BEIJING, HONG KONG - Lexy Zhang laughs nervously as he talks about his first experiences picking up men for sex in a country where condoms are widely available for family planning but not always promoted to prevent AIDS."I was just having unsafe sex all the time," said the 26-year-old, sitting in a fashionable Beijing bar frequented by gay men.
"Lots of gay Chinese think it's great that you don't have to worry about pregnancy but have no idea about sexually transmitted diseases," said Zhang, adding he now would never consider having unsafe sex.
"There are just not enough organizations paying attention to this community. The government thinks it doesn't exist."
How to prevent the spread of AIDS in places like China will be a major focus of researchers and policymakers at the 16th International AIDS Conference, which opens on Sunday in Toronto.
In China, homosexuality, while no longer officially considered a mental disorder, is still an off limits subject for many. That taboo often extends to discussions about AIDS and condom use for men who have sex with men.
Condoms are widely available thanks to China's long-standing one-child policy, but conservative attitudes and an unwillingness to talk about sex mean the connection with AIDS prevention is not always made.
"Sex is taboo, and condoms have mainly been used as part of family planning rather than for safe sex," said Lee Folland, a graduate student doing research at Cambridge University on the social marketing of condoms in China.
In a Beijing survey, only 15 percent of 482 men who had sex with men understood that they were at risk of contracting HIV, according to a 2005 report by the United Nations' UNAIDS. Some 49 percent reported having had unprotected anal intercourse with men in the prior six months.
A survey in late 2004 by the Chinese Center for Disease Control and Prevention in the northeastern city of Harbin found that almost 20 percent of men who had sex with other men also slept with women. More than 10 percent were married.
"There is strong social pressure to get married -- or what would the neighbors say? It's not only about how your parents would react, but how others will react to your parents," Folland said, referring to fear of social ostracism for parents whose sons were thought to be gay.
Condoms and safe sex information are often not available in Chinese gay bars or saunas. Although they are starting to appear thanks to volunteer groups and outreach programs and a government belatedly waking up to the problem.
But even that information can sometimes be too tame to include pictures of how a condom is used.
"Otherwise in China it would probably be considered pornography," said Chinese AIDS activist River Wei.
BORDER COMPLICATIONS
In Hong Kong, Ricky Fan, 40, goes cruising once a week at one of the city's many gay saunas, venues that have become increasingly popular in recent years among men looking for anonymous sex with other men.
These places are invariably pitch black. But once acclimatized to the darkness, visitors are likely to be greeted by eyecatching flyers and postcards on safe sex, HIV testing and free condoms from the locker rooms to the many tiny cubicles.
The message is certainly not lost on the more frisky members of Hong Kong's gay population.
"I always use condoms, 100 percent of the time. Because it's safer," said Fan, who has visited saunas in the last five years in Hong Kong, mainland China, Thailand, Taiwan and Japan.
"I will push away anyone who doesn't use them."
But this attitude is far from the norm. New HIV infections among men who have sex with men have shot up in almost every big city in Asia in recent years.
Insiders attribute it to unsafe sex, made worse by a population that is relatively cash-rich and highly mobile.
"In Hong Kong, those who are unattractive and can't find anyone go to Shenzhen (across the border in southern China) to buy 'money boys,'" said sauna owner Ray Chong, referring to gigolos who service male clients in big Chinese cities.
"They pay more to get the boys not to use any condoms."
MOBILE POPULATION
Activist groups, which have done much to keep new HIV infections down in Hong Kong, say their work is complicated by the rise in the commercial sex trade on the mainland, which shares an increasingly porous border with Hong Kong.
"Infection rates have gone up among men who have sex with men in Asia because the population is so mobile, so our work cannot remain so localized. We have to go where they go," said Lau Chi-chung of AIDS Concern, a Hong Kong-based group which has promoted awareness of the disease since the mid-1990s.
"What we can do is limited. We have to collaborate with the government, other NGOs (nongovernmental organizations) in mainland China to spread the message."
Another problem in China is that many men who have sex with men do not identify themselves as gay or bisexual. Indeed, thanks to a lack of education and cultural taboos they are not even be aware the concept exists, activists say.
"If you're 40, have been married all your life, have kids and live in the countryside then one day you discover your true self and have sex with a man, you aren't going to be thinking about using a condom," said Wei.
"But that one time could be enough to get you infected."
from Reuters
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