艾滋病对中国儿童影响的研究

目的了解和认识艾滋病对中国儿童的影响。方法利用方差分析等方法,提出一个多层次的分析框架,设计以儿童成长为核心的家庭调查表及儿童访谈提纲,并进行实地调查。结果受艾滋病影响儿童的家庭人均生产收入减少;救助活动对改善艾滋病孤儿家庭的经济状况起到了一定的作用;父母存活的受艾滋病影响儿童的缺课率最高;受艾滋病影响儿童感受到心理压力和忧伤。结论艾滋病对儿童的影响主要反映在儿童的生活环境、生存状况和身心健康三个层面。在这三个层面,受艾滋病影响儿童与非艾滋病家庭的儿童存在明显的差异。     

Problems with HIV/AIDS prevention,care and treatment in Togo,West Africa: professional caregivers' perspectives

This paper used accounts of professional caregivers to HIV/AIDS patients in Lomé, Togo, West Africa to explore the impacts of cultural, institutional and socio-economic factors in the fight against HIV/AIDS. Thirteen health professionals and 17 non-health professionals who work with people living with HIV/AIDS were interviewed in June and July 2002 in Lomé, Togo. The study found that, in Togo there are some cultural, socio-economic and institutional practices that put Togolese at risk of contracting HIV and complicate the care of those who become infected. People with HIV/AIDS face socio-economic, emotional and psychological battles as they attempt to deal with their physical health and the social reactions to such a stigmatizing disease. Thus, in order to contain the spread of HIV/AIDS, people living with HIV/AIDS, family caregivers, traditional healers as well as the public must be educated about the importance of preventing the disease and how each group can help achieve success in its control. Interventions in prevention and care should be designed with an awareness of these structural factors that contribute to the spread of AIDS and compromise the quality of care given to those who become infected.     

HIV/AIDS in Nigeria: a bibliometric analysis

Background  

Nigeria is home to more people living with HIV than any other country in the world, except South Africa and India-where an estimated 2.9 million [1.7 million – 4.2 million] people were living with the virus in 2005. A systematic assessment of recent HIV/AIDS research output from Nigeria is not available. Without objective information about the current deficiencies and strengths in the HIV research output from Nigeria, it is difficult to plan substantial improvements in HIV/AIDS research that could enhance population health. The aim of this study was to analyse the trends in Nigeria's SCI publications in HIV/AIDS from 1980 to 2006. Special attention was paid to internationally collaborated works that were identified based on the countries of the authors' affiliation.     

Home-based care for orphaned children infected with HIV/AIDS in Uganda

The primary aim of this paper is to describe an outreach programme from a main state hospital in sub-Saharan Africa, which has been running for three years. This programme is based in Mulago Hospital, Kampala, Uganda and cares for up to 200 children infected with HIV/AIDS in their home. We describe the clinic and how we meet the families and enrol them, the infrastructure of the programme and the personnel involved. Children and their families receive physical, psychological and social care and we describe each aspect of this. The knowledge base about older children with AIDS in Africa is scarce and the secondary aim of this paper is to publish observations that were made while providing care. This includes demographics and the health problems encountered among children living with HIV/AIDS in a resource-poor setting who do not receive antiretroviral medication. Finally, we discuss the strengths and weaknesses of this model of care and the prerequisites to setting up a similar model.     

The Plight of Older Persons as Caregivers to People Infected/Affected by HIV/AIDS: Evidence from Uganda

This paper describes the challenges faced by elderly persons (50 years and above) in Uganda, as parents and/or relatives of persons infected by HIV and as caregivers of the infected relatives and their uninfected children. Little is known regarding these indirect impacts of HIV/AIDS on the elderly in sub-Saharan Africa. Yet, the elderly are most often the main caregivers of HIV-infected persons and their families. Data used in this study were obtained from focus group discussions and in-depth interviews conducted among elderly respondents in 10 rural and urban communities within two Ugandan districts, Luwero and Kamuli. Findings indicate that the elderly do provide care to patients with AIDS at the terminal stage of the illness-when patients most need constant care. In most cases, the challenge of caring for the sick patients is compounded by the responsibility to care for the children affected by HIV/AIDS, which also starts when their parents are still living, not when the children become orphans. This demanding work was reported to negatively affect the elderly in various dimensions (economic, emotional, physical, and nutritional), all of which impacts their health and well-being. The responsibility for day-to-day patient care is borne primarily by elderly females, who reported a higher rate of physical ailments than male respondents-perhaps an indication of their disproportionate contribution to the care responsibilities. Most of the elderly respondents interviewed have a lot of anxiety about their future health and well-being, which they attributed in most part to the HIV/AIDS epidemic. These challenges do appear to exacerbate the aging process of the elderly whose health and well-being are already affected by the poor resource base and weak health infrastructure in this setting.     

