How to prevent the spread of AIDS in places like China will be a major focus of researchers and policymakers at this week’s 16th International AIDS Conference.

In China, homosexuality, while no longer officially considered a mental disorder, is still an off limits subject for many, reports Reuters. That taboo often extends to discussions about AIDS and condom use for men who have sex with men.

Condoms are widely available thanks to China’s long-standing one-child policy, but Reuters reports that conservative attitudes and an unwillingness to talk about sex mean the connection with AIDS prevention is not always made.

“Sex is taboo, and condoms have mainly been used as part of family planning rather than for safe sex,” Lee Folland, a graduate student doing research at Cambridge University on the social marketing of condoms in China, told Reuters.

In a Beijing survey, only 15 percent of 482 men who had sex with men understood that they were at risk of contracting HIV, according to a 2005 report by the United Nations’ UNAIDS. Some 49 percent reported having had unprotected anal intercourse with men in the prior six months.

A survey in late 2004 by the Chinese Centre for Disease Control and Prevention in the

northeastern city of Harbin found that almost 20 percent of men who had sex with other men also slept with women. More than 10 percent were married.

“There is strong social pressure to get married — or what would the neighbours say? It’s not only about how your parents would react, but how others will react to your parents,” Mr Folland said to Reuters, referring to fear of social ostracism for parents whose sons were thought to be gay.

Condoms and safe sex information are often not available in Chinese gay bars or saunas. Although they are starting to appear thanks to volunteer groups and outreach programs and a government belatedly waking up to the problem.

But even that information can sometimes be too tame to include pictures of how a condom is used.

“Otherwise in China it would probably be considered pornography,” said Chinese AIDS activist River Wei told Reuters.

Another problem in China, experts report, is that many men who have sex with men do not identify themselves as gay or bisexual. Indeed, thanks to a lack of education and cultural taboos they are not even be aware the concept exists, activists say.

“If you’re 40, have been married all your life, have kids and live in the countryside then one day you discover your true self and have sex with a man, you aren’t going to be thinking about using a condom,” Wei added.

“But that one time could be enough to get you infected.”

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