TheHIV/AIDSpandemic：Morethan40millionpeopletodaylivewithHIV/AIDS.Everyyear，morethan3millionpeopledieofAIDS.Itisadevastationthatafflictseverycountryonearth.However，itsburdensfallmostheavilyonpeopleindevelopingcountries.Theyarepersonal，economicandsocialburdens.Thesearenotjustmedicalstatistics.
FromthefirstsignsoftheHIV/AIDSpandemicintheearly1980s，theworldhascometorecognisethehugechallengepresentedbytheHIVvirus.Intheearlydays，itwaspredictedthatasafevaccinewouldbeavailablewithinadecade.Thishasnoteventuated.Securinganeffectivevaccinestillappearstobefaraway.AlthoughtherehavebeenadvancesintherapyforpeoplelivingwithHIVandAIDS（mostespeciallythedevelopmentofthetriplecombinationdrugtherapies）theseareexpensive，evenwhenavailableintheformofgenericdrugs.TheUnitedNations3×5programme（i.e.，3millionpeopleindevelopingcountriesreceivingantiretroviraltreatmentby2005）hasfallenbehinditstargets.TheobjectiveofradicallyincreasingaccesstoteststhatwillrevealHIVstatusinconjunctionwithcounsellingandprivacyhasalsofallenshortofitstargets.Inmanycountriesoftheworld，stigmastillsurroundsexposuretoHIV.Inpart，thishasbeenbecausedeathhasbeenthecommonconsequenceofinfection.Butinpart，ithasbeenbecauseoftraditionalattitudestothecommonmodesoftransmissionofthevirus：sexualintercourse，intravenousdruguse，andprostitution.
Intheearlyyearsoftheepidemic，indevelopedcountriessuchasAustraliaandtheUnitedStates，alargeproportionofpersonsdiagnosedasHIVpositiveweregaymen.Thishasneverbeenacharacteristicoftheepidemicindevelopingcountries.IthasnottodatebeenafeatureoftheepidemicinChina.Nevertheless，thepresentationofalargecohortofhomosexualpatientswithHIV，togetherwiththeabsenceofavaccineandtheearlyunavailabilityofeffectivetherapies，producedaconsequencethatisrelevanttosocialresponsestohumansexuality.
TheHIV/AIDSparadox：Facedwithanepidemicaffectingalreadyvulnerablegroupsinsociety，insusceptibletoeasymedicalsolutions，theearlydaysoftheHIV/AIDSpandemicwereverydifficult.Yettheyproducedaresponsethatinvolvedaddressingaparadox.Paradoxically，themosteffectivewaytoreducethespreadofHIVwasbyprotectingtherightsofthosealreadyinfectedorthosechieflyatriskofinfection.Thiswasaparadoxbecause，inthepast，facedwithepidemics，thenormalresponseofsocietyhadbeenquarantine.BythetimethemagnitudeofHIVwasrecognised，thepossibilityofquarantinehadpassed.Inanycase，giventheslowdevelopmentofHIVinmanyhumans，effectivequarantinewouldhavebeenadisproportionateandineffectiveresponse.
Recognisingtheneedforparadoxicalinitiatives，countriessuchasAustraliabegantakingstepstoaffordlegalandotherprotectionsforpersonsatrisk.Thesestepsincluded：
（1）Introductionofmajorpublichealthinformationcampaignsdiscussingsexualsubjectsopenlyinwaysthatwereunprecedented；
（2）Establishmentofanationalneedleexchangeprogrammeforinjectingdrugusers；
（3）Legalisationordecriminalisationofprostitution（commercialsexwork）；
（4）Passageofanti-discriminationlaws；
（5）Thedecriminalisationoflawsagainstsexualminorities.
Inconsequenceoftheseinitiallyradical，andparadoxical，measures，theearlyrapidgrowthofinfectionswithHIVwasturnedaroundincountriesthatadoptedtheseboldmeasures.Thenumberofsero-conversionsquicklyfell.Althoughthereissomeevidenceofariseinrecentyears（usuallyattributedtothedifficultyofmaintainingvigilanceandself-protectionoverlongperiodswithinnewgenerations），thegeneraleffectivenessofthenon-medicalresponseshasbeenwidelyacknowledged.Toasignificantextent，thecountriesthathavetakentheparadoxicalmeasureshavewitnessedafallinsero-conversions.Thosethathavecontinuedtopromote，orpermit，stigma；tocriminaliseadultsexualconductinprivate；andtostigmatizeminoritygroupshavewitnessedacontinuingriseinHIVinfections.
Inmostpartsoftheworld，accesstoconfidentialtesting，counsellingandexpensivetherapiesisstillalongwayoff.StigmacontinuestoimpedeeffectivestrategiesagainstHIV/AIDS.Thosestrategiesstilldependheavilyonbehaviourmodification.Suchmodificationreliesonawareness，self-perceptionandthecapacityofself-protection.
RelevanceforChina：Injectingdruguseandsexualrelationsaccountformanynewcases.Theearlyphaseoftheepidemic，involvingcontaminatedbloodproducts，hasbeensubstantiallyreversedandsolved.Butthe“twobehaviours”involvedininjectingdruguseandcommercialsexinparticularare“bothhidden”.ThenumberofHIVcasesinChinaisnotcertain.Radicalstepsarenecessarytoreduceandcontainthatfigure.
TheprotectivestepsforChinawillinvolveacceptingtheHIV/AIDSparadox.ThisincludesinthecohortofChinesepeoplewhoareatriskofinfectionthroughsexualcontact.Inturn，thisincludesmenwhohavesexwithmen（MSM）.Theymay，ormaynot，identifythemselvesinChinaasmembersofasexualminority.Butseveralfeaturesrenderthemspeciallyvulnerable.Theytendtobesociallystigmatized.Theyliveinaworldwheretheirsexualconductistypicallysecretandhidden，evenfromtheirownfamiliesandfriends.Theirexistenceisoftendeniedormockedbythemedia.Often，theydonothaveeffectivecommunityorganisations，professionalhelporpoliticalsupporttospreadmessagesofpreventionandtherapysoastoprovideself-protectionandsotoslowthespreadofthevirus.