'I believe that the staff have reduced their closeness to patients': an exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda

Background  

Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff.     

Students and their parental attitudes toward the education of children affected by HIV/AIDS: a cross‐sectional study in AIDS prevalent rural areas,China

Objective : To investigate the prevalence and determinants of student and parental attitudes toward the education of children affected by HIV/AIDS in areas of rural China where AIDS is prevalent. Methods : A cross‐sectional study of a random sample of students (n=732) and their parents (n=732) conducted in April 2010, using a questionnaire and in‐depth interview. Results : Twenty‐six per cent of students and 29% of parents had a ‘good’ attitude toward the education of children affected by HIV/AIDS. Following adjustment for sociodemographic characteristics, students’ attitudes were significantly associated with knowledge of HIV/AIDS non‐transmission (adjusted odds ratio [aOR]= 3.13) and their parents’ attitudes (aOR= 2.38), but not with knowledge of HIV/AIDS transmission, prevention or their parents’ knowledge. Parents’ attitudes were significantly associated with knowledge of HIV/AIDS non‐transmission (aOR= 2.12) and their children's attitudes (aOR= 2.52), but not with knowledge of HIV/AIDS transmission, prevention or their children's knowledge. Conclusion : Stigma and discrimination undermine the right to education of HIV/AIDS‐affected children in rural China. Improving non‐transmission knowledge may improve caring attitudes. Implications : HIV/AIDS public health educational campaigns highlighting non‐transmission and extending family education, combined with school education, may help to enhance an environment of non‐discrimination and safeguard public support programs for the right to education of children affected by HIV/AIDS.     

河南省农村地区HIV/AIDS卫生服务利用现状调查

[目的]利用2004年和2009年对河南省农村地区HIV/AIDS的基线调查数据,分析艾滋病防治政策实施后卫生服务利用的改善情况,为政策改进提供感染者数据支持。[方法]通过问卷调查收集HIV感染者、AIDS患者以及对照人群对各级医疗机构的门诊和住院服务利用情况。[结果]调查前三个月内,AIDS患者、HIV感染者和对照组门诊平均就诊次数分别为33.55次、24.55次和10.28次,平均住院次数分别为0.43次、0.37次和0.26次,前两组均高于后者;HIV/AIDS对各级医疗机构的满意度均高于健康对照者（t=3.046,P〈0.05）。[结论]与2004年调查结果相比,HIV/AIDS对各级医疗卫生机构利用率呈明显上升趋势,且集中在村卫生室和乡镇卫生院就诊和住院。建议加强基层医疗卫生机构卫生服务能力建设,以保证农村为基础的艾滋病医疗救治体系可持续发展。     

河南省艾滋病高发区村卫生室卫生服务能力状况分析

目的通过对艾滋病高发区重点建设的村卫生室卫生服务能力现状调查，探讨村卫生室在艾滋病防治中的作用。方法采用多阶段随机整群抽样方式抽取艾滋病高发区的15个村卫生室，对村卫生室基本情况、接受上级资助、指导情况、卫生服务提供情况等进行调查。结果在所调查的15个村卫生室中，卫生院设点村卫生室占66．67％，个体办村卫生室占20％；村卫生室开展艾滋病健康教育、预防、咨询、治疗和护理工作的比例分别为93．33％、86．67％、93．33％、100．00％、93．33％；村卫生室所治疗的病人中艾滋病人占87．36％，卫生院设点的村卫生室所占94．66％；仅卫生院设点村卫生室接受了艾滋病防治专项经费；村卫生室均接受到了价值不等的艾滋病防治药物，其中，卫生院设点村卫生室平均接受艾滋病防治药物价值最高，为40311元，个体办最低，为3500元；每个村卫生室年平均接受HIV／AIDS防治相关技术指导17．40次，累计接受到的培训平均为2．11次，平均累计收到HIV／AIDS防治工作相关文件24．13件次；所有村卫生室均和上级医院建立艾滋病病人的双向转诊制度；艾滋病病人总建档率达到88．97％，获得抗病毒治疗率达到79．18％，艾滋病病人被定期随访率达到100．00％。结论艾滋病高发区村卫生室建设一般状况良好；艾滋病高发区重点建设的村卫生室主要承担艾滋病防治工作；农村艾滋病高发区村卫生室卫生服务量较高，尤其艾滋病卫生服务量较高，表明艾滋病患者基本的卫生服务得以满足，充分发挥了重点村卫生室的作用。可根据承担的防治工作等内容加强和调整对重点村卫生室的支持力度。     

