It's estimated that 10 million Chinese had some type of a sexually transmitted disease in 1949. But after the communists took power and initiated mandatory screening, free treatment and a crackdown on prostitution, STD's were all but eradicated by the 1970s. However, in more contemporary times, the country has begun to experience what one CBC documentary referred to as China's "Sexual Revolution". With a cocktail of Westernization, liberalization, a rising economy and even a sense of rebellion from the years of unisex Mao suites and sex being "counter revolutionary," promiscuity is becoming more and more common across the country. As one might imagine, this phenomenon has consequently sparked a dramatic rise in the contraction of STDs (HIV/AIDS being the most often discussed), causing many to worry that China may be on the brink—or in the middle—of a public health catastrophe.

The numbers

The rate of STDs in China has recently skyrocketed. According to data from the Chinese Center for Disease Control (CDC), the number of people living with HIV/AIDS reached close to 800,000 by the end of 2011, even though fewer than 500,000 cases were recorded in 2010. Despite the low prevalence rate of .10% (about the same as Japan and less than the UK), more frightening are current projections that the number of people in China living with HIV/AIDS could potentially jump to 10 million within six years! According to a BBC report, syphilis too has risen at an "alarming rate", from .02 cases per 100,000 in 1993 to an incredible 20 infected individuals per 100,000 in 2010—thus turning syphilis into something of a modern epidemic. In addition, Chlamydia is still considered the most common sexually transmitted infection in the country, with one 2003 University of Chicago report suggesting that 16% of men and 10% of women living in the coastal provinces had been infected with the disease. Statistics also show that other sexually transmitted infections (STIs) like genital herpes and warts have also proliferated amongst the general population. According to data from a 2008 World Health Organization (WHO) publication, 10%-30% of the individuals residing in developing Asian countries (China included) have genital herpes while an estimated 65% of Chinese prostitutes are infected with this untreatable virus.

The infected groups

The high-risk communities for HIV and other STDs in China mainly consist of prostitutes and their patrons, migrant workers, drug users and homosexuals (and inevitably, many of the partners from each of these communities). Data from the Biomedical Center estimates that the country has 2.8-4.5 million female sex workers serving 21.9-37.4 million clients. It has also been reported that many of these sex workers seem to have little knowledge of STDs and STD prevention through condom use. In fact, the groups experiencing the highest surge in HIV and other STD infections are males over the age of 60 (who are said to visit brothels due to unhappy marriages) and male college students between the ages of 20 and 24, who are increasingly paying for sex. There is also a high rate of STDs amongst the country's 200 million migrant workers whom spend long periods of time away from their spouse and resort to prostitution. Habitual heroin users which account for 70% of China's total drug addicts contract diseases like HIV, hepatitis and many other blood transmitted diseases by sharing and reusing infected hypodermic needles. Homosexuals whom account for 32% of China's total HIV/AIDS patients are also believed to be experiencing an increase in STD prevalence as homosexuality becomes more accepted.

Governmental policy

Traditionally, topics related to sex have been regarded as taboo in China. Most parents never speak with their children about the issue while sex is rarely discussed in public. But due to the looming STD crisis in the horizon (or perhaps being in the midst of a major crisis), the government is being forced to act. Although the practice of mandatory HIV screening for foreigners entering the country ended in 1995 and the ban on foreigners with HIV/AIDS visiting China being lifted in 2010, as most China expats know, getting a resident/work permit still requires a full medical evaluation which tests blood for syphilis and HIV. And if you test positive for either one of these diseases, you'll be denied it. In 2010, health authorities launched a nationwide HIV/AIDS awareness campaign primarily targeting the threat-risk migrant worker population. Beijing has also launched a 10-year syphilis control measure with more testing and treatments to reduce the prevalence rate to under current levels by the year 2020. And there have been more TV, radio and commercials promoting safe sex while sex education has recently been implemented in schools. Most recently, in what was likely meant to coincide with World AIDS Day 2012 (December 1), Beijing announced that mandatory HIV/AIDS and STD tests would now be included in the health exam for attendants who work at high-risk places such as bars and KTV's.

Yet, traditional culture continues to clash with the government's agenda. Sex education has been ridiculed by conservative parents for being too graphic and inappropriate, while many learning institutions simply gloss over the subject in a few brief minutes with the assistance of a cartoon-illustrated pamphlet. Meanwhile, to tackle the prostitution dilemma, the government at various times has issued nation-wide crackdowns. But rather than educating the prostitutes who likely have little or no knowledge of STDs, they often resort to outdated methods of humiliation, parading them down public avenues. There has also been criticism about whether the government has done enough to inform rural doctors about the seriousness of sexually transmitted infections, while there remains zero discussion on advocating sterile needles for drug addicts.

Prevention

Stating the obvious, the only true way to avoid contracting one of these diseases is to remain celibate and/or not inject drugs. A more realistic approach that will greatly reduce the chances of contracting an STD is to not engage in unprotected sexual relations with members from high-risk communities. And while foreigners legally living in China initially passed the syphilis and HIV tests, one can never be certain of a potential partner's sexual history. Furthermore, there are still a number of STDs (chlamydia and herpes) that foreigners aren't tested for and it should be noted that many of these diseases don't have physical symptoms. In the end, just keep in mind that it's not a bad idea to follow safe sex principals with anyone, locals or expats alike, no matter where you are in the world, because it's truly better to be safe than sorry.

Hopefully, in the future this sensitive subject will loosen up within the Chinese mentality, allowing there to be more education concerning safe sex and even the treatment of drug addicts. In the Netherlands, comparable educational programs about safe sex and free screening for prostitutes have been proven to reduce the prevalence of STDs. In addition, the municipal government of Vancouver providing clean needles and paraphernalia for heroin addicts to reduce the spread of HIV and hepatitis, while controversial, has shown positive results thus far. And HIV/AIDS campaigns like the AIDS Marathon in the US have increased public awareness, raised money for the cure and broken much of the stigma associated with the virus. Perhaps adopting some of these methods in China could also be effective?

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Keywords: China sexually transmitted disease China safe sex practices China public health crisis China HIV/AIDS crisis