中盖项目实施对天津地区艾滋病发现与管理的效果评估

目的评估比尔及梅琳达.盖茨基金会资助的艾滋病防治合作项目(简称"中盖项目")的实施,对天津地区艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人(简称HIV/AIDS病人)的发现与管理的效果。方法以天津市2008-2010年的中盖项目数据为基础,通过项目检测男男性行为人群(MSM)HIV/AIDS阳性、梅毒阳性的发现结果、项目实施地区HIV/AIDS病人随访率、CD4检测情况以及CD4细胞均值情况的比较,对项目实施对天津地区HIV/AIDS病人的发现与管理的效果进行评估。结果截至2010年底,中盖项目在MSM人群中累计发现233例HIV/AIDS病人,项目发现的HIV感染者,最高占当年全市发现的HIV感染者人数的30.7%。2009年中盖项目MSM人群中,新发现HIV阳性者的CD4检测率为75%,首次CD4检测均值为491.1个/μL,仅次于性病门诊就诊者;2010年中盖项目MSM人群中,新发现HIV阳性者的CD4检测率为96.84%,首次CD4检测均值为461.5个/μL,仅次于公安、司法、在押人员。结论中盖项目的实施,充分发挥了非政府组织的作用,促进了HIV/AIDS病人的早期发现与管理,对当地疾病控制工作产生了有益的影响。     

汉中市2002-2013年HIV/AIDS的流行特征

目的分析汉中市艾滋病(AIDS)的流行现状、特征和变化趋势,为制定预防与控制艾滋病防治策略措施提供科学依据。方法对2002-2013年汉中市艾滋病监测资料、艾滋病病毒(HIV)感染者/AIDS病人(简称HIV/AIDS病人)报告病例的流行病学资料进行统计分析。结果2002-2013年底,汉中市累计报告HIV/AIDS病例285例,其中非本市户籍51例,居住本市并进行医学随访管理的234例。另有外地反馈并转入该市的67例,故该市当地的病人共301例。其中HIV感染者186例,艾滋病病人115例。死亡49例。以性接触传播占97.7%;农民占55.2%,家政或无业者占11.3%;高危人群中以男男性行为人群(MSM)HIV抗体阳性检出率占4.2%,性病就诊者HIV抗体阳性检出率为0.4%。结论汉中市艾滋病疫情呈上升态势,经性途径传播比例逐年上升,存在向一般人群蔓延的趋势。应继续加强对MSM等艾滋病高危人群的综合干预,提高对HIV/AIDS阳性者的干预效果。     

HIV/AIDS病人生活质量评价及影响因素分析

目的评价艾滋病病毒感染者/艾滋病病人(HIV/AIDS病人)的生活质量,并探讨其影响因素。方法对在中国医科大学附属第一医院就诊的289名HIV/AIDS病人,用世界卫生组织生活质量简表(WHOQOL-BREF)进行生活质量评价,并与同期高危人群及健康人群进行对比,通过多元线性回归分析生活质量的相关影响因素。结果 HIV/AIDS病人生活质量的生理、心理、社会关系和环境四个维度的平均得分依次为44.5、58.1、62.6和57.7分。HIV/AIDS病人生活质量显著低于HIV阴性的高危人群以及健康人群(P<0.05)。多元线性回归分析显示,尚未接受抗病毒治疗者、男男性行为人群(MSM)、低收入、低文化程度、缺少家庭支持和食欲差,是HIV/AIDS病人较低生活质量的显著影响因素(P<0.05)。结论 HIV/AIDS病人生活质量较低,尤以MSM人群明显,高效抗病毒治疗可显著提高HIV/AIDS病人生活质量,同时应加强对低文化程度、低收入和缺少家庭支持的MSM人群的医疗和社会支持,提高其生活质量,降低死亡率。     

