Syphilis and Social Upheaval in China
Joseph D. Tucker, M.D., Xiang-Sheng Chen, M.D., Ph.D., and Rosanna W. Peeling, Ph.D.
Free access:
http://content.nejm.org/cgi/content/full/362/18/1658
Syphilis, a sexually transmitted infection (STI) that was nearly eliminated from China 50 years ago,1 is now the most commonly reported communicable disease in Shanghai, China's largest city.2 No other country has seen such a precipitous increase in reported syphilis cases in the penicillin era. In 2008, an average of more than 1 baby per hour was born with congenital syphilis in China, for a total of 9480 cases; the rate had increased by a factor of 12 during the previous 5 years (see graph). A disease with social roots, syphilis has become a major scourge lurking in the shadows of a country that has rapidly ascended to the status of a global economic powerhouse.
After China's economy became increasingly market-based in the 1980s, the growing numbers of Chinese businessmen with money and young women without money translated into expanded demand and supply for the country's commercial sex industry. Meanwhile, Chinese social structures influence the effectiveness of syphilis-control programs in two important but countervailing ways: although newly established advocacy organizations for marginalized groups provide a foundation for expanding such programs, the social stigma associated with high-risk behaviors is a powerful deterrent to widespread syphilis-screening efforts.
In China, at least one third of men who have sex with men are married, and the transmission of syphilis to their wives and then children is an important consideration. The limited data that are available suggest that fear of being identified as a "social deviant" may steer members of marginalized groups away from official STI clinics where licensed physicians use national guidelines and have standardized laboratory facilities.
神色，生怕被她鄙视