Prostitutes, prostitution and STD/HIV transmission in Mainland China

China's opening to the world has enabled massive social and economic transformations and the liberalization of many policies, but also the rise of coincident social problems and diseases. A revival of wide-scale female prostitution since the 1980s has now accelerated to a nationwide dilemma. Prostitutes have long been considered to be reservoirs, if not 'vectors' for the transmission of sexual diseases. A well established STD epidemic in the last decade, plus the presence of growing HIV infections in China now, underscore the need to evaluate the prostitute's role in STD and HIV propagation. This report examines unobtrusive data on female prostitutes in the People's Republic of China through an analysis of prison records from eight sexually segregated prisons (six in Sichuan Province and two in Guizhou Province), two female re-education institutions, and arrest records for convicted prostitutes from four counties in Sichuan Province and Chengdu City (also in Sichuan). Collectively, these data represent 2057 female prostitution cases, and span the years 1988-1990. Demographics are examined to enable a profile of the prostitute as based on data reviewed, and this is contrasted to the stereotype of the prostitute as described in government propaganda against prostitution. STD prevalence rates in the samples are examined and contrasted to two other studies on STDs in nonprostitution populations made available to the authors. Prostitute arrest records reveal a majority had active STD infection[s] at the time of their apprehension, with gonorrhea being the most common bacterium; in many instances, prostitutes also had a history of other sexually transmitted diseases. Thus, data examined support the notion of prostitution as an agent in STD transmission. Presence of HIV infection in prostitutes could not be corroborated through sampled records, nor could prostitution itself be confirmed as an agent in HIV transmission at present. However, given the type of clients serviced by prostitutes in China, a prostitute's own risk of HIV infection is discussed. Control measures by the Chinese government to curb prostitution are examined at both national and provincial levels. Questions are raised as to the effectiveness of present tactics as adjunctive strategies in reducing STD infection and HIV risk in the prostitution population.