Where to Seek Care: An Examination of People in Rural Areas With HIV/ AIDS

Though HIV/AIDS has spread to rural areas, little empirical evidence is available on where patients living in these areas receive care. This article presents estimates of rural residents in care for HIV/AIDS, their demographic and health-related characteristics, information about whether they receive care in a rural or urban setting, and data on the drug therapies prescribed. The estimates come from the HIV Cost and Services Utilization Study (HCSUS), a nationally representative probability sample of HIV-infected adults receiving care in the contiguous United States. Regardless of the definition used--enrollment site, usual source of HIV care, or site of most recent hospitalization--almost three quarters of rural residents with HIV/AIDS obtained their health care in urban areas. The authors find that differences in the demographic characteristics of those using urban vs. rural care do not drive the decision on where to obtain care, with the primary difference being that people with a rural provider tend to be older. Rural residents with an urban usual source of HIV care incurred significant inconvenience in obtaining care--the majority said their care was not conveniently located, they had substantially longer mean travel times, and over 25% had put off obtaining care in the past 6 months because they did not have a way to get to their provider. Given the considerable burden this places on a chronically ill population,further research is needed to explore how provider supply and provider experience affect the decision to travel for care and how quality of care is affected.     

Challenges Experienced by Rural Women in India Living With AIDS and Implications for the Delivery of HIV/AIDS Care

Researchers explored the barriers to AIDS care for rural women living with AIDS, and they investigated alternative delivery models to increase the women's adherence to antiretroviral therapy (ART). Community-based participatory research focus groups were conducted by the researchers with a convenience sample of 39 women living with AIDS from a primary health center (PHC) near Chennai, India, and with nurses, physicians, and Accredited Social Health Activists (Ashas), who are lay health care workers. The most prevalent barriers expressed by the women were sickness-related, psychological, financial issues with childcare, and distance, or transportation to the site. Women living with AIDS reviewed Ashas favorably.     

Barriers to General Practitioners Caring for Patients with HIV/AIDS

This paper describes some of the barriers to caring for peoplewith HIV and AIDS by general practitioners. It is based on areview of the literature and on interviews with individuals.The first section examines the reasons given by intervieweesfor their involvement in HIV and AIDS care. The next sectiondiscusses the relationship between primary and secondary careservices in the care of patients with HIV and AIDS. One of thefactors previously underexplored seems to be that of who ‘owns’the patients. The final section looks at GPs' involvement inservices for intravenous drug users with HIV and AIDS. It isconcluded that there are still considerable barriers to GPs'involvement with patients with HIV and AIDS, in particular withdrug users who have HIV or AIDS. It is likely that needs forcontinuing training in this area are not being met.     

医疗机构推诿艾滋病病毒感染者/艾滋病病人应对策略

通过分析非定点医疗机构推诿艾滋病病毒感染者和艾滋病病人的表现形式和发展过程,认为:政策落实不到位、监督机制不健全、定点医疗机构诊疗能力弱、非定点医疗机构维护自我利益、相关保障机制不健全等是医疗机构推诿的主要原因。在分析的基础上,提出了解决的策略:完善政策、提高定点医疗机构的诊疗能力、加强培训、完善防护措施、健全补偿机制、加强与病人的沟通、加大监督力度。     

艾滋病治疗费用纳入新型农村合作医疗补偿的可行性分析

艾滋病感染者和患者较重的经济负担一直是社会比较重视的问题。在分析艾滋病治疗费用纳入新型农村合作医疗(简称新农合)补偿背景的基础上,探讨了艾滋病治疗费用纳入新农合补偿在政治上、经济上和技术上的可行性,并指出艾滋病纳入新农合应注意的几个问题:医疗服务人员治疗水平的问题,新农合、"四免一关怀"政策、医疗救助制度衔接的问题以及新农合基金可能遭受冲击的问题,并针对存在的问题提出对策及建议。     