哈尔滨市HIV/AIDS病人抗病毒治疗服药依从性的相关研究

目的探讨哈尔滨市艾滋病病毒（HIV）感染者/艾滋病（AIDS）病人（HIV/AIDS病人）服药依从性现状以及相关的影响因素。方法横断面调查研究,采用人口学问卷、服药依从性量表、AIDS耻辱量表等收集信息,运用SPSS 13.0统计软件进行数据分析。结果共调查104名HIV/AIDS病人,在耻辱量表、症状量表、敌意心理趋势、经济费用担忧以及医生信任度方面的得分,分别为（33.83±3.98）分、（18.64±15.16）分、（83.57±19.65）分、（45.51±29.31）分及（73.20±23.78）分;病人在过去的7天内平均服药依从性为90.24%;41.35%的病人在过去1个月内曾发生过漏服药物;多因素Logistic回归分析显示,年龄、婚姻状况、感染途径、AIDS耻辱得分,以及经济费用担忧得分对服药依从性有影响（P〈0.05）。结论有近一半HIV/AIDS病人存在漏服药物的现象,必须采取综合性干预措施,提高HIV/AIDS病人的服药依从性。     

HIV/AIDS病人抗病毒治疗后精液的感染性及其影响因素

艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)精液中的病毒载量,是HIV传播的重要影响因素之一。有效抗反转录病毒治疗(ART)可使HIV/AIDS病人血液中的病毒载量达到检测不到水平,然而部分男性病人,尤其男男性行为者(MSM)HIV/AIDS病人精液中仍有较高浓度的HIV。研究表明,病人的高危性行为、性传播疾病、生殖道炎症、CD4+T淋巴细胞计数及巨细胞病毒复制等因素,可能会增加精液中的HIV载量,从而增加HIV的传播风险。因此,防治艾滋病要加强相关影响因素的控制,如改善MSM病人高危性行为,预防和治疗性传播感染及生殖道炎症,提高CD4+T淋巴细胞计数等。     

HIV/AIDS病人歧视知觉的研究进展

艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)不仅要承受躯体上的痛苦,还要承受艾滋病相关羞辱和歧视所带来的心理压力,同时,也影响了HIV感染者及高危人群自愿咨询与检测、获取卫生服务的意愿,降低了HIV/AIDS病人抗病毒治疗的依从性,也影响了艾滋病预防工作的开展。文章从艾滋病相关羞辱和歧视的概念、分类、评估方法、及其与心理健康的关系、目前的国内外研究现状,对HIV/AIDS病人歧视知觉的研究现状进行综述。     

广州市HIV感染者感知和内化耻辱的相关因素分析

目的探讨广州市艾滋病病毒(HIV)感染者的感知耻辱和内化耻辱的现况及其相关因素。方法以方便抽样的方法,于2013年3-6月对广州市第八人民医院的450名HIV感染者进行匿名问卷调查。应用14条目的耻辱感量表测量感知和内化耻辱水平,采用多重线性回归模型分析其相关因素。结果在412份(91.6%)有效问卷中,内化耻辱和感知耻辱的平均得分分别为(18.1±5.8)分和(16.4±4.6)分。多因素分析结果显示:心理弹性高(β=-0.257, P 0.001)、社会支持高(β=-0.023, P 0.05)、大专及以上学历者(β=-1.671, P 0.05)的内化耻辱较低;心理弹性高(β=-0.094, P 0.05)、已婚/再婚者(β=-1.072, P 0.05)的感知耻辱较低。结论广州市HIV感染者的感知和内化耻辱均呈中等水平。不同类型的耻辱感,其相关因素不同:心理弹性、社会支持及文化程度是内化耻辱的相关因素;心理弹性及婚姻状况是感知耻辱的相关因素。     

