by Matt Avery
I’m in a hotel room in a remote area of western China where the food is unrecognizable and the local dialect exceeds my knowledge of Chinese. There is a strange man perched on the edge of my bed with a cigarette dangling between his lips, eying me darkly. I also happen to be stark naked. I have the sinking feeling I’m about to become the subject of a “cautionary tale.”
Perhaps I should back up.
I was in China completing my practicum for an MPH in Health Behavior and Health Education at UNC. I received funding from the Institute for Global Health & Infectious Diseases to travel to Nanning, the capital of Guangxi Zhuang Autonomous Region, where was helping local grassroots organizations improve HIV prevention activities targeting local gay men.
There are an estimated 700,000 people living with HIV/AIDS in China, which represents a prevalence of roughly 0.05%. While that figure may seem low, infections aren’t evenly distributed across China’s massive population. Prevalence is actually quite high among some populations, such as injection drug users and sex workers. Without effective prevention and treatment programs, these sub-groups could potentially feed a much larger epidemic.
In Guangxi, the Chinese government estimates that about 40,000 are infected with HIV, the third highest rate among China’s 31 provinces. While injection drug use has traditionally accounted for the majority of infections in this region, research suggests that sexual transmission of HIV is on the rise.
Guangxi is home to a sizeable gay population, as evidenced by numerous gay bars, bathhouses, and massage parlors. Surveys conducted in Guangxi confirm high levels of unprotected sex with multiple partners among men who have sex with men (MSM).
Here is the crux of the problem: local gay men, despite being (reasonably) well-informed about HIV transmission and associated risk factors, remain unconcerned about their chance of becoming infected. And yet local prevention programs remain focused on disseminating basic information that everyone has and distributing condoms that nobody uses.
My job that summer was to examine the available data on prevention programs and deliver recommendations on how best to promote safe sex and HIV testing to a population that by and large is unconcerned about HIV.
I found myself facing a problem of enormous complexity, influenced by competing institutional, political, and health priorities, while trying to navigate an unfamiliar culture and an incomprehensible language. So what did I do? I learned to speak “Chinglish.”
Which brings us back to the stranger in my hotel room.
During the summer in Nanning I had the opportunity to take a weekend motorcycle trip through the Chinese countryside, a mountainous region thick with tropical forests and dotted with towns and villages populated by ethnic minorities. In other words, just about the last place on earth that you would want to have a motorcycle accident.
So here I am, having made an unplanned stop in a small town I don’t even recall the name of, standing in a hotel shower gingerly removing pieces of the road from my skin. Unbeknownst to me, the stranger is making himself at home.
“Bat bot?” he says, when I come out of the shower and see him sitting on the bed. From his inflection, I know he’s asking me a question, but the words aren’t any Chinese I recognize.
“Bat bot?” he says again. He sounds angry, and looks a bit threatening. I am getting frantic and gesticulating wildly, telling him I don’t understand. Finally, whether out of inspiration or desperation I do not know, I run to my backpack and start rummaging through dirty clothes, notebooks, and maps.
My hands finally land on the item I’ve been searching for. I thrust it towards him and ask anxiously, “Passport?”
“Bat bot bat bot bat bot bat bot!”
Foreign guests in China are required to register their passports at hotel check-in, but between the wrecked motorcycle and the blood and gravel covering my body, the desk clerk and I seem to have forgotten that bit of protocol. This was the hotel manager asking for my passport. Believe it or not, his bold intrusion was actually sparing me a 2 a.m. wake-up call by the local police.
My summer practicum in China was supposed to be a learning opportunity, a chance to put what I learned in the classroom into practice. But when I first arrived in Guangxi, I seriously questioned whether anything I had learned at UNC would be of use to me in such an alien place. I feared that the locals and I would spend the entire summer together and never really understand each other, much less accomplish anything.
I was wrong.
Not only did we find ways to communicate, but that summer I drafted a new communications strategy for HIV/AIDS prevention among Chinese MSM (the subject of my master’s thesis). Ideally, this will eventually become the basis for published educational materials targeting Chinese MSM.
The experience that day in the hotel room taught me an important lesson: understanding happens, even in the unlikeliest of places. When people need to communicate with one another, they will find a way to make it happen. They will find their own “Chinglish.”
Matt Avery is a master’s student in Health Behavior and Health Education at the UNC Gillings School of Global Public Health. He graduates in May 2009.