HIV/AIDS患者的心理需求调查

目的 了解HIV／AIDS患者的心理需求。方法 对我国4个省111例HIV／AIDS进行流行病学问卷调查和个人深入访谈。结果 大部分感染者都表现出对结果的不相信，在知道感染后大部分感染者都选择不告诉其他人。对于是否愿意和其他感染者进行交流。在因吸毒和血液途径的感染者中均有较高的比例，分别是75．56％和87．10％，而且其中94．29％和100％的人将面对面交流作为首选。结论 HIV／AIDS患者承受的心理压力巨大，应采取有效措施加以改善。     

An assessment of community readiness for HIV/AIDS preventive interventions in rural Bangladesh

Efforts to prevent HIV from becoming widespread among the youth population 15–24 years in Bangladesh are in the early stages. However, conservative religious and cultural norms may curtail the dissemination of needed information about sexuality and condoms. The community-readiness stages model was adopted as a framework for assessing the level of preparedness of community leaders to facilitate planned HIV prevention efforts. Six focus group discussions with three professional groups (teachers, businessmen, drugshop vendors) in Hobiganj district were conducted in late 2005, and a single multi-professional group made up of teachers, imams, and drugshop vendors was convened in early 2007 to assess changes. The audio recordings in Bangla were coded as were English translations. Everyone had heard of AIDS and regarded it as a potential catastrophe for the health, economy and social fabric of Bangladesh. Remarks concerning Stage 1-Vulnerability indicated that most did not believe their community to be at risk, though Bangladesh was. Remarks at Stage 2-Knowledge of Transmission were mostly vague but accurately identified sex, blood and needles as the main means of spread; however sex with sex workers was also mentioned in each group. Remarks at Stage 3-Prevention showed strong opposition to condoms for unmarried males and a preference for current means of forbidding sex outside of marriage. A few in each group recognized the importance of condoms for wayward youth. Stage 4-Planning discussions centered on raising awareness and fear, and a desire for government and media to take the lead. By 2007 participants articulated more realistic strategies that they themselves could, and had, implemented, but also raised barriers that authorities should help them overcome. The findings provide formative information on the constraints and opportunities of community groups as partners in HIV preventive interventions and strategies to help them move to a higher stage of readiness.     

The community barometer: a breast health needs assessment tool for community-based organizations.

This article presents findings from the ACCESS Project focusing on the impact of an outreach initiative that used "data sharing" as a mechanism to establish a wide variety of academic-community partnerships for cancer awareness. The Community Barometer, a brief needs assessment tool developed for this purpose, was used to collect data from clients, and sometimes staff members, of a variety of community-based organizations in New York City. Over a 5-year period, Barometer data were collected from 1,001 women who were affiliated with 20 community-based organizations. Analysis of these data supported our hypothesis that community-based organizations are more likely than chance to serve women with similar needs and preferences for breast health education and screening and that customized or tailored programs were warranted. Four case studies are presented. Limitations of the instrument and its administration in community settings as well as future research objectives are discussed.     

Vulnerability, human rights, and comprehensive health care needs of young people living with HIV/AIDS

We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs. Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs.     

Student assessment in community settings: a comprehensive approach

Student assessment in community settings presents problems for medical teachers, e.g. difficulties in assessing the contribution of individual members to group work, and lack of test standardization due to varying field conditions. The Faculty of Medicine, University of Gezira, Sudan is a community-oriented, community-based medical school which has adopted a comprehensive approach to student assessment in community settings using various methods, including peer assessment, a supervisory checklist, community feedback, reports from students, short essay questions (SEQs) and multiple choice questions (MCQs). Each method focuses on a specific aspect of the objectives of the community-based programme and is weighted in the final grade according to the extent to which objectives were covered. This assessment programme contrasts with the conventional teacher-centred approach, and is continuously monitored and improved using a variety of sources of information. A total of 105 students participated in a study designed to measure the reliability and validity of this approach. The reliability of the methods was tested by computing the alpha coefficient and was found to range between 0·77 and 0·92. This was considered acceptable. The validity of the instruments was examined using confirmatory factor analysis, and their content validity was reviewed. The results show that the comprehensive approach used is fairly valid. It is suggested that the University's approach is successful in solving some of the problems of student assessment in community settings.     

