First published November 30 2018, 17.30 China Standard Time

HIV among China’s elderly is a growing problem; it is mostly older men who get infected with HIV through extramarital sex. Their knowledge regarding safe sex is often lacking.

As it is World AIDS Day on December 1st, and while major discussions on the alleged first gene-edited babies immune to HIV are still top trending, other noteworthy HIV-related news is also gaining a lot of attention on Chinese social media these days.

At time of writing, more than 220 million people have viewed the Weibo hashtag “Number of Elderly AIDS Cases on the Rise” (#老年艾滋病病例上升#). The hashtag has emerged amidst news reports that there is a significant rise in the number of HIV cases among the elderly in China, particularly among men.

According to an article published on Weibo by Chinese news outlet The Paper, the number of known cases of HIV among Chinese men above the age of 60 has risen from 8391 cases in 2012 to 19815 cases in 2017.

On November 27, the Hangzhou Center for Disease Control and Prevention (杭州市疾控中心) released news information relating to the problems of the rising cases of HIV and AIDS among the elderly.

In the city of Hangzhou, the detection of HIV among patients who are over 50 years old has doubled over the past three years.

According to a specialist from the Hangzhou center, this rise of HIV has to do with the limited HIV awareness among elderly communities, and with the fact that they are often not accustomed to using condoms.

Extramarital heterosexual sex is the main way of transmission for elderly men, with some also getting HIV because of homosexual sex. For elderly women, marital sex is the main way of transmission.

Because they are often late in seeking medical treatment when they feel unwell, the detection of HIV is often late, which makes that there is a relatively high number of AIDS-related deaths among elderly patients.

The problem of the rising number of HIV patients among China’s elderly population has received more scholarly attention of the past few years. According to a 2014 study by Tang et al, the sharp rise of HIV among elderly became more visible after 2010. In 2011, people over the age of 60 accounted for 28.4% of the total HIV cases Guangxi province (this was 18.7% in 2009).

A study in Nanning, capital of Guangxi, found that heterosexual transmission accounted for 90% of HIV cases among those over 50 years old, and that low-cost commercial sex venues were a primary site of infection (Tang et al 2014, 2).

The research by Tang et al shows that the use of aphrodisiacs (cheaper alternatives to Viagra, often illegally produced in local workshops) is significantly associated with an increased HIV risk for men over 50 who purchase commercial sex with female prostitutes (3).

One popular WeChat blog explained the reasons behind the problem of HIV among China’s elderly as follows:

1. They see prostitutes because they are seeking ways to fulfill their sexual needs.

2. There is little awareness on HIV or AIDS. (According to one story quoted in the blog, an elderly man who was diagnosed with HIV even told the doctor he had washed himself with detergent every time after he had sex with a prostitute – he “did not understand” how he got infected.)

3. They do not know how to use condoms / they are not accustomed to using condoms.

On Weibo, there are many commenters who show their sympathy for the elderly women who get infected with HIV within their marriage because of their husband’s extramarital sexual behaviors. “How tragic for them,” a popular comment said, while others wonder: “What’s the purpose of marriage then?”

The Center for Disease Control and Prevention advises people who have had extramarital sex, homosexual or heterosexual, to get themselves checked on HIV – also if there are people who suspect that their partner might have had sexual encounters outside of the marriage.

“The sex life of the elderly is a sensitive topic, but it needs to be talked about,” well-known lawyer Yi Shenghua (易胜华) writes on Weibo: “If we do not attach importance to the [open] discussion of this topic, the problem of AIDS among China’s eldery will only grow bigger.”

By Manya Koetse and Miranda Barnes

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Tang Z, Wu X, Li G, Shen Z, Zhang H, et al. 2014. “Aphrodisiac Use Associated with HIV Infection in Elderly Male Clients of Low-Cost Commercial Sex Venues in Guangxi, China: A Matched Case-Control Study.” PLOS ONE 9(10): e109452. https://doi.org/10.1371/journal.pone.0109452.

Photo used in featured image by David Sinclair.

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