Entrepreneurial masculinity, health, and the state in post-socialist China.
Article Type: Report
Subject: HIV (Viruses) (Risk factors)
HIV (Viruses) (Demographic aspects)
HIV (Viruses) (Care and treatment)
Men (Health aspects)
Men (Research)
Masculinity (Health aspects)
Sex (Research)
Sex (Health aspects)
Author: Zheng, Tiantian
Pub Date: 03/22/2012
Publication: Name: International Journal of Men's Health Publisher: Men's Studies Press Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 Men's Studies Press ISSN: 1532-6306
Issue: Date: Spring, 2012 Source Volume: 11 Source Issue: 1
Topic: Event Code: 310 Science & research Canadian Subject Form: Sexual behaviour; Sexual behaviour
Geographic: Geographic Scope: China Geographic Code: 9CHIN China
Accession Number: 295171078
Full Text: Drawing on the author's three years' ethnographic research of karaoke bar hostesses and male clients in the Chinese urban sex industry, this paper argues that men's health practices are impacted by the practices of entrepreneurial masculinity and the development of social relationships with the state. In addressing the ways in which men's health practices are impacted by social factors rather than individual factors, this research has significant implications for HIV intervention programs, which should be devised to alter men's health practice through breaking the association of condoms with authoritarian, top-down, and coercive family planning programs and changing peer culture, peer behaviors, and peer worldviews in men's workplaces including companies and government offices in China.

Keywords: masculinity, sex industry, state power, health, China


In addressing the epidemic of AIDS, the current dominant biomedical model in public health explains health as stemming from individually chosen lifestyles. Epidemiologists focus on individual health behavior, apply value-neutral objectivity, and rely heavily on surveys as their primary method of scientific study (Bastos, 1999; Frankenberg, 1994; Hunt, 1996; Mann, 1996; Schoepf, 2001, p. 339). In so doing, they reduce "understanding human health to the quantification and recording of information regarding individuals within populations" (Lupton, cited in Robertson, 2009, p. 5). Following the rational choice model, public health studies assume that people engage in dangerous behaviors because they fail to recognize the risk or underestimate the risk involved in such behavior. It is assumed that if individuals are informed of these risks, they will recalculate and abstain from such behavior.

In general, epidemiological studies on health behaviors tend to focus on surveys of risk-related behaviors. Previous studies on health behaviors and STD/HIV in China have collected quantifiable data on numbers of sexual partners, the frequency of different sexual practices, previous experiences with other STDs, and other similar issues related to HIV infection (Cheng, 2002; Cui, 2001; Gu, 1993; Ma, 2002; S.P. Lau, 2001; T.H. Lau, Siah, & Zhang, 2002; Liu, 1998; Pisani, 2000; Rogers. 2002; Singh, 1995; Van den Hoek, 2001 ;Wang, 2001 a&b; Wu, 2002; Zhang, 2002; Zheng, 2001). The underlying assumption was that individual behaviors would change with knowledge. There was a concerted effort to develop and employ medical technologies such as screening to eliminate risks by "changing behaviors or lifestyles that are perceived to cause illnesses within body systems" (Robertson, 2009, p. 5).

Public health literature in general exhibits three major characteristics: First, it follows a methodology centered on the investigation and analysis of "problem populations." Second, it uses a "rational-choice" model of human behavior that attributes high-risk behavior to inadequate knowledge. Third, it is based on survey results from questionnaire responses.

This paper contends that this dominant biomedical approach dismisses the fact that health behaviors are related to social conditions and shaped by cultural systems and therefore is "unable to deal concretely with the lived social realities" (Mann, 1996, p. 3; Parker, 2001). Eschewing the dominant biomedical model widely employed in public health, this article adopts a more complex, socially structured view of human behavior (see also Bolton & Singer, 1992; Carrier, 1989; Flowers, 1988; Herdt & Boxer, 1991; Obbo, 1995; Parker, 1987, 1988). I argue that the intricate relationship between the state and male clients and the meanings of the entrepreneurial masculinity are critical to understanding many male consumers' decision-making about condom use and hence the social dimension of HIV/AIDS (de Zalduondo & Bernard, 1995; Farmer, 1992; Gupta, 1993; Micollier, 2004; Parker, 1991; Schoepf, 1992; Sobo, 1993, 1995a & b, 1998). Entrepreneurial masculinity is characterized by behaviors that demonstrate risk-taking and control of the people that he interacts with. The ideal entrepreneurial male is the one who exhibits the ability to command in any given situation. This can be expressed in karaoke bars through the manner in which a man controls the hostesses that he interacts with.

Drawing on the author's three years' ethnographic research on karaoke bar hostesses and male clients in the Chinese urban sex industry, this paper argues that men's health practices are impacted by the practices of entrepreneurial masculinity and the development of social relationships with the state. It shows that knowledge of AIDS does not always translate into rational behavior and that interventions exclusively based on information on HIV/AIDS have apparent limitations.

