United Press International - March 11, 2003
Steve Mitchell, UPI Medical Correspondent

The findings, published in the March 12 issue of the Journal of the American Medical Association, signify China is in danger of experiencing an explosion in AIDS cases, researchers said.

"Chlamydia is itself concerning" because it can render women infertile, Edward Laumann, a sociologist at the University of Chicago and an author of the study, told United Press International. But the finding is doubly important, he said, because chlamydia spreads in a similar way to HIV, the virus that causes AIDS, which suggests the Chinese population is "vulnerable" to an HIV outbreak.

Although prostitutes in China seem generally free of HIV at present, "it's not hard to imagine that happening," Laumann said. About 10 percent of Chinese men frequent prostitutes.

He said he hoped the research would persuade officials to enact interventions now to prevent an accelerating outbreak of HIV/AIDS among the general population.

"Because this particular pattern of prostitution would be an ideal breeding ground for distribution (of HIV) if they get infected, there needs to be some concern about public intervention," he said.

Dr. Chris Beyrer, of Johns Hopkins University's AIDS International Training and Research Program in Baltimore, who wrote an accompanying editorial in JAMA, agreed about the urgency for implementing prevention programs.

"China right now looks like Thailand in 1990," which since has been struggling with an AIDS epidemic, said Beyrer, who has been working in China since 1997 and lived in Thailand from 1992 to 1997 working on HIV prevention.

"All the risks are there (in China) for an explosion," Beyrer told UPI. He noted although there have been concern about outbreaks of AIDS among needle-injection drug users and other fringe populations in China, the new study suggests the wider general population could be at risk.

"The pattern of sex behavior and sexually transmitted diseases (in China) looks a lot like Thailand and Cambodia," in which the diseases in men are highly associated with having sex with prostitutes, Beyrer said. "That pattern ... is an absolute set-up for how HIV can spread rapidly in a heterosexual population," he explained.

Beyrer said the findings represent "a window of opportunity to get prevention going." He noted programs focused on education and the use of condoms in the commercial sex industry have proven very effective at reducing HIV rates in Thailand and Cambodia.

In Thailand, the percentage of 21-year old males coming into the army who were HIV-positive dropped to less than 1 percent from 12 percent -- on a par with levels seen in Africa, which has the world's highest rate of HIV infection among adults, Beyrer said.

In Cambodia, there has been a steady decline in HIV rates in pregnant women after the government implemented condom campaigns targeted at the sex industry.

Now is the time to adopt such strategies, Beyrer said, because the situation in Africa has shown it is "very hard to mount effective prevention programs once it gets out there in the general population."

Between 1999 and 2000, Laumann's team, which included researchers in China, collected urine specimens and conducted interviews with more than 3,400 Chinese men and women ranging in age from 20 to 64 years who were representative of the general population.

About 2.6 percent of women were infected with chlamydia and 2.1 percent of the men carried the disease.

Risk factors for chlamydia among men ages 20 to 44 included unprotected sex with a prostitute. For women, risk factors included having a husband who earned a high income, socialized often or traveled less than one week per year.

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