Young Malawians on the interaction between mental health and HIV/AIDS

Previous research has identified high levels of mental health problems among people affected by HIV. This study surveys specifically adolescents in southern Malawi on their experience of the impacts of living with HIV or AIDS on one's mental health. At the same time, the study explores the link between mental health problems and subsequent HIV-risk behaviour. Short texts relating everyday scenarios that depicted symptoms of three mental health problems (i.e.depression, anxiety and HIV-related brain impairment) formed the basis of in-depth discussions in 12 existing groups of secondary school students, orphans and vulnerable children, teenage mothers, and out-of-school youths, in both rural and urban settings. The responses show that these young people recognised the mental health sequelae of HIV/AIDS as impacting upon many aspects of one's life. The young people traced these 'interruptions' and 'disruptions' through deteriorating psychological and socio-economic conditions. They showed awareness of a two-way interaction between HIV/AIDS and mental illness, indicating that the latter can increase thoughts of suicide and HIV risk-taking behaviour. More importantly, they identified a number of locally derived community interventions, which if supported by statutory health and education services, can significantly ameliorate their situations. The findings provide avenues for practical integration of mental health provision within HIV prevention, education and care initiatives.     

Understanding Family Support for People Living with HIV/AIDS in Yunnan, China

This study examines how family support affects people living with HIV/AIDS (PLHA) in China. In-depth, semi-structured interviews (n=30) were conducted with people living with HIV/AIDS who were infected through different routes (e.g., intravenous drug use, sex) and of different age groups. Findings showed that all of the participants were in great need of help and the primary source of support came from their families. Family support included financial assistance, support in the disclosure process, daily routine activities, medical assistance, or psychological support. This study illustrates that the support provided by family makes multiple levels of positive impact on people living with HIV/AIDS, suggesting the importance of including families in HIV/AIDS interventions.     

Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania

Young people in sub-Saharan Africa constitute an important group for HIV prevention efforts. Determining their exposure to HIV/AIDS information and communication and their perceived credibility of information sources is imperative to the development of interventions. However, the majority of studies on this topic have been conducted among school-based populations, with few focused on those out of school or on comparing the two groups. A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1 007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/ AIDS information and they communicated more frequently about the topic than did the out-of-school group. Among both groups, exposure to HIV/AIDS information occurred more frequently than discussing the topic. The in-school group gave high credibility ratings to medical doctors, the radio and parents as sources of information, while the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents and doctors as preferred communicators of sexual and reproductive health information. Interventions that address the determinants of educational attainment are needed, as well as ones specifically intended to reach girls or those out of school. The preferences and credibility rankings for sources of HIV/AIDS information suggest the need for evidence-based programmes that utilise peers and promote the involvement of parents or doctors. Particularly needed are interventions that explicitly aim to stimulate discussion among young people about HIV/AIDS and that foster the development of interpersonal skills.     

Recognizing HIV/AIDS volunteers' stressors and desire for support

Little research has focused on experiences of volunteers for people living with HIV/AIDS but other research on caregivers for this population illustrates the stress often experienced. This study identifies stressors experienced by volunteers for people with HIV/AIDS, and determines the types of social support needed to help volunteers cope with the stressors identified. Six volunteers were interviewed at a small non-profit organization in Appalachia providing such services. Participants indicated that providing services for people with HIV/AIDS is a rewarding experience; however, stress and frustration played a large role in their experiences with the organization. Further, the results of this study indicate that emotional and informational social support may help volunteers cope with stressors associated with providing services for people with HIV/AIDS.     

