Searching for ‘Culture’ in the Discourses of
Homosexuality and AIDS Prevention in China
Rodney H. Jones
Culture, Health and Sexuality Vol. 1 no. 2 161-80
Abstract
This paper examines the concept of 'culture' and its relationship to HIV prevention. Culture is here seen as the interaction between human beings and the various 'cultural tools' they appropriate when taking action. Among these tools are ways of speaking which encode certain meanings, ideologies and social practices. When individuals take action with regard to AIDS, what they do is mediated through voices which they borrow strategically from their environment. The textual tools that are available, and the ways individuals adapt and combine them work to either limit or amplify their participation in HIV prevention. What are traditionally seen as 'cultures' or 'sub-cultures', or worse, 'risk groups', are, in this perspective, viewed as 'communities of practice', groups of individuals who share particular cultural tools and ways of using them.
This conceptual framework is applied to recent discourses of homosexuality
and AIDS prevention in China. An instance of 'official' discourse in the
form of an AIDS education pamphlet for 'gays' is analysed for the voices
it contains and how these voices are strategically marshalled by the authors
and mixed with other voices in ways which amplify participation in AIDS
prevention for some and limit it for others. This 'official' discourse
is then compared to the discourse of homosexually active Chinese men recently
interviewed in Beijing and Fuzhou to examine which of these official voices
and what other voices they appropriate, and how they adapt these voices
in responding to HIV.
Keywords: China, communities of practice, cultural psychology, discourse analysis, HIV/AIDS, sociocultural practice theory
You cannot regard a condom as a condom or a condom.
Popular accounts and political polemics about AIDS in nearly every country have also made ample use of the notion of culture. Here, the nature of culture seems to depend chiefly on whether or not the culture we are talking about is our own or someone else's. 'Our culture' is usually seen as protecting us against infection. 'Their culture' is more often seen as the very reason they suffer from infection. The social construction of HIV/AIDS along cultural, racial and geopolitical boundaries in political and media discourses has been well documented in both the West (see for example Patton 1990, Treichler 1992, Watney 1989) and the East (Dearing 1992, Jones 1996a, 1996b).
In few places has the notion of 'cultural identity' in discourses about HIV/AIDS been more prominent than in China. From the first reported case in 1985, official discourses have portrayed the disease as the result of Western imperialism (Gil 1991) and identified 'traditional Chinese culture and morality' as the nation's bulwark against the epidemic. In 1987, for example, the English language Beijing Review (1987) reported Public Health Minister Chen Min Zhang's argument that the chances that AIDS would spread in China were 'slim' 'since homosexuality and casual sexual relations are both against the law and contrary to Chinese morality’, and a recent educational pamphlet for students informs readers that: 'Our nation's excellent cultural heritage can help young people avoid the calamity of AIDS' (NHEI 1995a).
The China/Hong Kong Meeting on AIDS, held on the eve of the transition from British to Chinese sovereignty over the territory, had as its theme the relationship between AIDS prevention and Chinese culture, and the cover of the program booklet distributed to delegates provides a striking visual expression of the way organizers conceived of this relationship. It showed an aerial photograph of the Great Wall with the words: ‘Our joined hands a wall to protect against AIDS!’ Delegates needed only to turn to the back cover of the programme booklet, however, to get a completely different picture of culture and its relationship to HIV/AIDS: an advertisement for Glaxo Wellcome with a photo of three Caucasian scientists peering at a complex molecular model and the words: 'Investing in our future.' Nothing perhaps contrasts more starkly with the 2000 year old wall, with its connotations of isolationism, traditionalism and xenophobia, than a modern multinational corporation, the epitome of globalization, speaking the international languages of technology and capitalism, and creating an 'us' that includes both Western doctors and Chinese readers.
A similar tension between the simultaneous globalizing and localizing aspects of culture can be seen in debates about homosexual transmission in China. Most official discourses, at least in the beginning of the country's epidemic, constructed homosexuality as a corrupt Western import, alien to Chinese culture. Officials continue to point to the low figure of reported homosexual transmissions — (5% of the total reported infections as of 1997 according to UNAIDS/WHO 1998), a figure that, for reasons that will become clear later, is of questionable accuracy — as evidence that homosexuality is 'not widely practised' (China Ministry of Health and UNAIDS 1997). Those arguing for acceptance and tolerance of homosexuality, both from within China (for example Li 1998, Li and Wang 1993) and from the West (Hinsch 1990) have also appropriated 'culture' to contest this view, pointing out the existence of homosexuality in ancient Chinese literature and history.
