Changing sexual attitudes and behaviour in China: implications for the spread of HIV and other sexually transmitted diseases

In Imperial China sexual behaviour was regarded as an indispensable activit y to reach harmony with the universe, through the unity of the interaction of two opposing forces: yin and yang. Sexual intercourse was accepted when linked to procreation within a family context, while an individual's sexual ity was not considered important. Homosexuality was tolerated although not advocated, while masturbation was denounced. Since the One Child Family and Open Door policies in the 1970s and the economic reforms of the 1980s, att itudes rewards sexuality in China have changed. Premarital sex has become w idely accepted among young people and people in China are now more tolerant toward extramarital sex. Nowadays young people consider that love should d ominate marriage and the quality of an individual's sex life is currently m ore valued than it used to be. Attitudes towards masturbation have become m ore tolerant and though homosexuality has been hidden by society for a long time, in recent years it has begun to be considered as a legitimate lifest yle choice. Attitudes towards sex and sexual behaviour have become recogniz ed as an individuals' responsibility as long as no offence occurs against s ociety or the interests of other individuals, resulting in the recognition of diversity of sexual behaviour. As part of the changing attitudes to sex and sexual behaviour, heterosexual transmission is becoming the most import ant route of HIV transmission in China. This is complicated by the internal migration of an estimated 120 million labourers moving from the countrysid e to the cities as the result of economic reforms, most of whom are sexuall y active young men. Unless addressed directly, these factors may add to the estimated 300,000 HIV-infected Chinese, further fuelling an already rapidl y spreading epidemic. The ramifications of the Chinese HIV epidemic will no t only be felt within China, but also within the surrounding Asian countrie s thereby fuelling the HIV pandemic.