探索以社区为基础的艾滋病防治关爱模式

[目的]探索以社区为基础的艾滋病防治关爱模式,减少社区居民、家庭对吸毒者和HIV感染者的歧视。[方法]建立目标人群(静脉吸毒者)档案、入户随访和例会制度;组织社区居民、目标人群及其家属开展丰富多彩的宣教、联谊活动;对吸毒者和HIV感染者实施情感交流、生活照顾、转介就业等。[结果]通过项目干预,吸毒人群建档率达70%以上,111个吸毒者和HIV感染者获得了生活救助;转介目标人群就业人数达75人;社区居民对艾滋病知识的知晓率达80%以上;新婚登记人员中接受艾滋病自愿咨询率和婚检时进行HIV检测率分别达67%和36%。[结论]利用社区资源,在社区内大力宣传艾滋病防治知识,对目标人群实施关怀和救助,营造社会对HIV/AIDS的支持性环境,是防治艾滋病的有效措施之一。     

People Living With HIV and AIDS on the Brink: Stigma—A Complex Sociocultural Impediment in the Fight Against HIV and AIDS in Botswana

HIV-related stigma is a life-altering phenomenon. The consequence of the stigmatization process sets apart stigmatized person(s) as a distinct category, leading to various forms of disapproval, rejection, exclusion, labeling, stereotyping, and discrimination. Stigma of HIV-positive people in Botswana is a complex social phenomenon associated with the disease itself and the behaviors that lead to infection. This is a synthesis paper based on the literature review on HIV- and AIDS-related stigmatization of HIV-positive people in Botswana and in-depth interviews with people living with HIV and AIDS (PLWHAs). I examine the literature on HIV- and AIDS-related stigmatization and subsequent discrimination and the implications for intervention programs for people living with HIV and AIDS. The findings from the literature and in-depth interviews show that HIV–AIDS-related stigma is deeply embedded in societal structures and culture which promote nonacceptance of those branded HIV positive. This often is reinforced at a practical level by pervasive negative attitudes toward PLWHAs. Recommendations argue for the adoption of Healthy Relationship. This intervention seeks to promote and strengthen decision-making skills among PLWHAs and programs that promote destigmatization of, and tolerant attitudes toward, PLWHAs.     

Relationship between physicians and HIV patients: influence on adherence and quality of life

OBJECTIVE: To assess the influence of the relationship between people living with HIV/AIDS and health care providers on treatment adherence and quality of life. METHODS: Qualitative study conducted in Mexico, in 2003, with informants recruited from HIV/AIDS support groups, non-governmental organizations, and infectious disease clinics in public hospitals. A total of 40 people living with HIV/AIDS and five support group leaders were interviewed. Data were collected using sociodemographic questionnaires and in-depth interviews exploring the experience of living with HIV/AIDS, including treatment, disease perception, quality of life, physical and emotional health, and relationship with physicians. Responses were recorded, transcribed and organized thematically based on codes using an inductive analysis. RESULTS: Most respondents aged between 26 and 45 years. The main obstacles to care were related to lack of risk awareness and information among people living with HIV/AIDS and physicians. Physicians proved not to be well trained on HIV/AIDS care. During the follow-up care, most problems were related to inadequate treatment adherence mainly caused by poor communication with physicians and discrimination in public services. CONCLUSIONS: Overall the problems identified were related to information deficiencies, physicians' lack of training and paternalism, and social stigmatization of people living with HIV/AIDS associated with the epidemic.     

某地既往有偿供血人群艾滋病歧视状况研究

目的 了解因既往有偿供血造成艾滋病流行地区艾滋病歧视现象及其产生原因和影响因素.方法 在安徽省某地利用目的抽样法从人类免疫缺陷病毒(HIV)感染者、家庭成员、村民及卫生工作者中各选择20名共80名作为调查对象.采用一对一深入访谈的方法,了解艾滋病歧视现象,分析产生原因与影响因素.结果 80名调查对象中,1名未完成调查,在完成调查的79名中,歧视的主要表现形式是扩大的歧视[81.0%(64/79)],嫌弃、回避及抛弁,看病时受到歧视[47.4%(28/59)],失去社会支持[33.3%(13/39)]等.艾滋病流行严重的村庄歧视相对较轻,艾滋病流行较轻的村庄歧视较严重.对艾滋病存在错误认识[57.5%(23/40)]、恐惧[32.5%(13/40)]及道德判断是歧视产生的主要原因.为了避免家人和孩子的正常生活受到影响,多数HIV感染者不愿暴露身份.结论 由于对艾滋病的错误认识等,导致歧视现象严重,亟须开展减少歧视相关工作.     

