国内外羁押场所艾滋病预防策略概论

本文回顾了国内外羁押场所艾滋病疫情现状和被羁人员相关高危行为,在此基础上简述了羁押场所防治艾滋病的重要性,重点阐述了国内外预防艾滋病策略,并在HIV咨询检测告知和同伴教育方面介绍了云南女子劳教所的做法和经验。     

缅甸果敢劳教所劳教人员艾滋病知识知晓情况分析

[目的]了解缅甸果敢劳教所劳教人员艾滋病知识知晓情况及影响艾滋病知识知晓因素。[方法]利用整群抽样的方法抽取缅甸果敢地区两处劳教所中所有在押的劳教人员作为调查对象。运用现况调查的方法,以问卷的形式进行调查,同时在现场进行HIV快速双试剂检测,阳性者进行实验室检测和确认。数据采用Epidata建立数据库,SPSS 17.0统计软件包进行统计学分析。[结果]共调查劳教所劳教人员277人,艾滋病相关知识总知晓率65.8%,三个问题均答对者130人（46.9%）,多因素分析显示：劳教人员的文化程度与艾滋病知识知晓程度呈正相关关系（OR值为1.479）,入所前一年内是否接受HIV干预服务、入所前是否接受过HIV检测与艾滋病知识的知晓程度呈负相关关系（OR值分别为0.436和0.316）。[结论]缅甸果敢劳教所劳教人员艾滋病知识知晓率普遍较低。应加强在该地区的HIV综合干预服务的宣传力度和覆盖面,同时由于缅甸果敢地区与中国接壤,中国应加大对缅甸果敢地区的卫生资源输出,帮助果敢当地建立覆盖整个地区的卫生服务网络及HIV监测体系,以提高当地人群艾滋病知识知晓率,减少高危行为和艾滋病的传播。     

Latinas and HIV/AIDS risk factors: implications for harm reduction strategies

OBJECTIVES: We examined risk factors for HIV infection among Puerto Rican and Mexican American women aged 15 through 44 years. METHODS: We used data from the 1995 National Survey of Family Growth. Analyses focused on the relation between sex role attitudes, sex education, anxiety, and consistent condom use. RESULTS: Nearly 60% of Puerto Rican and Mexican American women received no sex education from parents. Twenty-one percent of Puerto Rican and 38.3% of Mexican American women reported no sex education in schools. Women with some sex education in school, less than 13 years of education, or higher sex role attitude scores were more likely than other women to have partners who consistently used condoms. CONCLUSIONS: Harm reduction interventions must be designed to reach multiple Latino audiences by age, gender, and subgroup     

Correlation between HIV and HCV in Brazilian prisoners: evidence for parenteral transmission inside prison

OBJECTIVE: It is an accepted fact that confinement conditions increase the risk of some infections related to sexual and/or injecting drugs practices. Mathematical techniques were applied to estimate time-dependent incidence densities of HIV infection among inmates. METHODS: A total of 631 prisoners from a Brazilian prison with 4,900 inmates at that time were interviewed and their blood drawn. Risky behavior for HIV infection was analyzed, and serological tests for HIV, hepatitis C and syphilis were performed, intended as surrogates for parenteral and sexual HIV transmission, respectively. Mathematical techniques were used to estimate the incidence density ratio, as related to the time of imprisonment. RESULTS: Prevalence were: HIV - 16%; HCV - 34%; and syphilis - 18%. The main risk behaviors related to HIV infection were HCV prevalence (OR=10.49) and the acknowledged use of injecting drugs (OR=3.36). Incidence density ratio derivation showed that the risk of acquiring HIV infection increases with the time of imprisonment, peaking around three years after incarceration. CONCLUSIONS: The correlation between HIV and HCV seroprevalence and the results of the mathematical analysis suggest that HIV transmission in this population is predominantly due to parenteral exposure by injecting drug, and that it increases with time of imprisonment.     

An invisible barrier to integrating HIV primary care with harm reduction services: philosophical clashes between the harm reduction and medical models

Overall AIDS mortality in the United States has declined in recent years, but declines have not been consistent across all populations. Due to an array of barriers to care, minorities and poor people who are active substance users have not benefited as others have from advances in the treatment of HIV disease. One way to address this problem is to integrate HIV primary care into harm reduction programs that already effectively serve this population. Such collaborations, however, are difficult to initiate and sustain. Philosophical differences between the medical model and the harm reduction model, which often remain invisible to the parties involved, underlie these difficulties. This article addresses the issue by describing a partnership in the Bronx, NY, between CitiWide Harm Reduction Inc. (CitiWideHR) and the Montefiore Medical Center. It focuses specifically on the sources of philosophical differences between models, and briefly assesses the potential for successful collaborations of this sort.     

