外刊| 经济学人 伦敦：英国性病之都

文章概括：这篇文章报告了伦敦成为英国性病之都的情况。封锁期间，性病诊断数量下降，但随着限制放松，病例数量激增。2022年，伦敦确诊的淋病和梅毒病例创下历史最高纪录。伦敦的感染率是其他地区的两倍以上。年轻人口增长快、大型社交网络以及同性行为导致的感染是伦敦成为性病高发地的原因之一。此外，艾滋病不再是致命疾病，但性行为与毒品滥用带来的风险仍需关注。

Britain | Sexual health

英国|性健康

Clap for the NHS

为英国国家医疗服务体系鼓掌

London is the STI capital of Britain

伦敦是英国的性病之都

Jun 8th 2023

As the country locked down for covid-19, Britons had fewer chances for casual unprotected sex. They also had fewer tests for sexually transmitted infections (STIs). Not surprisingly, diagnoses plummeted. Not any more. On June 6th the UK Health Security Agency reported that nearly 83,000 cases of gonorrhoea were diagnosed in England in 2022—the most since records began in 1918. Cases of syphilis were at their highest since 1948. London’s rate is more than twice that of any other region, making STIs a particularly metropolitan problem (see chart).

随着新冠肺炎病毒在英国的蔓延，英国人进行随意的无保护性行为的机会越来越少。他们也较少进行STI(STI)检测。毫不奇怪，诊断数据直线下降。然而如今情况有所反转。6月6日，英国健康安全机构报告称，2022年英格兰确诊了近83000例淋病，这是自1918年有记录以来最多的一年。梅毒病例处于1948年以来的最高水平。伦敦的感染率是其他任何地区的两倍多，这使得STI成为一个大都市特有的问题(见图表)。

London’s special status is nothing new. In the 1500s Henrys VII and VIII shut down Southwark’s brothels, or “stew houses”, to try to stop the spread of syphilitic sores. A study in 2020 estimated that in the 1770s a staggering one in five Londoners was likely to have had “the pox” by the age of 35, against 8% of people in the provincial city of Chester and less than 1% in rural areas. Given that gonorrhoea is around four times as infectious, a majority of Londoners may have had an STI, marvels Simon Szreter of the University of Cambridge, the paper’s lead author.

伦敦的特殊地位并不新鲜。16世纪，亨利七世和八世关闭了萨瑟克区的妓院，别名“炖菜馆”，以试图阻止梅毒的传播。2020年的一项研究估计，在18世纪70年代，令人震惊的是，五分之一的伦敦人在35岁之前可能已经患有“梅毒”，而在省会城市切斯特，这一比例为8%，在农村地区不到1%。该论文的第一作者，剑桥大学的Simon Szreter惊叹道，考虑到淋病的传染性是其他疾病的四倍，大多数伦敦人可能患有STI。

Thanks to antibiotics, among other things, STI rates today are a fraction of what the Georgians endured. But London is still a relative hotbed. As in the 18th century it has a young, fast-growing population with large social networks to spread STIs. Rates are no longer highest among squaddies and scullery maids but in other marginalised groups (eg, in the Afro-Caribbean community). A more modern metric is that London is England’s gayest region. Though under 4% of its people identify as gay, lesbian or bisexual, where sexual orientation is known, men who have sex with other men account for half of its new STIs.

多亏了抗生素和其他东西，如今的STI率只是十七世纪格鲁吉亚人忍受的一小部分。但相对而言，伦敦仍是一张STI的温床。和18世纪一样，它拥有年轻、快速增长的人口，以及传播STI的大型社交网络。这一比例不再是在清洁工和洗碗工中最高，而是在其他边缘化群体中(如加勒比黑人社区)。一个更现代的衡量标准得出伦敦是英格兰同性恋最多的地区。尽管不到4%的人认为自己是同性恋或双性恋，性取向是已知的，但与其他男男性行为导致的传播占了新增STI的一半。

Such figures are in part a sign of liberation. HIV is no longer the death sentence it was for many in the 1980s. Pre-exposure prophylaxis (PrEP), a pill taken daily, can almost completely ward it off. According to Preventx, a testing firm, rates of gonorrhoea and chlamydia among men who take prep are nearly double those among men who do not, perhaps in part because they feel it is safe not to use condoms. Dating apps (notably Grindr) have made both sex and drugs easier to find. Surveys suggest that around one in five gay or bisexual men in London have sex while on drugs like crystal meth, which can reduce inhibitions and increase sex drive. “You can have a ridiculous amount of sexual partners, upwards of 20 in a weekend,” says Ian, who spent many years having “chemsex”.

这些数字在某种程度上是解放的标志。艾滋病毒不再像20世纪80年代那样是许多人的死刑。暴露前预防(PrEP)，每天服用一粒药丸，几乎可以完全避免艾滋病。根据Preventx检测公司的调查，接受PrEP的男性中淋病和衣原体感染率是不接受PrEP的男性的近两倍，部分原因可能是他们认为不使用避孕套是安全的。约会应用程序(尤其是Grindr)让性和毒品都变得更容易接触到。调查显示，伦敦大约五分之一的同性恋或双性恋男子在服用像冰毒这样的毒品时发生性行为，这种药物可以减少抑制力，以提高性欲。“你可以有多得离谱的性伴侣，一个周末可以有20多个，”伊恩说，他多年来一直从事“化学性爱”。

The fun is not without risk. Gonorrhoea is becoming increasingly resistant to antibiotics. As well as STIs, “chemsex” carries a greater risk of sexual assault, drug addiction and death. “We probably have more young men dying of chemsex than we do dying of AIDS,” says Dr Anatole Menon-Johansson of Brook, a sexual-health charity.

乐趣并非没有风险。淋病对抗生素的耐药性越来越强。除了STI，“化学性”还带来了更大的性侵犯、吸毒和死亡风险。性健康慈善机构Brook的Anatole Menon-Johansson博士说:“死于化学性行为的年轻人可能比死于艾滋病的还要多。”。

Georgian Londoners were loth to admit that sex outside wedlock spread STIs. Today it is fear of stigmatisation that can hold up the aiming of health messages at gay men—as in a monkeypox outbreak in 2022. When men who have sex with men get 84% of new syphilis cases and 72% of gonorrhoea cases, such reluctance is counter-productive. The figures should be “a wake-up call to improve sexual-health education targeted at gay and bisexual men,” says Peter Tatchell, a gay-rights activist. “Blame won’t solve the problem; education will.”

格鲁吉亚时期的伦敦人不愿意承认婚外性行为会传播性病。如今，正是对污名化的恐惧阻碍了针对男同性恋的健康信息传播——正如2022年爆发的猴痘。当男男性行为者导致的感染占84%的新梅毒病例和72%的淋病病例时，这种不情愿是适得其反的。同性恋权利活动家Peter Tatchell说，这些数字应该是“提高针对同性恋和双性恋男性的性健康教育警钟”。“责备解决不了问题；教育可以。”