Variations in Rural AIDS Epidemiology and Service Delivery Models in the United States

This article reviews AIDS surveillance data and the rural health literature to summarize what is known about the rural AIDS epidemic, characteristics of rural environments that affect HIV service delivery, and approaches that rural areas are using to address the health and support service needs of HIV-positive residents. During 1999, nonmetropolitan (non-MSA) adult/adolescent AIDS rates were highest in the South (11 per 100,000) and Northeast (9 per 100,000). The South had the highest non-MSA proportion of adult/adolescent AIDS cases (12%), followed by the North Central region (9%), the West (4%), and the Northeast (3%). Variations in rural HIV/AIDS epidemiologic patterns and the demographic, socio-economic, and cultural characteristics of rural environments are likely to require different levels of resource investment and different methods of organizing and delivering HIV services. Currently, many HIV-positive rural residents are traveling to metropolitan areas for medical care because of concerns about confidentiality or a lack of confidence in the HIV management capabilities of local physicians. Rural communities are attempting to address these problems by developing the HIV care capacity of existing clinics, building local networks of physicians with HIV management experience, and cultivating "shared care" arrangements with urban-based specialists.     

Psychosocial Differences Between Whites and African Americans Living With HIV/AIDS in Rural Areas of 13 US States

CONTEXT: Acquired immunodeficiency syndrome (AIDS) prevalence rates are increasing rapidly in rural areas of the United States. As rural African Americans are increasingly affected by human immunodeficiency virus (HIV), it is important to identify psychosocial factors unique to this group so that AIDS mental health interventions can be culturally contextualized to meet their unique needs. PURPOSE: The current study characterized psychosocial functioning in 43 rural African Americans living with HIV/AIDS and compared their levels of functioning to those of 196 HIV-infected rural white persons. METHODS: All participants were recruited through AIDS service organizations in 13 US states. Surveys were completed as part of a preintervention phase of a randomized clinical trial evaluating 2 mental health interventions for HIV-infected rural persons. FINDINGS: Compared to their white counterparts, fewer African Americans had progressed to AIDS. African American participants also reported higher levels of coping self-efficacy, more support from family members, and marginally fewer depressive symptoms, and they engaged in more active coping. African Americans who had greater HIV disease severity also received less support from family members and experienced more loneliness. CONCLUSIONS: Study findings caution that rural African Americans and whites living with HIV disease should not be considered a homogeneous group.     

Exploring China's rural health crisis: processes and policy implications

China today is experiencing a rural health crisis, one that has uncomfortable echoes of the past. Within China's 'second society' of the peasantry, a resurgence of historical health problems (including vulnerability of the rural poor to epidemics such as schistosomiasis and tuberculosis and high rates of infant and maternal mortality) merge with contemporary concerns over HIV/AIDS, respiratory problems and the threat of Avian Flu to seriously threaten the health and welfare of people in rural areas. This review illustrates and explores the roots of this crisis in terms of key processes of social and environmental change and state health care policy. We argue that this crisis can only be resolved via a fundamental rethink of health provision across China, one that focuses especially on the poorest, most remote parts of the nation (both spatially and socially), and in which the privatisation of health care is more evenly balanced by increased state investment in basic health provision.     

Public honour,private shame and HIV: issues affecting sexual health service delivery in London's South Asian communities

Within a wider discussion of health service provision for black and minority ethnic (BME) groups, this paper considers how socio-cultural factors affect the provision of HIV and sexual health services to South Asians in London. It argues that communally held concepts of honour and shame within South Asian communities create a framework of social control with significant implications for HIV/AIDS transmission. It examines the provision of culturally sensitive services to BME communities by ethnically specific and generic service providers through a case study of the Naz Project London. Finally, it proposes an agenda for future research into BME sexual health service provision.     

布拖县艾滋病关怀多渠道筹资探索

目的：探索政府与社会共同筹集资金解决农村艾滋病感染者／患者医疗费用问题的关怀道路。方法：通过在项目县布拖建立新型农村合作医疗试点的过程中把艾滋病覆盖在其中，以及在新型农村合作医疗之外建立覆盖艾滋病的医疗救助。结果：布拖县农村艾滋病感染者／患者卫生服务利用与需求，及医药费用支出均高于一般居民，二者两周患病率差异有统计学意义（P〈0．01），二者两周就诊率差异有统计学意义（P〈0．01）。将艾滋病感染者／患者纳入新型农村合作医疗不会对一般农民参合意愿和个人筹资水平造成负面影响。结论：可利用新型农村合作医疗以及医疗救助机制为布拖县解决艾滋病感染者／患者治疗关怀筹资问题。     

