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Reporting on sexual health in China, or how to embarrass an interpreter

By 22 June 2009 One Comment
Photo by Kelly West

Imperfect pitch: Advertising for health aids leaves something to be desired | Photo by Kelly West

On a recent afternoon, I was wandering through the neighborhood around my Beijing hotel looking for a health clinic displaying a flu poster one of my classmates had seen. I was researching a story about H1N1, and the clinic seemed like a good place to start. The only other identifying landmark my classmate had to offer, other than “down one of those alleys,” was that there was a dispenser of free condoms next to the entrance.

After wending my way through the rabbit warren of tiny passageways to no avail, I had an idea.

“Ask that bike mechanic if he knows where the place with the condom dispenser is!” I said.

My interpreter, Rio, was not as impressed with my brilliance as I was. “That would be way too embarrassing,” he said.

The next day, still on the hunt for H1N1 material, I tried to track down the clinic with a new interpreter, a sweet, serious university student surnamed Hao. I told her I wanted to ask healthcare workers a few questions about H1N1, and that while we were at it, about condoms and young people.  Her face flushed.

“You will need a male interpreter for those questions!” she gasped. “A girl can’t talk about these things.”

I guess the United Nations AIDS Agency’s report that only 19 percent of Chinese would use a condom if they had sex with a new partner was no joke. I couldn’t get anybody to even say the word.

***
When I finally found a brave soul — female, no less! — to crack the condom case, we headed to a community clinic in another part of Beijing where a condom dispenser lurked behind a potted palm in a corner of the reception area.

He Meiting, a public health doctor on the maternity floor, agreed to sit down with me and answer my questions. In her role as the women’s health clinician, Dr. He advises patients about their birth-control options. She showed us her cabinet of goodies — birth-control pills, IUDs, and condoms.

I was surprised to see the bright pink, government-issued box, featuring a glowing Caucasian couple smiling admiringly at one another.

During my days as an HIV researcher in Africa, I learned that adapting the message to the target audience is a central tenet of effective public health marketing. When I worked in Somali refugee camps in Kenya, for instance, we sought out local artists to depict Muslim characters for our HIV prevention posters to make them culturally relevant. If the most widely distributed condoms in China have a picture of a Caucasian couple on them, how clear can the message be to the average Chinese person that “Hey, this means you too”?

Perhaps the Chinese think the glamour of the airbrushed West will help popularize condoms, but it seems more like a sign of their ambivalence towards modern sexuality. Condoms still aren’t “Chinese.”

Dr. He explained that, while it was practically unheard of to speak publicly about one’s sex life five years ago, China’s young people are becoming more open about “these issues.” She said that a thirst for greater knowledge, including sexual awareness, has accompanied the urban Chinese improvement in quality of life.

But, as Dr. He pointed out, being better informed about sex is not the same as knowing how and when to use a condom.

The first AIDS case was reported in China in the 1980’s. Since then, the government has made stumbling progress in its public education efforts. Though the official AIDS case count stands at roughly 700,000, many, including UN AIDS and Chinese AIDS activists, speculate that that number is a significant underestimate. These organizations cite the huge black market in blood, unsafe injections, growing IV drug use in border areas and low testing rates as obstacles to finding out the real number.

Sex education generally begins at age 10 in China, but only covers anatomy, not the birds and the bees. Any condom instruction comes later, and less formally – mainly from college friends, coworkers, and in some cases, from parents.

As in other countries, class and education play a significant role in sexual-health knowledge in China. Dr. He said most of her patients are educated, married women in their 20’s.  Rural immigrants, who come to Beijing from outlying areas to find work, tend to be shy about big city ways, and too embarrassed to seek services. As a result, they typically have a much lower level of sexual-health understanding than their city sisters.

The director of the Beijing Cultural Development Center for Rural Women explained that many rural migrants don’t learn about pregnancy until after the fact – too late for an effective sex talk.

More highly-educated urban Chinese women, on the other hand, have come to expect more thorough sex education. They believe they have a right to ready access to appropriate health services.

“How many times do you need to refill the condom box in the lobby downstairs?” was my last question as I headed out the door. Dr. He said that the 40 condom packages in the lobby needed to be refilled weekly to monthly, depending on community events – not exactly a booming turnover for a thriving downtown neighborhood in one of the world’s largest cities.
***
It was time to have a good old-fashioned sex talk with some young Beijing women to get the real deal on condoms. Jane, the translator who had brought me to the community clinic, invited me to have lunch with her colleagues at a commodities trading firm. Worried that her coworkers might not agree to the meeting if they knew the topic of conversation, Jane simply told them an American friend wanted to chat with other young women.

While juggling a food tray and chopsticks in an underground cafeteria at the COSCO building in downtown Beijing, I not-so-subtly announced that this was going to be a girl talk. “So, do you guys talk to your friends about sex?” I asked.

“It depends.”

Sue (due to the sensitive nature of our conversation, the women asked that their real names not be used) is 31, recently married last year. Originally from a small village in northeast China, Sue has lived in Beijing for the past 10 years.

