International response to the HIV/AIDS epidemic: planning for success.

More assertive political leadership in the global response to AIDS in both poor and rich countries culminated in June 2001 at the UN General Assembly Special Session on AIDS. Delegates made important commitments there, and endorsed a global strategy framework for shifting the dynamics of the epidemic by simultaneously reducing risk, vulnerability and impact. This points the way to achievable progress in the fight against HIV/AIDS. Evidence of success in tackling the spread of AIDS comes from diverse programme areas, including work with sex workers and clients, injecting drug users, and young people. It also comes from diverse countries, including India, the Russian Federation, Senegal, Thailand, the United Republic of Tanzania, and Zambia. Their common feature is the combination of focused approaches with attention to the societywide context within which risk occurs. Similarly, building synergies between prevention and care has underpinned success in Brazil and holds great potential for sub-Saharan Africa, where 90% reductions have been achieved in the prices at which antiretroviral drugs are available. Success also involves overcoming stigma, which undermines community action and blocks access to services. Work against stigma and discrimination has been effectively carried out in both health sector and occupational settings. Accompanying attention to the conditions for success against HIV/AIDS is global consensus on the need for additional resources. The detailed estimate of required AIDS spending in low- and middle-income countries is US$ 9.2 billion annually, compared to the $ 2 billion currently spent. Additional spending should be mobilized by the new global fund to fight AIDS, tuberculosis and malaria, but needs to be joined by additional government and private efforts within countries, including from debt relief. Commitment and capacity to scale up HIV prevention and care have never been stronger. The moment must be seized to prevent a global catastrophe.     

性病艾滋病防治战略规划分析

目的 探讨省级艾滋病防治战略规划对本省艾滋病防治工作所发挥的作用,为进一步利用和修订规划提出建议。方法 对吉林、重庆等省、市和自治区的艾滋病防治战略规划的制定过程、内容和使用及各参与部门在战略规划修订过程中的参与情况进行了问卷调查,对调查结果和存在的问题进行分析。结果 战略规划的制定和实施等过程中确实在政策动员与多部门合作等方面发挥了重要的作用,各省、市和自治区都能将战略规划作为实际工作中的参考文件,但是并没有充分发挥战略规划的指导作用,也没有针对战略规划的实施情况开展相应的评估活动。随着时间推移和防治工作内容的调整,对已经制定的战略规划进行了认真的修订。结论 应该加强艾滋病防治战略规划在各省艾滋病防治工作中的指导作用,要根据形势变化,及时对战略规划进行修订。     

Operational Fidelity to an Evidence-Based HIV Prevention Intervention for People Living with HIV/AIDS

Evidence-based interventions are often disseminated in public health education with little known about their operational fidelity. This study examined the delivery of intervention components (operational fidelity) of a widely disseminated HIV prevention program designed for people living with HIV/AIDS named Healthy Relationships. Two hundred ninety-nine agencies that had been trained in the intervention by the Centers for Disease Control and Prevention were contacted, and 122 (41%) completed confidential interviews. Among the 93 agencies that implemented the program, 39 (40%) adapted at least one core element activity, and 21 (23%) dropped an activity. Most adaptations were intended to improve the community fit of the intervention. Agencies believed that funders demand that they implement the intervention with fidelity. Models of technology transfer that emphasize behavior change processes rather than specific curriculum content may advance prevention program dissemination.     

Measures needed to strengthen strategic HIV/AIDS prevention programmes in China

This paper traces the commonly believed three phases of the HIV/AIDs epidemic in China from the early 1980s to the present time and reviews how the Chinese Government and NGOs are dealing with the crisis. Transmission routes for HIV infection in China are thought to be via IDUs, blood plasma donors, sexual contacts and from mother-to-child transmissions. The author examined interventions for HIV/ AIDS prevention tried in other countries that could provide useful lessons learned and discussed how they could be adapted or replicated in China. While recognising the need for the treatment of HIV positive persons and AIDS patients, this paper is limited to suggesting a number of proven strategic interventions to prevent new HIV infections in China among the "general population", adolescents in schools, sex workers and their clients, injecting drug users, and, prevention of mother to child transmission of HIV/AIDS to stem the epidemic. An extensive literature search of articles in published academic journals, published and unpublished documents of international agencies and development NGOs and media reports was conducted for data source to this paper. Internet search engines such as ProQuest, PubMed, Google and Yahoo search engines were used as well as hard copies of reports and internal documents available at the UNFPA Country Technical Services Team's Office in Bangkok tapped for information.     

