Dylan Sutherland and Jennifer Hsu begin and end their work on understanding HIV/AIDS in China with an insightful quote from Louis Pasteur (1822–95): “The microbe is nothing: the terrain, everything.” This revelation by Pasteur, reportedly made on his deathbed, contains the central tenet underpinning this book, that is, when it comes to understanding HIV/AIDS in China, the social and economic terrain are vitally important.
In the book's Preface, Sutherland and Hsu state that the deliberate intention of the book is to “better understand the different factors contributing to the growth of HIV/AIDS in China” (p. xi). Throughout the book, they achieve their proposed intention by moving away from the narrow biomedical approach to epidemiology, which primarily concentrates on individual risk and individual agency, to also examine the social and economic factors that contribute to HIV vulnerability. In chapter one, they provide a valid justification for this broader approach to understanding HIV/AIDS. They argue that the social and economic factors considered in the book are “some of the key underlying forces driving the epidemic at the population level” (p. 17) and they propose to “identify and explain some of the more important economic and social forces that are central to the epidemic” (p. 18).
The analysis of the social and economic determinants of HIV/AIDS begins in the second chapter of the book. Here and in subsequent chapters, the authors reveal strong links between the economic and social transformations China has experienced in the Reform era and the types of social and economic terrains which increase HIV vulnerability. In their discussion, the authors provide both international and China-specific examples, thereby extending the relevance of the work beyond China. The chapters that follow examine the growing income and gender inequality being experienced in China, the ever-increasing numbers of commercial sex workers, rural–urban migration, the current state of China's healthcare system, and the role of civil society organizations in formulating China's overall HIV/AIDS response. These are all critical aspects in understanding HIV/AIDS in China and its impact on Chinese society.
The approach taken in this book, and the book's findings, have some affinity with my own research. While conducting field research on China's HIV/AIDS epidemic in 2003, a considerable cause of concern for me was the lack of attention being paid to the social, economic and political terrains in China's overall HIV/AIDS strategy. At that time, the governmental and non-governmental responses to AIDS in China were almost solely underpinned by biomedical responses focused on high-risk groups and attempts at disease control. Social science approaches that transgressed the disease control paradigm had not yet been incorporated, even though these types of approaches were starting to make significant headway in understanding the terrain of HIV/AIDS epidemics in many Sub-Saharan African nations. HIV/AIDS in China does pay attention to some of these factors, and it offers much to the existing literature on HIV/AIDS in China, and studies of HIV/AIDS epidemics more generally.
Sutherland and Hsu are successful in achieving the goals they set out to explore in the work. Part of the research for the book comes from direct observations and discussions by the authors with individuals in China over the past two decades. These observations and discussions are complemented by considerable research and analysis of disease epidemiology generally and HIV/AIDS in particular. They draw on a wealth of research that documents both international and China-specific examples, and situate these findings within a development-studies framework that easily accommodates the biosocial approach to understanding HIV/AIDS in China.
My only criticism of the work is that a fuller discussion of the difficult political terrain around government responses to the epidemic was warranted. In 2002, the United Nations report HIV/AIDS: China's Titanic Peril (UNAIDS, 2002) identified China's political system as possibly the most sensitive obstacle in tackling HIV/AIDS in China. This sensitivity was obvious during the time of my field research, which occurred just after the release of the report and after China experienced significant international backlash due to their mishandling of the SARS crisis. While the political terrain has undergone much positive change since this time, and the Chinese government has done a volte-face in terms of its response to HIV/AIDS within its borders, the political terrain is still of considerable importance.
Nonetheless, this book provides an excellent analysis of the biosocial approach to understanding HIV/AIDS in China and it will appeal to students and scholars of Chinese studies, development studies and health sciences. It would also provide valuable insights to governmental and non-governmental policy makers. The authors of the book rightly conclude that a comprehensive response to HIV/AIDS must include a combination of both biomedical and biosocial approaches. The immediacy of their conclusion is reflected in a 2011 government press release. It quoted Li Keqiang as stating that when it comes to preventing and treating HIV/AIDS, China still faces a “severe task” (“Vice Premier: China faces ‘severe task’ in preventing and treating AIDS,” gov.cn, 12 July 2011). As the epidemic in China continues to grow, works of this nature will have increasing salience in analyses of Chinese society, economy and politics. It is imperative for China's long-term stability that their HIV/AIDS epidemic receives a comprehensive and effective overall response.
