China is a large, complex, and socially, economically and geographically diverse country of approximately 1.3 billion people. With a Gini coefficient (a measure of social inequality) that lies between 45 and 60, China is home to some of the richest and poorest people in the world (Cai 2012; Hodgson 2012; Yao and Wang 2013). (By comparison, South Africa has the highest economic inequality with a Gini coefficient of around 65, while Denmark is considered the most egalitarian society with a Gini coefficient of only 25.) Although its middle class is growing, the distribution of income, education, power, and disease is increasingly unequal (Sun and Guo 2012: 3—5). There are many important factors related to this which drive the spread of HIV.
The inequality which has characterised China’s social and economic development since the economic liberalisation reforms of the late 1970s has directly shaped the way HIV and AIDS have affected the nation. This inequality has also impacted on the ways in which the virus has been managed, narrated and become a problem of governance. Although the central government issues policies that call for consistent responses to HIV, their implementation varies across the country according to local will, area economic profiles, budgets, and the income and education levels of target audiences. The resources assigned to HIV diagnostic technologies, and clinical and HIV-based civil society programs are also unevenly distributed (Wan and Beijing Aizhixing Institute 2011).
This problem of inequality, particularly where HIV is concerned, is shaped by the country’s sharp ethnic and class divisions. China is officially made up of over fifty recognised ethnic groups. The Han represent a significant majority, and are generally wealthier, more powerful, better educated and have lower infection rates than those from minority groups. Their more powerful ideologies have impacted on the transmission paths of HIV, as well as on the ways in which HIV is studied, researched, detected, and communicated in social and public health discourses. Assumptions about the value and character of peasants and minority cultures have influenced HIV policy and responses (Hyde 2007), as well as the representations of HIV in public health and consumer media (Hood 2011).