This paper is based upon my three years of ethnographic fieldwork on male clients in the Chinese sex industry in the port city of Dalian, in Northeast China. China's sex industry emerged in the wake of economic reforms. During the Maoist era, prostitutes were sent to labor camps for reeducation. In 1958, the Chinese Communist Party proudly declared to the world that prostitution had been eradicated, and this success was a symbol of China's transformation into a modern nation (see Hershatter, 1997). Since the economic reforms of 1978, the state's more lenient stance has opened the way for the reemergence of nightclubs and other leisure sites. Visitors to these bars are mainly middle-aged businessmen, male government officials, entrepreneurs, the nouveau riche, policemen, and foreign investors (see also Uretsky, 2008). Clients can partake of the services offered by the hostesses and at the same time cement social ties (ying chou) or guanxi (literally, relationships) with their business partners or government officials. Hostesses--mainly rural migrant women--play an indispensable role in the rituals of these male-centered worlds of business and politics. (1)

This paper is comprised of five sections. The first section reviews the literature. The second section explores research methods. The third section investigates the historical evolution of masculinities in China. The fourth section delves into the meanings of masculinities and social relationships with the state that shape men's health practices. The final section will summarize my conclusions.


Anthropologists have observed that gender is a key organizing principle of social relations. Among a wide array of sociocultural factors that underpin health behaviors, it has been argued that gender is one of the most important (Courtenay, 2000; Robertson, 2007; Serrant-Green & McLuskey, 2008). (2) Gender not only influences sexual behaviors, but also structures health issues.

Recently, there has been emerging feminist research focusing on women and health (Bayne-Smith, 1996). However, few researchers have dealt with how masculinities impinge on men's health (Courtenay, 2000; Robertson, 2006, 2007; Sabo, 1995; Serrant-Green & McLuskey, 2008; Verbrugge, 1985), and even fewer health scientists, sociologists, and theorists identify masculinities as a risk factor (Courtenay; Serrant-Green & McLuskey). It is only very recently that we see emerging critical analysis of men's masculine identities and health practices (see Robertson, 2007, 2009). It is crucial to demystify men's risk taking behaviors and debunk biological determinism that proclaims that men are biologically more prone to adopt unhealthy and risky behaviors (see also Robertson, 2006, 2007).

Connell (1995) states that hegemonic masculinity is the culturally dominant gender construction, which imposes power and authority upon femininity and other forms of masculinity. Among the few researchers who identify the linkage between masculinity and health, some demonstrate that hegemonic masculinity is constructed through certain health problems (Sabo, 1995). Others emphasize that men's health issues stern from the practice of hegemonic masculinity, which is reinforced by cultural norms. That is, men tend to adopt harmful behaviors to their health and sustain health risks to uphold dominant masculine ideals (Courtnay, 2000; Eisler, 1995; Neff, 1991; O'Neil, 1995; Pleck, 1994). (3)

While previous theoretical work is important, it is often not grounded in empirical studies, and therefore fails to contextualize men's health-related activities. To date, there has been very limited empirical work that explores the linkage between masculinity and health (Cameron & Bernardes, 1998, Chapple & Ziebland, 2002, Grogan & Richards, 2002, Robertson, 2006; Watson, 2000; Williams, 2000).

In his evaluation of the existent research on men, health, and masculinities, Robertson critiques the "striking absence of knowledge grounded in the everyday experience of men themselves," the simplistic analysis of men as "cavalier, uncaring and unconcerned about health matters," and the singular rather than plural conceptualization of masculinities (Robertson, 2007, p. 1,2006, 2009). In his ground-breaking research on masculine identities and men's health practices, Robertson (2006, 2007) critically explores laymen's and health professional's own accounts to unravel the ways in which social contexts shape masculinities and health practices. Drawing on the empirical information and qualitative research, Robertson argues that "men's own thoughts and behaviors" influence their health experiences and health practices and "cannot be fully understood outside of the social contexts within which they emerge" (2007, p. 2). His research also problematizes masculinity through a diversity of identities and differences among men and their health.

This paper follows this line of analytical inquiry and contributes to this limited, yet important terrain of research in three ways. First, this paper problematizes men and masculinity and recognizes the dramatic shift in the meaning of masculinities, rather than accepting them as immutable entities or unchanging norms. Through examining the ways in which the specific historical and cultural context in China shapes masculine identities, it "allows masculinities to be understood as being historically contingent but not essentially determined and as being fluid but hierarchical with dominant configurations acting collectively" (Robertson, 2007, p. 34).

Second, this paper contributes to the literature of gender and health by demonstrating the ways in which conceptualizations about masculinities are translated into, and impinge upon men's health-related activities.

Third" this ethnographic, in-depth study of men's lived experiences sheds light on the nexus between masculinities and men's health and furthers the current work on gender and health that is still lacking in empirical data. Presenting men's own narratives offers invaluable insights into the underlying complexities of men's perceptions and understandings of health practices (see also Robertson, 2007, p. 3). In demonstrating the contribution of ethnography to the study of public health, gender, and sexuality, this ethnographically contextualized study not only yields rich insights into men's understanding of health practices, but also provides a unique perspective on the study of disease transmission grounded in the everyday lives and worldviews of clients and hostesses.


Although surveys and questionnaires can be valuable in acquiring general information, qualitative methods in ethnographic fieldwork are far superior in foregrounding people's voices and illuminating people's lived experiences, stories, and perspectives.

In this research, as illustrated below, a myriad of research methods was employed to capture voices and accounts of research subjects. An interpretative approach was utilized to shed light on the intersection between masculinities and health-related activities. While the karaoke bars shape masculine identities, men who enter them bring with them hegemonic masculine rules that also shape and govern what is deemed appropriate embodied masculine behavior (Hey, 1986; McDowell, 1999; Robertson, 2006; Uretsky, 2008, 2010). In the rest of the paper, I will show how this normative masculine behavior has ramifications and implications for detrimental health-related activities.

