High HIV risk but inadequate prevention services for men in China who have sex with men: An ethnographic study

China is facing an emerging HIV epidemic among men who have sex with men (MSM). However, the HIV risk and prevention needs of these men are not well understood. We conducted in-depth qualitative interviews between August and October 2000 with 38 persons who identified as being MSM or knowledgeable about the MSM population in Beijing. Our ethnographic study identified 20 different segments of the population of MSM in Beijing and 14 distinct types of venues where these men congregate. Despite high levels of sexual risk taking, few men perceived themselves to be at risk for HIV. The main reasons cited for engaging in unsafe sex were economic survival, misconceptions about HIV, inaccurate assessment of a partner's risk, trusting a partner or needing to prove a partner trustworthy, meeting an attractive partner, and cruising in public sex environments. The HIV prevention services currently available in Beijing include mass media education, hotline information and counseling services, venue-based outreach, hospital-based services, and Internet sites, but few of these programs specifically targeted the MSM population. The major barriers to utilizing exiting services were lack of perceived risk, lack of privacy and anonymity, uninteresting program content, and distrust and questionable credibility of providers. Programs need to address issues broader than AIDS, be peer-designed and peer-led, be entertaining, and receive more government support. Our data suggest that many MSM are at high risk for HIV, but receive inadequate services. More effective and sustainable programs must be developed and implemented to prevent the further spread of HIV in this population.