FTER RECORD HIGH LEVELS OF sexually transmitted diseases (STDs) in the late 1940s, China's socialist regime was remarkably successful in suppressing commercial sex and STDs from the 1950s through the 1970s. 1-3 However, in the last 2 decades, commercial sex has returned, and STD prevalence in China has increased. Human immunodeficiency virus (HIV) infection has begun to spread beyond the initial transmission pockets of injection drug users (IDUs) and blood transfusions. 4-6 If current infection trends persist, absolute numbers of individuals with HIV infection are projected to surpass current numbers in the United States within 2 years and those in South Africa (currently the highest) within a decade. 6,7 Reports from public health clinics and special studies of highrisk clinic patients, IDUs, and commercial sex workers reveal several dimensions of the problem. 8-10 China's public health reporting system tracks 8 STDs, including HIV and acquired immunodeficiency syndrome (AIDS), gonorrhea, syphilis, genital warts, nongonococcal urethritis/ cervicitis, genital herpes, lymphogranuloma venereum, and chancroid. The system does not track chlamydial infections. The reported annual incidence of all 8 infections combined was only 0.07 per 100 total population for the year 2000. 4,11 Asymptomatic infections, incomplete coverage, and other issues could lead to underreporting. 4 Chlamydia trachomatis and, to a lesser extent, Neisseria gonorrhoeae can remain asymptomatic, leading to a hidden epidemic. 12-15 In this study, we surveyed a probability sample from the Chinese adult population aged 20 to 64 years to determine the prevalence of in
HIV prevention activities in China must focus on sociocultural aspects of sex work. Such interventions depend on detailed knowledge of its organization. The results of this study demonstrate the importance of prevention activities directed at the brothel managers and clients, as well as the sex workers.
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