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As he waited to give blood for an HIV test recently, Le, a marketing professional, explained why he was there. “I was aware of the consequences” of not using a condom, he said, “but somehow I didn’t know how to say no.”

Le, 25, a gay man who would give only his first name, was being tested at the Lingnan Health Center, an organization run largely by gay volunteers and whose walls are adorned with red AIDS ribbons and a smiling condom mascot. In the past, Le went to hospitals to be tested, he said, but the stigma of being a gay man made the experience harrowing.

“I’d always be concerned about what the doctors would think of me,” Le said. “Here we’re all in the same community, so there’s less to worry about.”

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Le is one of thousands of gay men in Guangzhou, a city of 13 million people, who are benefiting from an experiment that supporters hope will revolutionize how the Communist Party deals with nongovernmental groups trying to stop the spread of AIDS and other sexually transmitted diseases.

Encouraged by the leaders who came to power in November, civil-society activists hope the model taking shape in the prosperous southern province of Guangdong will be replicated nationally, not just in the fight against disease but on other issues such as poverty, mental health and the environment.

While China’s Center for Disease Control and Prevention has allowed community organizations across the country to participate in disease-testing programs since 2008, those efforts remain patchy. But in November, just before World AIDS Day the following month, the grass-roots movement received an endorsement from incoming Prime Minister Li Keqiang.

At a meeting with advocates for AIDS patients, Li, a red ribbon on his jacket, promised more government support and shook hands with HIV-positive people, an image that resounded in a society where those infected are routinely turned away by hospitals and hounded from their jobs. “Civil society plays an indispensable role in the national battle against HIV/AIDS,” he said.

Bureaucratic hurdles

Activists remain wary, however, noting similar government promises in the past. Despite the high-level support and a policy in Guangdong allowing grass-roots groups to register directly with the government — instead of being forced to find an official sponsor, as in much of the country — many organizations say they remain stymied by dizzying bureaucratic hurdles or are rejected for missing unannounced deadlines.

Tao Cai, director of AIDS Care China, which provides support to 30,000 HIV-positive people nationwide but remains unregistered, believes the obstacles come from local officials who are trying to prevent nonprofit groups from competing with their fiefs. “In China,” he said, “we say reform never gets out of Zhongnanhai,” a reference to the senior leaders’ compound in Beijing.

There is little doubt that public-health officials need help. Through October 2012, there were nearly 69,000 new HIV infections reported in China, a 13 percent rise from the same period in 2011. Almost 90 percent of the cases were contracted through sexual intercourse, with rising numbers involving gay men. Medical experts also worry about syphilis, which has returned with a vengeance after being virtually wiped out in the Mao era.

Grass-roots health groups have been frequent targets of official harassment. In most provinces, they can register with the Bureau of Civil Affairs only if sponsored by a government agency. But advocates say few agencies are willing to vouch for groups focused on issues such as homosexuality, prostitution or sexually transmitted diseases.

In the face of such constraints, most of China’s estimated 1,000 HIV organizations operate in a legal purgatory that deprives them of tax benefits and makes it risky to accept foreign donations, usually their main source of support.

Li’s uneven record

Li, the incoming premier, has a spotty record when it comes to HIV. In the 1990s, when he was the top official in central Henan province, a botched blood-collection program there infected hundreds of thousands of people with HIV. Critics say Li was more interested in covering up the problem than dealing with its causes. Even as he was holding court with AIDS groups, more than 100 of those infected in the scandal marched in Beijing to the Ministry of Health demanding justice.

For most Chinese, AIDS remains a fearful issue. People who get infected with HIV often become social outcasts, a situation made more perilous by the absence of legal protections for those who lose their jobs or their homes.

The Lingnan Health Center, a comfortable space decorated with couches and a fish tank, strives to be welcoming toward the dozens of gay men who come each day to roll up their sleeve and learn their fate. If they get bad news, patients can return for counseling and information on medical treatment. “We want it to feel like home, not a hospital,” said Meng Gang, Lingnan’s founder.

The center’s employees say unsafe sex is all too common among those tested, a result of deeply closeted lives. “With gay men the sex is all underground,” said Xiao Mi, a Lingnan staff member.

Meng founded Lingnan five years ago as a health-focused offshoot of his gay advocacy organization, Guangdong, which offers services like sex education, counseling on coming out, and online dating through its website, which receives around 3 million visitors a year.

Guangdong delves into a realm the Chinese government prefers to keep shrouded. Homosexual characters are banned from television, gay film festivals cannot advertise and the police often force lesbian and gay organizations to cancel programs during politically sensitive events.

Despite the state-sanctioned prejudices, Chinese health officials say cooperation with grass-roots organizations is beginning to transform the government’s approach to such issues. “The fight against STDs is not just about public health,” said Yang Bin, director of the provincial sexually transmitted-disease control center. “It’s a political issue, too.”

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