Preventing HIV transmission: the perspective of inner-city Puerto Rican adolescents.

PURPOSE: To examine the development of HIV prevention strategies that address the concerns and needs of urban Puerto Rican adolescents. METHODS: The study included 542 Puerto-Rican adolescents, divided into age sets of 12 to 14 years and 15 to 19 years. Participants were recruited from community work programs, recreation centers, schools, drug rehabilitation programs, and directly from neighborhood streets in North Philadelphia. A hierarchical series of peer-facilitated group techniques and interviews allowed adolescents to generate, prioritize and explain strategies. The study question was developed in focus groups. Ideas were generated and prioritized in Nominal Technique Groups. The ideas with the highest priority were used to develop a survey that allowed participants to rank those they believed would be most effective. Participants then clarified the top-ranked ideas in open focus groups. RESULTS: In both age sets, the strategy perceived as the most effective in preventing HIV-risk behaviors was "Have people who are HIV-infected talk to teens." Similar ideas addressing this theme varied in perceived effectiveness. The second and third rated ideas among participants aged 12 to 14 years were "Teach teens how HIV infects them, " and "Show teens how people die from AIDS." The second and third rated ideas among participants aged 15 to 19 years were "Show teens what AIDS does to people " and "Have parents be more supportive of teens, so if they are having sex, they can encourage them to use condoms." Other top-ranked ideas included the development of community programs, increased efficacy and availability of condoms, and assessing partners for the risk of HIV infection. Three items revealed significant gender differences. Males were more likely to rate "Give out more free condoms" and "Educate teens in schools about AIDS." Females aged 15 to 19 years were more likely to rate "Teens should know their partner's background before having sex." CONCLUSIONS: To develop effective prevention strategies for youth, their views of the problems and interpretations of proposed solutions must be understood.     

在劳教场所内开展对吸毒劳教人员减少伤害的干预

[目的]探索在劳教所内的吸毒学员中开展减少伤害教育的有效途径和方法；提高干警参与项目的能力，减少对劳教所内吸毒劳教人员的伤害。[方法]采用心理干预、提高认知水平、行为干预、社会适应训练等。[结果]提高吸毒劳教人员对性病艾滋病的认知水平；提高吸毒劳教人员的理性息维和自助能力，从而促进吸毒劳教人员减少感染性病艾滋病的高危行为，降低危害。[结论]在劳教所内开展心理矫治、行为干预、社会适应训练对促进吸毒劳教人员解教出所改变高危行为，重归社区起到了积极推动作用。     

广州市吸毒人群预防艾滋病及减少伤害的同伴教育效果研究

目的探讨和评价同伴教育对吸毒人群进行预防艾滋病及减少伤害的干预效果，为今后针对该人群提高预防艾滋病的知识和技能以及进一步开展艾滋病健康教育干预提供科学依据。方法采用横断面研究方法，使用统一的调查问卷收集干预前后调查对象的资料。将研究对象分为同伴教育组和普通宣教组，对同伴教育组开展为期3个月的同伴教育干预措施，普通宣教组实行常规宣传教育。结果干预前，2组吸毒人员对绝大部分知识知晓率差别无统计学意义（P〉0．05）；干预后，2组差别有统计学意义（P〈0．05）。干预后同伴教育组艾滋病知识的净增长率从大到小依次是：正确使用安全套知识（61．7％）、高危行为减少伤害（26．5％）和艾滋病基础知识（16．8％），干预手段和职业是影响吸毒人员艾滋病相关知识得分的2个因素。结论在吸毒人群中开展同伴教育取得了良好的效果，有效提高了吸毒人员在艾滋病防治基本知识、高危行为减少伤害、正确使用安全套方面的知识。但同伴教育能否改变吸毒人员对艾滋病高危行为的态度和行为还需进一步研究。     

Peer support to promote medication adherence among people living with HIV/AIDS: the benefits to peers

Since early in the AIDS epidemic, HIV-positive individuals have benefited from the services of peer support or buddy programs. However, little research has focused on the experience of the peer providing support. We conducted qualitative interviews with nine HIV-positive peers who had participated in an intervention designed to provide support to other HIV-positive individuals as one means of promoting antiretroviral therapy adherence. Analyses of the peers' common dialogue about their involvement in the study revealed four main themes: social acceptance, reciprocal support, personal growth and empowerment, and resistance and other challenges. Recommendations for future research and for implementing similar interventions in a health care setting are provided.     

