home dealing with day-to-day expenses while men had left the villages to seek employment elsewhere.

Studies of gendered school rules are still lacking in China though there were reported incidents in the past, where female students were fired after getting pregnant. On related issues, see Qian Xu, Shenglan Tang and Paul Garner (2004).

This group discussion took place in a labor reform institute in Guangdong on April 17, 2002. My analysis here draws upon the notes by Long, the lead interviewer in the Guangdong research project (Long and Zhu 2003: 193–6).

These interviews were conducted in a Health and Disease Prevention Clinic in Guangzhou on May 19, 2002.

These interviews were conducted in a Health and Disease Prevention Clinic in Guangzhou on September 15, 2002.

For more information on China's reform efforts to address gender inequalities in well-being, please see Günseli Berik, Xiao-yuan Dong, and Gale Summerfeld (2007).