HIV/AIDS. Some organizational and managerial issues

Discusses factors emerging from research into the management and organizational processes involved in developing services for HIV/AIDS which affected the speed and character of the response made by health authorities. An early response was promoted by perceived high local prevalence, an existing service infrastructure, and high status individuals "championing" the issue and helping to foster a mobilizing sense of crisis. Responses were shaped by the diverse interests and perspectives of those developing services; the lack of established guidelines for treatment and service delivery; and ring-fenced funding. The idiosyncratic nature of initial service development has sometimes made later strategic choices difficult. Argues that if the momentum of service development is to be sustained, HIV/AIDS needs to be integrated into mainstream service provision and managers need improved information about local prevalence and the evaluation of service initiatives.     

宝鸡市城乡居民艾滋病知晓率及态度调查分析

目的 了解宝鸡市城乡居民艾滋病知晓情况和态度,为有针对性地开展全市艾滋病健康教育工作提供科学依据.方法 采用整群随机抽样的方法,2013年调查全市城乡居民2 719人,其中学生1 142人,城镇居民647人,农村居民450人,农民工480人.结果 学生、城镇居民、农村居民和农民工艾滋病知识知晓率分别为82.36％、82.30％、81.16％和77.04％,各类人群知晓率之间差异存在统计学意义（P＜0.05）.城乡居民对待艾滋病感染者6个问题的正向态度持有率各类人群间差异存在统计学意义（P＜0.05）.结论 城乡居民艾滋病防治知识知晓率与“十二五”行动计划确定的既定目标尚有一定差距,对感染者的歧视态度仍然存在,我市艾滋病健康教育工作亟待加强.     

Help-seeking in a context of AIDS stigma: understanding the healthcare needs of people with HIV/AIDS in China

Despite the rapid increase of HIV infection cases in China, the majority of this population have not yet accessed AIDS-related healthcare services. Most current research in China focuses on HIV prevention and disease control, and pays inadequate attention to the barriers facing HIV-infected individuals in accessing and adhering with healthcare services. This article, as part of a research project on the illness experiences of people with HIV/AIDS in China, aimed to explore these individuals' healthcare experiences, shedding light on the gaps between their needs and existing healthcare services. Data for this qualitative study were collected through individual in-depth interviews with 21 HIV-infected adults in China. The results of data analysis suggest that these individuals' healthcare experiences were greatly affected by social discrimination and the limitations of healthcare resources. While AIDS stigma has reduced the social resources available for this population, HIV-related health institutions were perceived by them as an indispensable source of social support. It is concluded that healthcare institutions, as one of the few places in which HIV-infected people are willing to disclose their HIV positive status, should incorporate social care into healthcare service development and delivery so as to facilitate this population's accessing healthcare services and to address their unmet needs that go beyond the conventional scope of health care. Improving the visibility of people with HIV/AIDS in health care will also have a long-term impact on their own well-being and on HIV prevention in China.     

Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

Background  

Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities.     

HIV/AIDS prevention in the Nepalese context

With their numbers now approaching almost 30 million, Nepalese feature importantly in the South Asian demography. Yet, it has been only 60 years since Nepal gained international recognition as a nation-state. Nepal at present is one of the world's poorest countries and is in dire need of development, especially in the area of health. Given the current civil instability coupled with rapid modernization, the health and well-being of the Nepalese people have been increasingly affected by newer threats, such as HIV/AIDS. The present study discusses the uniqueness of the Nepalese context in relation to HIV/AIDS prevention. The authors suggest that HIV/AIDS prevention programs in Nepal should now focus more on adolescents from rural regions. The authors also suggest the ways one may approach the task of developing a prevention program targeting rural youths.     

Impact of HIV/AIDS education on health care provider practice: results from nine grantees of the Special Projects of National Significance Program

The study assessed the impact of health care provider HIV/AIDS education and training on patient care from nine Special Projects of National Significance. Telephone interviews were conducted with 218 health care providers within 8 months, on average, following completion of training. Respondents provided examples of how the SPNS trainings affected their provision of patient/client care. Transcribed comments reflecting change in patient/client care were classified by independent coders under 1 of 10 broad practice change categories. Eighty-two percent of the trainees identified at least one instance of change in patient/client care as a function of their training experience. Self-reported findings included changes in the number/types of patients seen, interpersonal interactions with patients/clients, HIV testing and counseling practices, patient/family education, infection control, advocacy, referrals and collaboration, documentation, and other service changes.     