Experiences of Stigmatization and Discrimination in Accessing Health Services: Voices of Persons Living With HIV in Ghana

Drawing on Earnshaw and Chaudoir’s HIV stigma framework, this study explored the experiences of persons living with HIV and AIDS regarding stigmatization and discrimination in accessing health services. Using a qualitative research methodology, 42 participants were purposively recruited during support group meetings of persons living with HIV and AIDS (PLWHA) at Amasaman in Accra, Ghana. Four focus group discussions (n = 22) and 10 in-depth interviews were conducted. Discussions and interviews were audio-taped, transcribed, and categorized based on the objectives of the study. The findings indicated that PLWHAs had knowledge of stigma that was experienced through enacted, anticipated, and internalized stigma mechanisms. Evidence showed that PLWHA did not experience stigma and discrimination when they accessed services at the Korle-Bu Teaching Hospital, the largest hospital in Ghana. However, the situation was different when they accessed services at other public health facilities. Based on the findings, implications are discussed for policy, social work, and public health practices.     

A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings

What accounts for differences in HIV stigma across different high prevalence settings? This study was designed to examine HIV stigma and discrimination in five high prevalence settings. Qualitative data were collected as part of the U.S. National Institute of Mental Health (NIMH) Project Accept, a multi-site community randomized trial of community-based HIV voluntary counseling and testing. In-depth interviews were conducted with 655 participants in five sites, four in Sub-Saharan Africa and one in Southeast Asia. Interviews were conducted in the local languages by trained research staff. Data were audiotaped, transcribed, translated, coded and computerized for thematic data analysis. Participants described the stigmatizing attitudes and behaviors perpetuated against people living with HIV/AIDS (PLWHA). The factors that contribute to HIV stigma and discrimination include fear of transmission, fear of suffering and death, and the burden of caring for PLWHA. The family, access to antiretrovirals and other resources, and self-protective behaviors of PLWHA protected against HIV stigma and discrimination. Variation in the availability of health and socioeconomic resources designed to mitigate the impact of HIV/AIDS helps explain differences in HIV stigma and discrimination across the settings. Increasing access to treatment and care resources may function to lower HIV stigma, however, providing services is not enough. We need effective strategies to reduce HIV stigma as treatment and care resources are scaled up in the settings that are most heavily impacted by the HIV epidemic.     

Women, reproductive rights, and HIV/AIDS: issues on which research and interventions are still needed

From 2002 to 2005, two literature reviews identified a number of reproductive health issues that appeared to be relatively neglected in relation to HIV/AIDS: contraceptive information tailored to the needs of HIV-positive people; voluntary HIV counselling and testing during antenatal care, labour, and delivery; parenting options for HIV-positive people besides pregnancy through unprotected intercourse (i.e. assisted conception and legal adoption or foster care); unwanted pregnancy; and abortion-related care. An additional finding was that stigma and discrimination were frequently cited as barriers to enjoyment of reproductive rights by HIV-positive women. Subsequently, a pilot project was initiated in which non-governmental organizations (NGOs) in developing countries used benchmarks to ascertain whether these neglected issues were addressed in local programmes and interventions serving women affected by HIV and AIDS. The benchmarks also assessed whether policies and programmes paid attention to the human and reproductive rights of HIV-positive women. This paper describes the main findings from the two exercises in relation to contraception for women living with HIV or AIDS, abortion-related care, legal adoption by HIV-positive parents, and reproductive rights. It concludes with a number of recommendations on topics to be incorporated into the international research agenda, policies, and programmes in the field of HIV/AIDS.     

Prevalence of, and factors associated with, HIV/AIDS-related stigma and discriminatory attitudes in Botswana

Botswana has the highest prevalence of HIV in the world. The epidemic of HIV/AIDS is often accompanied by stigma and discrimination that create the circumstances for spreading HIV. To facilitate the design of effective programmes to fight the high prevalence of HIV/AIDS-related stigma and discriminatory attitudes, this study examined survey data on the prevalence of, and factors associated with, such attitudes in Botswana. While most respondents showed discriminatory attitudes towards a teacher or a shopkeeper with HIV/AIDS, only 11% of 4,147 respondents reported unwillingness to care for a family member with HIV/AIDS. The more tolerant attitudes towards a family member with HIV/AIDS appeared to be promoted by the fact that family members have been and continue to care for their sick members through a government project called Community Home-based Care aimed at relieving public hospitals of HIV/AIDS patients. Since the burden of caring for sick relatives rests on the shoulders of women, they portrayed more tolerant attitudes towards HIV/AIDS patients. Young people and those who believed a person could get HIV infection by sharing a meal with an HIV/AIDS patient had discriminatory attitudes towards people with HIV/AIDS. The national information, education and communication programme needs to be strengthened to reach more people for HIV/AIDS education. Finally, programmes that aim to promote more tolerant attitudes towards people with HIV/AIDS may be more effective if the human rights of those with HIV/AIDS are promoted and respected.     

