Medics venture into twilight zone
Never did Qin Meirong, a gynaecologist in South China's Guangxi Zhuang Autonomous Region, expect that some day she would be involved in locating brothels disguised as hair salons or massage parlours and, less so, would make friends with prostitutes there.
It all started in late 2002 when the hospital affiliated to the Liuzhou No 2 Air Compressor Group Corp where she worked joined a programme to explore ways of preventing STDs and HIV/AIDS by offering community-based health counselling known to professionals as "outreach."
One of the commercial hubs in South China, Liuzhou has, since the 1980s, become a passage for narcotics trafficking from the notorious Golden Triangle. The city has a population of 3.64 million, and now has more than 9,000 drug addicts on police record. About 21 per cent of them test positive for HIV.
What is more, the city plays host to a perennial "floating population" of 250,000. Most of the migrant workers are rural labour surplus, who come to the city without their spouses and have hardly any knowledge of safe sex practice. Since 2000, the sexually transmitted HIV infection rate has grown from 0.5 per cent to around 9.5 per cent. For women engaged in the illegal sex business, the figure is 1.5 per cent. According to a 2002 survey, the city had about 5,000 women engaged.
To curb the spread of the deadly disease, the city's health department decided to focus on educating prostitutes about safe sex while providing them with standard STD diagnosis and treatment.
For years, it has been collaborating with the National Centre for STD & Leprosy Control in this "outreach" endeavour.
"The most difficult part is to win the trust of those in the sex trade," Qin said. "At first, we were able to reach women in 'beauty salons' or 'massage parlours' and talked at length with them about STD/AIDS. But few showed up at the hospital for diagnosis or treatment. They had no trust in us. Many thought we were laying a trap for them."
Patience, however, worked eventually. After studying their situations and habits, Qin and her colleagues decided to do on-the-spot health check-ups for the women. "The discovery was startling," Qin said. "One third of the first 151 women we examined had an STD of one kind or another."
As the work continued, Qin found that most women in the sex trade have no or limited ideas about STDs. "When feeling ill," she said, "they would either ignore it or visit a private clinic sometimes ending up with a quack at unlicensed clinics."
Although prostitution is illegal in China, Qin and her colleagues see keeping the privacy of patients confidential and respecting their dignity as overriding principles.
"We are doctors, not police officers or judges," Qin said. "Every person who comes for our help is a patient, just a patient. Our patients in the sex trade are allowed a discount in charges for treatment. We also explain to them the importance of condom use."
To strike up friendships with women in the sex trade, Qin always has small gifts, such as key rings and socks, at hand, She distributes these gifts with condoms, STD/AIDS brochures to them.
"One of them, who had begun serving male clients at 16, was moved to tears when I sent her a birthday cake."
Once trust is established between the doctors and the women, regular hospital visits follow. Now Qin's handset is the hospital hotline for STDs. "Every day, I receive about eight to 20 calls, mostly from those working at massage parlours or hair salons," says Qin.
Outpatient calls to the STD department of Qin's hospital are steadily increasing. According to Kong Fandan, director of the hospital, outpatient visits have been growing by 20 per cent every year. She says: "With increasing awareness of STD/AIDS, high-risk groups have better access to quality medical care. In addition, our standardized STD diagnosis and treatment have paved the way for a sustained patient-doctor relationship."
Nationwide, the epidemic has been rising since STDs made a comeback in the 1980s.
The incidence among prostitutes and other groups with high-risk behaviour has been rising sharply. Statistics from sentinel surveillance indicate that 20 per cent of prostitutes examined had STDs in 2003. In areas with serious drug problems, the infection rate among drug users exceeds 10 per cent. For long-haul truck drivers who are likely to visit roadside "brothels," the infection rate in 2000 approached 17 per cent.
"STD and AIDS are twins," cautions Dai Zhicheng, president of the Chinese Association of STD/AIDS, saying that nearly 8 per cent of the 89,000 identified HIV carriers in China were infected through heterosexual activities. Nonetheless, he said, intervention measures, such as early diagnosis and treatment, could turn the tables around.
But it is not easy. Most hospitals in China look forbidding and patients are afraid of the "moral verdicts" passed on them by doctors there. That may explain why private clinics, many run by quacks, have mushroomed and why "outreach" programmes are important.
"Doctors are actually in a much better position to give health education and counselling to the patients, especially those with high-risk behaviour," says Dai.