农村妇女预防HIV/AIDS健康教育近期效果评估

目的:评估河北省迁西县农村地区妇女预防HIV/AIDS健康教育干预的近期效果。方法:采用定性与定量调查相结合的方法对比干预前后农村妇女获得HIV/AIDS防治知识的途径、防治知识知晓率及相关态度和意愿,分析评价干预效果。结果:终末调查时干预组和对照组听周围人介绍HIV/AIDS知识的比例分别为54.58%和23.85%(P<0.05)。干预组知晓预防艾滋病母婴传播(PMTCT)的比例上升19.58个百分点(P<0.05),知晓蚊虫叮咬和共用马桶不会传播的比例分别升高42.09和29.17个百分点(P<0.05),知晓"四免一关怀"政策的比例上升了49.16个百分点(P<0.05),较对照组上升幅度更大。结论:农村妇女预防HIV/AIDS健康教育有效,同伴教育是农村预防HIV/AIDS的一种适宜健康教育方式。     

Approaches to HIV/AIDS prevention

The author describes approaches to HIV/AIDS prevention, especially prevention of HIV sexual transmission. Distinction is done to biomedical, behavioural, societal, gender and faith-based approach. The necessity of multisectoral community based approach is emphasized.     

Enteric Pathogens in HIV/AIDS from a Tertiary Care Hospital

Background:

Patterns of enteric infections in HIV in developing countries may differ in several important ways from developed countries, the knowledge of which can often guide therapy when resource limitations hamper the exact diagnosis of the etiological agent in HIV-associated diarrhea.

Objectives:

The primary objective of this study was to define and compare the microbial etiologies of diarrhea in HIV-1 infected and non infected patients and in HIV infected non diarrheal patients.

Materials and Methods:

This study was conducted between April 2007 and July 2007 at the Department of Microbiology, Maulana Azad Medical College, New Delhi. Stool samples from 50 HIV seropositive cases with diarrhea (study group), 50 HIV seropositive cases without diarrhea (control group I), and 50 HIV seronegative cases with diarrhea (control group II) were examined. After the diagnosis of HIV infection was made, routine parasitological and bacteriological detection was done. An ELISA was used for the detection of Clostridium difficile toxin and Cryptosporidium antigen in stool samples.

Results:

The overall prevalence of enteric parasitosis in the study group was 20% and the bacteria identified were Escherischia coli in 24% of the case, Clostridium difficile in 10% of the cases, Salmonella species and Vibrio cholerae in 4% of the cases, and Shigella species in 2% of the cases. Candida species was identified in 36% of the cases.

Conclusions:

Identification of the etiological agent of diarrhea in a patient with AIDS is very important as it can help in the institution of appropriate therapy and the reduction of morbidity and mortality in these patients.     

我国农村流动人口艾滋病宣传教育现状回顾

外出务工人员已成为将艾滋病由高危人群向一般人群传播的桥梁人群,在该人群中开展有针对性的干预措施,是当前预防艾滋病扩展的一种有效的手段.本文对近年来我国流动人口开展的艾滋病防治干预现状与健康教育研究进行阐述,为寻找行之有效的干预措施和今后艾滋病的防治提供借鉴.     

HIV/AIDS患者生活质量及相关因素的研究

目的探讨HIV/AIDS病人生活质量及影响因素。方法对湖北省随州市HIV/AIDS患者200例,采用世界卫生组织生活质量表(WHOQOL-100)中文版进行生活质量评估,同时抽取100名健康者进行对照研究。结果与健康对照组相比,HIV/AIDS患者除了在身材与相貌、行动能力两个方面得分没有差异性外(P>0.05),在生活质量的6大领域,总的生存质量和健康状况及其余的21个方面得分均低于健康对照者(P<0.05)。影响生活质量的主要因素有:生活满意度、个人经济收入、抑郁、环境条件、躯体症状。结论HIV/AIDS患者的生活质量下降。应该引起全社会及艾滋病防治工作人员的重视。     

