Drinking, eating, smoking and sex constitute labour for many elite men in contemporary China, argues Elanah Uretsky in Occupational Hazards, but this nonconventional work is particularly fraught with risk. The yingchou and guanxi that are encouraged by non-transparent resource allocation practices have made a class of otherwise powerful men vulnerable to sexually transmitted infections like HIV in China's market-reoriented economy. By observing how these men use yingchou to build their careers and business opportunities, this ethnographic case study authoritatively untangles the relationships between informal and formal governance, occupational cultures, gender, power and the health risks structuring Party-state capitalist practices.

The empirical data for Occupational Hazards derives from 18 months of participant observation and semi-structured interviews, and also includes many historical, media and pop culture sources. Her engagement with Chinese discourse (for example, renqing, mianzi, xiongdi, gemen, ganqing, routi) is impressive and enjoyable, despite many mistakes in its romanization, as is her deep engagement with Han verbal scripts. The text is instructive on the role of serendipity and unplanned encounters in the field and advocates for the need to relax participant recruitment and scheduling expectations. Gendered experiences of fieldwork also emerge as the author recounts how her status as a white woman who did not conform with dominant indicators of Chinese femininity impacted on her research, and the role that partners and status symbols (i.e. being married to a Harvard graduate) can play as research lubricants. By exploring how China's health system engages in HIV work among elite men, she reveals the bias and blind spots of science-based data collection which, in this case, may mislead and ultimately fail those it intends to serve. Uretsky suggests rapport-building and trust as alternatives but acknowledges, in this case, that open engagement with elite male vulnerability would expose the Party-state's working culture to unwanted critique, thus providing no clear answer to this “unknowable” predicament.

Throughout, Uretsky examines the complex networks of her predominantly male informants, who include government, Centre for Disease Control and Prevention (CDC) and public health officials, elite, educated businessmen, and less privileged individuals and ethnic minorities. Her fieldwork sheds light on the sociocultural, political and economic factors underpinning the sexual practices of these subjects and centres on two sites, one in Beijing and another along the Sino-Burmese border. Uretsky shows how occupational success is inextricable from the maintenance of good relations with the Party-state, a factor that even NGOs accommodate in their practices.

The book's first, longer part, “Building guanxi: the effect on China's male elite,” pioneers new understandings of work, sex and relationships by exploring homosocial male culture and elite masculinity. Chapter one unpacks the meaning and practice of yingchou through a historical overview of rites and rituals from imperial times through the present. Uretsky illustrates how the state became increasingly involved in yingchou practices through its control over relations of production, licensing and permits, and how traditional, illicit, “yellow” sexual cultures have become mixed up within contemporary “red” resources and giving. She also demonstrates how yingchou practices vary geographically but tend to revolve around elite male sharing and consuming food, drink, cigarettes, entertainment and the bodies and services of women. Uretsky's participants seek to build relationships and trust with Party members controlling these resources, power and promotions, to the detriment of the other forms of masculinity and loyalty they engage in as husbands and fathers.

Practices of nanzihan homosocial masculinity are the focus of chapter two, as observed in the lives of three men trying to build commercial success, Wang Jun, A Rong and Xiao Mei, who are from Han, mixed ethnicity and minority backgrounds, respectively. Understandings of elite masculinity vary inside and outside the home, and Uretsky illustrates how demanding the men in her study often find it to reconcile their responsibilities to the state, work and family, all of which they must serve while isolating them from one another. The biological vulnerability of her participants to disease stands in contrast to their relative socioeconomic empowerment. This chapter's engagement with international masculinity studies would pair well in further dialogue with China-based research.

In chapter three, Uretsky provides a historical overview of Chinese sexual culture from Confucian times. She rejects the claim that China's sexual revolution was inspired by economic liberalization and Westernization and uses historical continuities within China and similarities to Japanese and Thai sexual cultures to question this. Larger sociopolitical issues emerge, such as how ethnic minority sexuality is increasingly commodified and misunderstood by the Han majority, the governance challenges facing the financially retreating Party-state, and the role of technology and humour in contemporary sexuality. Chapter four explores the intersecting culturally and ideologically informed “scripts” on love, the body, status, trust and exoticism that determine behaviour choices. Uretsky shows how Euro-American engagements with love and marriage offer little insight into Chinese social traditions, which prioritize lineage stability and mutual devotion over monogamy. She then explains how this is configured within the homosocial quasi-kin networks and sexual choices of her elite male informants.