A Typological Approach to the Study of Rural HIV Service Delivery Networks

Despite the rapid growth of AIDS cases in nonmetropolitan areas, little is known about the characteristics and needs of HIV-positive rural residents or how rural areas are responding to the epidemic. This paper proposes a typology for distinguishing among rural environments and examining variations in HIV service networks. The typology identifies three dimensions that have a major effect on the development of rural HIV service networks: degree of rurality, the prevalence of AIDS, and the epidemiological and demographic characteristics of the infected populations. Data from four case studies are used to illustrate how variations in rural environments can affect the organization and delivery of HIV/AIDS care. The typology contributes to public policy discussions by identifying key attributes of rural environments that influence program planning and implementation and the transferability of service delivery models.     

Homosexuality and HIV/AIDS stigma in Jamaica

This paper reports on a study of the relationship of homophobia to HIV/AIDS‐related stigma in Jamaica. Ethnography, key informant interviews and focus groups were used to gather data from a sample of 33 male and female adults during the summer of 2003. The sample included health and social service providers, HIV positive men and women, and men and women with same sex partners in urban and rural Jamaica. A strong and consistent relationship between homophobia and HIV/AIDS‐related stigma was reported, but the relationship varied according to geographic location, social class, gender, and skin colour (complexion)—to the extent that this coincided with class. Stigma against people living with HIV/AIDS and homosexuality was implicated in low levels of use of HIV testing, treatment and care services and the reluctance of HIV positive people to reveal their serostatus to their sexual partners. Data reveal a pressing need for anti‐stigma measures for both homophobia and HIV/AIDS, and for training for health and human service professionals.     

绍兴、嘉兴两市农村居民艾滋病认知情况调查

目的:通过对绍兴、嘉兴两市农村居民艾滋病认知情况的调查,探讨对农民进行艾滋病宣传教育的有效途径和方法,为相关部门有针对性地开展防制艾滋病的健康教育工作提供理论依据。方法:采用分层整群抽样的方法,对2市15岁及以上农村人口共5 296人进行了问卷调查,调查数据用SPSS 11.5软件进行数据统计分析。结果:绍兴、嘉兴两市农村居民艾滋病知晓率为69.6%,不同年龄、婚姻、受教育程度、职业的农村居民间差异有统计学意义。结论:浙江省部分地区农村居民对艾滋病认知水平偏低,因此,对农村居民应有针对性地深入开展艾滋病宣传教育工作,提高其认知水平,以更有利于开展艾滋病防制工作。     

河南省4县艾滋病家庭收支及社区支持状况调查

目的了解4个项目县艾滋病感染者家庭的基本需求,为制定预防进一步传播、促进感染者健康生存和生活的综合社区健康促进策略提供依据。方法整群抽取患病家庭,然后按照一定的比例选取非患病家庭.采用联合国儿童基金会推荐的问卷对每个家庭的感染者进行现况调查。结果患病家庭的年经济收入、支出与非患病家庭相比有统计学差异（P〈0.05）,患病家庭的感染者艾滋病相关知识知晓率高于非患病家庭,二者有统计学差异（P〈0.01）,但对药物治疗、预防母婴传播及机会性感染的预防性治疗方面的信息仍然需要加强。结论社区综合健康促进策略可主要考虑提高患病者家庭的经济收入能力、药物依从性能力、机会性感染预防性治疗及预防母婴传播的能力。     

我国部分地区艾滋病抗病毒治疗服务体系现状及特点分析

目的 了解我国部分地区艾滋病抗病毒治疗服务体系现状,分析其主要模式及特点,明确主要问题。 方法 采用面对面定性访谈方法,调查我国9省份抗病毒治疗工作人员49人,运用主题分析法对资料进行归纳总结。 结果 我国已逐步形成以医疗机构为主承担抗病毒治疗工作的基本模式,但在治疗转介和随访、药品采购管理、医保与救助、异地治疗、社会组织和基层医疗卫生机构参与等工作机制上呈现出地区性特点。抗病毒治疗服务体系在药品采购管理、经费保障、人员稳定、医疗保障、关怀救助、社会组织及基层医疗卫生机构参与方面存在不同程度问题。 结论 需要不断加强艾滋病抗病毒治疗服务体系建设,完善药品采购管理体制,健全经费投入和人员保障机制,改善艾滋病医保及救助政策,促进社会组织及基层医疗卫生机构参与。