Islamic perspectives on HIV/AIDS and antiretroviral treatment: the case of Nigeria

Some religious reactions to the HIV epidemic in Africa unwittingly contributed to the expansion of the epidemic in its early years. This was because many religious people regarded the emergence of HIV and AIDS as divine punishment for man's sins as a result of people's sexual promiscuity. Some also opposed public promotion of the use of condoms for HIV prevention. However, religious bodies have made positive contributions to HIV/AIDS responses in many African countries in recent times. Though Christian bodies are taking the lead in faith-based responses to HIV and AIDS in Africa, Islamic bodies have also been major partners in HIV/AIDS interventions in several countries. Against this background, this article examines some Islamic perceptions of HIV and AIDS, and especially the impact of antiretroviral treatment (ART) for people living with HIV in Africa, with particular emphasis on Nigeria. In spite of the emergence of antiretroviral (ARV) drugs in Africa, Islam still emphasises the prevention of new infections and care for people living with HIV or AIDS. The article discusses basic issues associated with ARVs, such as health, sickness, life-prolongation and death, from an Islamic viewpoint, as well as some Islamic measures to prevent HIV-risk-taking behaviours in an era of ARVs. It also looks at the nature and extent of Islamic involvement in the national HIV/AIDS response in Nigeria. The paper concludes that while Islam sees HIV and AIDS and other diseases as ‘tests’ from Allah, the religion is not opposed to ART. Thus, efforts need to be intensified by Islamic bodies and Muslim leaders in Nigeria for an improved response to HIV and AIDS in the country.     

中国18省市城市高中生预防艾滋病知识和态度分析

目的了解中国城市高中生预防艾滋病知识、态度情况,为进一步制定高中生艾滋病预防教育提供依据。方法按照分层整群抽样方法,抽取全国18个省(自治区、直辖市,下同)的109 754名城市高中生进行《中国青少年健康危险行为》问卷调查,问卷采取无记名自填方式。结果 109 754名城市高中生中,55.3%的学生曾从学校接受过艾滋病教育,79.0%的学生"知道艾滋病病原体",68.6%的学生"不同意将感染艾滋病的同学隔离",66.0%的学生表示"会像以前那样和感染艾滋病的朋友继续来往"。各省之间艾滋病预防教育差异较大,职业高中学生在学校接受艾滋病教育和反歧视态度的报告率,均低于重点高中和普通高中的学生(P<0.01);社会经济水平好的地区反歧视态度较高(P<0.01)。结论我国学校预防艾滋病教育资源分布不均衡,北方地区学校开展预防艾滋病知识教育的覆盖率还不够,还应加强对职业高中学生艾滋病的宣传和健康教育力度。     

安徽省临泉县艾滋病社区关爱体系调查研究

目的了解皖北农村地区艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人及其亲属的生活质量和社会支持现状,分析其相关的影响因素。同时了解当地各阶层健康居民关于艾滋病的相关知识、态度、行为(KAP)。方法通过典型抽样法对85名HIV感染者和病人及65名HIV感染者和病人家属进行调查,经分层抽样方法对519名社会各阶层健康居民进行调查。结果不同性别、不同文化程度的HIV感染者和病人及其家属生活质量评分差异有显著的统计学意义(P<0.05);不同乡镇的HIV感染者和病人社会支持评分差异有显著的统计学意义(P<0.05)。负性生活事件是影响HIV感染者和病人及其家属社会支持的不利因素,而好的邻里关系、烦恼诉说是影响HIV感染者和病人生活质量的有利因素。KAP调查中,有76.3%的人没有帮助过艾滋病患者,11.3%的人不愿意长期援助艾滋病患者,42.4%的人则看情况。结论诸多因素在不同层面影响皖北农村地区HIV感染者和病人及其亲属的生活质量和社会支持,我国农村现有的艾滋病社区关爱、社会支持工作还亟需加大力度。     

丰台区流动人口学生家长艾滋病健康教育实践及效果评价

目的了解流动人口学生家长艾滋病相关知识,以及对艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人的态度,探索和评估流动人口家庭内的艾滋病健康教育模式对家长的影响。方法选取丰台区流动人口较为集中的7所中学,通过健康教育课对初中学生开展艾滋病防控健康教育后,学生将艾滋病知识宣传资料带回家中让家长学习。采用自行设计的调查问卷,在开展艾滋病健康教育前,从每所学校初中一、二年级各随机整群抽取1～2个班级的家长进行问卷调查,第2学期再次以相同的方式进行家长调查。结果健康教育前后分别对754名和756名学生家长进行了问卷调查。干预后学生家长的艾滋病知识知晓率从52.5%提高到88.1%（χ2=228.96,P〈0.01）,对艾滋病感染者的歧视率从71.2%降低到59.5%（χ2=19.34,P〈0.01）。结论学校主导、中学生与家长学习的方式进行艾滋病健康教育具有有效性和可行性,一定程度上提高了流动人口学生家长的艾滋病知识知晓率,降低了对HIV感染者的歧视。     