During my two-year fieldwork between 1999 and 2002, I lived and worked with karaoke bar hostesses as a karaoke bar hostess myself. In my previous book Red Lights, I discussed the trials and tribulations throughout the fieldwork (Zheng, 2009). During this time, I lived and worked with a group of hostesses working as a hostess myself in a karaoke bar, facing many of the same dangers as they did and forming strong, intimate bonds with them. The result was an ethnographic story of young, rural women struggling to find meaning, struggling to shape a modem and autonomous identity, and, ultimately, struggling to survive within an oppressively patriarchal state system. During this period of my fieldwork, I was deeply disturbed to find from my colleagues that many male clients abjured the use of condoms. As a result, many hostesses suffered from frequent abortions and STDs.

Upon the Institutional Review Board approval, I went back to the field in the metropolitan city of Dalian in 2004, and conducted fieldwork off and on for twelve months until 2007, on condom use, sex work, and HIV/AIDS, among the same population of hostesses and male clients. The site of Dalian was chosen due to my close relationship with over two hundred bar hostesses and a hundred clients in the city from my previous two years of intense fieldwork. To conduct this research, I went back to the three karaoke bars I bad studied during my previous fieldwork from 1999 to 2002. Through hostess and client informants from my previous research, I resumed contacts with a bar owner and bar manager, over fifty clients, and over fifty hostesses. As stated, the sampling was of my previous informants, and the clients studied and interviewed for this research were middle-aged businessmen, political officials, police officers, entrepreneurs, and the nouveau riche.

Compared with surveys and quantitative research, ethnographic research not only enhances the quality of the data obtained, but also augments the quality of interpretation of the data. As a fieldworker, I had actively engaged in the lives of the people, participated in the daily activities, rituals, interactions, and events, and learned the explicit and tacit aspects of their culture. This research method of participant observation is superior because it helps the researcher achieve both an emic and etic understanding of the participants' point of view. Incorporating active participant observation with personal stories, survey, questionnaires, and interviews of clients, hostesses, and owners of adult health shops, this research allows the voices of people at risk to be heard.

I engaged in long-term participant observation of interactions between clients and hostesses, and I observed the everyday lives of hostesses and the socializing activities of clients. I followed clients and attended their group activities such as playing golf, singing songs at karaoke bars, consuming at sauna bars and observing interactive behaviors of male consumers and female hostesses, including dining at restaurants, chatting at coffee shops and teahouses, and so on.

Aside from the fieldwork with the clients and hostesses, I also served as a sales clerk at a local condom company in an attempt to understand the condom market in the local area and committed a month and a half to active participant observation as a counselor at a local AIDS NGO to understand the local cultural milieu of AIDS organizations.

I designed a survey on HIV knowledge, condom use, and attitudes toward AIDS patients for eight groups: hostesses, clients, female and male hotel service workers, female and male college students, and female and male professors. My intention was to compare and contrast the answers and find out which group had the highest HIV knowledge.

To conduct interviews, for my own safety and the privacy of male consumers, I invited my informants to coffee shops and restaurants for interviews. Individual tables at coffee shops were pretty secluded and quiet, as were the rented rooms at restaurants, which provided ideal places for interviews on sensitive topics.

My interview questions were intended to better contextualize and situate their survey answers. I started out with questions that tested their HIV knowledge and the source of their knowledge, followed by questions about the source of their sexual education, their opinions about their sex education, their first sexual experience and condom use, and their sexual history. I asked when they started using protection, whether they were consistent in their practice of protection, their definition of sex and their control over sexual desires, the setting and occasion of their first intercourse, and subsequent sexual exchanges and so on. (4)

Undoubtedly, these questions generated an immense embarrassment and hesitation in the interviewees. The interviewees, understandably, were red-faced and smoking the whole time to cover up their embarrassment. Among all these questions, clients were most resistant to the topic of HIV/AIDS and condom use. Due to the sensitivity of interview topics, I never used recorders that could potentially exacerbate interviewees' nervousness and disrupt the conversation flow. I jotted down details during interviews and typed the entire interviews into the computer after each interview.

I have combined participant observation with formal and open-ended, as well as informal, interviews and surveys. Matthew Gutmann (2007, p. 27) observes, "There are practical limits to studying sexuality and sexual relations." In this study, the limitations include selection bias and reliance on self-reporting of sexual behaviors.

As stated, the hostesses and clients who participated in my research were my previous informants and their friends. Given the sensitivity of the topic, I relied heavily on these key informants with whom I had developed a close relationship over the past decade. Because of this particular selection process of my research subjects, I was not able to reach a vast number of hostesses and clients in the city. This recruitment bias circumvented the breadth of research subjects and, hence, could potentially affect research findings.

Like all other researchers on sexuality, we are confronted with the limits of self-reporting. Unlike other social activities, sexual activities are private and reclusive. It is impossible for a researcher to be present, to observe, or to participate in my informants' sexual activities. However, although researchers have no other options but to rely on informants' self-reporting, I have found ways to enhance the reliability of the data. In my research, since I have developed a close relationship with both the hostesses and their client lovers and friends for a decade, I was able to corroborate their stories and detect and account for inconsistencies or discrepancies in their words and actions. Daily interactions with the hostesses and clients on a casual basis throughout a whole year's intensive fieldwork, not counting the previous two years of intense interaction, exposed me to a wide array of information and knowledge, either from group gossiping or through their family members that aided the verification process.


