We can only be healthy if we love ourselves: Queer AIDS NGOs, kinship, and alternative families of care in China

ABSTRACT

In this article, I draw from recent developments in the anthropological literatures on kinship and care to complicate and extend analyses of Chinese queer NGOs and AIDS activism. By highlighting the practical, moral, and political dimensions of daily life and work within Chinese queer NGOs, I argue that they constitute what I call “alternative families of care” by serving as important sources of material and emotional support and care for queer men, including increasing numbers of HIV-positive men who have sex with men, in a social climate that is still largely unsupportive and hostile toward both queerness and people living with HIV/AIDS. I also show how HIV/AIDS prevention and care are additionally regarded by many Chinese queer activists as an important political strategy for demonstrating the responsibility of queer men in the face of the AIDS crisis, achieving greater recognition from the government and society, and eventually attaining increased rights, including same-sex marriage.

KEYWORDS:

• HIV/AIDS
• kinship
• care
• NGOs
• queer men
• China

Introduction

One evening in May 2011, I was sitting on a bed in a small hotel room in Sichuan with Xiao Chang,¹ a 30-year-old full-time staff member at Guangming, a grassroots queer or tongzhi² NGO in southwest China focused on HIV/AIDS prevention and care. Xiao Chang was telling me his life story. He first realized that he was queer when he was 13 or 14 years old:

At first I thought that I was very strange, that I wasn’t like everyone else, because I was interested in men … . Part of me rejected this, but another part was really urging me. It was a struggle. (zhengzha)

Unlike most of the queer men I interviewed in China, in 2003, Xiao Chang had come out to his parents. At the time, he was in college and had a boyfriend.

I thought my tongzhi identity wasn’t that big of a deal (bu shi dabuliao de shiqing), that as long as I explained things it wouldn’t make much difference. I wanted my parents to know about my relationship  … . One day when they were at home, I just told them. I asked, do you know what my relationship with that person is? I said we were lovers. They became very silent. After a while, my father, whom I had never before seen cry, began to weep silently.

While Xiao Chang’s mother was relatively accepting of his homosexuality, his father was not. “He is a very traditional person”, Xiao Chang explained. “He thinks that every man must carry on the next generation (chuanzong jiedai)”. Xiao Chang’s father initially threw him out of the house, and for several years, he lived in a nearby city. Even after he moved back in with his parents, their relationship was so strained that they were contemplating a divorce. Despite all this, Xiao Chang did not regret coming out. “I think about things more clearly now”, he said. “I accept this identity, and I know how to live happily with it”.

In 2003, the same year he came out to his parents, Xiao Chang began volunteering at Guangming, and in 2011, he started working for the organization full-time. He was very happy with his work: “Doing work for the [queer] community is also doing work for yourself, so for all sorts of reasons the work is very happy. There is a lot of work, but I never feel tired”. Working at Guangming also made Xiao Chang feel healthier: “I have made many friends, and we chat together very cheerfully, which improves my health. Before, I didn’t use protection during sex; now I am aware of all kinds of sexually transmitted infections [STIs]”. As we ended the interview, Xiao Chang left me with a parting thought: “For the [queer] community, health and rights are basic needs. Everyone in the community needs health and rights”.

Xiao Chang’s personal story of coming to terms with his sexuality and his experiences and motivations as a member of a queer NGO resonates with similar narratives that I heard from queer men in urban areas across China. These stories often featured feelings of confusion and anxiety upon realizing that one was different from one’s peers; difficult decisions about whether and how to come out to close family members, especially parents; and becoming part of a queer community and discovering a sense of self-acceptance and self-love. Many also expressed dedication to the goal of creating stronger, happier, and healthier queer communities through providing HIV/AIDS prevention and care to men who have sex with men (MSM), a project that many believed would eventually lead to greater visibility, inclusion, and rights for queer people in Chinese society.

Such stories shed light on some of the enormous transformations taking place in China following social and economic reforms aimed at “opening up” the country to the outside world and spurring economic development after decades of state socialism. In this article, I draw from recent developments in the anthropological literatures on kinship and care to complicate and extend analyses of Chinese queer kinship and activism. By highlighting the practical, moral, and political dimensions of daily life and work within Chinese queer NGOs, I argue that they constitute what I call “alternative families of care” by serving as important sources of material and emotional support and care for queer men, including increasing numbers of HIV-positive MSM, in a social climate that is still largely unsupportive and hostile toward both queerness and people living with HIV/AIDS (PLWA). I also show how HIV/AIDS prevention and care are additionally regarded by many Chinese queer activists as an important political strategy for demonstrating the responsibility of queer men in the face of the AIDS crisis, achieving greater recognition from the government and society, and eventually attaining increased rights, including same-sex marriage.

