Genital Beading: A Risk Factor for HIV in Taiwanese Men

An Interview With Tony Szu-Hsien Lee

I'm at a poster entitled, "Genital Beading as the Predictor of HIV Status in Male Drug Offenders in Taiwan."1 I'm here with one of the researchers. Could you please introduce yourself?

My name is Tony Szu-Hsien Lee. I am from National Taiwan Normal University.

Can you please tell us a little bit about your study on genital beading?

Genital beading [is] a way of putting beads underneath your penis. Genital beading among the injection drug users in Taiwan represents masculinity and hierarchy of their subgroups.

We conducted a study to find out if [genital beading is] correlated with HIV status. Of the more than 944 drug offenders we studied, we found out that about 40% had genital beading. The HIV prevalence rate is about 25%. [We found that] two factors are correlated with HIV infection: age [at which the man] first has sex and genital beading. It's quite fascinating to find out that genital beading is actually a risk factor for HIV infection.

Why do you think genital beading is a risk factor for HIV?

Well, once you put the genital beading in your penis, it's harder to put a condom on. It really hurts their penis once they have sexual intercourse. [Also,] if they didn't put a condom on, the genital beading would make them bleed during the process of coitus.

Did you find any difference in genital beading between males and females?

We are trained to search literature relating to genital beading [among females], but no study has been found. We only found literature on genital beading for males. It's a way of representing their masculinity and hierarchy of their male standards.

Do you find that genital beading is mostly practiced within the injection drug-using community? Or is it more widespread?

It's only among the injection drug-using community. It's not found among the general male population.

Why do you think this is?

This is probably just my guess: The men in Taiwan, they have to be successful in some way. For the injection drug users, they are not successful in their achievements, so they find a way to make themselves proud. I think this is the way. They put beads in their penis and they feel proud of it. They also compete with each other: If you have more beads in your penis, then you probably will be [higher within] the hierarchy of your subgroups.

What kind of interventions do you feel could be useful for this community, as far as helping them stay HIV negative when they continue to use the genital beading?

We came up with three suggestions. One is to educate them about gender equality. If they understand that putting beads on their penis may not represent masculinity, they may see that it's not so important in their lives.

The other way is: We try to get surgeons to take out the beads. In consideration of human rights and their willingness to take it off, we are not sure if they would let the surgeons do it.

The third is: We try to educate more about HIV and AIDS. If they have positive attitudes about condom use, if they really think HIV is important to prevent, they probably would consider reducing the beads.

When you said there were issues around using condoms with the beads, is it because the condoms won't fit over the beads? Or do the beads cut through the condoms?

Both. Actually, they can still put the condoms on, but the condom would tighten up, so they would feel the beads press against their penis. It's quite uncomfortable, so they have no willingness [to use] condoms. They have to choose, "I want to have beads," or "I want to have condoms." The other way is when they have intercourse, the beads would rub [against] the condom and it's easier to break.

Is it possible that, if the condoms were manufactured a different way, they could fit over the beads and not constrict them?

Oh, that's a really good suggestion. We will try to talk about that [with] the manufacturers of condoms.

Where do people go to get these beads put into their penis? Do they go to a local shop? A physician?

Actually, they do them themselves, or they help each other [when they are] in prisons. All you need is ... to make a little hole and push the beads in.

Where do they buy the beads?

They also do that themselves. You just need a small piece of glass or a small piece of plastic; they rub and [mold] it into a bead shape.

What are the beads usually made out of?


It's plastic? Not metal?

Sometimes metal, but it's rare. Most of them are plastic.

Interesting. Thank you so much for talking with us today.

Thank you so much.

This transcript has been lightly edited for clarity.


  1. Lee S-C, Lee TS-H. Genital beading as the predictor of HIV status in male drug offenders in Taiwan. In: Program and abstracts of the XVII International AIDS Conference; August 3-8, 2008; Mexico City, Mexico. Abstract TUPE0744.

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