Most recently, official voices have begun themselves to appropriate the discourse of Western gay liberation in addressing the spread of HIV. China Responds to AIDS, the joint report of the Chinese Ministry of Health and UNAIDS, declares for instance that 'means must be found to empower (homosexual men) to protect themselves from HIV and STD infection' (China Ministry of Health and UNAIDS 1997:1, author’s emphasis). Meanwhile, there is a growing movement within communities of men who have sex with men to resist Western identity politics and embrace an indigenous model which sees homosexuality as an activity rather than an identity, and to replace Western labels like gay and queer with the Chinese word tongzhi (Zhou 1997). Ironically, you might be more likely today to hear the claim that 'there are no gay people in China' from a tongzhi activist than from a government official.
As in many other Asian countries, current arguments about homosexual identity in China, both among men who have sex with men and government and health officials, increasingly seek to draw a line between what is 'foreign' (or 'global') and what is 'local'. Altman (1996:87) describes this debate 'as presenting a choice between political economy, which argues for universalizing trends, and anthropology, which argues for cultural specifics.' This dichotomy, however, ignores the inevitably fluid nature of culture and the extent to which Western or global cultural meanings are adapted to local situations, and local cultural meanings change as they come into contact with discourses from the outside.
This paper looks at the discourses around homosexual transmission of HIV in China in a way which attempts to transcend this binary opposition of global and local and reframe the question from one which sees individuals as parts of cultures to one which sees cultures as part of individuals. In it I will examine the ways individuals in China draw on different voices, different meanings, if you like, of HIV and homosexuality when constructing texts and taking action around the virus, and how, by doing so, they negotiate identities for themselves in relation to HIV and various 'communities of practice' (Lave and Wenger 1991).
SEARCHING FOR CULTURE IN HIV/AIDS RESEARCH
Recent work in the fields of anthropology (Mannheim & Tedlock 1995, Rodseth 1998, Schwartz 1978,), psychology (Bruner 1990, Cole 1990, Wertsch 1991, 1994, 1995a, b, 1997) and linguistics ( Fairclough 1992, 1995, Scollon 1998) suggests a way of conceptualizing culture for HIV research which both accounts for its multi-voiced and dialogic nature, and focuses on questions of how and why cultural meanings are appropriated by individuals in particular historical moments. James Wertsch and his colleagues (Penuel and Wertsch 1995, Wertsch 1991, Wertsch, del Rio and Alvarez eds.1995) call this perspective 'the sociocultural approach to mind', while others (Cole 1990, Bruner 1990) refer to it as 'cultural psychology'. Influenced by the writings of Soviet theorists Lev Vygotsky (1987) and Mikhail Bahktin (1981, 1986), it takes as its unit of analysis neither people, either individually or collectively, nor texts, the 'tools' people use to think and interact, but action and more specifically mediated action. Culture, in this view, is essentially a series of actions people take either individually or together through the use of the various mediational means which are at their disposal. Culture exists neither solely in the collection of tools available in a society, nor in the individuals who use those tools, but in the 'tension between the mediational means as provided in the sociocultural setting and the unique contextualized use of these means in carrying out particular concrete actions' (Wertsch 1994:205).
Chief among these mediational means for Wertsch and his colleagues are semiotic systems: languages, codes and ways of speaking and signalling particular identities and social practices. Wertsch calls these semiotic systems voices. They include not only languages and texts, but also dominant genres and ways of speaking which encode ideologies, knowledges, memories and systems of human relationships. While some of these voices may be 'privileged' (Wertsch 1991), none exists except in dialogue with a multitude of other voices and utterances.
Wertsch's concept of the multivoicedness of culture owes its debt to Bakhtin, who insisted that we never speak in a voice that is purely our own; instead, we 'borrow' and 'ventriloquate' the voices of others, we 'rent' meaning and then give it back to the community according to the protocols it establishes. Every utterance is therefore both heteroglossic, in that it may contain many different voices at once, and dialogic, as each voice exists in response to, or in 'dialogue' with, other voices.
