Recent trends in condom use are riding on changing Chinese attitudes toward sex, Zhang Lei and Wu Wencong report from Beijing.
On World AIDS Day last year, the Shaanxi Provincial Communist Youth League organised volunteer activities to help raise awareness and prevention of the disease.
The tradition on Dec 1 across the world included giving out free condoms to passers-by in Xi'an, capital of Shaanxi province.
But three boxes of condoms out of the six that volunteers checked out were returned shortly.
A volunteer from Xi'an's Northwest University said people were still embarrassed when she approached them with the condoms.
During the half-day campaign, eight volunteers distributed just 35 boxes of condoms.
It was a similar situation in Chengdu, capital of Sichuan province.
A passer-by rejected the condoms from a volunteer, and only four out of 10 people accepted the safe-sex brochures and condoms.
Volunteers in both cities said women were much more reluctant to accept the condoms than men were.
One volunteer in Chengdu even reported a woman indignantly rejecting the handouts, saying that she did not have AIDS.
While the scenes in Xi'an and Chengdu seem to reinforce the stereotype of Chinese people's conservative attitudes toward sex, recent developments and trends suggest that they are actually becoming more sexually open.
US-based men's online magazine AskMen last July surprised even the Chinese when it ranked China as the fourth most-sexual country, behind Greece, Brazil and Russia.
The website said that China had won its place due to its sexual revolution, particularly illustrated by the numerous sex shops on its streets.
"In the past eight years, 5,000 sex shops have opened in Beijing alone.
Plus, China even has a Sexpo, where Chinese residents come to check out sex paraphernalia," the website said.
Unlike the cold reception from passers-by to the condoms offered by volunteers in Xi'an and Chengdu last December, latest condom production and utilization rates also point to changing sex attitudes among the Chinese.
According to major online research store Research and Markets' latest report on the condom industry in China, manufacturing output of condoms totaled 10 billion in 2013, and the export value of condoms exceeded US$90 million (S$111 million).
In 2013 the value of condom imports to China was estimated at about $133 million.
The report also said that in China, condoms belonged to the sanitary-products category before 2002, which led to strict government control, low production capacity and limited markets.
Since 2002, the Chinese government has loosened control over the condom industry, which subsequently gained rapid development.
Annual output volume of condoms was 1 billion in 1995 and grew to exceed 10 billion in China in 2013.
China also now has one of the world's highest rates of contraception use in the world.
According to figures from the United Nations, the prevalence rate among women who are currently married or in union is about 85 per cent, whereas Japan only has a 54 per cent rate.
Faced with these encouraging figures, condom makers and retailers are also stepping up their presence in second- and third-tier cities to boost sales.
Shao Yufei, a 35-year-old sex shop owner in Yantai, Shandong province, said: "I thought people in South China, where China's opening-up started, should have a large demand for condoms.But I was wrong. The business was just bad."
Shao also ran a shop in Beijing in 2007, but due to bleak business and fierce competition, he opened another one in Guangzhou and ran it for only six months.
He has instead found Yantai, a city with a population of 7 million, ideal for his business.
Shao sells about 300 yuan($48) of condoms a day.
Most of them are of the more-expensive foreign brands such as Durex and Jissbon. In Beijing, his daily sales were about 100 yuan.
Duan Tao, deputy director from the medical committee of the China Sexology Association, said: "Condom use is related to a combination of factors including people's awareness of contraception and personal incomes. The awareness of contraception there is no less than that in big cities.
"They also earn more now and are willing to spend more on condoms,"he said.
Thinness vs safety
More Chinese use condoms not just for contraception and the prevention of sexually transmitted diseases and AIDS, but also to improve the quality of their sex life.
"Interestingly, the Chinese emphasise more on the thinness of the condom, while Westerners view safety as a primary concern," said Lin Xiaokang, a sociology professor at Renmin University of China.
In February, Chinese manufacturer Guangzhou Daming United Rubber Products said that it had developed a condom with a thickness of only 0.036 mm, and the product was recognised by the Guinness World Records as the world's thinnest condom.
The previous world record was held by Japanese brand Okamoto, which prides itself on the 0.038 mm series.
Studies show that in real life, many people are still reluctant to use condoms due to various reasons, even as they admit that the devices are the most effective tool to prevent unwanted pregnancies and the spread of AIDS and STDs.
A Bill & Melinda Gates Foundation study found that many men are still "feeling bad about it".
Some people said it is like taking a bath while wearing a raincoat.
Others cite the use of condoms as still not user friendly. Some said that when they stop to wear a condom, they can experience erectile dysfunction afterward.
In Guangzhou, a research team last month received funding from the Gates Foundation for the "Grand Challenges Explorations" programme that aims to make condoms thinner than 0.3 mm.
Zuo Lian, the project manager of the team, said she hopes in the next year, researchers will succeed in creating condoms with a thickness of between 0.025 mm and 0.03 mm, and most importantly, produce them at an affordable price for the general public.
There is essentially a conflict between thickness and durability in making condoms, Zuo said, and finding a "middle point" is crucial.
"If the thickness of a condom can be reduced to lower than 0.03 mm, the human body will not feel it exists. In medical terms, it is called foreign body sensation. It will revolutionize the sex experience," she said.
With more women using female condoms, they are also expected to have more say in choosing contraceptive methods in a healthy and effective way.
Zhang Yun, project manager of the Program for Appropriate Technology in Health, said that in many Western countries, female condom awareness is on the rise.
But the devices are still considered a new thing in China.
Some people are not used to women condoms, and some worry about its inconvenience of use that make partners feel uneasy.
Efforts are being made to promote it among young women because they might be more likely to accept new things.
According to the World Health Organisation, since 1993, there have been about 300 million female condoms distributed in more than 120 countries.
In developing countries, female condom use has increased from 14 million in 2005 to 50 million in 2010.
But the female condom market share is still small, accounting for less than 0.2 per cent of the global condom market.