Help-seeking in a context of AIDS stigma: understanding the healthcare needs of people with HIV/AIDS in China

Despite the rapid increase of HIV infection cases in China, the majority of this population have not yet accessed AIDS-related healthcare services. Most current research in China focuses on HIV prevention and disease control, and pays inadequate attention to the barriers facing HIV-infected individuals in accessing and adhering with healthcare services. This article, as part of a research project on the illness experiences of people with HIV/AIDS in China, aimed to explore these individuals' healthcare experiences, shedding light on the gaps between their needs and existing healthcare services. Data for this qualitative study were collected through individual in-depth interviews with 21 HIV-infected adults in China. The results of data analysis suggest that these individuals' healthcare experiences were greatly affected by social discrimination and the limitations of healthcare resources. While AIDS stigma has reduced the social resources available for this population, HIV-related health institutions were perceived by them as an indispensable source of social support. It is concluded that healthcare institutions, as one of the few places in which HIV-infected people are willing to disclose their HIV positive status, should incorporate social care into healthcare service development and delivery so as to facilitate this population's accessing healthcare services and to address their unmet needs that go beyond the conventional scope of health care. Improving the visibility of people with HIV/AIDS in health care will also have a long-term impact on their own well-being and on HIV prevention in China.     

Facing the HIV / AIDS challenge: a study on household and community responses

In countries where the health care system cannot cope with the growing number of AIDS cases, the family and the community are significant sources of care and treatment. A qualitative study conducted in Mumbai, India, in 1994 sought to identify household- and community-based strategies for effective AIDS care. Enrolled were 26 individuals with HIV or AIDS, 4 couples (both partners infected), and 25 members of households with an HIV-infected person; in addition, 18 focus group discussions were held with low-income youth. None of the households contacted had abandoned a member with HIV. Household dynamics played a crucial role in the nature and quality of care received, however. The most supportive care was received by men, even when their female partner was also sick. In-laws often showed little compassion toward widowed, infected daughters-in-law. Individuals without open sores or lesions were better accepted by family members and perceived as less likely to transit the virus. Concerns about social stigmatization and isolation prevented many family members from turning to their community for support. Recommended, on the basis of these findings, are measures such as support programs to reduce the burden on female caregivers, subsidized and appropriate medical care, support groups for people with AIDS, HIV/AIDS community awareness programs, and increased involvement on the part of nongovernmental organizations in integrated programming.     

基于农村社区HIV/AIDS患者关怀支持活动模式的研究

目的探讨基于农村社区HIV/AIDS患者关怀支持活动模式。方法以农村社区为基础,由艾滋病防治专家、志愿者、社区医务人员、患者家属等组成关怀支持团队,通过开展培训、社区宣传教育、心理支持、患者交流、营养支持活动,为HIV/AIDS患者提供情感关爱和心理支持。结果本活动目标人群为150例HIV/AIDS患者,平均年龄为(44.61±10.78)岁,男性65人,女性85人。活动结束后抽取目标人群60例,采用《生存质量测定量表简表》测量其生存质量情况。活动前生存质量总分为(74.30±12.64)分,活动后总分为(84.95±16.31)分,差异有统计学意义(P<0.01)。结论建立以社区为基础的关怀支持体系,对充分发挥社区在艾滋病控制方面的参与功能、互助功能、整合功能及动员社会力量控制艾滋病传播方面有重要意义。     

Recently released with HIV/AIDS: primary care treatment needs and experiences

The research objectives of this study are to describe the re-entry experiences of people recently released from jail who were living with HIV/AIDS, and to identify factors that influence their access to primary care and adherence to a treatment regimen. The research used a mixed-method, qualitative and quantitative research design. The findings indicate that the overall instability in the lives of many of the former inmates studied hampered their ability to attend to their HIV/AIDS-related health care needs. Most former inmates returned to the community with co-occurring problems related to housing and substance abuse. Complicating their access to health care were fragmented health care and correctional systems. The study highlights the need for coordination and collaboration between correctional facilities and community-based health care and human service providers that leads to a deliberative and planned transition from jail to service systems in the community.     

Cultural heuristics in risk assessment of HIV/AIDS

Behaviour change models in HIV prevention tend to consider that risky sexual behaviours reflect risk assessments and that by changing risk assessments behaviour can be changed. Risk assessment is however culturally constructed. Individuals use heuristics or bounded cognitive devices derived from broader cultural meaning systems to rationalize uncertainty. In this study, we identify some of the cultural heuristics used by migrant men in Goa, India to assess their risk of HIV infection from different sexual partners. Data derives from a series of in-depth interviews and a locally informed survey. Cultural heuristics identified include visual heuristics, heuristics of gender roles, vigilance and trust. The paper argues that, for more culturally informed HIV/AIDS behaviour change interventions, knowledge of cultural heuristics is essential.     

