Sexual health testing in China's LGBT community

How can Shanghai’s gay community take care of sexual health?

Sexual health remains a thorny issue in China. How can members of Shanghai’s gay community limit their exposure? Time Out finds out

For LGBT individuals, the available data on sexually transmitted infections (STIs) in China makes for grim reading. The World Health Organization, the Aids Relief Fund for China (ARFC) and UNAIDS, the Joint United Nations Programme on HIV/Aids, all back an estimate that a disproportionate 30 per cent of new HIV infections in China come from male-male sexual activity, and that HIV often travels in tandem with other infections such as syphilis, HPV (genital warts) and hepatitis B.

Humphrey Wou, director of the ARFC, says that new syphilis and HPV cases in particular seem to have skyrocketed among gay individuals in China.

The ARFC estimates that, while the national rate of infection for syphilis among men who have sex with men (MSM) is around 10 per cent, among the highest-risk groups – particularly patrons of gay saunas and male brothels – it can be as high as 30 per cent. Both the ARFC and UNAIDS estimate that the national rate of HIV infection is around five to six per cent, rising to 20 per cent in the highest-risk groups.

‘Going back to the late 1980s when China’s epidemic started, it developed first among intravenous drug users, and then spread to sex workers and their clients, and later to MSM, who now make up the majority of new infections,’ says David Shallcross, a programme assistant with UNAIDS.

It’s thought that most LGBT Chinese remain in the closet for life, with many going on to marry and conducting gay affairs. The fear of being ‘outed’, even if it means risking the health of a spouse as well as one’s other sexual partners, is often too great a deterrent. Add in a government that refuses to comment on LGBT issues, and it’s easy to see how China’s STI epidemic continues to rage through the gay community.

‘While homosexuality is not illegal, there’s still a risk of stigma,’ says Shallcross. ‘In China, guarantees of confidentiality don’t always exist. People don’t feel secure about how their information may be used.’

Humphrey Wou believes that the rigid assignment of either a top (yi, or ‘1’) or a bottom (ling, or ‘0’) role to partners in a male-male sexual relationship has made risky intercourse almost the norm for Chinese MSM. 

‘Chinese gays learn to be gay by watching straight people. Gay men are so fixated on these heteronormative roles that this mitigates negotiation between the two sides – there’s a sexual expectation, but no verbal communication. The assumption is that sex is pretty much 100 percent anal,’ says Wou.

‘I see a lot of gay men who want to use condoms, but won’t stress this to their partner. People say I’m against men having anal sex. I’m not, I simply want people to do it right,’ he adds.

However, Wou believes that the work done by NGOs in China’s fledgling gay communities is already having an impact. Simply educating MSM about the importance of correct condom use, placing emphasis on lower-risk behaviours and even just good oral hygiene can make all the difference. ‘In China, people are taught that it isn’t hygienic to brush your teeth less than two hours before sex, because gingivitis is so common. It’s not that oral sex is unsafe. It is oral sex with gingivitis that is unsafe.’

He adds that LGBT sexual culture in China is, today, almost unrecognisable compared to the past. ‘Ten years ago, there was no lube available anywhere in China,’ Wou says, laughing. ‘I mean, can you imagine?’

While the data on new infections can often seem terrifying, Wou believes that Shanghai’s LGBT individuals should count themselves lucky, seeing the city as a resource-rich community for LGBT adults. ‘Second-tier cities are a totally different ballgame,’ he says. ‘Many of them don’t even have a gay bar, let alone a gay sauna; many people still cruise in parks or online instead, and so the risk of STI transmission is very high.’

A little common sense and regular checkups are often all that is required. In this regard Wou says those living in first-tier cities are often spoiled for choice. ‘There are so many options it can get quite confusing,’ he says. ‘Rapid HIV home testing kits are even available on Taobao.’

For a comprehensive guide to sexual health in Shanghai, including where to get tested for STIs, see

Jack Smith