Health Utilities in Patients with HIV/AIDS in Thailand

Objectives:  We measured health utility (HU) in Thai HIV/AIDS patients using visual analog scale (VAS), EuroQOL (EQ-5D), and standard gamble (SG), determine the relationships between these HU measures and health-related quality of life (HRQOL) measures of HIV and patient characteristics, and assess the feasibility of the HU methods.
Methods:  A sample of 120 HIV/AIDS patients was identified at Bamrasnaradura Infectious Disease Institute, Thailand, during September to December, 2004. Face-to-face interviews included VAS, SG, and EQ-5D, HRQOL assessment using the Thai abbreviated version of the World Health Organization quality of life (WHOQOL-BREF THAI) and HIV-related symptom instruments, questions about ease of understanding HU approaches and sociodemographic items. Data were analyzed with repeated-measures ANOVA, followed by Dunn–Bonferroni t -test, intraclass coefficients (ICC), Spearman's rank correlation, and multiple linear regressions.
Results:  The mean (95% confidence interval) HUs were as follows: VAS, 0.79 (0.76–0.82); EQ-5D, 0.80 (0.77–0.84); and SG, 0.65 (0.60–0.70). A significant difference in HU by method was found ( P  < 0.001). Agreement by ICC was 0.71 for VAS versus EQ-5D, 0.41 for VAS versus SG, and 0.38 for EQ-5D and SG. The regression models showed that WHOQOL-BREF THAI, frequency of HIV symptoms, and patient characteristics could explain approximately 50% of the variation in the VAS and the EQ-5D and 20% in the SG². Among these three HU methods, the SG was the most difficult task.
Conclusion:  VAS, EQ-5D and SG yielded different HUs for this sample. VAS and EQ-5D showed stronger construct validity with other health measures than SG. From a feasibility perspective, the SG was the least satisfactory of the three approaches.     

HIV感染者/AIDS患者心理状态调查

目的 了解HIV感染者／AIDS患者的心理状态。方法 采用90项症状清单（SCL--90）、汉密顿焦虑量表（HAMA）、汉密顿抑郁量表（HAMD）对162例HIV感染者／AIDS患者进行调查。采用SPSS11．0软件统分析资料。结果 HIV感染者／AIDS患者SCL-90各因子分与全国常模相比,除人际关系和偏执外,躯体化、强迫、抑郁、焦虑、精神病性和恐怖等因子分显著高于常模,而敌对性等因子分明显低于常模,阳性总分显著高于常模（P〈0．05）;HIV感染者与AIDS患者各因子分均无显著差异。HAMA评定97．53％的HIV感染者／AIDS患者存在焦虑症状,HAMD评定98．77％的HIV感染者／AIDS患者存在抑郁症状。结论 焦虑、抑郁是HIV感染者／AIDS患者普遍存在的负性心理表现．在艾滋病的防治过程中,不仅要医治患者躯体上的痛苦,而且还要针对不同个体的特点开展心理干预,对其负性情绪予以积极疏导,提高生活质量。     

Using AIDS mortality data to reconstruct HIV/AIDS epidemics

The back-calculation methods used to reconstruct HIV epidemics and to predict future AIDS cases use data on the number of AIDS reported cases and information about the time from HIV infection to AIDS diagnosis. In this paper we modify a back-calculation method, presented in Verdecchia and Mariotto, to estimate HIV incidence from AIDS mortality data rather than the AIDS registered cases. In this application the AIDS incubation time is replaced by the time from HIV infection to AIDS death. Since AIDS is an irreversible condition leading to death within a few years, mortality data is expected to be approximately as informative as AIDS data. The main application of this method would be in countries where an AIDS registry is not available or where the registration of AIDS cases is not consistent, for example, due to changes in the definition of AIDS. Application to the Italian AIDS mortality data shows that the number of AIDS cases reconstructed from this method is very close to the registered number of cases. Also, the two estimates of HIV incidence and prevalence obtained from back-calculation on both AIDS mortality data and the number of AIDS reported cases were very similar, although there was more variability in the estimates obtained from mortality data.     