Theorizing kinship, care, and queer activism in China

My analysis of Chinese queer NGOs as alternative families of care is informed by a growing emphasis on the practical, moral, and political dimensions of both kinship and care in anthropology. Beginning with Schneider’s (1984) trenchant critique of anthropological interpretations of kinship, anthropologists have increasingly viewed kinship as “a doing rather than a being”, focusing on understanding “concrete practices and local articulations of the patterning and meaning of kinship” rather than its symbolic or structural dimensions (Ramberg, 2014, p. 194). As with other proponents of a “new kinship studies” (Franklin & McKinnon, 2001), Ramberg also highlights the moral and political aspects of kinship, arguing that kinship practices “occur in regulating and normalizing fields of power that shape legitimized forms of relations, recognizable kinds of persons, and possible relations to the state” and calling attention to how “innovative kin-making practices open new pathways to forms of social and political recognition and inclusion” (2014, p. 12). In the Chinese cultural context, anthropologists are also increasingly attending to the intimate, creative, material, and practical qualities of Chinese kinship practices (Brandtstädter & Santos, 2008; Yan, 2001, 2003).

Although notions and practices of caregiving have long been a foundational concern within medical anthropology, Aulino argues that “it is increasingly clear that care itself has been undertheorized” (2016, p. 92). Similar in many ways to developments in new kinship studies, Aulino calls for an increased analytical awareness of the practical, routine, and mundane aspects of care rather than the inner mental states or beliefs of caregivers. Doing so, she argues, enables care to “be understood as moral labor” (p. 98; see also Stevenson, 2014, p. 3). Referencing traditional Chinese perceptions of personhood, Kleinman also underscores the moral dimensions of care, arguing that caregiving “is a moral practice that makes caregivers, and at times even the care-receivers, more present and thereby fully human” (2009, p. 293). In addition to its practical and moral aspects, anthropologists have also accentuated the politics of care, including the bureaucratic and biopolitical calculations made by states in terms of which citizens are deemed worthy of access to medical treatment, resources, and care (Biehl, 2012; Farmer, 1999; Scheper-Huges, 1993; Stevenson, 2014).

This article also synthesizes the growing anthropological literature on Chinese queer kinship (Engebretsen, 2014; Kam, 2013; Miège, 2009; Rofel, 2007), activism (Engebretsen, 2015; Rofel, 2012), and NGOs (Wei, 2015; Zheng, 2015) by analyzing Chinese queer NGOs as alternative families of care. The term “alternative families of care” highlights the different kinds of networks and relations of kinship and caring that people create under circumstances where biological families and governments are unable or unwilling to provide them with the support, love, and care that they need. Rather than remaining ensconced within earlier, heteronormative or biogenetic frameworks and understandings of kinship, by describing these families as “alternative” I index their unconventional and queer qualities while acknowledging that queer forms of kin-making always coexist and are constrained by (even as they seek to contest and change) more standard notions and practices of kinship (Ramberg, 2014; Weston, 1991). Indeed, rather than serving as substitutes or replacements for biological families, Chinese queer NGOs more often work in tandem with biological families to serve as additional sources of support, love, and care for queer men.³ In foregrounding care, I draw inspiration from Borneman’s (1997) argument that, by focusing on “either the institution of marriage or categories of kinship, sexual identities, gender inequality, or of power differentials generally”, anthropological analyses of kinship have tended to elide the most fundamental and creative aspect of kinship, “the need to care and be cared for” (p. 583). However, rather than suggesting that “‘care’ can and must trump ‘kinship’” (Aulino, 2016, p. 100), the notion of “alternative families of care” points to the mutually constitutive nature of kinship and care.

The anthropological record contains numerous examples of alternative families of care that have emerged in response to situations of need and abjection in diverse social and cultural locations. These include the “personal kindreds” (Stack, 1974) developed by members of urban Black communities in the United States to cope with conditions of institutional racism and extreme poverty; the “chosen families” created by queer people in response to their exclusion from normative North American idioms and practices of kinship (Weston, 1991); and the forms of “spiritual kinship” (Klaits, 2010) created when members of an Apostolic Christian church in Botswana provide love and care to people dying of AIDS whose families are unable to do so. These alternative families of care all demonstrate the creative ways that people in different cultural contexts have constructed novel kinship relations in order to fulfill the basic human need to care and be cared for when their biological families and governments are not up to the task.

Queer NGOs emerged throughout urban China in the late 1990s and early 2000s in response to official indifference to a growing HIV/AIDS epidemic among MSM and the stigmatization and invisibility of homosexuality in Chinese society. Queer NGOs dispense knowledge and information about the prevention of HIV and other STIs, hand out condoms at local queer meeting places, and provide free, safe, and confidential HIV and STI testing. In addition to serving as crucial sources of emotional and psychological support in their communities (see Zheng, 2015, p. 129), these NGOs help queer men to foster positive, self-accepting, and self-loving identities while also providing treatment and care to increasing numbers of PLWA. Understanding Chinese queer NGOs as alternative families of care enables us to see how the work of Chinese queer NGOs is an important form of moral and political labor. By providing care for their fellow queers when biological families and the state are unwilling or unable to do so, Chinese queer activists assert that they are worthy and deserving of care, thereby mounting a powerful challenge to hegemonic and heteronormative state logics that seek to exclude them from family, society, and, ultimately, from life itself.