The meanings of masculinity evolved throughout Chinese history. Before the May Fourth Movement in 1919, courtesan house was a site that produced an elite masculinity of self-control and cool demeanor. Elite masculinities had to be validated by the courtesans, the arbiters of their masculinity, as worldly, urbane, knowledgeable, sophisticated, and refined (Henriot, 2001; Van Gulik, 2003). (5)

Concerns about masculine identity at this secure time of "culturalism" (Fitzgerald, 1996) have to do with social class. "Culturalism" entailed a universal superiority that Chinese people felt at that time, considering themselves the "Middle Kingdom"--the center of the world and universal superiority. Fairbank states that China embraced an attitude of being the large ethnocentric universe which "remained quite sure of its cultural superiority even when relatively inferior in military power to fringe elements of its universe" (Fairbank, 1973, p. 178).

With the Western intrusion into China, Chinese male insecurity was linked to the perceived decline of China and contributed to the growth of Chinese nationalism. Elite masculinity was attacked because it was identified with the elite cultural tradition (Earson, 2002). Nationalism produced a new model of masculinity. For the first time in Chinese history, the sexual prowess of Chinese men was not measured internally as a means to establish social class but came to be measured against the outside predators whose military prowess identified them as more sexually potent (see Brownell, 2000).

Later on, the Maoist state, with its emphasis on gender equality, attempted to control men's sexuality by suppressing female sexuality (Zheng, 2009). (6) In the 1990s, masculinity and marital stability were seen as dependent on women's enjoyment of sex. This radical notion that women should enjoy sex was not out of a concern for the happiness of women, but rather reflected the new competitive capitalist economic model where men proved themselves through entrepreneurial activity. Chinese entrepreneurs, instead of taking offense against the Taiwanese and Japanese businessmen who had taken Chinese mistresses, simply emulated them and took mistresses themselves (Brownell, 2000). While young entrepreneurial men recovered their economic and sexual potency, older retired cadres were faced with impotence (Brownell, 2000). So devastated was this group, there was an upsurge in the market for tonics to reinvigorate their sexual life. Here, the link between politics, economics, and sexuality is drawn. Men with economic and political power become sexually potent, whereas men who have lost such power feel emasculated by the market reforms.

Entrepreneurial masculinity has been analyzed as inextricably linked to economic and state power (see Brownell, 1999, 2002; Chen, 2002; Connell, 2001; Gilmore, 1990; Louie, 2002; Jankowiak, 2002; Zheng, 2009; Zhong, 2000). (7) Men were judged not by birth status or even education but by their competitive abilities. The impact of this change on the relationship between men and women was profound. Because of the risks and social trust needed in the alliance between entrepreneurs and officials, the consumption of sex served as an institution for the preselection test and bonding activities, which ensured social trust (Zheng, 2006). The most powerful men were identified as those who could emotionally and physically control the hostesses, exploit them freely, and then abandon them. The less powerful men engaged in sex-for-money transactions with a large number of hostesses. The weakest men were those who became emotionally involved with the hostesses. Hence, in the new, fluid urban entrepreneurial environment, men resurrected their lost masculinity by emulating the economically successful Japanese and Taiwanese businessmen in the consumption of women. Their subjugation of women represented the recovery of their manhood in post-Mao China Women became a testing ground for male entrepreneurial ability. In this competitive world, men's skill in charming women and keeping them under control came to define their success (see Zheng, 2009). Hence, in the new fluid urban entrepreneurial environment, men attempted to rebel against the Maoist control of their sexuality and resurrect their lost masculinity by emulating the economically successful Taiwanese businessmen in the consumption of women. "Masculinity is related to state power, nationalist ideology, the free market, and the marriage/sex markets. The current situation has unleashed an entrepreneurial masculinity that is apparently proceeding hand in hand with the return of male privilege and female disadvantage" (Brownell, 2000, p. 230). Their subjugation of women represented the recovery of their manhood in post-Mao China. (8)


In Red Lights, Zheng (2009) analyzed the clients' metaphoric use of liang (grain) in their reference to having sex with their wives as "jiao gong liang" (turning in the grain tax). I detailed how the history of the hierarchical system of food rationing in colonial and Maoist Dalian placed the Japanese and Maoist states at the top of the food chain and the men at the bottom. Meanwhile, men perceived their masculinity as lost in the alliance of the Maoist state and Chinese women to liberate women. In the post-Mao era, men's attempts to recover their lost sexual identity with free-ranging promiscuity in the karaoke bars were further curtailed by the continued presence of socialist moralities and state laws. Thus, clients analogized turning in their jing (semen) to their wives as peasants turned in the grain tax to the state (Zheng, 2009). The clients/peasants perceived themselves at the bottom of the hierarchy vis-a-vis the wives/state. The clients operated on an economy of scarcity where the semen was perceived as finite. The social stress of a lack of control was expressed in the bodily symbolism in which they assumed more control over their "limited" amount of semen. Self-perceived as the managers of their bodily assets, the clients exercised what I called "misappropriation;" that is, they allocated their semen between their wives and hostesses. Such a misappropriation of their jing (semen) was a mode of resistance, just as liang (grain) was misappropriated by peasants who rebelled by cheating the government of their taxes. The clients' subversive misappropriation was intended to maintain their bodies' independence as "impermeable, inviolable entities" (Brownell, 1995, p. 243; see also Brownell & Wasserstrom, eds., 2002; Chen, 2002; Jankowiak, 2002; Louie, 2002, 2003; Zhang, 2001; Zhong, 2000).

