Although not an HIV hotspot, over the last three years China’s north-eastern province of Heilongjiang has seen a surge of local NGOs working on AIDS prevention. But, Nick Young and Mian Liping (勉丽萍) ask, is this a civil society success story or an opportunistic response to the influx of international funds?

HARBIN Away from the bright lights of Gogol Street, the main entertainment strip in this northern industrial city with historic ties to Russia, a Saturday night crowd has gathered in a downmarket bathhouse that caters for MSM—“men who have sex with men.”

A shower room that would not be out of place in a factory gives way to a resting area where around 50 men, mostly naked but some in close-fitting shorts, recline on couches, chatting, smoking cigarettes and flicking channels on a widescreen TV.

In a dimly lit area to the side, half a dozen couples cuddle under quilts.

Beyond a plastic screen are private cubicles where customers can go with one of the ten or so resident “money boys,” as male sex workers are called in China. They are a jaunty, good-looking crew, with feathery hair and fully dressed—in tight jeans, T shirts and leather jerkins.

According to Kang Tong (康同), a gay support group that formed in Harbin in 2002, 90% of sexual encounters in such places are “high risk”—unprotected by the use of condoms and lubricants.

Harbin’s Centre for Disease Control (CDC) reports that 2% of MSM who have come forward for voluntary HIV checks have tested positive. But Long Xiaoshuai (龙小帅), who has run a gay information website for several years, believes that the actual figure is much higher. HIV prevalence among the city’s MSM is at least 4%, he says, adding that other sexually transmitted infections, including syphilis, are also rising steeply.

The MSM tag is apt in China where, facing family and social pressure, many gay men get married and have children but continue to seek same-sex partners. They refer to themselves ironically as tongzhi (同志,“comrades”).

Harbin’s health officials now take a tolerant and pragmatic approach to the tongzhi and other high-risk groups. Last October, the city CDC hit national headlines with an AIDS prevention training workshop for women commercial sex workers. Although rampant, prostitution is officially outlawed in China.

Wen Yingchun (温迎春), who leads the CDC’s HIV prevention efforts in the city, says that “Although total HIV prevalence is low, stigma is quite high. If there were more cases, it would be easier for people to see them as normal.”

To combat stigma, Wen and his CDC colleagues have conducted trainings for staff from other government and Communist Party agencies and parasatatal “mass organisations” such as the Womens Federation.

The Harbin city CDC and the CDC for Heilongjiang Province are housed in separate buildings: gleaming, new office blocks built in the wake of the 2003 SARS outbreak, when central authorities realised the need to boost epidemic prevention efforts.

SARS is widely credited with alerting the authorities to the threat of a full-blown AIDS epidemic. At the end of 2003, the central government adopted a “four frees, one care” (四免一关怀) policy, pledging free HIV testing and counselling for all who want it, and free anti-retroviral treatment for people in economic hardship who have contracted the virus.

Health officials now also see NGOs as essential partners in HIV prevention among high-risk groups. The national CDC has set out to encourage and foster NGOs, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, which is mainly bankrolled by Microsoft founder, Bill Gates.

NGO incubator

The Global Fund has so far committed USD 190 million for AIDS prevention and care in China, with a growing proportion of this earmarked for NGO projects. A new funding round (Round 6) will see more than USD 17 million distributed to NGOs.

“Grassroots networks are very important and very necessary,” according to Wang Liqiu (王立秋), who manages Global Fund Round 5 projects at the national CDC. “It is often hard for government health workers to reach high-risk groups,” he says, whereas NGOs find it easier to win trust through peer exchange and education.

Yet some government staff doubt whether Chinese NGOs, which have begun to emerge only in the last decade, are run well enough to put grants to effective and accountable use. Harbin CDC’s Wen Yingchun complains that the administration of some groups is “extremely slack” and that their use of funds is “casual.”

The CDC has therefore started to provide “capacity building training” for nascent NGOs. Heilongjiang is one of the provinces where the national headquarters has rolled out such trainings, with an initial emphasis on the preparation of project proposals to the Global Fund.

One apparent result has been a rapid proliferation of tongzhi NGOs. Three years ago there were only a handful of such groups across the whole of north-east China. Now, CDC officials say, they now know of eight in Harbin alone, and fully 11 in the even more northerly city of Qiqihar (pop. 5.6 million).