Field site and methodology

This article is based on data collected during 17 months of ethnographic fieldwork in urban China between 2007 and 2011, including 13 months of extended fieldwork from 2010 to 2011. My primary field site was Tong’ai, a grassroots queer NGO located in Shaanxi made up of four full-time staff and 30 or so active volunteers dedicated to providing HIV/AIDS prevention and care to MSM and advocating for greater recognition and equality for queer people in Chinese society. As an NGO volunteer, I assisted in daily office work; participated in HIV/AIDS prevention and community outreach (waizhan) activities in local queer establishments and meeting places including bars, bathhouses, and public parks; observed meetings between NGO members and government officials; and simply spent time “hanging out” with my queer informants as they went about the ordinary and mundane tasks of their daily lives. To gain a more comprehensive understanding of the Chinese queer NGO movement, I conducted additional fieldwork with five other queer NGOs in other parts of urban China, including Beijing, Tianjin, Heilongjiang, Sichuan, and Ningxia (Table 1).

Table 1. List of selected NGOs and members.

NGO	Location	Founded	Member	Role
Dongfang	Tianjin	2004	Dandan	Leader
			Xiao Chen	Staff
			Xiao Yang	Staff
Guangming	Sichuan	2002	Da Xiong	Leader
			Xiao Chang	Staff
Leyu	Heilongjiang	2005	Xiao Sun	Leader
			Lao Guo	Volunteer
			Xiao Lei	Volunteer
Tong’ai	Shaanxi	1998	Tianguang	Leader
			Xiao Pu	Staff
			Xiao Shan	Staff
			Xiao Yu	Volunteer
			Yangyang	Volunteer
Xifeng	Ningxia	2006	Lao Hu	Leader
			Xiao Chai	Volunteer
Zhen’ai	Heilongjiang	2005	Xiao Song	Leader

Research was conducted in Mandarin Chinese and involved daily participant observation with over 70 informants including leaders, staff, and volunteers of queer NGOs; local queer community members; other NGOs involved in HIV/AIDS prevention among MSM; and officials from local and provincial Chinese Centers for Disease Control and Prevention (CCDC). Altogether, I interviewed 51 different people, many of them multiple times over several years, including 17 members of Tong’ai, 13 members of other queer NGOs, and 2 CCDC officials in Shaanxi, and 17 members of queer NGOs in other parts of China. I also held 4 focus groups or “salons” (shalong) in Shaanxi, 2 in 2008 which were held in the offices of Tong’ai and involved 9 and 7 Tong’ai volunteers, and 2 in 2011 which were held in a cafe and attended by 13 and 19 local queer NGO members.

My experiences in the field were ineluctably shaped by my position as a gay-identified, white, cisgendered, American man in his late twenties. Although I do not argue that being gay gave me a privileged understanding of my informants, most of whom identified as queer in their own ways, I do think that it reduced the ethnographic distance between me and my informants and allowed me to access a variety of situations and information that may not have otherwise been as readily available had I identified as straight. My sexuality was one of the things new people would always ask about when meeting me for the first time; when this happened, my previous informants would quickly reassure them, “he’s also [queer]” (ta ye shi).

HIV/AIDS and Chinese queer NGOs

China’s HIV/AIDS epidemic began in the mid-1980s when four Chinese hemophiliacs tested positive for HIV (World Health Organization, 1986, p. 226.) From 1985 to 2004, HIV/AIDS in China was primarily restricted to certain high-risk groups, including injecting drug users and paid blood and plasma donors (State Council AIDS Working Committee Office and UN Theme Group on AIDS, 2004, pp. 1–2). However, by 2007, HIV in China was being spread primarily through sexual contact, with 44.7% of the estimated 50,000 new HIV infections that year transmitted through heterosexual contact and 12.2% between MSM (Wang et al., 2009, p. 417). The proportion of new HIV cases among MSM has continued to increase steadily, rising from 2.5% in 2006 to 21.4% in 2013 (National Health and Family Planning Commission of the People’s Republic of China, 2014, p. 11).

The initial reaction to HIV/AIDS by the Chinese public, state, and medical profession was to label it a “Western disease” and to scapegoat various behaviors and stigmatized populations, including sexual promiscuity, illegal drug use, ethnic minority groups, sex workers, and MSM (Gil, 1992; Hyde, 2007; Kaufman, 2012).⁴ For example, during the First Sino-American Management of HIV Disease Symposium in Beijing in 1990, Yang Shangchi of the South Fujian Province Public Health Office claimed that “AIDS is mainly transmitted by sexual intercourse, with the highest incident among sexual promiscuity [sic] such as illicit prostitutes, whore mongrels, and homosexuals” (Gil, 1992, p. 571, footnote 5). Despite these negative responses, by the late 1990s, queer men all over urban China had begun mobilizing to address the challenge of HIV/AIDS in their communities.