This theme of clients' resentment and defiance against state control of sexuality and pleasure continued throughout the current research. Clients expressed their resentment toward the cultural understanding of sex as evil and the state's need to restrict and repress it. This echoes the traditional cultural values of "sexual silence" between many men and women described in the Latino context by scholars such as Carrillo (Carrillo, 2002; G6mez, & VanOss Marin, 1996). (9) As with many Latino people who have demonstrated a strong favor for cultural change, clients in my research also vehemently voiced their dissatisfaction with this cultural norm. Client Zhang said, "Sex is sin in China. We are taught that sex is the first and foremost evil among the ten thousands of evils. This Confucian idea is still prevalent in people's minds." Client Zhang said that he has never talked about sex with his wife because he was too embarrassed. Other clients told me the same story. Client Jiang said, "In China, no one likes to talk about it [sex]. Even with male friends, no one talks about sex. Sex is still a taboo. I don't want to answer these questions about condom use. I'll just say 'I don't know' to handle these questions, not because I don't know, but because I don't want to answer them." I thanked him for telling me honestly his resentment toward the questions on condom use. I then pressed him and said, "I understand that sex is a taboo and no one likes to talk about it, but why did the male clients respond to this topic with so much resentment? Why is the topic of condom use so unpleasant to them?"

Client Jiang responded, "This is because of the conflict between the mainstream which is conservative, and the personal and private sphere, which is liberal. Just like the saying that goes, 'One Muslim can eat full, but two Muslims have to starve to death.' One Muslim person can eat pork when alone and private, but two Muslims will have to starve because of the taboo. This is the conflict between the conservative mainstream and the liberal personal sphere."

Here the story of Muslim was appropriated to demonstrate the contrast between the government that repressed expressions of sexuality and the clients who rejected the mainstream, and were hence censored, controlled, and condemned. One might be justified in questioning client Jiang's response since he was more than willing to talk about sex when it allowed him to brag about his sexual exploits. As noted earlier, performing emotional coolness and rational control over hostesses was essential among clients because it reflected their trustworthiness and rationality, the qualities that were put into test during sex consumption before their admission into the male alliance (see Zheng, 2006). It was only after the topic of condom use and HIV/AIDS was brought up that he was concerned with the distinctions between the public and private sphere and claimed the fight of privacy.

Client Ren expressed his indignant hatred toward the government's hostile attitudes toward extramarital sex among hostesses and male clients and premarital sex among college students. He said,

Client Ren construed extramarital sex and hedonistic sexual pleasure an active rebellion against government repression and a liberating space from the suffocating repressive state. He continued:

This attitude, while not universal among the clients interviewed, was representative of a large proportion of those who were willing to speak on the subject. Client Ren's words vehemently criticized the state ideology as useless and meaningless and pinpointed the detrimental impact of such an empty state ideology on people, that is, a moral vacuum and a lack of basic kindness to others. Such a moral vacuum drove clients to explore their sexual urges and pursue their sexual liberation as a voice of defiance and rebellion against the deceiving and repressive state ideology.

Throughout the interviews during my research, clients stated again and again that they resented condom use because it was just another scare tactic that the government used to further repress their sexuality. These interviews contended that the state's repression and surveillance of individual private spheres instigated the clients' resistance through sexual liberation. Such sexual liberation not only included engaging in illicit sex with hostesses but also entailed resentment against condom use.

Hyde argues that, in competing with the state family planning apparatus, the market economy opens the door to new kinds of sexual practices (Hyde, 2007). Certainly, the market economy has unleashed and catapulted male clients' sexual revolution. About condom use, Hyde argues that purchasing condoms in the market, compared with acquiring condoms from the state, is more discreet and increases privacy, which helps individuals resist state intrusion into their personal lives as "everyday practices of resistance" (Hyde, pp. 160, 168). In this particular aspect, male clients and hostesses in my research told a different story. During this research, some male clients who purchased condoms said that purchasing condoms in the market is a "public act," involving a great embarrassment. For instance, one client explained, "I am afraid of buying condoms. When I do, I drop my head like a criminal who has just committed a crime, hastening to escape after paying for the condom." Young unmarried women, such as hostesses in my research, encountered stigmatizing comments from the sales workers who called them sex workers. Although purchasing condoms in the market is embarrassing, they still preferred the market to the state apparatus because, as they remarked, the state-distributed free, poor-quality condoms (too dry and easily broken), in limited quantities (only ten free condoms a month), and for married couples only. The difference between Hyde's research findings and the authors' could result from the different research locations and disparate research populations.

While Hyde concludes that the market "provides a potent weapon against STDs and AIDS through the sale of condoms" (Hyde, 2007, p. 152), the story of male clients in this research points to a cultural dimension that thwarts and undercuts the potency of this "weapon." I define this cultural dimension as the perception of condoms by male clients. To clients, condoms symbolized state repression of sexual pleasure and state intrusion into the individual private sphere. By talking about condoms, restrictions are put on male clients' sexual pursuits and sexual pleasure. It reminds people that the state interferes with and represses their sexual desires. Hence, many clients regarded rejection of condoms as a political act of defiance. This is one of the factors that shape many men's refusal to use condoms.

