China Faces ‘Hidden’ Chlamydia Epidemic; Could Have Implications for HIV Spread in Country
China is experiencing a "hidden" chlamydia epidemic, causing concern among researchers that factors contributing to the spread of the sexually transmitted disease may lead to a "rapid spread" of HIV and other STDs in the country, according to a study published in today's issue of the Journal of the American Medical Association, Reuters reports (Reuters, 3/11). William Parish, a professor of Chinese studies at the University of Chicago, and colleagues interviewed and tested urine samples from nearly 3,500 Chinese men and women between the ages of 20 and 64 from August 1999 to August 2000. The researchers found that the overall prevalence of chlamydia was 2.6% for women and 2.1% for men (Parish et al., JAMA, 3/12). These rates are similar to those found in developed Western countries, Reuters reports. However, a "suprising finding" of the study was that the disease is being spread most rapidly among upper-income businessmen who have unprotected sex with commercial sex workers and then spread the disease to their wives or girlfriends. Among high-income men who had sex with sex workers, 15% were infected with chlamydia, and 6% of their partners were infected. The researchers found that the prevalence rate was highest in the "rapidly developing" southern coastal regions, where 16% of men and 10% of women have chlamydia. "The silent chlamydia epidemic may cause many women to be infertile, to have ectopic pregnancies and be at greater risk of HIV infection," Parish said (Reuters, 3/11). "Were the current growth rates to continue, absolute numbers of individuals with HIV infection in China will surpass current numbers in the United States within two years and those in South Africa (currently the highest) within a decade," coauthor Edward Laumann, an expert on the social aspects of sex at the University of Chicago, said. Parish added, "A failure to confront the epidemic could have serious consequences" (Agence France-Presse, 3/11).
Prevention is 'Urgent Priority,' Opinion Piece Says
Preventing a "generalized" HIV epidemic among reproductive-aged adults in China is an "urgent priority," Dr. Chris Beyrer of Johns Hopkins Bloomberg School of Public Health Department of Epidemiology writes in an accompanying JAMA editorial. Beyrer points to the study, which showed "most strikingly" that the risk of chlamydia infection among men younger than age 45 was linked with unprotected sex with commercial sex workers and the risk of infection for women was largely associated with their spouses' or steady partners' behaviors, as an example of the problem. The study is "invaluable" in showing how the "crucial question for China remains its vulnerability to a widespread" heterosexual HIV epidemic, Beyrer says. He asks, "Could a 100% condom campaign aimed at the commercial sex nexus and adapted to Chinese culture and behaviors be implemented in China," similar to a successful program that was launched in Thailand? In order to implement such a program, China will have to face "important challenges: sex work is illegal, and police and security agencies continue to harass, arrest and detain sex workers," Beyrer writes. He states that public health officials in China "cannot provide sex venue outreach and condom education and promotion alone," so security agencies must also play a part by "enforce[ing] condom use with owners, managers and clients." Beyrer concludes, "The African experience ... shows that once HIV is widely transmitted among reproductive-aged adults, prevention becomes much more difficult. China does face a crisis -- and an opportunity to avert a public health tragedy" (Beyrer, JAMA, 3/12).