Early forms of Chinese queer AIDS activism involved free telephone hotlines (rexian) that provided psychological support, legal advice, and medical information about HIV and other STIs, and passing out copies of Friend Exchange ⁵ in queer meeting places. At first, these efforts were carried out informally by small groups of friends, but by 2008 dozens of Chinese queer NGOs had been established (State Council AIDS Working Committee Office and UN Theme Group on AIDS, 2008, p. 14). Working in private homes, offices, clinics, public parks, bars, bathhouses, Internet discussion forums, and instant messaging programs, Chinese queer NGOs provide a broad range of HIV prevention and treatment services to MSM, including voluntary counseling and testing (VCT) for HIV and other STIs, free condoms and personal lubricant, social and cultural programming and activities, and, increasingly, care and case management for PLWA. Although some people may avoid them due to the stigmatization of homosexuality and HIV/AIDS in China, queer NGOs have reached a wide range of MSM, including high school and college students; blue-collar, professional, unemployed, and commercial sex workers; rural–urban migrants; married and unmarried men; and seniors.

The Chinese queer NGO members I interviewed often spoke of moral and personal motivations for fighting HIV/AIDS. Many reported becoming involved because no one else in their communities was doing so. Dandan, the founder and leader of Dongfang, an NGO in Tianjin, recalled being at a bathhouse in Beijing in 1999 when he saw someone handing out condoms and talking about HIV. “A couple of days later when I returned to Tianjin I discovered that no one was doing this work”, he told me. “So I thought I should use some of my energy in promoting it”. Xiao Song, the 42-year-old leader of Zhen’ai, an NGO in Heilongjiang, recalled feeling a similar “sense of mission” (shiming gan): “I just felt that I should go and do this kind of thing. There had to be a change. I felt that it was my responsibility”. Others cited a more pressing motivation: saving the lives of their friends and loved ones. Lao Hu, the leader of Xifeng, an NGO in Ningxia, explained why he became involved: “It’s simple. My close friends were dying from AIDS”. Xiao Chai, a Xifeng volunteer, had a similar response: “This is why we have been doing this kind of work for such a long time: many people close to us have been slowly leaving this world because of AIDS. It is robbing us of so much”. These sentiments recall Kleinman’s personal observations regarding caregiving: “I learned to be a caregiver by doing it, because I had to do it; it was there to do. I think this is how most people learn to be caregivers” (2009, p. 293).

An early challenge facing Chinese queer NGOs was a combination of official indifference to increasing HIV infection rates among urban MSM and governmental suspicion or hostility toward grassroots community organizing. Da Xiong, the 40-year-old founder and leader of Guangming, recalled how at first “the government ignored (moshi) the existence of the [queer] community … .They didn’t care what problems our community might have, including AIDS and psychological problems”. Tianguang, the 50-year-old founder and leader of Tong’ai, argued that although HIV was already present in the queer community from the mid-1980s, “The Chinese government didn’t start paying attention to this problem or doing prevention work until 2008, twenty years later”. Xiao Chai similarly described the early relations between CCDC officials and Xifeng as somewhat strained. “In the beginning, the Chinese government didn’t support this kind of work”, he said. “They didn’t acknowledge (chengren) us, much less give us any resources, services, or training … .We had to slowly survive from then until now”.

Although relations between many Chinese grassroots queer NGOs and the government had improved in recent years, things were far from perfect. Xiao Chai told me how in 2009 his local CCDC put up an advertisement in public bus shelters throughout Ningxia which read “drug addicts, prostitutes, and homosexuals = AIDS (xidu, maiyin, tongxinglian dengyu aizibing)”. The ads were taken down only after Xifeng protested to the CCDC. “Sometimes we joke that only if a government official gets HIV will they support HIV prevention work”, Xiao Chai said. “Right now in China, most of the [HIV prevention] work is being done by NGOs”. These descriptions of Chinese queer activists’ interactions with the state recall Stevenson’s observation in her ethnographic account of the biopolitics of care in the Canadian arctic that bureaucratic forms and logics of care often manifest a sense of ambivalence and indifference toward marginal or subaltern groups. This indifference can be perceived by queer men and indigenous people alike “as uncaring, even at times murderous, though it is always couched by the state in terms of benevolence and concern” (Stevenson, 2014, p. 4).

