Objectives: To explore the characteristics and issues specific to HIV related risk behaviours among men who have sex with men (MSM) in rural China. Method: Qualitative study using semistructured in-depth interviews in Dali prefecture, Yunnan. 24 informants recruited through a local MSM network, snowballing and byword of mouth. The main outcome measures were themes identified as increased exposures and risks to HIV. Results: Risk behaviour, social stigma, one child policy and concepts of traditional Chinese medicine (TCM) had significant roles in the spread of HIV in rural China. Many MSM lead a life with double identities in China and condom use was found to be variable with attempts to "rationalise" the risky behaviour being its major determining factor. Health seeking behaviours of genitourinary problems were infrequent and illogical, which were further held back by the existing healthcare system and lack of sensitivity expressed by the health professionals. Conclusions: Clear education messages to the general public while raising awareness among health professionals of the health risks and needs in MSM are essential in the prevention of the current HIV epidemic.