Cultural heuristics in risk assessment of HIV/AIDS

Behaviour change models in HIV prevention tend to consider that risky sexual behaviours reflect risk assessments and that by changing risk assessments behaviour can be changed. Risk assessment is however culturally constructed. Individuals use heuristics or bounded cognitive devices derived from broader cultural meaning systems to rationalize uncertainty. In this study, we identify some of the cultural heuristics used by migrant men in Goa, India to assess their risk of HIV infection from different sexual partners. Data derives from a series of in‐depth interviews and a locally informed survey. Cultural heuristics identified include visual heuristics, heuristics of gender roles, vigilance and trust. The paper argues that, for more culturally informed HIV/AIDS behaviour change interventions, knowledge of cultural heuristics is essential.

Résumé

Les modèles de changement de comportements dans la prévention du VIH tendent à se construire sur l'hypothèse que les comportements sexuels à risque reflètent les évaluations des risques, et qu'en changeant ces dernières, on peut changer les comportements. Pourtant l'évaluation des risques est une construction culturelle. Certains individus ont recours à des heuristiques ou à des dispositifs cognitifs limités, ancrés dans des systèmes plus larges de signification culturelle, pour rationaliser l'incertitude. Dans cette étude, nous identifions certaines des heuristiques culturelles employées par des hommes migrants à Goa, en Inde, pour évaluer leurs risques de contamination par le VIH, liés au multipartenariat sexuel. Les données proviennent d'une série d'entretiens en profondeur et d'une enquête locale. Les heuristiques culturelles identifiées comprennent les heuristiques visuelles, celles du rôle des genres, de la vigilance et de la confiance. L'article soutient que pour des interventions mieux culturellement informées sur les changements des comportements sexuels vis‐à‐vis du VIH/sida, la connaissance des heuristiques culturelles est essentielle.

Resumen

En los modelos de cambios de comportamiento con respecto a la prevención del sida, normalmente se considera que los comportamientos sexuales de riesgo son un reflejo de las valoraciones de riesgo y que si se cambian éstas también variará el comportamiento. Sin embargo la valoración del riesgo se construye en función de los valores culturales. Para racionalizar esta incertidumbre, los sujetos usan instrumentos heurísticos o cognitivos definidos a partir de sistemas de significado cultural más amplios. En este estudio, identificamos algunas de las capacidades heurísticas culturales que los hombres inmigrantes en Goa, India, usan para evaluar su riesgo de infección del VIH con diferentes compañeros sexuales. Recabamos los datos a partir de una serie de entrevistas exhaustivas y un estudio con información local. En este estudio identificamos heurísticos culturales, por ejemplo, los heurísticos visuales, los heurísticos del rol de sexos, y los heurísticos de vigilancia y de confianza. En este ensayo argumentamos que es de vital importancia tener conocimiento de los heurísticos culturales para poder elaborar intervenciones en el cambio de conducta sobre el VIH/sida con un mayor fondo cultural.     

HIV/AIDS and community conflict in Nigeria: implications and challenges

This paper discusses how HIV/AIDS prevention, treatment and mitigation activities and funding for such work can lead to community conflict. The central role of communities in combating HIV/AIDS is widely agreed, with the contributions of social capital networks and civil society seen as pivotal; a rights-based approach to HIV/AIDS activities is considered essential. Yet experiences from a UK Department for International Development funded project in Nigeria suggest that greater critical attention must be given to the impacts and effects of HIV/AIDS on communities, and the ways in which conflict can develop, emerge and be sustained, resulting in severe breakdown of social cohesion and reduction or cessation of HIV/AIDS activities. It is argued here that conflict can be fuelled by the different priorities and perceptions of community members and groups vis-à-vis those of development organisations, and by the impact of funds on often desperately poor communities. Case studies analyse the development of the conflict, failed attempts at resolution, and two post-conflict project interventions whose design and implementation were informed by its experiences and outcome. The paper concludes by considering the potential input of participatory approaches, community psychology and change management in the development and implementation of HIV/AIDS interventions specifically so as to reduce potential for conflict. Its intention is to contribute to the debate on how best to implement genuinely community-based and managed HIV/AIDS interventions.     

Challenges in providing comprehensive and coordinated care to HIV/AIDS patients: a Canadian perspective

This article focuses our attention on the means by which healthcare is provided to HIV-infected patients who require comprehensive and coordinated care to address the variety of changing and challenging needs presented by the acquired immunodeficiency syndrome (AIDS). Improved clinical management of HIV infection over the past decade, with antiretroviral agents, protease inhibitors and prophylactic therapies against opportunistic infections has transformed HIV infection from an acute to a chronic illness. Many individuals with AIDS are now living longer with more chronic conditions. Concomitant with the transformation of HIV infection from an acute to a chronic illness comes the challenge to provide effective, humane and economical care to patients with chronic conditions that continue to reside in the community, within a healthcare delivery system that has evolved to treat patients with acute diseases.