In addition to dealing with official opposition and indifference, queer NGOs also struggle with the widespread social stigmatization of homosexuality and HIV/AIDS in China. Queer NGO leaders often described having to repeatedly move their organizations due to harassment by hostile landlords and complaints from nosy neighbors. For example, between 2007 and 2011, Dongfang had to move offices five times, sometimes as often as once every three months. One landlord would not allow them to run the air conditioning during the summer; another even dug a hole in front of their office to prevent people from coming or going. When I asked why, Dandan replied, “Because we are tongzhi”. By persevering the face of such opposition, Chinese queer NGOs like Dongfang not only challenge bureaucratic indifference toward the existence and survival of queer men, but they also contest their exclusion and erasure from hegemonic and heteronormative social and state institutions through the creation of alternative families of care.

Together we are stronger: Chinese queer NGOs as alternative families of care

Along with social disapproval and discrimination, by their late twenties, queer men in China also experience enormous pressure from their families, friends, and coworkers to marry and have children. These expectations are related to filial piety (xiao), a multifaceted concept linked to the belief that children are morally obligated to support, revere, and obey their parents and to continue the family bloodline (Ikels, 2004, p. 3), and to China’s One Child Policy, which caused many queer men to be single children or only sons, increasing pressure to marry and have children of their own.⁶ Kong argues that for many Chinese men, marriage (and, by extension, having children) not only confers a degree of “moral privilege and access to social and material power”, but is seen as a “precondition for becoming a successful citizen” (2011, p. 159). As Rofel writes, “family is the metonym for belonging, not simply to the nation-state but to Chinese culture writ large” (2007, p. 100).

Many Chinese queer men feel that they cannot come out due to the harm that such disclosure might cause their parents. For this reason, most of my informants were not out to their families, nor did they regard coming out as a method of gaining self-acceptance and greater visibility in society. For example, Xiao Chai told me that “in Chinese society, coming out (chugui) should not be supported … . Coming out is a spiritual attack (jingshen shang de daji) on your parents, because Chinese people are relatively conservative”. Xiao Lei, a volunteer at Leyu, an NGO in Heilongjiang, argued that rather than alleviating social pressure, coming out merely transfers that pressure to parents. “If your parents don’t know that you are like this there will be pressure for you to get married”, he conceded. “But if your parents don’t know, when people ask why you are not married, they can just say that you haven’t found the right match”.

The experience of Xiao Sun, one of the leaders of Leyu, illustrates the severity of the pressure queer Chinese men experience from their families. Unlike most of the men I interviewed, Xiao Sun was not only out to his parents, but he and his male partner were living with them in his family home. When Xiao Sun came out to his mother “she thought it was a bad thing … . That I had been corrupted (xuehuai). She was very angry (shanghuo)”. Despite knowing that he was queer, Xiao Sun’s parents continued pressuring him to get married. “My mother would ask, ‘Why are you like this?’” Xiao Sun recalled:

She would talk about marriage, about finding me a girlfriend. She would say that she didn’t understand. I slowly discussed it with her. I asked her, “Don’t you think I am a filial son (xiaoshun de erzi)? Don’t I work hard? Aren’t I very responsible? Aren’t I an honest person?”

Even after his parents finally accepted that he would not marry, Xiao Sun did not feel good about coming out. “In my heart it didn’t feel like a success”, he said. “I made [my parents] unhappy. I gave them a lot of pressure. I also felt a lot of pressure in my heart”. Although coming out afforded him some relief, it left him feeling guilty and “conscience-stricken” (kuijiu).

Because of the continuing stigmatization of HIV/AIDS within the Chinese medical establishment, several HIV-positive queer men I interviewed had inadvertently had their serostatuses revealed to their families by their doctors. “As soon as I tested (positive) my whole family knew”, said Lao Guo, an HIV-positive Leyu volunteer. “The doctor didn’t do a good job of maintaining my confidentiality. He revealed it. He went looking for my family and told them first before I even knew”. After his family found out, Lao Guo suffered discrimination and exclusion. “Things are a lot better know”, he told me, “but they are still not OK”. Xiao Chen, an HIV-positive Dongfang staff member, also experienced discrimination from family members. “Most of my family really cares about me”, he said. “But some exclude (paichi) me. For example, one of my aunts avoids me. When we are together, she won’t speak with me”.

As many Chinese queer men and PLWA continue to experience pressure and discrimination from their families, queer NGOs act as alternative families of care by serving as important sources of support, love, and care. The familial aspects of queer NGOs are reflected in the language used by many NGO volunteers and staff members. Yangyang, a 20-year-old Tong’ai volunteer, said, “I think that Tong’ai is a very warm family (wennuan de jiating). Everyone can tell their stories, make some new friends, and learn some new knowledge”. Apart from working to make themselves and their communities healthier, volunteering was a way of becoming part of a caring and supportive network of queer friends. Many Tong’ai volunteers spoke of the group as a kind of “queer family” (tongzhi zhi jia). Xiao Yu, a 22-year-old who joined Tong’ai in 2010, described his first impressions of the NGO this way: “Even though we are all strangers, there was still a feeling of familiarity (qinqie). It’s probably because we are all the same kind of people; in our subconscious we all feel a kind of closeness”.