HIV/AIDS, sexual and reproductive health: intersections and implications for national programmes

HIV and AIDS have a myriad of effects on sexual and reproductive health and rights, and sexual and reproductive health services are critical for women and men with HIV and AIDS. Yet there has been a dearth of visible, in-depth mainstream attention to the links between sexual and reproductive health and prevention and treatment of HIV/AIDS since the early 1990s among major stakeholders internationally. This paper argues that access to essential sexual and reproductive health care should be provided in HIV/AIDS prevention, care and treatment programmes, and appropriate forms of prevention and treatment of HIV/AIDS should be included in all sexual and reproductive health services as a public health priority, particularly in sex education, family planning and abortion services, pregnancy-related care, sexually transmitted infection (STI) services and services addressing sexual violence. The paper analyzes existing barriers to linking and integrating these services, e.g. at country level due to the traditional training of health workers to implement vertical programmes, separate sources of funding for National AIDS Control Programmes and sexual and reproductive health services, and in international donor programme and UN agency structures. This paper calls for leadership to be exercised by donors, all the UN agencies working together, governments, health service managers and providers, NGOs and advocates in both fields to develop and implement these linkages at country level. Finally, it is crucial that UNAIDS, WHO, UNFPA, UNICEF, the Global Fund to Fight AIDS, TB and Malaria and those working to reach the targets set by the Millennium Development Goals come on board in these efforts.     

在吸毒人群中开展健康教育干预预防艾滋病试点的研究

目的 探索开展健康教育干预对预防艾滋病在吸毒人群中传播的可行性，为全面开展健康教育干预工作提供经验和科学依据。方法 采用社区干预研究方法在戒毒所和社区内开展健康教育干预活动；用艾滋病知识知晓率，艾滋病传播危险行为变化和艾滋病病毒（HIV）抗体阳性率评估干预效果。结果 干预后吸毒人群的艾滋病知识知晓率比干预前高；干预后吸毒人群的艾滋病传播危险行为率比干预前低；干预前后吸毒人群的HIV抗体阳性率差异没有显著性。结论 在吸毒人群中开展健康教育有助于提高吸毒者对艾滋病相关知识的认知，改变HIV感染者的危险行为，控制艾滋病传播。     

远洋船员实施艾滋病行为干预的预实验研究

〔目的〕了解远洋船员对AIDS知识、态度、行为和观念的情况,探讨进行行为干预的方法,遏制艾滋病的进一步的流行。〔方法〕自行设计表格,采取匿名问卷(KABP)方法,对上海口岸的远洋船员进行调查。〔结果〕远洋船员对艾滋病知识已有一定的了解,但对艾滋病的高危行为认识模糊,预防知识欠缺,大多数人员愿意接受健康教育。〔结论〕在远洋船员中存在导致艾滋病传播的危险因素,对其进行行为干预势在必行。     

受艾滋病影响儿童的健康教育干预模式研究

目的 评价参与式生活技能教育模式在受艾滋病影响儿童中的适宜性与有效性,为相关健康促进工作及政策制定提供依据.方法 对河南省某县104名受艾滋病影响的中学生进行以普及艾滋病知识、建立关爱态度、提高自尊与自信水平为目标的参与式生活技能教育干预,另105名学生为对照,评价干预效果.结果 干预前,干预组学生艾滋病知识、关爱态度、自尊量表(SES)、个人评价问卷(PEI)得分与对照组基线水平一致;干预后,干预组上述得分均显著高于对照组.干预组内,干预后男生自尊与自信水平均显著低于女生.结论 参与式生活技能教育干预模式对受艾滋病影响的儿童是有效、可行的,男生在干预过程中应被给予更多关注.     