When we search for 'culture' in the name of HIV/AIDS prevention with this perspective, what we are likely to find is a constantly changing dialogue of voices and tools — and the sociocultural knowledge and patterns they carry (Wertsch 1994) — with which people take action with the world. The condoms, media reports, official voices, personal narratives, medical interactions, sexual practices, societal prohibitions, identities, places, social relationships, modes of communication, and other tools that go to make up the cultural 'tool kit' that individuals have at their disposal in taking action against HIV are not deterministic of their response. Instead, individuals selectively appropriate from among these tools to create particular responses to particular life moments.
In this view, the focus of cultural approaches to HIV/AIDS prevention shifts from identifying discrete 'groups' and cataloguing their vulnerability, to identifying the tools participants have available to them and how they are used. This is not to say that social groupings are not important. In fact, they play a crucial role in determining what tools are available and 'apprenticing' members in how to use them. Scollon (1998) borrows the term 'communities of practice' from educational psychology (Lave and Wenger 1991) to describe the social groupings in which people are 'apprenticed' in the use of cultural tools and to argue that how people use tools helps them to negotiate their identities in relationship to the various communities of practice they participate in.
The term 'community of practice' is particularly apposite when trying to understand the position of men who have sex with men in China since it describes simply a group of people who over a period of time 'act together' rather than a discrete political or social entity. It sees communities not as fixed, easily definable groups, but as constantly emergent collections of people who come together not necessarily on the basis of shared identities, but rather on the basis of shared tools and texts, and are defined not so much by how they think, as by what they do. Such a conceptualization moves us away from notions of membership towards notions of participation, allowing us to regard individuals not as either belonging to or not belonging to particular communities (or cultures), but rather as inhabiting various positions within various fields of participation with other social beings. Participation in such communities is, according to Lave and Wenger (1991), always to some degree peripheral, and individuals are always multiply membered in many communities of practice.
AIDS PREVENTION AND MEN WHO HAVE SEX WITH MEN
In 1995, the first officially produced health education pamphlet for 'gays' appeared in China, produced by the National Health Education Institute in cooperation with the Ministry of Health (NHEI, 1995b). The pamphlet appeared as one of a series about STDs and AIDS targeted at different groups. Along with the pamphlet for 'gays', the series includes pamphlets for students, farmers, migrant workers, long distance truck drivers, STD patients and prostitutes (called euphemistically, 'Women in Crisis'). The pamphlet for men who have sex with men marks an important shift in official discourses of homosexuality in China, not just because it acknowledges its existence, but also because the homosexual subject has become the reader. Perhaps for the first time, official voices address homosexuals directly, and in so doing, dialogically create a 'reading position' (Fairclough 1992), an identity or mixture of identities (Jones 1997a) for readers to take up.
In assessing the role of culture in the way this pamphlet is designed and written and how effective it might be in amplifying participation in AIDS prevention, it is necessary to examine the discursive tools the authors draw on to construct the homosexual reader and the tools they offer to this construction to help him avoid HIV infection. More simply, we have to ask: Whose voice is this? (Scollon 1998), and how is this voice operating in dialogic chorus with other voices both within the text and outside it.
The simplest answer to the question 'Whose voice is this?' would be to look at the bottom of the last panel where we learn that the text and design are the work of Zhu Qi. The inclusion of an author's name in a public health pamphlet is itself an interesting cultural tool within the community of practice of government bureaucrats. But we should not be deceived into believing that this is his voice only. The pamphlet itself declares that Zhu Qi is simply animating (Goffman 1981) the voice of the National Health Education Institute (NHEI) and those of the Departments of International Cooperation and Epidemic Control of the Ministry of Health. Less directly acknowledged are the voices of the colleagues at the NHEI who collaborated on the project, the voices of the international consultants the Ministry of Health was cooperating with, and all the myriad of other textual voices, from media reports about AIDS and homosexuality to other public health education pamphlets both local and foreign.
Besides these 'personal' and institutional voices are the larger 'ideological' voices that speak through them, social languages that reconstruct certain kinds of social relationships and common sense knowledge. These include professional voices: the voice of biomedicine, the voice of health promotion, and the voice of the government bureaucracy. They also include broader 'political' voices which speak to fundamental issues regarding the relationship between the individual and the state.
