The new Chinese middle class and syphilis

In his recent book on the financial crisis, John Lanchester mentions China’s unprecedented economic growth, which has created a “hugely expanding, highly consuming new middle class.”

China’s [middle class] went from 174 million to 806 million, arguably the greatest economic achievement anywhere on Earth, ever. Chinese personal income grew by 6.6 percent a year from 1978 to 2004, four times as fast as the world average. Thirty million Chinese children are taking piano lessons. … Hundreds of millions of people are measurably richer and have new expectations to match.

The combination of more wealth and Chinese regard for socially correct behavior has resulted in an increase in sexually-transmitted diseases. As a recent issue of The New England Journal of Medicine points out (emphasis added):

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.

Social “deviants” don’t show up for testing

The social stigma is associated with behaviors that have the greatest risk of contracting syphilis: selling or buying sex and men having sex with men. To get tested for syphilis might suggest that one’s behavior had been less than socially acceptable.

National surveillance data reveal that female sex workers and men who have sex with men disproportionately bear the burden of the Chinese syphilis epidemic, in part because unsafe sexual practices in these populations are driving the rate of infection and in part because the stigma attached to their sexual behaviors discourages them from obtaining needed care. 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 [sexually transmitted infection] clinics where licensed physicians use national guidelines and have standardized laboratory facilities.

The problem is compounded by the attitude of the police towards Chinese sex workers, who can be fined or sent to “reeducation centers” for engaging in their trade.

Although the stigma associated with syphilis and other STIs is present the world over, its burden can be particularly severe in a social structure such as China’s, which highly values dignity or “face” (mianzi) and social relationships (guanxi). Stigma and the isolation to which it can lead present barriers to widespread syphilis screening among high-risk groups in China. … The conventional public health approach focusing on empowering marginalized groups assumes the presence of a vibrant civil society.

It’s the children who suffer most

Syphilis was nearly eliminated in China 50 years ago. In the early 1950s, the commercial sex industry was shut down, sex workers were treated with penicillin, and STIs were virtually unknown 10 years later.

But with affluence comes a change in behavior. Over the past five years the number of babies born with congenital syphilis has increased by a factor of 12. Every hour in 2008 saw the birth of more than one case.

One of the problems with syphilis, which can be asymptomatic, is that it increases the chances of contracting and transmitting HIV. A pregnant woman with syphilis has a greater than 50% chance of a spontaneous abortion or stillbirth. The death rate for babies with congenital syphilis is more than 50%, and those who survive suffer serious, irreversible consequences.

Resources:
Photo source: ChinaLuxCultureBiz

Joseph D. Tucker et al., Syphilis and Social Upheaval in China, The New England Journal of Medicine, May 6, 2010

John Lanchester, I.O.U.: Why Everyone Owes Everyone and No One Can Pay