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Opinion: Syphilis is making a comeback in China

The government's ability to curb the epidemic banks on its ability to address social challenges.

China Health Syphilis Sexually Transmitted Disease
A man steps out of a shop beside an advertising board for glow in the dark condoms in Beijing. Though the government started a campaign to combat the growing syphilis epidemic, its failure to address underlying social challenges risks a public health catastrophe. (Frederic J. Brown/AFP/Getty Images)

NEW YORK — Ignored in the wake of a booming economy, syphilis in China is making a comeback.

Although the Chinese government recently launched a plan to combat the growing epidemic, its failure to address underlying social challenges risks a public health catastrophe.

Since 2004, incidents of the disease have tripled in China. In August, syphilis was among the top five most frequently reported infectious diseases in the country. While China's 211 million migrant workers and 6 million sex workers have been at high risk for some time, the general population is becoming increasingly susceptible to infection. A recent study found that one baby is born with syphilis every hour in China.

Nearly eradicated 50 years ago, syphilis is resurging as a result of China's vastly transforming social structure. Burgeoning migrant and commercial sex worker populations, driven by three decades of economic growth, are contributing to the fastest rise of syphilis incidence in the world since the discovery of penicillin.

The resurgence of syphilis also implies greater difficulties for other major epidemiological concerns in China, namely HIV/AIDS. People living with syphilis are at five times greater risk of contracting HIV/AIDS.

After an initially tepid response, China's Health Ministry has begun to take important first steps to better prevent, detect and treat syphilis. In June, the Health Ministry issued a working plan calling for increased clinical screening, the launch of full-fledged public awareness campaigns and standardized treatment for at least 80 percent of syphilis patients by 2015.

The plan, however, overlooks broader social challenges underpinning the disease's comeback. Slowing the incidence rate will largely depend on China's ability to confront deep-seated social taboos and ease restrictions on public health activists.

While stigma associated with syphilis and other STDs exists in every country, it can be particularly burdensome in China, which values "saving face" and social relationships. Such a barrier presents a challenge to syphilis screening among high-risk groups.

In 2003, the China Health and Family Life Survey found that, among those Chinese who exhibited symptoms consistent with an STD, more than half avoided seeking medical care. Such avoidance has been linked to the stigma associated with visiting STD clinics. These stigmas undermine prevention and treatment efforts and discourage serostatus disclosure, which means disclosure about the presence or absence of specific substances in the blood serum — an imperative to halting the spread of syphilis.

Stigma also forces a large number of people living with STDs to seek self-treatment or treatment in small roving clinics. Such clinics, which operate outside of the purview of the government, usually do not provide quality services, potentially exacerbating the crisis.