Gu (1996), in his examination of public discourse in China in the post-Mao era, describes two broad, contrasting discourses at play in everything from political speeches to advertising billboards. He calls these two discourses the discourse of revolution and the discourse of reform. The discourse of revolution, he says, is characterized by an attempt to 'change the world to fit discourse' (e.g. 'Put politics in command'). The discourse of reform attempts to 'fit discourse to the world' (e.g. 'seek truth from facts'). In AIDS education, a reflection of these two discourses can be seen in a moral education approach, which seeks to change the way people think (and thus behave), and a health education approach, which seeks to assess how people think and behave and offer harm reduction measures. The most important thing about these contrasting voices is that, whether in a political speech or an AIDS prevention text, one seldom appears without its 'dialogic partner'.
These social voices have an important effect on all of the other tools the pamphlet offers up for AIDS prevention. A condom, for example, is not simply an object. It is a text that is dialogically connected to the multiple discourses which speak of it and through it. The two primary tools this pamphlet presents Chinese men who have sex with men to protect themselves against AIDS are a 'moral' solution, exemplified in the slogan 'Preserve Moral Integrity' (jie shen zi ai), and a 'medical' solution, exemplified in the illustrated instructions on how to use a condom. These two (not necessarily mutually exclusive) solutions are presented through a series of 'competing discourses' (Lee 1992), in which they are portrayed in opposition, with one voice constantly undermining the other. Advice to use condoms, for instance, is consistently juxtaposed with cautions regarding their effectiveness (e.g. 'Proper use of a condom can reduce the chances of infection, but it is not 100% reliable.'), and underneath the instructions for how to use a condom, the following warning appears:
Another important tool the text offers for the prevention of HIV infection is 'knowledge' both in the form of concrete 'facts' regarding STDs and AIDS (modes of transmission, symptoms, where to seek testing and treatment) and in the form of a broader discourse which quite literally equates knowledge with prevention as in:
Strangely absent from the pamphlet are direct references to 'Chinese cultural traditions', strange because they feature so prominently in other pamphlets in the series, particularly those for farmers and students. Even the figures in the illustrations are uniformly dressed in Western clothes, as opposed to the more characteristically Chinese dress seen in other pamphlets. This 'culturally neutered' version of AIDS prevention, while in some ways releasing readers from the constraints of traditional social norms imposed on other target audiences, serves to situate same sex eroticism and, as I will demonstrate below, the homosexual person himself, outside the 'protective wall' of 'Chinese culture'.
Speech Genres
The same kind of double-voicedness observed in the appropriation of social languages can also be seen in the appropriation of speech genres, with two primary genres juxtaposed. The first of these is the genre of health education, characterized by the question and answer format, a large number of imperative sentences, and reasoned arguments based on 'medical facts'. In this regard, the pamphlet differs little from similar texts produced in other cultures or for other health related purposes (e.g. pamphlets on smoking, occupational safety, food hygiene). Embedded within this 'global' speech genre of health education, however, is the particularly local speech genre of the 'political slogan' (panel 6) of the type which might be seen written on walls or on banners strung across busy boulevards in China. Particularly prevalent in earlier more 'revolutionary' periods, this genre remains a staple in public discourse today, now often appropriated to promote things like environmental awareness and the glory of entrepreneurship. Characteristic of this genre is that it inevitably takes the form of short, imperative sentences and tends to employ verbs like 'abolish' (po), 'study' (xue xi), and 'establish' (que li) (Gu 1996).
The mixing of the genres of the political slogan and the health promotion pamphlet not only provides a generic correlate to the juxtapositioning of the discourses of revolution and reform discussed above, but also serves to frame sexual behavior as a matter of 'public responsibility' rather than private choice. This politicization of sex lies at the very core of current debates in China on the role of the state in regulating the private lives of its citizens, a debate to which the threat of AIDS has added a new dimension. A more explicit example of AIDS prevention couched in political/nationalistic terms as opposed to individualistic terms can be seen in the NHEI pamphlet for students, which declares:
Sexual behavior is not purely a private matter
This particular form of interdiscursivity also affects the way authors and readers are constructed. These slogans do not appear in all of the pamphlets in the series, only those for 'gays', travellers, and prostitutes. Pamphlets for groups such as truck drivers and farmers, use, in place of the political slogans, a different genre, that of San Zi Jing, a form of poetry developed in the Song Dynasty and used to instruct children in both literacy and moral behavior (Liu 1985). The use of these two very different genres in pamphlets for different target groups suggests a different conceptualization of these groups, with farmers and truck drivers seen as responding to a more traditional, didactic approach, and groups perceived as 'outside' of traditional culture, either socially or geographically, being offered a more authoritarian approach.