Preventing sexual risk behaviors among gay, lesbian, and bisexual adolescents: the benefits of gay-sensitive HIV instruction in schools

OBJECTIVES: This study compared sexual risk behaviors of gay, lesbian, and bisexual (GLB) and heterosexual adolescents and evaluated associations between gay-sensitive HIV instruction and risk behaviors of GLB youths. METHODS: A random sample of high school students and HIV education teachers completed surveys. Self-reported risk behaviors of heterosexual and GLB adolescents were compared, with control for student and community demographic characteristics. Sexual risk behaviors of GLB youths in schools with and without gay-sensitive instruction were compared. RESULTS: GLB youths reported more substance use, high-risk sexual behaviors, suicidal thoughts or attempts, and personal safety issues than did heterosexual youths (P < .001). Among those who were sexually active, GLB youths reported more lifetime and recent sexual partners than did heterosexuals (P < .001), and more of them reported alcohol use before last sex (P < .01) and a history of pregnancy (P < .001). GLB youths in schools with gay-sensitive instruction reported fewer sexual partners, less recent sex, and less substance use before last sex than did GLB youths in other schools (P < .05). CONCLUSIONS: The findings document increased risk behaviors among GLB youths and demonstrate the potential benefits of providing gay-sensitive HIV instruction in schools.     

The participation of the united states government in providing financial support for medical education

This paper examines the different issues and topics related to the support of medical education with specific emphasis on federal support. The importance of such an analysis lies in the fact that the current legislation, the Health Professions Educational Assistance Act of 1976 (P.L. 94-484), expires on September 30, 1980. Preparations for new legislation are currently under way. Therefore, discussions, such as those presented in this paper, are appropriate and should be part of the current literature with the hope of generating ideas from potential readers.Education, as developed in the US, has been strongly viewed throughout history as a public right (an inherent individual right) which produces public benefits. A discussion of this issue is presented along with an historical analysis of federal support for higher education, including medical education. The purpose is to establish the case that federal involvement (investment) has been and is at such a level that discontinued support could not be absorbed at the local or state level. Conditions and restrictions of federal support are also included in this section.Another section of the paper discusses the financial structure (sources of support, costs) found in most medical schools with an emphasis on the need for federal support both in terms of the amount and type of aid desired. The major points stressed are related to preserving institutional autonomy, diversity, and integrity and maintaining equality of educational opportunity. Alternative sources and types of financial support are discussed. The paper concludes with a summary of major points leading to the authors' position of continuing, unrestricted federal support for medical education on an institutional basis.     

Seroprevalence of HIV, HCV and syphilis in Brazilian prisoners: Preponderance of parenteral transmission

Between November 1993 and April 1994, our physicians' team interviewed and took blood samples of 631 prisoners randomly drawn from the largest prison of South America, which counted about 4700 inmates at that time. The interview consisted of questions related to risk behaviour for HIV infection, and the subjects were asked to provide blood for serological tests for HIV, hepatitis C and syphilis. Our main purpose was to investigate the relationship between HCV and injecting drug use as related to HIV seropositivity. Participation in the study was voluntary and confidentiality was guaranteed. Overall prevalences found were as follows: HIV: 16% (95% confidence interval (CI): 13–19%); HCV: 34% (95% CI: 30–38%), and syphilis: 18% (95% CI: 15–21%). Acknowledged use of ever injecting drug was 22% and no other parenteral risk was reported. Our results, as compared with other studies in the same prison, suggest that HIV prevalence has been stable in recent years, and that the major risk factor for HIV infection in this population is parenteral exposure by injecting drug use.     

Preventing mother-to-child HIV transmission in the new millennium: the challenge of breast feeding

Short courses of antiretroviral drugs have greatly enhanced the prospect of reducing mother-to-child HIV transmission. Yet transmission by breast feeding clouds hopes for this seemingly simple intervention. We revisit mathematical models to assess the competing risks associated with feeding by breast vs. formula. These indicate that, in the less developed world where the HIV epidemic predominates, neither option, unmodified, offers a reasonable choice for HIV-positive women. Where infant mortality rates are greater than about 40 per 1000 live births, if formula were made available to HIV-infected women only, the excess number of deaths that would result from formula use would be approximately the same or greater than the number of HIV infections that might be prevented. Only at lower infant mortality rates, less than about 40 per 1000, is the risk greater on the breast. There are thus no good grounds for the total avoidance of breast feeding under all conditions. Research to develop and test safer infant feeding alternatives is an urgent priority. On the one hand, ways to reduce HIV transmission while preserving breast feeding, as exclusive breast feeding could do, need to be fully tested. On the other hand, ways to reduce non-HIV morbidity and mortality associated with formula feeding, as educational or sanitary interventions could do, equally need testing. With either approach, a necessary foundation for implementing all the core components of preventing mother-to-child HIV transmission is competent counselling for mothers. Innovative approaches are needed to mobilise and train effective counsellors among health care workers and, as appropriate, community members.     