Clients in my research rejected warnings about HIV/AIDS and believed that inculcating fear of the disease is a strategy the state uses to curb their free sexual expressions, which threaten the state. AIDS and condoms represent exactly what they rebel against--control and regulation of their sexual pleasure. Warning about AIDS and condom use shackle their sexual pursuits and thwart their absolute enjoyment of free sex. Their free pursuit of sexual pleasure poses a direct challenge and menace to the state, and hence constitute the main target of state control. As Foucault contends, "policing of sex is an important component in maintaining the unmitigated power of the central state" (Foucault, 1978, pp. 24-26). If sex can be regulated and maintained within the confines of marriage, then social stability and state control is ensured. Thus, it is essential that "the state knew what was happening with its citizens' sex, and the use they made of it, but also that each individual be capable of controlling the use he made of it" (Foucault, p. 26). Reshaping and disciplining sex is hence central to the state's desire to maintain and secure the social fabric.

The post-Mao state has exercised many strategies to negate, to silence, and to police non-marital sex. The state's obsession with sex and with controlling it is seen as necessary to achieve what the state envisions as a harmonious society, in which citizens are obedient and the state is in control. Paralleling state control with condom use, clients' sentiment is analogous to the gay community in their sexual revolution during the early 1980s. When little was known about AIDS, the gay community in the San Francisco area was unreceptive to attempts by local government and medical institutions to promote safe sex or condoms and to discourage high-risk behavior like anonymous sex in bathhouses (Shilt, 2000). These educated efforts were largely thwarted by the history of misunderstanding and outright prejudice that had existed between the gay community and the American medical establishment. Before the AIDS outbreak and outreach programs, homosexuality was defined by the medical establishment in general and psychiatry in particular as mental illness (APA, 1973). (10) This view of sexual orientation as a pathological behavior caused homosexual groups to distrust government and medical agencies so that people like Michele Foucault believed that AIDS was designed to further stigmatize homosexuality (Halparin, 1995). It was not that Foucault did not have the facts, but rather, it was the inseparable relationship between medicine and, in this case, politics, history, and power that led to the unchecked spread of AIDS in the early period and the tragic loss of life.

Clients held similar kinds of resentment against the state's regulation of their pursuit of sexual pleasure and expressed an outright hostility to HIV/AIDS and condoms. As a result of their cultural perceptions of condoms, knowledge of HIV/AIDS is not conducive to protective sexual behavior and condom use.


Clients' health practices are not only shaped by their relationships with the state, but also informed by their perception of entrepreneurial masculinity as fearless and valiant. Their audacity in taking risks and their consideration of diseases as "bad luck" remind us of the notion of "edgework" analyzed by Collison (1996). While young men in Collison's research occasionally "lived on the edge" to transcend the banality of everyday existence, clients in my research enacted this kind of fearless entrepreneurial masculinity on a daily basis.

During my research, I asked each interviewee the following question: "What do you think of your male friend who does not use condoms with hostesses?" The common response I received was, "I think he is very valiant (meng). You know, very brave, fearless, has the courage to take risks." Their responses showed that clients attempted to project a brave and valiant (meng) persona for the peer group through abjuring condom use.

Here, the idea of "valiant," or "virile," is similar to the meaning of masculinity in other cultures, such as in Africa and in Latin America. In South Africa for instance, flesh-to-flesh sex with multiple sexual palmers is valorized, and condom use is seen as undermining South African men's notions of masculinity (Holland et al., 1994a&b; McGrath, 1993), fertility (Abdool et al., 1992), and pleasure (Preston-Whyte et al., 1991).

Clients in my research demonstrate entrepreneurial masculinity through engaging in illicit sex with multiple sexual partners, not wearing condoms, and not fearing STDs, while imposing control over hostesses. Peer norms among clients valorize macho displays of a fearless spirit and the pursuit of absolute sexual pleasure and prevent them from protecting their health.

When I asked one client if he was afraid of getting STDs, he responded, "Not at all." When I asked him why, he smiled and said, "Well, even if you just drink cold water, you may get something trapped in your teeth. Not every hostess has disease. If it just so happens that the hostess you sleep with has disease, you have to acknowledge that you have had bad luck. You'll have to say, well, I happened to meet such a hostess. I have nothing to say but to recognize my bad luck!" Similarly, another client said, "Not every hostess has disease. Every day you see other people sleeping with hostesses without condoms and they have not caught any diseases. You know that it's your bad luck if you catch it once in a while."

Catching diseases from illicit sex is portrayed by clients as a matter of luck and chance. Conceptualizing health as a matter of luck or fate "may be psychodiscursive practices mobilized to help people through difficult material circumstances and a mechanism for allowing the separation of illness, impairment and death from individual blame" (Robertson, 2007, p. 60). While clients' notions may resemble the fatalistic views on health by men in other research (Donovan, 1986; Howlett, Ahmad, & Murray, 1992; Robertson, 2007), I believe there is a difference. The men in other research are from the lower socio-economic strata whose control over their lives is marginal (Donovan; Howlett, Ahmad, & Murray; Robertson, 2007). A fatalistic belief system more accurately represents reality for them and may better allow them to accept their lack of control. For the upper middle class men in my research however, it seems more likely that the fatalistic worldview is a romantic pretense meant to enhance their masculine identity.

It was important to clients in my research to portray themselves as fearless risk-takers in their attitude toward STDs. Clients asserted that they did not care about STDs because so many people got them and one shot was enough to treat the infection. One client said, "Did you see how many people queue up in the municipal STD hospital every day to be treated for venereal diseases? Tons of people! So no one feels embarrassed about having venereal diseases."