Identities
Through these social languages and speech genres, the authors construct a number of identities and social relationships for readers to take up and position themselves within. The main characters in this cast are the 'homosexual' (tong xing lian zhe), the 'gays' in the English title, the 'AIDS infected person' (ai zi bing gan ran zhe) and the 'AIDS patient' (ai zi bing bing ren).
Obviously the most important identity label employed by the pamphlet is 'homosexual' (tong xing lian zhe), a term which identifies the text's target audience and constructs that audience as a 'risk group'. Numerous scholars have pointed out the relatively recent introduction of the term 'homosexuality' into the Chinese language (Dikotter 1995, Pan and Aggleton 1996, Zhou 1997). According the Pan Suiming, for example the word tong xing lian (same sex love) was appropriated from the English term 'homosexuality' near the end of the last dynasty, and even today is not widely used or understood. The concept of the homosexual person as a distinct identity, achieved linguistically by adding to tong xing lian ('homosexuality') the suffix -zhe (like the -er in baker or writer) is even less common. Tong xing lian, observe Pan and Aggleton (1996), is normally an intransitive verb which is descriptive of behavior rather than an adjective or noun descriptive of identity. Even more unusual—in fact, contend Pan and Aggleton (1996:181), 'incomprehensible to the majority of Chinese'—is the term 'bisexual' (shuang xing lian zhe).
This is not to say that there are not Chinese men who have sex with men, especially younger urban dwellers, who see their sexual practices as inseparable from their identity, but even many of them resist using the term tong xing lian zhe because of its 'clinical' connotations (see below). The appropriation of the term in a pamphlet for men who have sex with men thus severely narrows the 'reading position' set up by the pamphlet, a limitation compounded by the instruction at the end of the pamphlet which declares: ‘Distribution restricted to homosexuals’. Similar restrictions on distribution do not appear in other pamphlets, giving the information presented in this particular pamphlet a 'double-edge': the same information which is presented to 'homosexuals' to help them protect themselves against AIDS is at the same time portrayed as something the 'general public' should be protected from.
Similarly limiting is the nature of the 'homosexual person' as portrayed in the pamphlet's illustrations. All of the figures pictured are young, dressed in Western style clothing and appear to be rather well off. It might be argued that the lack of inclusion of older men, and lower income men is also common in AIDS education for gay men in the West, but these pictures also serve to reinforce the notion that homosexuality is a 'bourgeois' Western import. The social world these illustrations create, while perhaps relevant to a small group of urban, educated men who have sex with men, is far removed from the reality of the vast majority of men practising homosexuality in China.
Another important identity presented is that of the 'AIDS infected person' (ai zi bing gan ran zhe). While similar texts in the West make the distinction between HIV infection and AIDS in order to highlight the 'normality' and 'health' of people living with HIV, the distinction in this pamphlet, and most other AIDS prevention discourse in China, is one between the 'visibility' and 'invisibility' of the disease. 'AIDS infected people' are constructed as fundamentally ill. Though 'they look exactly like healthy people', they harbor a 'deadly virus' which poses a hidden danger both to others and to themselves. They are represented as at best ignorant, and at worst 'impostors', and the HIV antibody test is constructed not so much as a tool to aid medical treatment as one whose primary purpose is to uncover the 'true' identity of the 'AIDS infected person' for the protection of the society as a whole. This presentation has a potentially limiting effect on readers' willingness to submit to testing, as to do so would be to risk taking on this identity.
In contrast to the 'AIDS infected person', with whom sexual contact is 'extremely dangerous' is the 'safe' sexual partner, characterized by the equally invisible traits of 'faithfulness' and 'trust'. By presenting this type of relationship as the 'only guarantee against infection', the pamphlet shifts the focus of AIDS prevention from concrete practices to abstract notions of identity and character, notions that may be defined differently by different people on different occasions. The result of this is not just to limit participation for those with multiple partners, but also to encourage readers to place the responsibility for prevention on their potential partners. It also limits participation in 'moral society' for those already infected by implying that infection is the result of a character flaw — HIV infection becomes the consequence of a violation of 'trust' by one or both partners. Finally, this prototype of the 'safe partner' subtly revives the discourse of heterosexual monogamy and seems to contradict the social world presented in the illustrations, which portray men chatting with presumably new acquaintances in public parks.