Fighting down the scourge, building up the church: organisational constraints in religious involvement with HIV/AIDS in Mozambique

Religious organisations (ROs) are often said to play an important role in mitigating the impact of HIV/AIDS. Yet, limitations of that role have also been acknowledged. While most of the literature has focused on ideological and individual-level implications of religion for HIV/AIDS, in this study we shift the focus to the organisational factors that shape and constrain ROs' involvement in both HIV prevention and HIV/AIDS care and support. Using primarily qualitative data collected in a predominantly Christian area in southern Mozambique, we show that the organisational vitality of a RO as determined by its membership size and its relationships with other churches and with governmental and non-governmental agencies is a pervasive priority of RO leaders. Therefore, all church activities, including those related to HIV/AIDS, are instrumentalised by the religious leadership to achieve the church's organisational aims--maintaining and growing its membership, safeguarding the often precarious coexistence with other churches, and enhancing its standing vis-à-vis the government and powerful non-governmental organisations. As a result, the effectiveness of ROs' involvement in HIV/AIDS prevention and assistance is often compromised.     

农村孕产妇HIV自愿咨询检测现状及影响因素分析

目的:了解云南农村孕产妇HIV自愿咨询检测现状,分析影响农村孕产妇接受HIV检测的因素。方法:采用入户形式对223名农村孕28周至产后3个月妇女及310名相关人群进行横断面调查,辅以孕产妇个人深入访谈。结果:孕产妇HIV检测率为57.4%,孕28周前HIV自愿咨询检测率为15.2%。孕产妇回答未检测的原因主要是没有必要(46.9%),其次是检测相关知识信息不足(33.7%),如担心收费贵、不知道到哪里检测。多因素Logistic回归分析显示,产检时接受过艾滋病知识宣教,知晓孕产妇艾滋病咨询和初筛检测是免费的及HIV检测地点与孕产妇检测有相关性。结论:云南农村孕产妇在孕早、中期的HIV自愿咨询检测率较低,“进村入社”采血送检方式在促进农村孕妇早期检测中发挥着重要作用,缺乏感染的危险意识、羞辱和歧视以及检测相关知识信息不足是影响孕产妇检测的主要原因。     

The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal,South Africa

Abstract

This study aims to understand the influence of AIDS stigma and discrimination, and social cohesion to HIV testing, and willingness to disclose an HIV status. A cross-sectional, interviewer administered survey (N=594) was conducted. Independent sample t-tests explored the mean differences between sex and age groups on stigma, discrimination, and social cohesion measurement. Logistic regression models were fitted with the above independent variables, and the binominal dependent variables: having had a test, willingness to have a test and disclose a positive status. The mean age of participants was 25.3 years and 60% were women. Only 28% had an HIV test, 63% were willing to have a test, and 82% reported a willingness to disclose an HIV status. High levels of stigma and discrimination were anticipated from the community, less so from their partners, and very little from families. Low levels of social distance exist towards people with HIV/AIDS, membership to social networks seems limited, and inadequate social support for people with HIV/AIDS was reported. The analysis indicates that AIDS stigma and discrimination, and inadequate social cohesion, limit access to voluntary counselling and testing (VCT), inhibit disclosure, and are, thus, barriers to care, support and prevention. Interventions need to extend the focus on information and education to strengthen social capital within a participatory and sustainable development framework.     

Response of religious groups to HIV/AIDS as a sexually transmitted infection in Trinidad

Background  

HIV/AIDS-related stigma and discrimination are significant determinants of HIV transmission in the Caribbean island nation of Trinidad and Tobago (T&T), where the adult HIV/AIDS prevalence is 2.5%. T&T is a spiritually-aware society and over 104 religious groups are represented. This religious diversity creates a complex social environment for the transmission of a sexually transmitted infection like HIV/AIDS. Religious leaders are esteemed in T&T's society and may use their position and frequent interactions with the public to promote HIV/AIDS awareness, fight stigma and discrimination, and exercise compassion for people living with HIV/AIDS (PWHA). Some religious groups have initiated HIV/AIDS education programs within their membership, but previous studies suggest that HIV/AIDS remains a stigmatized infection in many religious organizations. The present study investigates how the perception of HIV/AIDS as a sexually transmitted infection impacts religious representatives' incentives to respond to HIV/AIDS in their congregations and communities. In correlation, the study explores how the experiences of PWHA in religious gatherings impact healing and coping with HIV/AIDS.     