This dialogue demonstrates the need for these men to conform to this new rebellious group identity, which defines them as real men. Whatever these men's real fears might be, they are attempting to project a certain kind of masculine image to me as an interviewer. Clients in my research tend to take venereal diseases lightly because it is not only easily treatable but also something shared by their male friends. As they expressed throughout the interviews, a valiant man is not timid; a valiant man does not worry about taking risks; a valiant man is fearless of STDs. In fact, as a client told me, his friends "took it so lightly that they were even trying to hook up with hostesses in the STD hospital when they were queuing to see the doctor."


In their chapter on men, masculinities, and health, Robertson and Williams (2009) contend that "Very little work to date on men's health promotion identifies the significance of socially structured factors as determinants of men's health practices/outcomes and therefore seeks social/political rather than individually based interventions" (p. 58). In addressing the ways in which men's health practices are impacted by the social factors of entrepreneurial masculinity and social relationships with the state, this research has significant implications for HIV intervention programs, which should be devised to alter men's health practice through breaking the association of condoms with authoritarian, top-down, and coercive family planning programs and changing peer culture, peer behaviors, and peer worldviews in men's workplaces including companies and government offices in China.

In addition to the practical implications for HIV/AIDS intervention, this paper also contributes to the current theoretical knowledge on men, health, and masculinities in three ways. First, this paper demonstrates the changing nature and complexity of masculine identities rather than taking it as an immutable entity or an unchanging norm. The concept of masculinity, as the paper illustrates, is historically evolving. It changes, evolves, and takes on different meanings and embodiments according to different historical eras. In China, during the imperial time, elite masculinities were defined as worldly, urbane, knowledgeable, sophisticated, and refined. In the 1990s, the most powerful men were identified as those who could emotionally and physically control the women they consume, exploit them freely, and then abandon them. The less powerful men engaged in sex-for-money transactions with a large number of women. The weakest men were those who became emotionally involved with women. In the new, fluid urban entrepreneurial environment, men attempted to rebel against the Maoist control of their sexuality and resurrect their lost masculinity by emulating the economically successful Japanese and Taiwanese businessmen in the consumption of women. Their subjugation of women represented the recovery of their manhood in post-Mao China.

Second, this paper contributes to the literature of gender and health by demonstrating the ways in which conceptualizations about masculinities inform and impact on men's health-related activities. Men's voices and narratives reveal a complicated relationship between masculinities and health-related activities in everyday life that involves their negotiations and resistances against the repressive state. I believe the proper interpretation of their voices also contests a reductionist approach that views men as inherently careless about their health and physical wellbeing.

Because condoms symbolize state repression of sexual pleasure and state intrusion into individual private spheres and hence a loss of masculine control, clients sought to rebel against the restrictions on their sexual pursuits and achieve masculine liberation. Such sexual liberation was multi-layered. It not only entails resentment against condom use and engagement in illicit sex, but also necessitated complete flouting of mainstream moralities and pursuit of absolute sexual pleasure. It is also characterized by a care-free posture in the male culture that regards clients' own pleasure, virility, and control over women rather than the welfare of women.

Third, this ethnographic, in-depth study of men's lived experiences sheds light on the nexus between masculinities and men's health and furthers the current work on gender and health that is still lacking in empirical data.

Future research needs to recognize the complexities in the relationship between health-related activities and other aspects of male identity in different configurations of social class and ethnicity. Consuming services of women in karaoke bars is only one model of Chinese masculinity, and not all men subscribe to it. As one might suspect, men find masculine identities through other kinds of venues and sports such as soccer, golf, and bowling, and through conspicuous consumption of clothing, automobiles, and elegant housing. As Robertson points out, there has been a move in studies of men's health from "theorizing masculinity in the singular to masculinities," which "gives recognition to the multiple ways men live out masculine gender identifies, as well as growing recognition of intersecting aspects of masculine identities" (Robertson, 2009, p. 13). Future research needs to take this approach into other areas of men's experiences and consider how different aspects of male identities interact and impact on health practices (see also Robertson, 2006).


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(1) Although karaoke bars are legal, they have always been one of the government's main "culture purging" targets. It is claimed that they work against the state's cultural logic in three aspects: (1) Socialist business should prioritize the needs of people and serve the people. It should be different from the commercial system, where the pure objective is to pursue and procure sudden huge profit. Many bar bosses operate their business by cheating customers and providing erotic services. (2) "Erotic company" (seqing peishi) is illegal and immoral and runs counter to socialist "spiritual civilization." Such "ugly phenomena" associated with capitalism should be wiped out to maintain the healthy and inspiring socialist cultural environment and "civilized consumption." (3) Juxtaposed against socialist recreations enjoyed by the masses, karaoke bars are more individually based, places where individuals pursue and express their "repulsive and hideous" desires to show off their performing talents and satisfy their sexual demands. In view of these reasons, karaoke bars regularly undergo a purging process to become part of "spiritual civilization." Frequent police raids are part of this process.

(2) These authors argue that we should integrate varied sociocultural factors and male diversity in health-related activities in order to shed light on the relationship between men and health.

(3) In his study of men and health in the U.S., Courtenay points out that men tend to engage in risky behaviors and less healthy lifestyle patterns (Courtenay, 2000). He argues that in the U.S., forms of masculinities, enactments of gender, and institutional structures contribute to health risks. Men engage in certain behaviors to display the hegemonic masculine ideals (Connell, 1995). Courtenay notes that it is not only hegemonic masculine ideals, but also power and prestige that men attempt to procure through appropriating behaviors that are detrimental to their health (Courtenay). Through these risky and harmful behaviors that include suppression of pain, denial of health needs, sexual aggression, physical dominance, violence, sexual conquest, denial of physical discomfort, and disregard of physical pain, men embrace risks, reject femininity, exhibit fearlessness, and perform their masculinities that disregard health. Those who fail to do so risk being ridiculed and relegated to inferiority and hence lack of power and prestige. These activities that define and enact masculinity are informed, shaped, and upheld by cultural norms and institutional structures that reward men with money, power, and prestige (Courtenay).