HIV传播动力学模型的研究

目的 用数学模型来预测中国近几年艾滋病病毒感染伎滋病(HIV／AIDS)的流行情况。方法 用离散型HIV传播动力学的基本模型和分阶段模型进行了分析。结果 给出了基本模型和对HIV感染者进行分阶段的模型，确定了一些有关参数，并用：Matlab软件对未来几年HIV感染者和AIDS患者人数进行了预测。结论 未来几年内中国的HIV感染者和AIDS患者人数将会继续增加。从两种模型可以看出：如果对AIDS不加有力的控制，到2010年中国的HIV感染者人数将达到1000万人左右，AIDS患者人数约达到65万人左右。因此，预防和控制AIDS的发生及对其流行动态的研究已是一件非常紧迫的任务。     

Factors associated with disclosure of diagnosis to children with HIV/AIDS

Disclosure of the diagnosis of human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) to a child is a controversial and emotionally laden issue. To understand the factors that affect the process of disclosure and its consequences, we studied 99 parent-child dyads recruited from patients being treated at the National Cancer Institute (NCI). Parents and HIV-infected children were interviewed and administered several standardized measures. Parental depression, family environment, social support satisfaction, socioeconomic status, child and parent gender, child's age, parental HIV serostatus, and disease severity were used to predict disclosure status. Results indicate that the majority of caregivers do disclose the diagnosis to the child, usually with no ill effects, and that age is the most significant predictor of whether or not a child has been told. The Centers for Disease Control and Prevention currently estimate that there are over 6611 children with AIDS (under age 13), and 2184 adolescents with AIDS (ages 13-19) in America. As an increasing number of children who are born infected with HIV live to older ages, the question of when and how to talk with them about their illness becomes more crucial. In addition to the growing number of children infected with HIV, there are many thousands of children profoundly affected by the impact of this disease on a close family member--a mother, father, sibling, or other relative in the kinship network. Yet, the initial reaction most adults have upon learning of their own, or of a family member's, HIV diagnosis is that the diagnosis must be kept a closely guarded secret. One reason frequently cited by parents and family members is their fear that the stigma of AIDS will have a negative impact on their children and their families. Disclosure of an HIV diagnosis to a child is a controversial and emotionally laden issue in the pediatric health-care community as well. However, no systematic research has studied the issues that surround disclosure of an HIV diagnosis to the patient and the factors that predict disclosure.     

Experiences of stigma in older adults living with HIV/AIDS: a mixed-methods analysis

Older adults are increasingly becoming impacted by HIV disease, both as newly infected individuals and as long-term survivors of HIV/AIDS living into older age. HIV-related stigma impacts the quality of life of all persons with HIV/AIDS. However, little is know about HIV-related stigma in older adults because many studies do not include older subjects or ignore age as a variable. This mixed methods study examined the experiences of HIV-related stigma in a sample of 25 older adults with HIV/AIDS from the Pacific Northwest. Quantitative methods measured HIV-stigma and depression, while in-depth qualitative interviews captured the lived experiences of these individuals. Stigma was positively and significantly correlated with depression (r = 0.627, p = 0.001) and stigma was found to be significantly higher in African American, as compared to white informants (chi (2) = 4.16, p = 0.041). Qualitative interviews yielded 11 themes that correspond to the four categories constructed in the stigma instrument. Rejection, disclosure concerns, stereotyping, protective silence and feeling "other" were all common experiences of these individuals. HIV stigma should be routinely assessed when working with older, HIV infected clients and interventions should be tailored to the individual experiences of stigma.     

HIV/AIDS and older adults in Cameroon: Emerging issues and implications for caregiving and policy-making