安徽农村地区某项目乡AIDS病人/HIV感染者社会支持状况评价

目的了解安徽农村地区艾滋病(AIDS)病人/艾滋病病毒(HIV)感染者社会支持状况。方法整群抽取安徽农村地区某项目乡AIDS病人/HIV感染者进行横断面研究,社会支持状况采用社会支持量表评定。结果219名AIDS病人/HIV感染者社会支持总分为32.50±7.13,主观支持为17.95±4.15,客观支持为8.90±3.02,支持利用度为5.65±2.42;家庭和政府在AIDS病人/HIV感染者的社会支持网络中起到了决定作用,家庭人口数多及子女孝顺的AIDS病人/HIV感染者社会支持评分较高。结论AIDS病人/HIV感染者社会支持网络建设应充分发挥政府和家庭的主导作用,同时进一步调动其他组织和人员参与其中。     

广西壮族自治区某城市社区艾滋病相关歧视现象分析

随着我国艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人数的上升,HIV感染者/AIDS病人在遭受社会甚至家人歧视的情况下,逆反和报复社会心理将成为向更多人传播艾滋病及造成蔓延的隐患.     

HIV/AIDS病人内在羞辱及其影响因素调查

目的了解艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的内在羞辱及其影响因素。方法采用Berger HIV羞辱量表,通过网络和现场调查两种方式对210例HIV/AIDS病人进行调查。结果210例HIV/AIDS病人平均年龄(36.40±10.83)岁;确诊时间平均为(3.41±3.58)年;教育程度以初中及以下为主;民族主要是汉族和彝族;性传播是主要感染途径;71.4%(150例)调查对象主动告知病情。HIV羞辱总分为(112.79±19.24)分。多元线性回归分析发现,民族、感染告知和性取向是HIV/AIDS病人内在羞辱的重要影响因素。结论 HIV/AIDS病人内在羞辱水平较高,民族、感染告知和性取向是内在羞辱的影响因素。调试民族文化、鼓励感染者告知病情和增加社会对性取向的包容等,可能有助于减轻HIV/AIDS病人的内在羞辱。     

HIV/AIDS stigma among a sample of primarily African-American and Latino men who have sex with men social media users

The recent increase in social media use allows these technologies to rapidly reach communities with higher HIV prevalence, such as African-American and Latino men who have sex with men (MSM). However, no studies have looked at HIV/AIDS stigma among social media users from African-American and Latino MSM communities, or the association between stigma and social media use among these groups. This study sought to assess the level of HIV/AIDS stigma among a sample of social media-using African-American and Latino MSM from Los Angeles. A total of 112 (primarily African-American and Latino, n?=?98, 88%) MSM Facebook users completed a survey on demographics, online social network use, and HIV/AIDS stigma. A composite stigma score was created by taking the cumulative score from a 15-item stigma questionnaire. Cumulative logistic models were used to assess the association between HIV/AIDS stigma and online social network use. In general, participants reported a low level of HIV/AIDS stigma (mean?=?22.2/75, SD?=?5.74). HIV/AIDS stigma composite score was significantly associated with increased time spent on online social networks each day (Adjusted odds ratios (AOR): 1.07, 95% CI: 1.00, 1.15). Among this diverse sample of MSM online social network users, findings suggest that HIV/AIDS stigma is associated with usage of social media. We discuss the implications of this work for future HIV prevention.     

Stigma and discrimination experiences of HIV-positive men who have sex with men in Cape Town, South Africa

Since the primary mode of HIV transmission in sub-Saharan Africa is heterosexual, research focusing on the sexual behaviour of men who have sex with men (MSM) is scant. Currently it is unknown how many people living with HIV in South Africa are MSM and there is even less known about the stigmatisation and discrimination of HIV-positive MSM. The current study examined the stigma and discrimination experiences of MSM living with HIV/AIDS in South Africa. Anonymous venue-based surveys were collected from 92 HIV-positive MSM and 330 HIV-positive men who only reported sex with women (MSW). Internalised stigma was high among all HIV-positive men who took part in the survey, with 56% of men reporting that they concealed their HIV status from others. HIV-positive MSM reported experiencing greater social isolation and discrimination resulting from being HIV-positive, including loss of housing or employment due to their HIV status, however these differences were not significant. Mental health interventions, as well as structural changes for protection against discrimination, are needed for HIV-positive South African MSM.     