实现资源整合 建立防治艾滋病的综合模式

<正> 今天,我们为了一个共同目标聚集在这里:寻求并推进一个遏止艾滋病并减少其危害的最佳方案。 20年过去了,艾滋病疫情扩散仍然在持续。已经有将近7 000万人受到感染,其中2 500万人死亡。     

农村校外青少年感染艾滋病脆弱性的现状分析

目的了解农村地区计划外出务工的校外青少年感染艾滋病脆弱性现状。方法利用匿名结构式问卷，对某县劳务输出机构2007年8月到12月期间所有计划外出务工的15～24岁未婚农村校外青少年1654人进行问卷调查。结果调查对象以初中毕业文化程度为主，平时活动52．1％（841／1615）选择去网吧，艾滋病知识知晓率为47．8％（707／1480），51．9％（697／1343）对感染艾滋病危险行为缺乏正确的认识，婚前性行为发生率10．6％（169／1599），其中多性伴发生率30．5％（51／167），最近一次安全套使用率38．5％（60／156），5．5％（89／1632）曾使用过毒品，心理健康水平低于常人。结论农村校外青少年是一个需要关注的人群，其感染艾滋病的脆弱性受到生理、心理和社会多种综合因素影响。     

HIV/AIDS治疗关爱综合管理模式探讨

目的 探讨并建立一种适合湖南省会城市HIV/AIDS人群的治疗关爱综合管理模式. 方法建立以定点治疗医院为中心的医疗服务网络,与各级综合医院、省市区CDC密切联系,及时将发现的HIV/AIDS人群纳入治疗关爱系统,为他们建档,定期追踪观察,提供与之相适应的抗病毒治疗及机会性感染的治疗,并提供心理支持以及服药依从性督导. 结果建立了由省市区各级综合医院、疾病控制中心、以及长沙市传染病医院共同参与的完善的医疗服务网络,组建了由疾病预防医师、临床治疗医师、护士、药师以及社区同伴教员一起工作的团队,为HIV/AIDS人群提供全方位的治疗关爱服务,极大地提高了HIV/AIDS人群的随访率及治疗可及性,OIs发生率下降20%左右;AIDS病死率降低到4.92%. 结论该模式的建立,充分、合理地利用了湖南省会长沙市丰富的医疗资源,在管理HIV传染源,延缓HIV/AIDS疾病的进程,降低相关疾病发生率、病死率,降低人均治疗费用,提高HIV/AIDS生活、生命质量以及阻断AIDS的迅速蔓延方面发挥了较好的作用.     

Older Adults' Perspectives on HIV/AIDS Prevention Strategies for Rural Kenya

HIV/AIDS is devastating sub-Saharan Africa with great impact in the rural communities. Though prevention is the mainstay of various responses to the epidemic, communication strategies used to influence risk perception and motivate behavior change are culturally inappropriate, hence the lack of success. The bulk of prevention efforts target the 15–49 age group, resulting in limited knowledge and understanding of HIV/AIDS in adults over age 50 who are considered at a lower or no risk of infection. This paper addresses older adults as a key segment of the population in HIV/AIDS prevention given the increasing number that is living with the disease or newly infected. Many older adults are also caregivers of those infected and affected by the disease. As cultural, social, political, and opinion leaders in rural Kenya, older adults are in a position to influence attitudes and behaviors of their community members, but they have not been involved in the current intervention strategies. Through application of a participatory and culture-centered approach, the study sought views of older adults on the factors contributing to the epidemic in rural Kenya and their opinions on effective prevention strategies that are culturally appropriate. Several recommendations are made for a culture-specific HIV/AIDS prevention intervention for rural Kenya.