The book's second part, “Building guanxi: the effect on China's HIV epidemic,” concerns the geography and history of HIV in China, but also touches on the history of opium use, addiction treatment, the chieftain borderland system, cross-border resource trade and minority designation and dynamics, politics and flows. The Sino-Burmese frontier is the main setting for chapter five, in which Uretsky argues that informal border economies based on sexual exchanges, narcotics and gambling and sociality are integral to regional and national development, and any attempt to disrupt STIs must address these complexities.

Chapter six is an overview of China's response to SARS and HIV. Uretsky critiques the “mobile sovereignties” of international aid, global health work, local public health and data production practices, which she claims neglect and often clash with local moral worlds, discourses and community relations. Instead, she calls for community sense-making and improved participatory development practices. Uretsky also reviews the achievements of China's healthcare reforms from liberation to the present and the challenges facing these. She details the dismantling of China's universal healthcare system and illustrates how the transition to vertical governance hampered responses to HIV and AIDS, as the central government is only able to enforce laws, not policies. Support for HIV programmes is thus contingent on local government coffers and priorities, which are linked to economic development, social stability and family planning, not infectious disease management.

The conclusion returns to the tensions between official Chinese state ideologies and global frameworks and approaches to infectious disease management. Uretsky argues that the former are unable to recognize and transform the practices of elite men because these are part of elicit mechanisms of promotion and resource access that are the lifeforce of Chinese governance. Global approaches to health, meanwhile, have also failed to protect these men, who may find exposure to disease impossible to bear, as the suicide of one high-ranking HIV-positive official illustrates. Uretsky's discussion of how to reframe such risks in direct relationship to “work” is valuable, and in doing so she illustrates how Euro-American understandings of occupation and leisure fail to adequately capture these phenomena in China. This ties in with contestatory observations throughout the text on how sex work, occupation, and risk are perceived within dominant frameworks.

The text brims with other examples of tensions and contradictions between the formal and informal political economies and the way these are typically studied. Uretsky is particularly insightful on the role of informal mechanisms (such as yingchou and guanxi) for career promotion in China. She opens up new debates by reframing labour to encompass activities beyond typical “in-office” work and by advocating for the recognition of the economic contributions of, for example, the homosocial trust-building practices that underpin the success of elite men in China's new economy. Uretsky also shows how socioeconomically powerful men elide risk assessments and how organizations win funding through biased reporting, thus challenging the validity of dominant international approaches to infectious disease within China. Arguing that health-based and non-governmental organizations locate risk in individual behavior and not within structural, political, class and economic networks, Uretsky suggests that these models are effectively destined to fail. Instead, Occupational Hazards argues that understanding local “scripts” should be at the heart of effective control strategies because the Party-state, resources, loyalty, promotion, language and HIV transmission are intimately linked. As such, society network analysis theory may provide locally grounded understandings of risk and the text gives examples of the successful integration of local trends into HIV programmes.

The questions the book prompted were mostly for additional detail and/or clarification. For example, the text would have benefited from more information on methodology (i.e. sample size, selection, time spent at the two sites). I would also ask how far the conclusions from this focused case-study could be used to understand HIV throughout China, given that only Yunnan and Henan received State Council emergency funds. I also wondered if CCP recruitment of “red capitalist” entrepreneurs following Jiang Zemin's “three represents” in 2002 impacted on power relations, resource control and practices of yingchou. Finally, I hope Uretsky will eventually share more on the women she engaged with during her fieldwork and how gender and relationships structured their risk of infection, particularly considering these women (tongqi, laopo, xiao laopo) may be even more vulnerable to “unknowable” infection than the elite men in their social, professional or familial relations.

Overall, Uretsky's contributions to multiple disciplines and the understanding of HIV in China are highly impressive, highly teachable and highly recommended.