基于患者导向的艾滋病综合防治服务体系现状

目的了解黄冈市艾滋病感染者/患者在反歧视、医疗救治、关怀救助等方面的卫生服务利用现状。方法采取统一问卷调查的方法对2013年6-7月全市所有可随访到的艾滋病感染者/患者进行问卷调查。结果感染途径以血液传播为主,占63.91%;样本来源以医疗机构检测为主,占74.17%。感染途径是影响配偶感染状况的重要因素（P=0.00）。家庭收入是影响歧视的重要因素（P=0.00）。艾滋病知识知晓情况与安全套使用差异无统计学意义（P=0.58,P=0.16）。70.49%的人对咨询检测总体评价十分好,99.66%的人对目前由疾控中心负责的抗病毒治疗工作满意,93.81%的人对目前的医疗费用报销方式满意,86.97%的人对政府关怀救助工作满意。结论黄冈市现有的艾滋病综合防治服务体系基本满足患者的需求,在反歧视、咨询检测、医疗救治、关怀救助等方面取得了显著的效果,但是,随着疫情传播方式和规模的发生改变,现有的防治模式还需进一步的调整和完善。     

艾滋病“四免一关怀”政策对农村家庭及其子女的影响

为有效控制艾滋病、保障社会安全和维护国民健康,2003年以来,我国政府开始实施＂四免一关怀＂政策,对经济困难人群中的艾滋病患者实行免费抗病毒治疗,对艾滋病患者遗孤实行免费就学,对孕妇实施免费艾滋病咨询、筛查和免费抗病毒药物治疗;将生活困难的艾滋病患者及其家庭纳入政府救助范围。文章结合实证访谈,评述了这一政策的贯彻落实所获得的积极成效,分析了在救助艾滋孤儿方面有待进一步解决的问题和应采取的措施。该文的研究资料基于2006-2007年间在中国中部2个农村县所作的实证调查,包括对65人的详细访谈。研究结果显示,这一政策已经获得一定的积极成效,但仍有某些需要改善之处。     

HIV/AIDS-related stigma and discrimination: accounts of HIV-positive Caribbean people in the United Kingdom

This paper explores the effects of HIV/AIDS-related stigma and discrimination (HASD) on HIV-positive Caribbean people in the Caribbean and the UK. In-depth, semi-structured interviews were held with a purposively selected group of 25 HIV-positive people of Caribbean origin, using primary selection criteria of sex, age, sexuality and country of birth. Interviews with respondents revealed that they are keenly aware of the stigma surrounding HIV/AIDS, which some attribute to a particularly Caribbean combination of fear of contamination, homophobia, and ignorance, reinforced by religious beliefs. In fact, religion serves a double role: underpinning stigma and assisting in coping with HIV. HASD has usually occurred where respondents have lost or do not have control over disclosure. Compared to UK-born respondents, the accounts of Caribbean-born respondents, most of whom were born in Jamaica, include more reports of severe HASD, particularly violence and employment discrimination. All respondents mobilise a variety of strategies in order to avoid HASD, which have implications for their social interactions and emotional well being. While some manage to avoid the "spoiled identity" of the stigmatised, thereby creating their own understandings of HIV infection, these may remain individual-level negotiations. HASD affects HIV-positive Caribbean people at home and in the diaspora in a variety of ways: emotionally, mentally, financially, socially and physically. Interventions specifically addressing stigma and discrimination must be formulated for the UK's Caribbean population. Tackling stigma and discrimination requires more than education; it requires "cultural work" to address deeply entrenched notions of sexuality.     

1 126例艾滋病病毒感染者和病人相关知识行为调查

目的了解安徽省艾滋病综合防治示范区/全球基金艾滋病项目地区艾滋病病毒感染者/病人的艾滋病知识和行为状况,为评估项目前期执行效果和制订后期计划提供依据。方法采取整群抽样方法,对8个县(市、区)1 126名艾滋病病毒感染者/病人进行问卷调查。结果艾滋病知识知晓率为92.01%,传播途径和非传播途径知晓率分别为82.42%和86.59%;与配偶最近1次安全套使用率和最近3次安全套坚持使用率分别达91.42%和81.83%,明显高于基线调查结果;在婚外性行为中,最近1次安全套使用率和最近3次安全套坚持使用率分别为77.78%和55.56%;VCT服务的利用率达到94.05%,无偿献血知识知晓率为57.02%。结论我省项目地区艾滋病病毒感染者/病人艾滋病知识知晓率和配偶间安全套使用率有所上升,但无偿献血知识知晓率和婚外性行为安全套使用率较低。因此今后应大力开展艾滋病防治知识和无偿献血知识宣传,增强安全套使用的干预力度,提高感染者和病人的安全套使用率和知识知晓率。     