There are other identities which figure prominently in other pamphlets in the series which do not appear in this one, most significantly those which portray readers as members of families — husbands, sons, and fathers. Like the absence of 'traditional Chinese values' (and intimately connected with it), the absence of any identity formations based on kinship positions place the 'homosexual' in a kind of cultural limbo. In a society in which conceptualizations of the 'self' are intrinsically tied to kinship relations (Hsu 1985), the 'homosexual' is not just an isolated identity, but an incomplete one.
CULTURAL TOOLS AND SOCIAL PRACTICE
TALKING WITH MEN WHO HAVE SEX WITH MEN IN
CHINA
This pamphlet and the various voices it animates, voices which can also be heard in many other official discourses on AIDS, make up part of the cultural tool kit available to men who have sex with men in China for protecting themselves against HIV infection. How effective they are in amplifying participation in AIDS prevention, however, depends not on the voices alone, but on how men who have sex with men appropriate them to fashion their responses to specific situations. In what follows, I will attempt to trace these official voices in the talk of actual men who have sex with men in China about AIDS and how they believe it can be prevented.
The data presented here come from a larger study on HIV/AIDS related discourse in China in which I have been involved since 1995 (see Jones 1997c, 1998a, in press). As part of this study, fieldwork was conducted in two sites in Mainland China, Beijing and Fuzhou, between July 1996 and October 1997 involving 40 individual and group interviews in parks, bars, alleys and discos with self-identified men who have sex with men. Informants ranged in age from 16 to 55. Among them were students, factory workers, hotel workers, government employees, private businessmen, unemployed men who had sex for money, health care workers and police officers. While it cannot be claimed that their responses are representative of men who have sex with men more generally in China, they do provide examples of how individuals appropriate the various cultural tools available to them within particular 'communities of practice'.
It was observed above that official discourses on AIDS prevention present two primary, competing voices, the voice of health education, characterized by the promotion of harm reduction measures, and the voice of moral education, which undermines harm reduction efforts. The same two voices also dominated in the discourse of the informants when they addressed the issue of their own vulnerability and the measures they deemed appropriate to protect themselves against infection, and, as in official discourses, moral arguments tended to predominate. Informants, however, rarely used moral discourses to call into question their own behavior. Instead, these discourses were used as tools in judging potential partners. A television director in Beijing, for example, described his standards for choosing sexual partners thus:
Central to this notion was the concept of homosexual identity itself . Significantly, the majority of those I questioned were reluctant to take on 'homosexuality' as an identity, many reminding me that they were either married or planned to marry in the future and presenting this fact as evidence that they were not at risk for HIV infection. A 28 year-old doctor in Fuzhou, for example, indicated that he saw little need to use condoms during sex with men since he himself was not a 'full time' homosexual. Another young man in Beijing who had sex with other men for money used a similar rational for seeing himself as not at risk, insisting that he was neither a homosexual nor a prostitute.
Fuzhou, informants expressed the belief that encounters with residents of their own cities were less risky than with outsiders, primarily because non-residents were perceived to be both less educated about AIDS and more likely to be involved in prostitution. Moreover, certain gathering places were avoided because they were know to be frequented by non-residents.
Finally, the discourse of 'knowledge' observed in the pamphlet also played a key role in informants' responses. The 'educational level' of potential partners was often cited as a factor in assessing risk with more 'educated' individuals being seen as 'safer'. A student in Beijing, for example, used his educational level, reinforced by the frequent code-mixing of English words into his Chinese, as evidence that he was less at risk than others:
Others, however, appropriated this discourse of knowledge in very different ways. When asked about peer education for AIDS prevention, some informants mentioned that they were reluctant to display knowledge about HIV infection to their friends for fear that this would mark them as 'knowing too much' about a potentially stigmatizing topic. One informant even equated ignorance with safety, mixing the discourse of knowledge with notions of cultural/ethnic identity. The disturbing result of this mixture was that he seemed content to leave the issue of AIDS prevention in the hands of a potential foreign partner rather than learn about it himself:
Both the 'official' and the 'unofficial' voices of AIDS prevention analysed here make use of a wide variety of cultural tools, both foreign and local, and in appropriating and adapting these tools, end up 'globalising' local tools and 'localising' foreign ones. Among the most pervasive tool people use when constructing their response to AIDS is the notion of 'culture' itself and the system of inclusion and exclusion it provides. Cultural identity can both empower individuals to build strong communities and, and the same time, blind them to potential dangers. As can be seen in some of the examples above, by locating AIDS outside of Chinese culture and themselves inside of it, Chinese men who have sex with men, while in many ways limiting their participation in AIDS prevention, amplify their participation in their own society. By locating homosexuality outside of cultural norms of identity and interaction, and using global or 'Western' labels and discourses, the authors of the pamphlet for 'gays' in some ways legitimate the notion of homosexual identity, but in other ways limit readers' participation in 'Chinese culture'.