Five of Heilongjiang’s gay groups, have been awarded Global Fund grants of CNY 20,000 (USD 2,600) each for projects that started in April of this year.

Kang Tong is one of the recipients, and will use the funds to encourage tongzhi bathhouse customers to go for voluntary HIV tests. The group also hopes to persuade more tongzhi, especially those who have contracted HIV, to “come out.”

Kang Tong members view the surge of new organisations sceptically. “Some of the new groups do things if they get money but do nothing if they don’t get money! This damages the reputation of the tongzhi community” says one 59-year-old member.

Long Xiaoshuai, whose website is the centrepiece of an NGO called Loving Sky (爱心天空), agrees that new groups are springing up in a scramble for funds. “There are two kinds of NGO in China” he says: “The wild grass variety and the hothouse variety.” The Global Fund, he implies, is primarily a hothouse.

Still underground

Guo Yaqi (郭雅琦) of the Beijing Gender Health Education Institute (北京纪安德咨询中心) questions the efficacy of some tongzhi activism.

“Some donors start out thinking that if they find a gay representative then they will be able to reach the MSM community,” he says.

However, he points out, in China most gay men are not yet ready to come out and they shun activities that attract attention. “Now a lot of programs are widely publicised and although some gay people do participate the majority don’t want to be involved because they are still semi-underground.”

“The main intervention approach is still rather narrow, focusing on fun activities and on distributing condoms,” Guo adds. “A lot of ‘trainings’ take place, but they are very basic and they don’t reach many people.”

Humphrey Wou (乌辛坤), whose California-based AIDS Relief Fund for China makes small grants to NGOs, believes that large-donor preference for condom promotion is stifling local initiative. Condom distribution, he says, “usually happens about once a week for three hours. They will go to two or three different spots—parks, bars, whatever.”

At best, he says, this reaches only a small fraction of the target community. “Moreover, given Chinese mentality, giving away things for free means that people will not buy them. People are missing the issue here.”

Wou also questions donor ambitions to “strengthen” NGO efforts. “People at the moment feel a lot of the grassroots NGOs are too small, so people get them together in networks or pingtai [平台, “platforms”]. But this creates the opposite effect of what is intended: frictions, tensions, criticisms.”

Wou would prefer “a wild flower effect: let them grow in their own way and in the end they cover the mountain.”

Zhao Donghui (赵东辉) of Heilongjiang CDC counters that he cannot understand criticism of CDC involvement with NGOs because “they need some level of government backing in order to work effectively.” For example, he says, the NGOs need to show that public activities are officially authorised in order to avoid police interference.

Coming up for air

With the tacit acceptance of the authorities, an open gay scene is now developing and the “fun activities” mentioned by Guo Yaqi seem to be creating a more liberated gay identity for some.

Across town from the Harbin bathhouse is a mixed-sex gay bar where Saturday night brings a lively, young crowd. There is an open-mike singing competition
and then Lu Hao (吕浩), a veteran of the Harbin scene and founder of Kang Tong, comperes an AIDS knowledge quiz.

Harbin’s first gay bar opened in 2002, says Lu, and several others have sprung up since 2004 when “government policy turned around completely.”

In private, Lu speaks nostalgically of times 20 years ago when men sought each other out in public parks in an “innocent” way. Now, he complains, although there is more freedom there is also more commercialisation of same-sex love.

But the government’s new acceptance of the gay community may be making it easier, especially for young men, to come out.

In neighbouring Liaoning Province, Mu Yang (牧羊) established a gay “telephone hotline” in the 1997 and this has now grown into an NGO, Dalian Rainbow (大连彩虹), similar to Harbin’s Kang Tong. Mu chose to tell his parents about his sexuality, and in 2005—after the big swing in government policy—his father established an information and support club for the parents of gay people.

This more liberal atmosphere may encourage other men to come out instead of marrying, and thus reduce the number of women who are exposed to risk of infection from closet gay husbands.

May 22, 2007

Nick Young and Mian Liping are preparing an in-depth Special Report on HIV/AIDS and Civil Society in China, for publication in September.