In January 2025, a 79-year-old man went viral on social media after testing positive for HIV at a hospital in the southern Chinese province of Guangdong where he was being treated for chronic obstructive pulmonary disease.
Asked when he could have become infected, the man told the Yangcheng Evening News that he had found a lover after his wife died 10 years ago, but had “never used condoms.”
News of the case quickly went viral on social media, registering in the list of hot search topics on Sina Weibo.
The social media reaction betrayed considerable social prejudice about the sex lives of older people, experts told RFA Mandarin in recent interviews.
And the case highlighted a public health problem that has been brewing in China for many years.
Studies have shown that older people are a fast-growing high-risk group for HIV infection.
A 2020 report in the journal Microbiology found that 58.4% of new HIV infections reported in the southwestern megacity of Chongqing were in the over 50s, while 46% of newly reported cases in the southwestern region of Guangxi were in men aged 50 and over.
Some studies have predicted that nearly 33% of HIV positive people in China will be over the age of 60 by 2035.
“The proportion of older people among among newly reported HIV or AIDS patients in China has been gradually increasing since 2015,” former China Red Cross official Ren Ruihong told RFA Mandarin in a recent interview. “It’s just that nobody has paid that much attention.”
Changing transmission patterns
Huang Yanzhong, a senior fellow at the Council on Foreign Relations, said patterns of HIV transmission in China have changed drastically since the 2000s, when it was mostly driven by rural blood-selling schemes.
“Before about 2010, the spread of HIV/AIDS in China was mainly due to blood selling, which was more likely to attract media attention,” Huang said. “But the spread of HIV/AIDS in China has undergone very significant changes, with the increase in the number of elderly HIV patients the most important challenge.”
As of June 30, 2024, China has more than 1.32 million people confirmed to be living with HIV/AIDS, exceeding the number of infections in the United States (which stand at around 1.2 million) -- nearly 1% of the population, according to a report from China Radio International.
Infection rates among the over 50s stand at around 2.1%, twice the prevalence in the wider population, and higher than in most other countries.
While younger at-risk groups may be more aware of the need to take precautions or get tested, the danger of getting HIV as an older person in China is that you may not find out until it’s too late.
“The thing about older HIV/AIDS patients is that they usually don’t find out until the disease is very advanced,” Chinese AIDS expert Wan Yanhai told RFA Mandarin.
“It shows that prevention campaigns shouldn’t only target specific high-risk groups, but should target the entire population, including older people,” he said.
According to China’s Statistical Communiqué on the Development of Civil Affairs in 2023, the number of people aged 60 and above in China was 297 million in 2023, or 21.2% of the total population.
Yet there is almost no mention of their sex lives in the mainstream media.
A 2019 survey by the Shenzhen University’s School of Communication found that around 40% of respondents think older people are “pure,” while others believed they were “healthy.”
The results suggest that social attitudes don’t expect people of a certain age to have sex lives at all.
The latest figures show a marked gender difference when it comes to reported HIV infections.
Between 2012 and 2018, the number of cases in older men rose threefold, while they only doubled in women.
Yet Chinese women over 50 are also increasingly getting infected with HIV, accounting for 38.1% of cases in the over-50s in 2016, compared with 17.8% in 2010.
There are also obvious regional differences, too. According to the Chinese Journal of Epidemiology, from 2015 to 2022, HIV infections in the over 60s were mainly concentrated in the southwest and southern parts of the country.
Shenzhen Center for Disease Control and Prevention data for January-October 2023 shows a total of 198 cases in the over-50s, 75.8% of whom were men. The number accounted for 15.1% of total new HIV cases for that period.
According to Huang, those figures are likely just the tip of the iceberg.
“These are just the officially released data, so the real figures are probably higher,” he said. “Many of them don’t find out until they develop other infections due to decreased immunity, and go to hospital for treatment.”
“But a lot of people may not have symptoms at all, and the older people are unlikely to take the initiative to get tested for HIV,” Huang said, citing the case of the 79-year-old man whose case was reported by the Yangcheng Evening News.
Relationships with sex workers
More than 90% of cases in this age group are the result of heterosexual transmission, most commonly during “commercial or extramarital sex,” according to a recent report in the Chinese Journal of Epidemiology.
This is borne out by a survey by sociologist Pan Suiming, whose survey of the nation’s sexuality found that 53% of Chinese people aged 55-61 have sex at least once a month, and 14% have sex more than once a week.
Some 47% reported never having sex at all, while 40% of men over 50 told the Shenzhen University survey they had used the services of sex workers. Nearly half were married.
The data point to a growing number of older men across China engaging in commercial sex, while a 2012 study by the journal Population Research found that many older men who seek out sex workers become long-term clients, and feel as if they have a relationship with them.
The sense of cosy familiarity means people are far less likely to use condoms. And surveys have found that more than 40% of sexually active people in China said they would never use protection at all.
Yet the perception of older people as somehow “pure” means that many who seek out sex workers or find lovers are castigated by their families.
And there is a general lack of education around HIV/AIDS, according to a 2020 survey by the World Health Organization and the Chinese Center for Disease Control and Prevention.
Researchers interviewed 45 people over 60 in three rural areas, nearly half of whom were HIV positive. They found that none of the respondents knew much about HIV.
In December 2022, Practical Preventive Medicine conducted a survey on AIDS-related knowledge, sexual behavior, and acceptance of HIV testing among people aged 50 and over who participated in community health examinations in an unnamed province.
It found that the overall awareness rate of AIDS prevention and control knowledge was only 32.9% among city-dwellers. Out in rural areas, that number was just 23.3%.
And there is scant support for HIV/AIDS awareness campaigns.
“Even back in the day when there were a lot of NGOs, there wasn’t much support for HIV/AIDS prevention work or publicity,” Ren said.
“A lot of organizations didn’t want to be associated with it, and non-government organizations have been declining in China since 2012,” she said.
“There aren’t any younger or middle-aged people to publicize this stuff.”
Translated and edited by Luisetta Mudie. Edited by Malcolm Foster.