Future explorations into the effect of culture on HIV/AIDS prevention, if they are to be of practical use, must take into account what culture means, not just to us as researchers, but also to those we are researching. They must remember that culture is not a solid, concrete thing that people either possess or live inside, but a dynamic phenomena which is continually being constructed and re-constructed as individuals mix and adapt various, often competing discourses in response to specific situations. Cultures and communities, rather than discrete, identifiable groups, are actually little more than collections of 'meanings', meanings which, according to Madson (1993:193),
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Appendix 1
National Health Education Institute AIDS/STD Education Pamphlet for 'Gays'
English Translation
PANEL 1
AIDS/STD prevention education
Worldwide the first to face the risk of AIDS were homosexuals.
AIDS/STD AND GAYS (in English)
(Picture: two men in park)
AIDS is already spreading among homosexuals in China.
Ministry of Health, Department of International Cooperation
Ministry of Health, Epidemic Control Department
National Health Education Institute
NATIONAL HEALTH EDUCATION INSTITUTE (in English)
PANEL 2
Cherish your health
Cherish your life
(3 PICTURES: 2 OF MEN TALKING ON PHONE, ONE OF MAN LOOKING AT A COMPUTER SCREEN THAT SAYS : 'AIDS HIV STD')
Do you know how homosexuals should prevent AIDS and STDs?
1. Only by having just one fixed, healthy sexual partner with whom you have mutual understanding and trust can you guarantee not becoming infected. Frequently changing partners or having many partners at the same time is extremely dangerous.
2. It is easier to contract the AIDS virus and STDs through oral and anal sex. Provided there are no small wounds on the hands or genitals, mutual masturbation is safe
3. Proper use of a condom can reduce the chances of infection, but it is not 100% reliable. You cannot regard a condom (bi yun tao) as a condom (an quan tao) or a condom (bao xian tao)
4. Do not engage in sex in public places. In such circumstances, even if you use a condom,
because you are nervous, it is easy for the condom to slip off or break and for AIDS and STDs to be transmitted.
5. It is easier for those who suffer from STD's to be infected with the AIDS virus, so avoid STDs and promptly seek treatment.
6. You cannot tell from the genitals or anus whether or not a person has been infected with an STD. Just because people appear outwardly healthy does not mean they have not been infected by the AIDS virus. The only surefire strategy to prevent AIDS and STDs is by 'preserving moral integrity' (jie shen zi ai).
7. Do not take drugs. More importantly, do not share syringes to inject drugs.
PANEL 3
What is AIDS?
AIDS is a deadly disease mostly passed on through hetero or homosexual contact. It is also passed on through sharing syringes to inject drugs and having transfusions of blood that has not been tested. Up until now there is no effective treatment or vaccine. So presently AIDS remains a fatal illness.
What is an 'AIDS infected person' (ai zi bing gan ran zhe)
People who have contracted the AIDS virus are called 'AIDS infected people'. They look exactly like healthy people. Without having a laboratory test, even they do not know that they have already contracted this deadly virus. The blood, semen, vaginal fluids, breast milk, and puss of 'AIDS infected people' all contain the AIDS virus. The virus is highly infectious, and having sexual contact with an infected person is extremely dangerous. Going to an epidemic prevention station or hospital for a AIDS virus antibody test can determine for sure whether or not you have been infected with the AIDS virus, but, in the first three months directly following infection it is impossible to detect the antibodies.
What is an AIDS Patient?
After contracting the AIDS virus, as soon as half a year or as late as ten or more years AIDS begins to develop. The AIDS patient's immunity suffers serious damage, his resistance to diseases drops drastically, and it is easy to suffer from difficult to cure pneumonia, enteritis, encephalitis, herpes, oral yeast infections, malignant tumors, etc. The most commonly seen symptoms are fever, wasting, cough, diarrhoea, headache, fatigue, mental abnormalities, rashes, swollen lymph glands, etc. Finally the entire body is exhausted and the patient dies.
