Internationally, HIV is understood to spread in the following groups: recipients of blood products, truck drivers, injecting drug users, men who have sex with men (MSM), and commercial sex workers and their clients (UNAIDS 2011). Such categories have been developed through statistical reliability. That is, they become significant when large numbers are detected, and then ideas about infection are formed based on such findings, which then influence detection practices.

China’s experience of HIV shares similarities and differences with other international case studies, but the characterisations of each risk group and their relationships to China’s reform process are unique. HIV in China is typically transmitted via blood (drugs, blood selling, hospital borne-transmission), via mother-to-child transmission, and via unprotected sex with infected partners, prostitutes, or MSM. HIV then spreads into families and communities via these channels.

The Chinese government confirmed the first official case of HIV in 1984, in a Latin American tourist, and the first local cases were confirmed among a small number of patients who had consumed imported plasma products for the treatment of conditions such as haemophilia. This led to a ban on imported blood products, and a subsequent shortage. This also contributed to

China’s media first portraying HIV as a disease of gay Euro-Americans and Africans, and later as a problem of disadvantaged rural Chinese, minority folk, and other types widely believed to have undesirable qualities or practices. HIV was later detected in communities with high rates of intravenous drug use, in sex workers, and in minority groups, such as those along the borders of southern China, notably Yunnan province (Hyde 2007, Liu 2011). Although concern for HIV in drug using and sex-selling populations was well established by the 2000s, official statistics reported very few infections outside of Yunnan province.

In the 1980s, however, an untold tragedy was unfolding in central China in blood selling communities which supplied China’s growing plasma economy (xiejiang jingji). HIV had begun to spread rapidly among this population due to unsanitary collection practices and government inaction and profiteering (Wang 2012c). China’s booming blood trade initially arose due to several factors. There was a shortage of blood products resulting from the ban on their import after HIV was detected among haemophiliacs in the mid-1980s. Second, due to Confucian values and medical norms in China, the human body has largely been considered family, and not individual, property. Body parts and substances are not to be removed or drained (Kuriyama 1999). Spigner et al. (2002: 87-101), Glynn et al. (2006: 980-90) and Eggerston (2011: E537-E538) suggest that these beliefs in part explain the resistance of ethnic Chinese to selling or donating their blood. In particular, older and non-urban Chinese are said to resist donation because of these beliefs (China Culture 2010; Burkitt 2012; Anonymous PRC health official interviewed by the author in Canberra on health reform and the blood authority in China, 2013).

Although culture plays a role in shaping ideas about blood, it is not the only factor. Hong and Lok (2011: 49-52) show that Chinese beliefs about blood have little to do with tradition or cultural understandings of the body. Rather, due to China’s development and modernisation trajectories which had prioritised coastal areas of the country, blood selling was endemic in more remote areas which were very poor and economically underdeveloped, among people who were generally excluded from the benefits of China’s modernisation and development policies (Gao et al. 2003; Anagnost 2006: 509-29; Erwin 2006: 139-59; Shao 2006: 535-69; Zhou 2007; Su 2010: 101-16). These factors led to the rapid establishment of a highly lucrative, exploitative blood trade which journalists were frequently unable to report on. China’s most populous province, Henan, became the epicentre of this tragedy, and others such as Anhui, Shaanxi, and Sichuan were also affected. Blood-selling also occurred in urban and modernising areas to which inland people migrated in search of work. They, and the urban unemployed, were easily exploited by what seemed like an easy way to obtain income. In these spaces of marginalisation in the 1990s, though the practice was not connected to HIV, a pint of one’s blood was worth more than a week’s wage in a factory or construction site (Guo 1997; Qi 1997: 8; Zhao and Shang 2001).

The unsanitary practices prevalent at blood collection stands, such as shared needles and the pooling and reinjection of red blood cells following the extraction of plasma, led to the rapid spread of HIV through entire families and communities (Gao et al. 2003; Watts 2003; Zhou 2007; Wang 2012c). Due to a publicity and media ban in Henan province where blood selling was widespread and critical to the incomes of many, the severity of the spread of HIV did not come into public light until the late 1990s. Those who questioned the blood collection management practices in such areas or reported their findings and suspicions to their superiors, such as doctors Zhang Ke, Wang Shumin and Gao Yaojie, were threatened, intimidated, and/or lost their jobs. Unfortunately these unsafe practices, although less prevalent, continue today (Guan 2007a; 2007b; Dianjijinri 2012; Wang 2012a; Zhang Yanling et al. 2012). The blood-trade had become critical for the economic survival and wellbeing of areas where the practice was prevalent, regardless of the long-term consequences on peoples’ health and livelihoods. This disturbing trend has been recorded in other areas of the country and in pharmaceutical industries requiring whole blood and plasma (Wang 2009; China Ministry of Health 2010a).