HIV and syphilis in young Chinese adults: implications for spread

Abstract

Our objective was to explore the epidemiology of HIV and syphilis at population level in young Chinese adults. The study was carried out in six areas of three Chinese provinces: Zhejiang, Yunnan and Shaanxi. All couples attending the compulsory premarital examination were recruited. Routinely taken blood was collected onto filter paper. Tests for HIV and syphilis used modified particle agglutination techniques. In all, 17,226 individuals were tested. There were no HIV infections in Zhejiang or Shaanxi. In Yunnan, there were 28 positives: 0.75% (95% confidence interval: 0.5, 1.1), with 22 (78%) in men and 16 (57%) in known high-risk individuals. Syphilis prevalence ranged from 0.33% to 0.71% across study sites, with 58% in men. Although syphilis levels suggest that unsafe sexual activity is occurring in all areas, HIV is not yet affecting the general population of Zhejiang or Shaanxi. The epidemic in Yunnan is being driven by injecting drug users, but there may now be transmission in the general population.

Syphilis in China: results of a national surveillance programme

“…Our report provides a comprehensive view of the reemergence of syphilis in China. These fi ndings are consistent with reports of the exceptional prevalence of syphilis in high-risk groups in China [16][17][18] and of the spread of other STD in China, 19 including a nationwide cross-sectional survey that showed a high prevalence of chlamydial infection, especially in urban coastal areas. 20 Worldwide, resurgence of syphilis in China corresponds to epidemics reported in several cities in the UK, 21 Ireland, 22 the Russian Federation states, 23 and the USA.…”

China’s Syphilis Epidemic: A Systematic Review of Seroprevalence Studies

“…In their large study of premarital couples, Hesketh et al 173 found similar syphilis prevalence in rural and urban areas in 3 provinces: Yunnan (home of the largest number of injecting drug users in China), Zhejiang (the province with the highest STD incidence), and Shaanxi (a poor central province with low STD and HIV prevalence). Although this suggests widespread unsafe sexual practices, HIV does not yet appear to have spread significantly beyond localized epidemics through heterosexual transmission.…”

“…In Yunnan, they did report HIV cases among known high-risk injecting drug users, but unexpectedly, also among low-risk, nondrug users. 173 These results hint that in some places, HIV prevalence may have reached a threshold from Particularly concerning is the increasing prevalence of syphilis among high-risk potential bridge populations. Among drug users, females were infected at 2 to 10 times the rate as their male counterparts.…”

“…Among premarital couples in rural and urban areas in 3 representative provinces, 0.33% to 0.71% of premarital individuals were infected. 173 In van den Hoek et al, 13.87% of 966 FSWs in Guangdong were infected with syphilis. 174 Also, in a study of injecting drug users in Sichuan, 15.3% were seropositive for syphilis.…”

Sexually Transmitted Infections among Heterosexual Male Clients of Female Sex Workers in China: A Systematic Review and Meta-Analysis

“…The prevalence of HIV in China is currently estimated to be 0.06%, corresponding to 11.8 times lower odds of HIV infection than clients in this review [11]. A large study of couples receiving compulsory premarital examinations found a low prevalence of syphilis across various study sites in China (0.33% to 0.71%) [72]. In comparison, clients in this review were found to have 5.7 times higher odds of being infected with syphilis.…”