What are the modes of transmission of the AIDS virus?
1. Sexual transmission. In sex without a regular partner or when partners are changed frequently, it is easiest to contract the AIDS virus through anal sex and oral sex.
2. Transmission through blood. Several people using one unsterilized syringe and needle to inject drugs is the easiest way to contract AIDS. Apart from that, unsterilized hospital and clinic syringes, acupuncture needles, dental equipment, prolonged deep kissing, unsterilized knives, scissors and needles for hair styling, beauty treatments, ear piercing, tattooing, and pedicure, electric razors, toothbrushes, bloody fist fights all can lead to infection.
3. Mother to infant transmission. An AIDS infected mother infects her baby.
4. Transmission cannot take place in the following circumstances through foodstuffs,
air, beverages, public communications equipment, schools, factories, shops, theaters, offices
swimming pools and other public places and through daily contact. Brief, polite kissing with the lips, hugging in situations where there are no injuries to the skin, clean toilets, baths, and mosquitoes and other blood sucking insects all cannot lead to infection.
What are the important STDs in China?
Gonorrhoea, non-gonococcal urethritis (including chlamydia) syphilis, acute condyloma, genital herpes, genital warts, STD-related lymphadenopathy are the most important STDs to prevent and treat in China. Among them, the first 5 are the most frequently seen
What harm comes from infection with an STD?
1. STD patients are more susceptible to contracting the AIDS virus.
2. Gonorrhea and NGU can lead to lifelong sterility.
3. Acute condyloma, genital herpes, are difficult to completely cure and easily re-occur
4. Acute condyloma, genital herpes can give rise to cervical cancer, penile cancer and other cancers of the reproductive system.
5. Syphilis, if not completely cured, can cause life-threatening damage to the brain and the heart.
6. Gonorrhea and Syphilis can both endanger the health and life of the next generation.
What can I do if I suffer from an STD?
1. It is necessary to go to a hospital or STD clinic for treatment. The doctor will maintain your confidentiality. Do not use medicine yourself or place your trust in advertisements on the street
promoting the treatment of STDs. Quacks cheat you of your money but do not completely cure the disease. To avoid improper treatment, private clinics are not permitted to treat STDs.
2. Alert your spouse and those you have had sexual contact with to go to the hospital for treatment.
3. Before you are cured, cease all sexual activity.
4. The disappearance of symptoms does not necessarily mean the disease is cured. Do not terminate treatment by yourself. Only a doctor can judge whether or not you are completely recovered.
5. Avoid non-sexual transmission to family members. Use antiseptic washing powder to wash underwear. Do not share a bathtub or towels with family members. Especially guard against girls being infected.
PANEL 5
How to properly use a condom
1. First look at the package to check whether or not the expiry date has passed
2. With your fingers, pinch the small bubble on the tip. Before use, do not unroll the condom.
3. Cover the head of the penis with the condom and smoothly unroll it downward
4. With condoms you can just apply water-based lubricants. You cannot use face cream, Vaseline or cooking oil.
5. During use if you find the condom slips off or breaks, discontinue sexual activity and immediately clean your genitals with antiseptic or soap
6. After ejaculation do not wait until the penis becomes soft. Tightly grasp the collar around the mouth of the condom and, at the same time, withdraw the penis
7. Put the used condom in a plastic bag and throw it in the rubbish bin. Do not flush it down the toilet.
8. Each condom can only be used once.
Remember: Properly using condoms can reduce the chances of contracting AIDS, but it is not foolproof. When condoms fail in contraception, an abortion is always an option. But when they fail in the prevention of AIDS there is no turning back. 'Preserving moral integrity' (jie shen zi ai) is the only sure way to protect yourself against the threat of AIDS
PANEL 6
Understand AIDS Prevent Aids
Pay attention to and study AIDS knowledge
Change the attitude of complacency
Establish the concept of prevention among all people
Choose a healthy lifestyle
Become adept at controlling your behavior
Be triumphant in preventing AIDS
(Distribution limited to homosexuals)
ZJS AlDS/STD--95--08
Design: Zhu Qi
Text: Zhu Qi
Prooreading: Zhang Beichuan
Illustrations: Li Huiling Li Qinping