This feeling of closeness from sharing a common sense of identity and purpose is captured in the Chinese expression zhitong-daohe, “shared will and common path”, which is used to describe like-minded people or kindred spirits.⁷ Many of my informants used the expression to illustrate the sense of support they derived from being part of a queer NGO. For example, Xiao Shan, a 30-year-old Tong’ai staff member, said that “when we work, because we share the same goals, we share one will and a common path (zhitong-daohe) and have developed a very profound sense of camaraderie”. Xiao Pu, the staff physician at Tong’ai who ran the group’s HIV testing and care programs, talked about how working as part of a team felt empowering. “Of course my individual abilities are extremely limited”, he told me. “Only when there are more of us investing in this intervention work [can we make a difference] – together we are stronger (ren duo liliang da)”.

An important aspect of the work of Chinese queer NGOs was cultivating feelings of love in their communities, particularly self-love and self-acceptance. This was related to the ways that queer AIDS activists from across China understood the concept of health. With striking uniformity, all NGO members with whom I spoke emphasized that health is comprised of two parts, “physical health” (shenti jiankang) and “mental” or “emotional health” (xinli jiankang). Loving oneself was understood to be a crucial component of living a healthy, happy life. Xiao Pu explained how “we can only be healthy if we love ourselves (zhiyou zi’ai cai hui jiankang ) … . [This] includes physical health and mental health”. Similarly, Xiao Chai believed that “self-acceptance (ziwo rentong) is very important … . Only if you value yourself can you take care of this community, and it can take care of you”. Dandan argued that “from the perspective of preventing STIs and HIV, if you don’t love yourself, you can’t love others”. He considered Dongfang’s primary goal “to make people who are threatened by HIV/AIDS feel a little bit of love (ai)”:

Those who are threatened by HIV/AIDS, including the queer (tongxinglian) community, sex workers, PLWA, all suffer a lot of discrimination. In China they are excluded and ignored; people pretend that they don’t exist. So they urgently need to feel that they exist, that they have worth and that people care about them.

Care was also a core component of the work of Chinese queer NGOs. As the prevalence of HIV among MSM in urban areas increased, by the mid-2000s, the emphasis of many NGOs had shifted from HIV prevention to providing treatment support and case management to PLWA.⁸ Referred to as guan’ai (to show concern and care for), the work of providing care to PLWA involved offering them many services that ordinarily might have been provided by their biological families, including taking them to see doctors and specialists, helping them to enroll in free antiretroviral therapy (ART), ensuring that they had adequate nutrition, and even assisting with end of life care. When I interviewed him in July 2011, Xiao Chen told me that his organization was now providing guan’ai to over 300 HIV-positive MSM. He explained that guan’ai involved “psychological support and physiological support, like helping people take their medicines on schedule. Some need help going to the hospital for their initial physical examination, or when they get sick we take them to see the doctor”.

Many HIV-positive queer NGO volunteers and staff reported discovering that in the process of caring for others, they were also caring for themselves. Xiao Chen told me how caring for others helped him accept his own HIV status. “It wasn’t a problem that I could solve by myself”, he said. “When I am doing this work … I don’t try to change other people’s lives, rather I try to change my own”. Lao Guo also reflected on how his mindset had changed after joining a queer NGO. When his HIV-positive status was confirmed in 2006, he thought that his life was “over” (wanle). “I was afraid of everything”, he said. “I kept myself hidden. I was afraid of other people knowing”. In spite of his fears, he joined a support group for HIV-positive queer men and in 2008 started volunteering at Leyu. By 2011, through his volunteer work, Lao Guo came to realize that “AIDS is actually nothing to be afraid of”. He told me that being a volunteer at a queer NGO gave him a feeling of “liberation” (jietuo). Such experiences demonstrate the practical, moral, and political labor performed by Chinese queer NGOs as alternative families of care. By providing care to each other and themselves, Chinese queer men not only fight the spread of HIV in their communities but also demonstrate and affirm their humanity. In doing so, they articulate a powerful moral and political message: that queer people are fully deserving of acknowledgement and inclusion by the state, society, and family.

We must be healthy to have rights: political goals of Chinese queer NGOs

As I interviewed members of queer NGOs all over China, I was struck by the uniformity of their political agenda; although improving the health of queer men by providing HIV/AIDS prevention and care was an urgent practical concern, it was ultimately seen as a means to eventually win greater acceptance of homosexuality in China and to advocate for the rights of queer people, including same-sex marriage. Just as being healthy required having self-love, achieving rights and equality for queer men required building healthy communities. In the words of Xiao Lei, “we must be healthy in order to have rights”.