The context of HIV risk behaviours among HIV-positive injection drug users in Viet Nam: Moving toward effective harm reduction

Background  

Injection drug users represent the largest proportion of all HIV reported cases in Viet Nam. This study aimed to explore the perceptions of risk and risk behaviours among HIV-positive injection drug users, and their experiences related to safe injection and safe sex practices.     

The context of HIV risk behaviours among HIV-positive injection drug users in Viet Nam: Moving toward effective harm reduction

Background  

Body image disturbance is an increasing problem in Western societies and is associated with a number of mental health outcomes including anorexia, bulimia, body dysmorphia, and depression. The aim of this study was to assess the association between body image disturbance and the incidence of depression.     

Drug users’ involvement in the drug economy: Implications for harm reduction and HIV prevention programs

The purpose of this article is to explore individual and social characteristics associated with drug user’s involvement in the drug economy among a sample of lowincome heroin and cocaine users (n=1,288) in Baltimore, Maryland. The study sample had participated in a network-oriented intervention study of human immunodeficiency virus (HIV) risk behaviors among drug users. Of the sample, 44% (n=569) held at least one role in the drug econonry, performing an average of 1.17 roles. A significantly higher percentage of those involved in the drug economy reported being daily drug users (60.6% vs. 40.2%), injecting heroin daily (36.0% vs. 21.8%), injecting speed daily (23.6% vs. 14.7%), and snorting heroin daily (18.3% vs. 13.4%). In terms of social networks, those involved in the drug economy reproted a significantly larger social network (9.98 vs. 8.97), greater percentage of active drug users in their social network (47% vs. 44%), greater percentage of daily drug users in their social network (40% vs. 33%), and larger drug support networks (6.7 vs. 5.6). The study indicates the far-reaching influence of drug use on many aspects of their lives, including their involvement with the drug economy. Reducing drug users’ frequency of use could have the consequence of decreasing this involvement. Being a part of the drug economy exposes drug users to many risks, but also places them in a position to influence others. Examining drug users’ social networks could provide insight into the composition of their immediate social environment and could inform HIV prevention programs.     

Social support and maintenance of safer sex practices among people living with HIV/AIDS

The study discussed in this article addressed the relationship of social support to the maintenance of long-term safer sex practices of 360 HIV-positive adults recruited from outpatient medical facilities. Medical professionals, friends, and siblings were reported the most frequent sources for assistance, whereas regular sexual partners, medical professionals, and community organizations were rated as the most helpful. Differences in social support use across ethnic, gender, and sexual orientation groups were observed. Those engaging in safer sex practices perceived the support they received as more helpful. These findings emphasize the link between positive support networks and avoidance of high-risk sexual behavior in HIV-positive individuals. Implications for the delivery of culturally appropriate, gender-specific, and community-based interventions are discussed.     

Delivering care out of the box: the evolution of an HIV harm reduction medical program

Disparities in HIV health care continue to exist among New York City's marginalized populations. We describe the evolution and development of a unique collaborative program that blends harm reduction and medical care. This program addresses disparities and needs of a particularly marginalized population: unstably housed substance users with HIV infection.     

Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programmes

OBJECTIVES: to examine attitudes of Russian policy-makers and HIV stakeholders towards harm reduction (HR) scale up, focusing on the factors constraining the scale-up process. METHODS: Semi-structured interviews with representatives of 58 government and non-governmental organisations involved in HIV policies and programmes in Volgograd Region, Russian Federation. RESULTS: We found a considerable diversity of opinion on HR scale-up and suggest that Russia is experiencing the situation of power parity between HR supporters and opponents with many stakeholders being indecisive or cautious to express their views. We identified six main factors which constrain policy decisions in favour of HR scale-up: insufficient financial resources; lack of information on HR effectiveness; perception of HR as being culturally unacceptable; reluctance of IDUs to use the services; opposition from law enforcement agencies and the Russian Church; and unclear legal regulations. We demonstrate a complex interplay between these factors, policy-makers' attitudes and their choices on HR scale-up. CONCLUSIONS: A number of actions are needed to achieve a successful scale-up of HR programmes in Russia and similar political contexts: (i) a strategic approach to HR advocacy, targeting neutral and indecisive stakeholders; (ii) more systematic evidence on HR effectiveness and cost-effectiveness in the local context; (iii) HR advocacy targeting law enforcement agencies and the Russian Church; and (iv) aligning best international HR practices with the objectives of local policy-makers, practitioners and service-users.