Is HIV/AIDS stigma dividing the gay community? Perceptions of HIV-positive men who have sex with men.

Stigma surrounding HIV/AIDS has existed since the beginning of the epidemic, but little is known about HIV/AIDS stigma within the gay community and how it affects men who have sex with men (MSM) living with HIV. A better understanding of the effects of stigma on this population is needed to reduce it and its harmful effects. Our study used quantitative data from 206 HIV-positive MSM and qualitative data from 250 to document beliefs about HIV/AIDS stigma within the gay community and to measure its effects on sexual risk behaviors, substance use behaviors, serostatus disclosure, and mental health. Stigma was associated with increased levels of anxiety, loneliness, depressive symptoms, engaging in avoidant coping strategies, and history of suicidal ideation. HIV/AIDS stigma exists within the gay community and has a negative effect on the mental health of people living with HIV. HIV/AIDS stigma should be monitored closely so that we may better understand how to address it.     

医务人员对HIV/AIDS患者的羞辱与歧视认知现状及干预探讨

目的调查医务人员对艾滋病病毒(HIV)/艾滋病(AIDS)患者羞辱与歧视的认知现状,分析存在羞辱与歧视的原因,探讨如何减少和消除医务人员对HIV/AIDS患者羞辱与歧视的方法。方法通过个别访谈和小组访谈,了解医务人员对HIV/AIDS患者羞辱与歧视的具体表现。采用不记名问卷的方法对283名医务人员进行调查,进行AIDS的预防及治疗、职业防护和如何认识羞辱与歧视等内容的培训。通过前后问卷比较进行效果评价。结果受训者对AIDS相关知识、职业防护意识和能力、对羞辱与歧视的认知有明显提高,但行为态度改变不明显。结论在医务人员中对HIV/AIDS患者的羞辱与歧视广泛存在并被忽略。通过培训提高了医务人员对HIV/AIDS羞辱与歧视的认识及了解,教育培训是解决这一问题的可行的方法。     

Layered stigma among health-care and social service providers toward key affected populations in Jamaica and The Bahamas

While considerable research has documented stigma toward key populations affected by HIV and AIDS – men who have sex with men (MSM), sex workers (SWs) – it provided limited empirical evidence on the presence of layered stigma among health-care professionals providing services for these populations. C-Change conducted a survey among 332 staff of health-care and social service agencies in Jamaica and The Bahamas to understand the levels of stigma toward people living with HIV (PLHIV), including MSM and SWs and factors associated with stigma. While most health-care professionals responding to the survey said that PLHIV, MSM, and SWs deserved quality care, they expressed high levels of blame and negative judgments, especially toward MSM and SWs. Across a stigma assessment involving eight vignette characters, the highest levels of stigma were expressed toward PLHIV who were also MSM or SWs, followed by PLHIV, MSM, and SWs. Differences were assessed by gender, country, type of staff, type of agency, and exposure to relevant training. Findings indicate higher reported stigma among nonclinical vs. clinical staff, staff who worked in general vs. MSM/SW-friendly health facilities, and among untrained vs. training staff. This implies the need for targeted staff capacity strengthening as well as improved facility environments that are MSM/SW-friendly.     