For many Chinese queer NGOs, fighting HIV was an obvious first step. Da Xiong told me “our biggest goal for this community is to be equal, to be free, to live a healthy life”. When I asked him why Guangming focused on HIV/AIDS, he replied:

First, it is very clear that HIV/AIDS prevention is something that we can talk about with the government, something we can solve together. Second, HIV/AIDS prevention is something this community needs very urgently, because more people are still getting infected. Another very good reason for starting with HIV/AIDS is that it isn’t simply a health problem, it is a problem of social inequality … . This is why we emphasize HIV/AIDS: it is a means to advance our biggest goal, improving [queer] health and rights.

Many people who initially became involved in the queer NGO movement out of a commitment to fighting HIV/AIDS later developed broader ambitions. For example, Xiao Song said:

I originally thought this work was about preventing disease. Then I started to think it was more about living a happy, healthy, and sunny (yangguang) life. Now I think it is more about rights, opposing discrimination, getting recognition from society, having some power, and speaking our voice.

Statements like these clearly demonstrate the inherently political nature of Chinese queer NGOs, as well as the tight conceptual link made between health and rights within the Chinese queer activist community. They also challenge the unfortunate tendency within some of the literature on queer Chinese NGOs and activism to equate a focus on HIV/AIDS with a lack of political activism, engagement, or efficacy (see Zheng, 2015). Far from expressing a lack of desire to change the social and political status quo (p. 137), Chinese queer NGOs and AIDS activists ultimately seek to radically transform the institutions of the Chinese state, society, and even the family in a way that allows for the recognition and inclusion of queer men and women.

Indeed, many Chinese queer men view fighting HIV/AIDS as a way to demonstrate their responsibility and positivity, which will in turn combat social discrimination and encourage the state to recognize and cooperate more fully with queer NGOs. Xiao Sun told me: “We hope that through our service we can make more [queer] friends live their lives healthily and responsibly in the sunshine. Through this we can change society’s views and impression of homosexuality and reduce discrimination”. Dandan saw HIV/AIDS prevention and treatment as a way for queer NGOs to become more influential: “Our group exists to give the tongzhi community a voice, to start working for ourselves, to unite, to come together and become more powerful”. Many of my informants believed that they were already making progress in this regard, as queer NGOs became an increasingly crucial component of the Chinese government’s response to HIV/AIDS and as working relationships between NGOs and the CCDC continued to improve.

Several queer NGO members hoped to use their increasing influence to shape state policy, including advocating for queer rights and legalizing same-sex marriage. For example, Xiao Yang, a 26-year-old Dongfang staff member, said how “my ultimate goal of my hard work and effort is to achieve the legalization of same-sex marriage in China”. Although he personally felt that state recognition of queer relationships was not important – “The reason I want to get married to my boyfriend isn’t for the government to give us some little book”, he said – he argued that “promoting the legalization of same-sex marriage is very important as a means to oppose discrimination and to achieve greater social awareness” of homosexuality.

Conclusion: HIV/AIDS, Chinese queer NGOs, and the politics of care

The prevalence of HIV among MSM in China has risen dramatically, from 0.9% in 2003 to 7.3% in 2013, with MSM comprising the fastest-growing risk group in China’s HIV/AIDS epidemic (National Health and Family Planning Commission of the People’s Republic of China, 2014, p. 10). However, although HIV/AIDS remains a formidable challenge, many queer NGOs across China additionally view the disease as an opportunity to begin mobilizing their communities and advocating for increased visibility and rights. Not only are some groups able to obtain resources from international and national HIV prevention programs, but their role as gatekeepers to at-risk MSM populations also affords them a measure of political cover and legitimacy, allowing them to pursue broader social and political goals under the seemingly narrower framework of biomedical services provision. As Da Xiong told me: “Without AIDS, this community wouldn’t be able to do this kind of work, to fight for our rights”.

Despite facing many obstacles, queer NGO members expressed optimism about the future. Xiao Yang said that “although the road is winding and complicated (quzhe), I think the future of queer NGO work in China is very bright”. Lao Hu quoted a poem by the Southern Song dynasty poet Lu You (1125–1209) to express a similar sentiment:

Mountains multiply, streams double back, I doubt there is even a road; willows cluster darkly, blossoms shine – another village ahead! (Lu, 1973, p. 3)

Lao Hu described the meaning of the poem in this way:

When you are walking through dense mountains, when you are faced with a series of difficulties, you may ask yourself where the path lies. But with every forward step, as you discover your path you achieve a practical kind of happiness. (shijian de kuaile)

As many queer men continue to experience discrimination and disapproval from the state, society, and family, queer NGOs have taken on many of the affective and instrumental roles and functions of the family, providing material and emotional support, love, and care to urban queer men and HIV-positive MSM. For many queer men, these NGOs act as alternative families of care, helping them to develop positive identities and self-love, to construct healthier and happier lives for themselves and their peers, and to begin advocating for their rights in Chinese society.

