HIV testing as prevention among MSM in China: The business of scaling-up

Abstract

In this paper, I examine the emergence of goumai fuwu, or contracting with social organisations to provide social services, in the HIV/AIDS sector in China. In particular, I interrogate the outsourcing of HIV testing to community-based organisations (CBOs) serving men who have sex with men (MSM) as a means of scaling-up testing in this population, and how the commodification of testing enables new forms of surveillance and citizenship to emerge. In turn, I tie the scaling-up of testing and its commodification to the sustainability of CBOs as they struggle to survive. In recent years, the HIV/AIDS response in China has shifted to expanding testing among MSM in order to reduce new infections. This response has been catalysed by the transition to sexual contact as the primary transmission route for HIV and the rising rates of infection among MSM, leading government institutions and international donors to mobilise CBOs to expand testing. These efforts to scale-up are as much about testing as they are about making visible this hidden population. CBOs, in facilitating testing, come to rely on outsourcing as a long-term funding base and in doing so, unintentionally extend the reach of the state into the everyday lives of MSM.

Community engagement in sexual health and uptake of HIV testing and syphilis testing among MSM in China: a cross‐sectional online survey

“…The Chinese Centers for Disease Control and Prevention (CDC) offer free HIV testing at voluntary counselling and testing sites [15]. However, Chinese MSM face major psychosocial and structural barriers to testing, including fear of stigma and discrimination from providers, concerns over confidentiality, and inconvenience of testing sites [16][17][18][19]. Greater understanding of testing behaviours among MSM is needed to inform public health strategies.…”

HIV vulnerability and the erasure of sexual and gender diversity in Abidjan, Côte d'Ivoire

“…This includes thinking about the ways in which interventions shape identity. Importantly, as Fan points out in her work on the outsourcing of HIV testing among men who have sex with men in China (Fan 2014), much of the current international HIV funding for key populations requires that NGOs continually redefine themselves in order to exist. Heartland needs HIV peer educators at Alternative and Arc-en-Ciel to produce these numbers in order stay relevant.…”

“…Ethnographic research provides a powerful tool for studying both the complexity of the lived experience of sexual and gender minorities and the impact of interventions in shaping new form of social reality and may lead to greater insight into the “broader politics that enmesh and shape global health priorities” (Fan, 2014, p. 95). Ethnographic data that engages both the complexity of lived experience and the impacts of interventions that almost always overlook those complexities could serve as a starting point for rethinking the assumptions inherent in the culture of public health itself.…”

“…Both organizations acquired large headquarters, well equipped with computers, office furniture, LCD projectors, and Wi-Fi capabilities and employed government-certified HIV peer educators with different titles, responsibilities, and pay scales. This outsourcing of HIV prevention programming and testing is part of broader trends in the commodification of testing (Fan, 2014, p. 86) and came with the expectation that these “community members” would recruit an ever increasing number of MSM into intervention programming, data which they can then use to prove a “return” on donor investments.…”

Constructing publics, preventing diseases and medicalizing bodies: HIV, AIDS, and its visual cultures

“…Of course, it must be done in a thoughtful manner, and media campaigns must work to avoid neglecting communication with Mexican society in general. As Elsa Fan (2014) has shown in the case of China, MSM are still widely believed to be the highest-risk group, even though heterosexual transmission accounts for more than half of new infections. A different scenario is found when we analyze sexual workers.…”