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High prevalence of syphilis and other sexually transmitted diseases among sex workers in China: potential for fast spread of HIV

van den Hoek, Annekea; Yuliang, Fub; Dukers, Nicole H. T. M.a; Zhiheng, Chenb; Jiangting, Fengb; Lina, Zhangb; Xiuxing, Zhangb

Epidemiology & Social

Objectives: In China, in the early 1980s, sexually transmitted diseases (STD) started to increase steeply. Sex workers and their clients appeared to play an important role in the spread of STD. Prostitution is illegal in China, and therefore no specific services exist for sex workers unless they are arrested and detained in re-education centres. Staff of a maternal and neonatal hospital in Guangzhou felt the need for an STD care and prevention programme for sex workers outside detention, and started a programme within their hospital, which was unique in the Chinese context.

Methods: From March 1998 to mid-October 1999 sex workers were recruited through various outreach methods, and were interviewed, counselled and examined for the presence of STD/HIV.

Results: A total of 966 women, originating from all over China but working in Guangzhou, entered the programme. The median duration of prostitution was one year, and the median number of clients was seven per week. Antibodies to HIV were present in 1.4%. The prevalence of STD was very high: syphilis 14%, Chlamydia trachomatis 32%, gonorrhoea 8% and trichomoniasis 12.5%. Knowledge about STD/HIV transmission and condom use was poor.

Conclusion: Given the high prevalence of STD, the potential for the further spread of HIV is clearly present. STD care and prevention programmes for these women, outside detention, are urgently needed, and appear also to be feasible in China.

From the aMunicipal Health Service, Amsterdam, the Netherlands; and bMaternal and Neonatal Hospital, Guangzhou, China.

Received: 10 October 2000;

revised: 12 January 2001; accepted: 23 January 2001.

Sponsorship: This work was supported by UNAIDS and the World AIDS Foundation.

Correspondence to: Anneke van den Hoeka, MD, PhD, Municipal Health Service, Department of Public Health and Environment, Nieuwe Achtergracht 100, 1018 WT Amsterdam, the Netherlands Tel: +31 20 5555 341; fax: +31 20 5555 533; e-mail:

© 2001 Lippincott Williams & Wilkins, Inc.