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An estimated 18 million men engage in homosexual sex in China, and they face growing risks to their health. Transmission between homosexuals has continued to gain ground among all reported HIV cases since surveillance of HIV among this group began a decade ago, rising from 0. The alarming spread of HIV among gay men is not seen in other high-risk groups, such as intravenous drug users and former commercial blood donors, and is fuelled by a stigma against homosexuality in China.
In many ways, attitudes towards sexuality today in China resemble those of Western countries a quarter of a century ago. For instance, homosexuality was declassified as a mental illness in the United States in the earlys; this was not done in China until The main pressure for homosexuals to conceal their identity comes from friends and family, who place large emphasis on traditional obligations to uphold the family reputation and lineage.
Many gay men say that they fear 'losing face', or having their social integrity damaged, if their orientation were to be revealed. Indeed, surveys of Chinese men who have sex with men have reported that up to Chinese people aren't uncomfortable just in discussing homosexuality — sex in general is still considered extremely personal and is rarely addressed openly or directly, irrespective of orientation.
This discomfort has resulted in a pervasive stigma against people with HIV, a lack of general sex education for young people and poor epidemiological data about the spread of HIV in some populations around the country.