The burden of human immunodeficiency virus (HIV) infection and acquired immune deficiency syndrome (AIDS) on the elderly population in three divisions within the Northwest Region of Cameroon was examined. Data for this paper were extracted from a larger study which had been conducted concerning the burden of HIV infection and AIDS on the older adults in the Northwest Region of Cameroon. Using in-depth interviews (IDIs) and focus group discussions (FGDs), data were collected from 36 participants who were purposively selected from the three divisions which had been chosen randomly. 6 FGD sessions were held with 30 women aged 60 years and above and who were affected by HIV infection and AIDS, while IDIs sessions were held with 6 male community leaders. The results revealed that HIV infection and AIDS has added another dimension to the role of older persons. HIV infection and AIDS affects older people in diverse ways, as they have to look after themselves, their sick children and are often also left to look after their grandchildren orphaned by HIV infection and AIDS. These emerging issues in their lives make them vulnerable to health, social, economic and psychological challenges, and place a burden on them as caregivers instead of being cared for in their old age. Apart from increased direct expenditures, taking care of victims of HIV infection and AIDS requires older people to stay away from social, religious and community activities. The results showed that the loss of a child to HIV infection and AIDS affects the economic/financial well-being, participation in social/religious interactions as well as the community activities of older people participants. The implications of these findings for caregiving and social policy are discussed.     

Discourses of childhood innocence in primary school HIV/AIDS education in South Africa

This article draws from interview data to examine the meanings that teachers in two race and class-specific contexts in greater Durban, South Africa, may give to children's right to sexual health information as a part of HIV/AIDS education. The article focuses on the regulation and production of childhood innocence by means of the ways the primary school teachers talked about sex in their HIV/AIDS education lessons to grade-four students. I argue that discourses of childhood innocence regulate and limit the possibilities of conversing about sex in such a context. The dominant discourses construct children as 'too young to know' and displace children's right to sexual health information to older children, while stressing anxieties about parent hostility to sex education, which precludes effective coverage of sexual topics in HIV/AIDS education. Showing how race, class and culture are deployed in upholding innocence, I contend that the notion of childhood innocence is embedded within the varying social contexts that make up the South African landscape. But, I suggest that an assumption that primary school teachers will engage with HIV/AIDS education while mediating information about sex in health promotion is simplistic. In conclusion, I propose a need for ongoing theoretical and practical work with teachers and the need to build alliances with parents.     

HIV/AIDS knowledge and stigma among women of reproductive age in Ethiopia

HIV/AIDS stigma is one of the major public health challenges in Ethiopia. This study examined knowledge about HIV/AIDS and factors behind stigmatisation towards people living with the virus based on demographic and health survey data collected in 2011 from women in the age group 15–49 years. The result shows that 49.3% of rural women had adequate knowledge about HIV/AIDS compared with 74.7% of urban women. About three-fourths (72.1%) of the rural women had stigmatising attitudes towards PLWHA whilst the proportion in urban areas was only about a third (34.2%). The likelihood of having adequate knowledge about HIV/AIDS was significantly higher among educated women but lower among those living in Afar, Somali, and Gambella regions and Dire Dawa City. Women with higher levels of education and frequent access to media had a lower tendency to stigmatise people living with the virus. Adequate knowledge about HIV/AIDS was also significantly associated with lower likelihood of stigmatisation. The results generally indicate that HIV/AIDS stigma in Ethiopia is partly explained by people's knowledge about HIV/AIDS and by socio-cultural factors that shape their perception of the epidemic. Awareness-raising efforts should thus consider the socio-cultural contexts in which stigma occurs to tackle discrimination against people living with HIV/AIDS.     

The Impact of a Community-based Pilot Health Education Intervention for Older People as Caregivers of Orphaned and Sick Children as a Result of HIV and AIDS in South Africa

The increasing HIV and AIDS epidemic in South Africa poses a substantial burden to older people, in particular older women who mainly provide care for sick adult children and their grandchildren who have become orphaned and rendered vulnerable by the death or illness of their parents. In this study, 202 isiXhosa speaking older caregivers from Motherwell in the Eastern Cape Province of South Africa were trained to provide care for grandchildren and adult children living with HIV or AIDS. Based on a community needs assessment, a health education intervention comprising four modules was designed to improve skills and knowledge which would be used to assist older people in their care-giving tasks. Some topics were HIV and AIDS knowledge, effective intergenerational communication, providing home-based basic nursing care, accessing social services and grants, and relaxation techniques. Structured one-on-one interviews measured differences between pre-intervention and post-intervention scores among those who attended all four modules vs. those that missed one or more of the sessions. The results demonstrated that older people who participated in all four workshops perceived themselves more able and in control to provide nursing care. The participants also showed a more positive attitude towards people living with HIV or AIDS and reported an increased level of HIV and AIDS knowledge. The results provided valuable information upon which the development of future interventions may be based and psychosocial and structural needs of the older caregivers may be addressed by relevant stakeholders.