With successful economic reforms, China has gradually accelerated its integration into the globalising international system. In the process, China’s participation in multilateral dialogues and its cooperation with other countries and international institutions in relation to global issues has increased rapidly. It has demonstrated an increasing willingness to comply with international norms and rules in a variety of policy areas, ranging from arms control and human rights, to public health. Regarding public health, China has gone through three different stages since the establishment of the People’s Republic of China (PRC). In the transition from the Maoist cradle-to-grave system to Deng’s market-oriented healthcare system, health care was largely deregulated and left to the market. China’s public health system has subsequently become one of the worst in the world in terms of financing and the allocation of resources. Its ailing health system has exposed its deficiencies and weaknesses in controlling emerging infectious diseases. At the turn of the century, the Chinese government began to shift its health policy again, from framing it as an internal domestic social issue, to proactively embracing multilateralism in managing its looming health crisis. As seen from HIV/AIDS, the focus of this article, China concealed the existence of a crisis in the country for more than 15 years. In June 2001, the government officially admitted the crisis in the country and thereafter, its commitment to tackling the problem has been increasing. It has not only proactively participated in international and regional fora in tackling HIV/AIDS but has also drawn in a wide range of transnational actors to combat the disease inside China. This paper argues that China’s changing health governance at the turn of this century, particularly in respect to HIV/AIDS, was driven by four motivations. First, international concerns about good governance, particularly after the Asian financial crisis of 1997–98, put China under normative pressure to change tack. Second, China’s interaction with United Nations agencies has triggered a learning process and accordingly securitised communicable diseases as a security threat. The third cause is utilitarianism whereby China has utilised multilateralism to gain access to international resources and technical assistance. Finally, it is due to China’s determination to burnish its international image and thereby gain normative power in the international community.