Communicable disease control in China: From Mao to now

Hipgrave, David

By contrast to the targets of vertical disease-control initiatives, sexually transmitted diseases (STDs) have re-emerged as a major priority in China due to the lack of such a program. China' s legendary success in controlling STDs during the 1950s and 1960s was due to a combination of socialization (in which STDs were portrayed not typically as a sign of "bad behaviour" but as a legacy of the old bourgeois and exploitative society, particularly with respect to women); treatment (destigmatising syphilis and gonorrhoea made mass screening and drug treatment relatively easy), and socio-economic approaches (the banning of prostitution, emancipation of women and creation of employment for poor women) (4,6,10,11). This combination was inseparable from the revolutionary milieu of the time, and despite very high rates of infection during the early years of the People' s Republic, helped to "eliminate" STDs from China by 1964 (10, 56) . This situation prevailed until the liberalization of commerce, movement, social customs and secular changes in sexual behaviour allowed the reappearance of STDs in the 1980s (39, 56) . There were massive increases in STD incidence and an emerging HIV problem in China in the 1990s (57) , and the same problems that have led to difficulties in sustaining control of TB and schistosomiasis have plagued STD control: lack of knowledge of disease prevention and treatment, including HIV, among the poor and some echelons of the health sector (58); lack of physical and financial access to good care, along with profiteering by health providers; lack of funding for screening programs, and poor coordination across sectors (including within the health sector, between MCH staff and other clinicians), creating an urgent problem (59, 60) . According to a former director at China' s National Centre for Women' s and Children' s Health, in 2008: "In the past fifteen years, the prevalence of congenital syphilis increased by 2000 times in China, excluding foetal deaths, stillbirths and abortions caused by syphilis during pregnancy. Surveillance data reveal the incidence of congenital syphilis increased at the rate of 72% each year from 0.01 in 1991 to 35 in 2006 per 100000 live births" (Wang Linhong, former Director, National Centre for Women' s and Children' s Health at China CDC, personal communication). Syphilis is now numerically the third most common reportable infectious disease in the PRC, behind viral hepatitis and TB (Dr Yang Weizhong, China CDC, personal communication). To its credit, the government has again massively increased funding for education, screening and treatment of STDs, including HIV (60), but the long term success of these measures will again depend on the level of uptake of these activities, fair access to care and local government support.