安徽省重点地区HIV感染者和AIDS病人艾滋病知识行为调查分析

目的了解安徽省全球基金艾滋病项目重点地区HIV感染者/AIDS病人知识、行为的现状,客观评价2010年度艾滋病防治工作效果及五年行动规划(2006-2010年)目标实现情况。方法采取整群抽样方法,对安徽省9个全球基金项目重点县1 226名HIV感染者/AIDS病人进行面对面问卷调查,以项目中期(2008年)调查结果进行对比。结果艾滋病相关知识8题全答对者1 005人,占81.97%,对艾滋病相关知识获得途径和希望知识获得途径均为"医生"、"电视"、"免费宣传材料"。与2008年项目评估比较,"无偿献血不会传染艾滋病的知识点"正确回答率由84.30%上升到94.78%(χ2=60.435,P0.001),"每六个月以上献血对身体无害"由84.46%上升到93.20%,(χ2=41.011,P0.001);"最近一次使用安全套的比例"由93.58%上升到98.00%,(χ2=38.163,P0.001);"最近三个月坚持使用安全套的比例"由80.90%上升到92.00%,(χ2=14.765,P0.001)。结论重点地区HIV感染者/AIDS病人艾滋病和无偿献血知识知晓率较2008年评估结果有所提高,安全套坚持使用率较2008年大幅度提高;获得艾滋病知识的途径较单一,个人及家庭歧视现象依然存在,消除歧视、向"零"艾滋迈进将是今后一段时间的工作重点。     

180名医务人员艾滋病相关歧视的认知和行为研究

[目的]为了解医务人员艾滋病相关歧视的认知和行为,揭示艾滋病毒感染者和艾滋病患者（people livingwith HIV/AIDS,PHA）就医时遭遇的歧视,为在医务人员中开展艾滋病反歧视活动提供有效的干预策略提供依据。[方法]通过问卷调查某区180名医务人员和定性访谈50名PHA,收集相关资料。[结果]医务人员对PHA存在歧视,PHA歧视的总平均分为29.3分。不同的职业、不同工作岗位和不同等级医疗机构间的歧视水平存在差异（P〈0.05）。[结论]应加强该市各级医疗卫生人员对艾滋病相关法律法规的培训,亟需采取多种措施减少并最终消除艾滋病相关歧视。     

Revealing the full extent of households' experiences of HIV and AIDS in rural South Africa

Households experience HIV and AIDS in a complex and changing set of environments. These include health and welfare treatment and support services, HIV-related stigma and discrimination, and individual and household social and economic circumstances. This paper documents the experiences of 12 households directly affected by HIV and AIDS in rural KwaZulu Natal, South Africa, between 2002 and 2004. The households were observed during repeated visits over a period of more than a year by ethnographically trained researchers. Field notes were analysed using thematic content analysis to identify themes and sub-themes. This paper focuses on three dimensions of household experience of HIV and AIDS that have received little attention in HIV and AIDS impact studies. First, that experience of HIV and AIDS is cumulative. In an area where population surveys report HIV prevalence rates of over 20% in adults, many households face multiple episodes of HIV-related illness and AIDS deaths. We describe how these challenges affect perceptions and responses within and outside households. Second, while over 50% of all adult deaths are due to AIDS, households continue to face other causes of illness and death. We show how these other causes compound the impact of AIDS, particularly where the deceased was the main income earner and/or primary carer for young children. Third, HIV-related illness and AIDS deaths of household members are only part of the households' cumulative experience of HIV and AIDS. Illness and death of non-household members, for example, former partners who are parents of children within the households or relatives who provide financial support, also impact negatively on households. We also discuss how measuring multiple episodes of illness and deaths can be recorded in household surveys in order to improve quantitative assessments of the impact of HIV and AIDS.     

降低医疗保健服务中HIV/AIDS相关歧视研究:背景、问题及研究框架

医疗保健领域中艾滋相关偏见与歧视问题已得到国际社会及众多艾滋病防治领域工作者的广泛关注。在欧洲联盟资助下,设计并实施了一个为期1年的行动性研究以探索如何降低医疗保健领域的偏见与歧视。本文回顾了偏见与歧视的概念以及UNAIDS提出的医疗保健领域艾滋相关歧视的主要表现形式,提出了本研究中的偏见与歧视的操作定义及范畴,并给出了本研究的背景及框架。