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.
The Chinese government's treatment of activists and sex workers further stifles dialogue and propagates stigma. In early August, authorities detained leading women's rights activist Ye Haiyan for circulating a petition that called for legalizing prostitution. Ye had argued that legalizing prostitution would offer sex workers better protections. While legalizing prostitution may not be realistic, providing better protections would help break down stigma.
In recent years, numerous AIDS activists have fled China for fear of being detained for being outspoken. In May, renowned AIDS activist Wan Yanhai fled for the United States after his advocacy group, Aizhixing, came under intense official scrutiny for criticizing the government. Authorities from multiple government agencies had been conducting unannounced visits at Aizhixing's offices, searching for violations.
Such pressure from the government worsens the pervasive stigma associated with STDs. A working plan failing to address these issues fails to comprehensively address the syphilis epidemic.
With incidence already rising at 30 percent a year, syphilis will become more difficult to curb as China's urban and migrant worker populations increase. By 2025, the percentage of Chinese living in urban areas will increase to 67 percent of the total population, up from 43 percent in 2010. Over the same time span, China’s migrant worker population will more than double.
Health experts agree that providing sex education and condoms to sex workers is integral to syphilis prevention and must be made widely available, as detailed in China's working plan. In addition, innovative screening methods, such as point-of-care testing — which can be conducted in as little as 15 minutes — should be implemented in brothels, karaoke bars and massage parlors, to avoid the stigma associated with visiting STD clinics.
Along these same lines, health care must be made more affordable and accessible to migrant and low-income populations. Opening the political space for civil society will be essential to sustaining and scaling up prevention efforts.
Issuing a working plan outlining screening and treatment methods is a good start. Combating syphilis in China successfully, however, will depend on the country's ability to confront not only peripheral but also fundamental social challenges.
Curran Kennedy and Jaeah Lee are both research associates at the Council on Foreign Relations in New York City.