HIV/AIDS prevention in prisons: experience of participatory planning

Objetive: To describe the application of participatory methodology in the prison setting for the determination of the most appropiate contents and methods of a HIV/AIDS prevention program.Methods: Community study in the Centro de Cumplimiento del Establecimiento Penitenciario in Valencia (1250 inmates) in Spain. The study was carried out in two phases: identification of key informants and collection of information. In the second phase, a community forum composed of the center's male and female inmates was created, personal interviews with convicted female prisoners were carried out and a self-administered questionnaire was distributed to the center's health professionals and management as well as to health promotion experts.Results: Community forum. The following proposals for HIV/AIDS prevention were made by the male and female prisoners: a) those directed at the prisoners themselves: increasing preventive mesures in material used in injection and in sexual relationships; b) those directed at the prison management: increased distribution of condoms, safety razors and bleach and the introduction of sterile injection material. In the personal interviews, agreement on a future prevention program was high among the female inmates and the other key informants. Preferred measures were the acquisition of information on the mechanisms of HIV transmission and prevention and on the differences between HIV carriers and those suffering from AIDS and the acquisition of skills for disinfecting material used for drug injection and in negotiating the use of condoms with partners. The preferred methodology was based on groups that would allow for an interchange of experience and would deal with the difficulties of putting preventive measures into practice.Conclusions: The participation of the prison's inmates and staff supplied information that facilitated the design (choice of aims, measures, methods and resources) of an HIV prevention program adapted to the needs and preferences of all the interested parties.     

AIDS programmes in transition.

National AIDS programmes of industrialized countries are moving from rapid growth to consolidation. This transition should afford opportunities for strengthening the approaches to AIDS prevention.     

男男性接触者艾滋病干预效果分析

目的了解干预后男男性接触者(MSM)人群的艾滋病相关知识、高危险行为和性病相关感染情况,评价干预效果。方法采用匿名问卷形式对MSM人群进行干预前及干预后6个月、12个月共3次横断面调查和血标本的采集检测H IV和梅毒。结果干预后艾滋病知识的知晓率有明显提高(P0.05),最高提幅达19.83%。2个以上性伴数的人数比例从84.79%下降为65.95%,保持单一的性伴数比例从15.21%上升至34.05%。最近1次肛交和最近6个月肛交时安全套的使用率分别从72.17%和43.04%上升至75.10%和45.20%。最近1年作过H IV检测比例从28.26%升至44.69%。H IV的感染率为0.87%~2.43%,梅毒感染率为8.18%~11.28%。结论针对MSM人群的宣传、干预措施,取得一定的效果,可推广使用。     

我国吸毒人群艾滋病预防干预效果的Meta分析

目的 综合评价我国吸毒人群艾滋病预防干预效果,为在吸毒人群中进行艾滋病预防干预提供依据.方法 计算机检索中国生物医学文献光盘数据库(CBM)、中国学术期刊网全文数据库(CNKI)、PubMed、中文科技期刊全文数据库(VIP)、万方数据库等,收集1999～2008年国内外公开发表的关于我国吸毒人群艾滋病预防干预研究的文献并使用RevMan4.2软件对检索并入选的国内16篇文献进行综合定量的Meta分析.结果 经干预后,吸毒人群对"是否知晓共用注射器可以传播艾滋病"(知识点1)、"是否知晓正确使用安全套可以预防艾滋病"(知识点2)的知晓率分别提高了23%(0.16～0.30)和13%(0.09～0.17)."最近一个月与别人共用注射器的比例"(共针率)降低了24%(0.18～0.30).结论 我国对吸毒人群开展的艾滋病预防干预措施具有较好的效果.     

流动人口艾滋病知识健康教育干预模式探讨

目的探讨利用免疫规划网络平台开展流动人口艾滋病知识健康教育,并观察评估效果。方法选取芜湖市市区流动人口集中的10家预防接种门诊作为本次研究现场,随机从每个接种门诊抽取一定数量流动人口进行艾滋病知识的基线调查;根据预先设计的干预方案对流动人口开展艾滋病知识健康教育;干预一年后,再次随机抽取样本进行调查,观察干预前后艾滋病防治知识、知晓率,评价干预活动的效果。结果流动人口干预前后知识知晓率分别为69.35%和94.00%,差异有统计学意义(χ2=107.96,P0.01)。结论依托免疫规划网络系统开展流动人口艾滋病知识健康干预效果较好,是艾滋病综合防治的一种值得探索的模式。     

Ethical principles for collective immunisation programmes

Ethical issues arise in discussion of both the content and implementation of collective immunisation programmes. In this paper we propose and discuss seven principles that may guide reflection and debate in this controversial area. Whilst this paper is not intended to be a final and complete account of the relevant principles for collective immunisation programmes we hope that it can help stimulate more active discussion of these issues. Debate about these principles may help to make moral conflicts more explicit and open up the possibility of resolution. We argue that analysis and discussion of the ethical issues should be part of any justification of collective vaccination programmes.