ABSTRACT
Male and transgender sex workers in southern China are at high risk for AIDS and other sexually transmitted infections. However, their understanding of “safe sex” is often shaped by local germ theories and by their internalized shame and fatalism rather than by medically accurate information. These workers practice good hygiene as a means of minimizing risk and of coping psychologically with the stigma of their profession, which they associate with “dirt.” They connect the use of condoms with hygiene, but condom use is not framed specifically as a means of avoiding disease. Chinese public health services do not recognize male and transgender sex workers as a group. Their invisibility in Chinese health policy, and in Chinese society more broadly, means not only that are they neglected but also that opportunities to challenge myths around sexual health and HIV are missed. This chapter stresses the importance of including the voices of marginalized groups in discussions of HIV prevention in China, but it also makes a larger point: Public health officials everywhere must take into account local understandings (and misunderstandings) of health.