Sue revealed that, until a year ago, she wouldn’t have been comfortable discussing the topic – and not just her own sex life. If a sexually active single friend had come to her, she wouldn’t have approved. But now that she was married, she felt more open.

Jane, who is 25 and lives with an American boyfriend, almost spit out her dumpling when Sue revealed that she and her boyfriend had waited out their entire decade-long courtship to have sex. Only after they got married did that aspect of their relationship begin.

Jackie, 22, joined in from the other side of the table, squealing in disbelief, repeating a phrase that I later learned meant: “Ten years!! That’s crazy!”

Jackie, who’s single, and has lived in Beijing for three years, explained. “That’s because she’s old. We call traditional women like [Sue] ‘the seventies women’,” said Jackie, while my 33-year-old self gulped inwardly.

So if 10 years is too much time to wait, then what is “just right?”

“It’s okay to have sex before marriage,” Jackie said, “And you don’t necessarily have to think that you’ll end up marrying the guy. But you have to really like him and wait at least several months.” And that’s when the subject of condoms finally took the stage.

Jane said that her friends used them so they didn’t get pregnant. She tilted her head in thought when I asked if anyone worried about HIV or other sexually-transmitted diseases. In all the condom advertising she has seen, Jane said, pregnancy prevention was the only focus.

“I don’t really know that much about HIV,” Jackie admitted. “I don’t know how common it is.”

The only time she had even heard of an STD was after a friend’s boyfriend had gotten one, and the other girls in their group whispered not to sit where the couple had been sitting, afraid that they would get the disease. Because of such rumors, all three  women said they had to be very careful who they talked to about sex, even among their friends. No wonder they had so little information.

All three women gasped when I revealed that it was a pretty mainstream practice among my friends to speak frankly about one’s sexual history — not only among one’s friends, but with a new partner. “I would never tell a boyfriend about my past!” Jackie said.

Though today’s generation of Chinese might be more open to a certain amount of experimentation, there is still a widespread belief that “good” girls will be virgins, so such honesty would paint them in a negative light. Even if a boyfriend had some idea about one’s previous experiences, it would never be confirmed.

Furthermore, the idea of open discussion just “wasn’t romantic.”

“Once you are with someone, you should love only him and forget about the rest,” Jackie passionately declared. Sue explained that she would never want to hear about her husband’s past girlfriends because she didn’t want to know if she wasn’t his only love. This romantic perspective seemed to trump any desire to find out if one might be exposing oneself to STDs.

Chopsticks clattered to the tray when I upped the ante: Most of my friends have their partners tested for STDs before having unprotected sex in a new relationship.

“I wouldn’t even know where to go to get tested!” said Jackie, ever more intrigued by my alien views. Just to shake things up a little bit more before the women had to go back to work, I explained that I had written an e-mail to my classmates — most of whom were female undergraduates — before my reporting trip, listing condoms among the items they should bring with them.

“In America,” I somewhat optimistically stated, “it’s both partners’ responsibility to come prepared.”

Jackie, eyes wide open and searching my face for signs of a joke, stammered, “Ah! Girls can’t buy – or even have – condoms. No – this would be bad.”

The escalators had carried us back up to the ground floor by now, and poor Jackie was trying to wrap her mind around the two contrasting sexual identities we had limned in our conversation. I could almost see her mind ping-ponging between the image of her old-fashioned co-worker who had waited 10 years to have sex, and the futuristic foreigner describing a decidedly post-romantic modern woman.

***
In Africa, AIDS workers often spoke about the self-efficacy test. It was all well and good to have condoms readily available, but could girls talk themselves, and then their partners, into using them?

Despite a recent Wall Street Journal article talking about the Chinese government’s big public health push to get condoms into the hands of young people to combat the growing AIDS problem, I don’t think China would pass the test — at least yet.

A modern Chinese woman can pursue a career, buy her own car and learn a foreign language, but taking a proactive stance on her reproductive health still appears to conflict with her female Chinese identity. While China’s bursting-at-the-seams economic growth surges into the 21st century, it seems that other aspects of Chinese society haven’t quite caught up.

Under cover of public disapproval and personal embarrassment, HIV can run rampant through China’s booming metropolitan development. I can only hope that the modest 700,000 number of AIDS victims doesn’t skyrocket before it’s okay, in Beijing, for a young woman to turn to any of her friends and say, “Can we talk about sex?”

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Marketing challenge: Talk of sexual health remains rare in China | Photo by Kelly West

One Comment »

  • veronica phoebus said:

    I found this article very interesting but it raises a question about the history of public health measures in China. Around 20 years ago I attended a reception in san francisco for a physician who was, at the time, the public health director in China. (He was not Asian, but, as I recall, originally from Bulgaria. It was a rarity, or so we were told, for a Caucasian to hold such a high position in the government.) He was introduced as the man who single-handedly, through education and who-knows-what-else, had prevented std’s from spreading in China, which, allegedly, had one of the lowest venereal disease rates in the world, if not the lowest. If that was true 20 years ago, what changed? Did people refrain from having sex under Mao and his succesors? Or was the low rate of std’s a reporting issue?

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