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