By theorizing queer Chinese NGOs as alternative families of care, this article advances recent efforts within anthropology to refocus analytical attention to the practical, moral, and political dimensions of care. It also drives forward our knowledge of changing Chinese practices and ideas of kinship, calling attention to how the family in China is increasingly being created and sustained by material and practical bonds and profound emotional ties rather than being defined simply in terms of biogenetic and genealogical relationships. Finally, by highlighting the important moral and political work being done by queer NGOs, it sharpens our understanding of Chinese queer AIDS activism. As Kleinman argues, traditional Chinese perceptions of personhood hold “that we are not born fully human, but only become so as we cultivate ourselves and our relations with others” and “that by building our humanity, we humanise the world” (2009, p. 293). Through their efforts to care for one another and themselves, Chinese queer activists not only seek to improve the health of their communities but, through doing so, they assert their common humanity and articulate a powerful political message of equality, inclusion, and dignity.

Acknowledgements

I extend my appreciation and gratitude to the brave and dedicated Chinese grassroots queer NGO members who participated in this research. A special thanks to the editors, anonymous reviewers, and to Ellen Block and Lenore Manderson for their detailed and helpful comments on an earlier version of this article. Thanks also to Casey Golomski, Joan Kaufman, Sarah Lamb, Ellen Schattschneider, and Janet McIntosh for their ongoing support and advice.

Disclosure statement

No potential conflict of interest was reported by the author.

ORCID

Casey James Miller http://orcid.org/0000-0002-2464-0227

Additional information

Funding

This work was supported by the National Science Foundation [grant number BCS-1022035], the U.S. Student Fulbright Program, the Chiang Chung-kuo Foundation for International Scholarly Exchange, the Brandeis University Graduate School of Arts and Sciences and Department of Anthropology, and the Bryn Mawr College Provost Office.

Notes

1. All names in this article are pseudonyms.

2. Many terms are used in China to describe men who are attracted romantically or sexually to other men, including gay, tongzhi (comrade), tongxinglian (homosexual), quan’er nei de ren (people inside the circle), and MSM (men who have sex with men). Although each term connotes slightly different meanings, they are often used interchangeably. In this article, I use “queer” as an umbrella term to designate a variety of non-normative sexualities.

3. This is one important manner in which Chinese and North American practices of queer kinship differ; while many of Weston’s gay and lesbian informants in San Francisco regarded queer families as possible “substitutes” for biological family relationships (1991, p. 116), none of my Chinese informants thought of queer kinship as replacing the biological family.

4. Initial reactions to HIV/AIDS in the U.S. were similar, with some members of the medical establishment and the media claiming that AIDS had spread to the U.S. via Haiti and later blaming gay men and heroin addicts for spreading the disease (Farmer, 1992, pp. 210–212).

5. Friend Exchange, first published in 1998 by Dr. Zhang Beichuan, was a bi-monthly magazine that offered emotional support and information about HIV/AIDS to queer men across China. One of the first members of China’s academic and medical community to begin researching and writing about homosexuality, Zhang was also instrumental in supporting the foundation of queer NGOs and telephone hotlines across China (Zhang & Kaufman, 2005).

6. The relationship between the One Child Policy and expectations facing Chinese queer men is complex. Although being a single child or only son can make one’s filial duty seem even more pressing, many queer Chinese men who were not single children or only sons report that the pressures they faced to marry and begin families are no less onerous. Both the One Child Policy and pressure on queer Chinese men are symptoms of a broader change in attitudes toward sexuality in China whereby sexual relations are increasingly becoming delinked from biological reproduction and associated with romantic love, conjugal intimacy, individuality, consumption, and modernity (Davis & Friedman, 2014; Rofel, 2007; Pan, 2006; Yan, 2003).

7. The phrase zhitong-daohe (shared will and common path) has special resonance within the queer community because of its similarity to the term tongzhi (comrade).

8. This shift corresponds to a move by the Chinese government away from victim-blaming and the stigmatization of HIV to the rapid adoption and scaling up of evidence-based HIV prevention and treatment. Beginning in 2003, the China Comprehensive AIDS Response (China CARES) program provided care and assistance to PLWA in 127 high-prevalence counties (Wu, Sullivan, Wang, Rotheram-Borus, & Detels, 2007, p. 683), and the “Four Frees and One Care” policy dispensed free antiretroviral drugs to rural residents or PLWA with financial difficulties living in urban areas, free VCT, free mother-to-child transmission prevention and HIV testing of newborns, free schooling for AIDS orphans, and expanded care and assistance to the families of PLWA (State Council AIDS Working Committee Office and UN Theme Group on AIDS, 2004, p. 9). The “Five Expands, Six Strengthens” policy in 2010 expanded HIV “information, education, and communication activities; surveillance and testing; prevention of mother-to-child transmission; comprehensive interventions; and coverage of ART” and strengthened “blood safety management, health insurance, care and support, rights protections, organizational leadership and … response teams” (Ministry of Health of the People’s Republic of China, 2012, pp. 6–7).