Sexual Behavior as a Function of Stigma and Coping with Stigma Among People with HIV/AIDS in Rural New England

The relationship between coping with HIV/AIDS stigma and engaging in risky sexual behavior (i.e., inconsistent condom use) was examined in HIV-positive adults living in rural areas. Participants answered questions about their experiences with HIV/AIDS prejudice and discrimination (enacted stigma) and their perceptions of felt HIV/AIDS stigma (disclosure concerns, negative self-image, and concern with public attitudes). They were also asked about how they coped with HIV/AIDS stigma, and about their sexual activity during the past 90 days. We hypothesized that using disengagement coping to manage the stress of HIV/AIDS stigma would be related to risky sexual behavior. Multinomial logistic regression results showed that using disengagement coping (avoidance, denial, and wishful thinking) coupled with high levels of enacted stigma was associated with less risky rather than more risky sexual behavior. That is, disengagement coping coupled with high stigma increased the odds of not having vaginal or anal sex versus inconsistently using condoms. Implications for people with HIV/AIDS who use disengagement coping to manage stress to deal with HIV/AIDS stigma are discussed.     

Measures of Condom and Safer Sex Social Norms and Stigma Towards HIV/AIDS Among Beijing MSM

Social norms around condom use and safe sex as well as HIV/AIDS stigma are used to identify persons at higher risk for HIV. These measures have been developed and tested in a variety of settings and populations. While efforts have been undertaken to develop context specific measures of these domains among Chinese MSM, the feasibility of using existing measures is unknown. A survey of MSM, based on respondent-driven sampling, was conducted in Beijing. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma were piloted. Internal consistency of all measures was high. As expected higher levels of condom social norms and positive attitudes towards safer sex were associated with condom use. HIV/AIDS stigma and discrimination had a significant relationship with never having an HIV test and lack of discussion of HIV/AIDS with male partners. Correlates of low condom social norms were age, education, employment and resident status. Existing measures of condom social norms, attitudes towards safer sex and HIV/AIDS stigma appear to be appropriate for use among Chinese MSM. Using existing measures as opposed to developing new measures has the potential to expedite investigations into psychosocial correlates of HIV risk behavior.     

HIV感染者/AIDS病人生活质量及其影响因素研究

目的 了解艾滋病病毒（HIV）感染者／艾滋病（AIDS）病人的生活质量及其影响因素。方法 采用世界卫生组织生活质量简表中文版测量其生活质量，对215名HIV感染者／AIDS病人进行匿名问卷调查。结果 HIV感染者／AIDS病人生活质量四个维度的平均得分为50．74（生理领域）、46．01（心理领域）、53．78（社会关系领域）和43．94（环境领域）。单因素分析显示，性别、文化程度、收入、居住地、病情、感染途径、医疗费用占家庭收入比例、艾滋病知识水平和耻辱等因素与HIV感染者／AIDS病人的生活质量各个领域有关（P＜0．05）。多元线性回归分析结果表明，工作、收入和艾滋病相关知识水平是影响生活质量的有利因素，而感受到的耻辱和医疗费用占家庭收入比例则是不利影响因素（P＜0．05）。结论 社会经济等因素在不同方面影响着HIV感染者／AIDS病人的生活质量。     

Men Who have Sex with Men: Racial/Ethnic Disparities in Estimated HIV/AIDS Prevalence at the State and County Level, Florida

Population-based HIV/AIDS prevalence estimates among men who have sex with men (MSM) have been unavailable, but have implications for effective prevention efforts. Prevalent (living) Florida HIV/AIDS cases reported through 2006 (numerators) were stratified by race/ethnicity and HIV exposure category. Based on previous research, MSM populations were posited as 4–10% of all males aged ≥13 years in each subgroup (denominators). At the estimated lower and upper plausible bounds, respectively, HIV/AIDS prevalence per 100,000 MSM was significantly higher among black (8,292.6–20,731.4); Hispanic (5,599.5–13,998.7); and Asian/Pacific Islander, American Indian or multi-racial (4,942.6–12,356.8) MSM than among white MSM (3,444.9–8,612.3). HIV/AIDS prevalence among all MSM was 13.8–36.9 times that among all other males. Across 19 high-morbidity counties, MSM HIV/AIDS prevalence was highest among those in the most populous counties and highest among blacks. This methodology, adaptable by other states, facilitates calculation of plausible MSM HIV/AIDS prevalence to guide HIV prevention/care community planners and MSM.     

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.