(4) Interview questions also focused on the use of alcohol in their sexual interactions; their perception of the beginnings of a sexual relationship; their views about who should initiate a sexual relationship and how they communicated with their partners about their likes and dislikes during sex; what told them that an interaction was sexual; their understanding of safe and unsafe sex; their views about whether there were differences between sex behaviors with a wife and with a prostitute or a lover; whether they carried condoms; whether their partners had condoms available; whether they assessed the dangers of disease before engaging in sex; assessment of education and social class as a basis for trust; which party normally spoke about protection; where they obtained condoms when they needed them; what prevented them from asking for a condom in an encounter; what had happened to them when they had asked for protection; how emotional involvement related to use of protection; and so on.

(5) Courtesan houses or public places where courtesans were summoned as professional entertainers formed an integral part of the official and business routine where social relations of officials, literati, artists, and merchants were conducted. Every official entertained his close colleagues--superiors and inferiors and merchants--to conclude or to negotiate deals. An official could ensure his promotion by introducing his superior or an influential politician to a discreetly chosen courtesan, and by the same means, a merchant could obtain a much-needed credit or an important order.

(6) Before liberation, men could gain economic and political power, but in the Maoist society, they were stuck in socialist work units earning the same meager wages as women. The party-state constantly watched over them, stifling their personal ambitions and prohibiting them from speaking their own minds. That led to men's feminization and lack of initiative and creativity. It was believed that the Maoist state's alliance with liberated women stifled men's ability to discover their own strength and led to their feminization.

(7) David Gilmore's cross-cultural study of various masculinities and R.W. Connell's call for both international and local approaches to the study of masculinity have generated much interest. Zhong Xueping and Kam Louie examine masculinity through in-depth readings and intricate analysis of Chinese films and literary works that were produced throughout the crucial historical junctures in China. Zhong utilizes a feminist psychoanalytic lens to argue that Chinese men feel "besieged" in post-Mao China and attempt to negotiate an image of strong men vis-a-vis women and the state as a part of the effort to create a geopolitically strong Chinese nation. Kam Louie traces the historical changes of the dyad wenwu (cultural attainment-martial valor) and argues that this dyad is an analytical tool and theoretical construct facilitating the conceptualization of Chinese masculinities. Brownell and Wasserstrom's edited book takes an anthropological and historical approach to evoke how femininity and masculinity in China are mutually constructed and have changed over time.

(8) My ethnography of the karaoke bars (Zheng, 2009) not only displays the kind of entrepreneurial masculinity sought there but also demonstrates the responding femininity performed there. I argue that the hostesses take advantage of the clients' use of them and perform an obedient and promiscuous role to satisfy the clients. In return, hostesses redistribute the clients' social and economic resources and claim for themselves a cosmopolitan image.

(9) Scholars have emphasized the prevalence of "sexual silence" in Mexican culture and Latin culture (Carrillo, 2002; Gomez & VanOss Marin, 1996). Sexual silence refers to the phenomenon in which individuals are acculturated to avoid talking openly about sex and maintain indirect and veiled communication about sex. As Carrillo notes, it is a "widespread method used to keep transgressive sexual behavior under wraps in order to maintain the appearance of normality. They [people] indeed discovered how one can transgress and simultaneously comply with cultural expectations, how nonnormative behaviors can be carried out without triggering negative social consequences. This included, as well, learning that certain forms of sexual joking were allowed in order to refer to sexual matters in good company or to safely express interest or desire to potential sexual partners" (Carrillo, 2002; Gomez & VanOss Marin).

(10) The American Psychiatric Association (APA) removed homosexuality from its official Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973.


* State University of New York, Cortland.

The author would like to acknowledge the incisive and constructive suggestions and comments made by the editor Steve Robertson and anonymous reviewers that have greatly improved the quality of the paper.

Correspondence concerning this article should be addressed to Tiantian Zheng, State University of New York, Cortland, NY 13045. Email: tiantian.zheng@cortland.edu
Police often attack sauna bars and karaoke bars to arrest those who
   sleep with hostesses unless the manager is a friend of the police.
   Some of my colleagues were dismissed from their positions because
   they were caught by the police sleeping with hostesses. College
   students can be dismissed from schools for engaging in sexual
   activities. It's only recently that college students have been
   allowed to get married--the policy has only started to open up
   recently. All these behaviors run against the mainstream and they
   are the target of expulsion and punishment. That's why in personal
   space people can be very open and liberal, but they're not willing
   to talk about it in public. It's because of this conflict. This
   conflict forces people to appear conservative and traditional.

There was a thought in the past--communism. It was communism that
   guided people to do everything. Today this thought is no longer
   useful. It is of no use in the society; it is of no use in the job.
   It lost its function as guidance. It lost its meaning. Because
   China doesn't have any religions like other countries. China
   doesn't even have the simplest principle of being kind to others
   [yuren weishan]. People lost their directions and embraced all the
   new things. I lack an understanding of these new things. All I know
   is that the basic nature of human beings is evil [renzhichu,
   xingbene]. I have this sexual urge; I need sexual satisfaction; and
   hostesses can offer it.
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