In Imperial China sexual behaviour was regarded as an indispensable activity 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 sexuality 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, attitudes towards sexuality in China have changed. Premarital sex has become widely accepted among young people and people in China are now more tolerant toward extramarital sex. Nowadays young people consider that love should dominate marriage and the quality of an individual's sex life is currently more valued than it used to be. Attitudes towards masturbation have become more 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 lifestyle choice. Attitudes towards sex and sexual behaviour have become recognized as an individuals' responsibility as long as no offence occurs against society 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 important route of HIV transmission in China. This is complicated by the internal migration of an estimated 120 million labourers moving from the countryside to the cities as the result of economic reforms, most of whom are sexually active young men. Unless addressed directly, these factors may add to the estimated 300,000 HIV-infected Chinese, further fuelling an already rapidly spreading epidemic. The ramifications of the Chinese HIV epidemic will not only be felt within China, but also within the surrounding Asian countries thereby fuelling the HIV pandemic.
PIP: This paper discusses the changing attitudes towards sex and sexual behavior in China and its implications for the potential future spread of HIV. Two important philosophies have influenced the evolution of imperial Chinese attitudes toward sex and sexual behavior. Confucianism stressed conformity of sexual behavior within the boundaries set by society, while Taoism encouraged multiple sexual partners and prolonged sexual intercourse to promote better health and pleasure. In addition, homosexuality and commercial sex was tolerated, but masturbation was denounced. This tolerant attitude came to an end in the 17th century when the government exerted effort against all forms of extra-marital sexuality including homosexuality and masturbation. However, with the introduction of the One Child Family and Open Door policies by the end of the 20th century, attitudes toward sex and sexuality changed again. The Chinese have widely accepted premarital sex and are more tolerant toward extramarital sex. Homosexuality has begun to be considered as a legitimate lifestyle choice and attitudes towards masturbation have become more tolerant. Attitudes towards sex and sexual behavior have become recognized as an individual's responsibility as long as no offence occurs against society or other individuals, resulting to an increasing diversity of sexual behavior. Consequently, HIV infections are also rapidly increasing with heterosexual transmission becoming the most important route of transmission. This critical situation needs to be addressed immediately in order to control the AIDS epidemic in China as well as the rest of the Asian region.