1996—2012年广西艾滋病流行地理差异分析

目的探讨广西1996—2012年艾滋病流行的地理差异,为针对性防控策略和措施的制定提供科学依据。方法以县(市、区)为基本统计单位,通过地理信息系统(GIS)软件的自然断点分级法,划分艾滋病累积报告感染率(CRIR)和累积报告发病率(CRI)的高、中、低流行区,对比分析各县的差异。结果累积报告感染率为高、中、低流行区的县分别有19、40、50个,相应区间分别为302.91/10万~700.98/10万、124.90/10万~302.90/10万、18.42/10万~124.89/10万;累积报告发病率为高、中、低流行区的县分别有13、35、61个,相应区间为159.79/10万~428.09/10万、64.69/10万~159.78/10万、7.23/10万~64.68/10万。以CRI为参照,CRIR与CRI高、中、低流行区的分布一致率分别为100.00%、82.86%、93.44%。广西艾滋病CRIR和CRI高、中、低流行区的分布呈"同心圆"状辐射递减及"孤点"现象。结论广西艾滋病流行有明显的地理差异性,其流行强度是地理、经济、社会、资源等各方面因素相互作用的结果,今后艾滋病防控策略研究应该融合更多的经济社会因素,以使防控更有成效。     

Gender and Mental Health Aspects of Living with HIV Disease and Its Longer-Term Outcomes for UK Heterosexual Patients

Gender is important in the experience of illness generally and HIV specifically. In this study the authors compare 183 HIV positive women with 76 HIV positive heterosexual men attending United Kingdom HIV clinics on clinical, treatment, and mental health factors. Participants completed a questionnaire on mental health and HIV-related factors. Laboratory measures of HIV viral load and CD4 cell count were obtained at baseline and 6–18 months later. After adjusting for age, employment, and treatment status, men were significantly less likely than women to suffer from high psychological [adjusted odds ratio (OR) = 0.38, 95% confidence interval (CI): 0.17, 0.86] and global symptom distress (adjusted OR = 0.42, 95% CI: 0.19, 0.92). However, men were more likely than women to report having suicidal thoughts (adjusted OR = 1.85, 95% CI: 0.95, 3.58). Relational, sexual behavior, and quality of life factors were similar for men and women. Adherence levels did not differ by gender but were sub-optimal in 56% of patients. Men had significantly lower CD4 counts than women at baseline, but not at follow-up. No differences were observed in the proportions with viral suppression. The groups had generally similar HIV experiences with high psychological distress. Adherence monitoring and gender appropriate psychological support are needed for these groups.     

“They (ARVs) are my life, without them I’m nothing”—experiences of patients attending a HIV/AIDS clinic in Johannesburg, South Africa

This paper is a part of a larger study that explores the “social complexity” of antiretroviral therapy (ART), in resource-limited environments. Drawing on in-depth interviews with a sample of 44 patients in an urban HIV/AIDS clinic in Johannesburg, South Africa, this paper examines how people with HIV/AIDS conceptualise their illness and its treatment in this context. The paper concludes that the fear of stigma plays a significant role in patients’ experiences throughout the disease trajectory. Yet, demonstrates that there are indications that ARVs are transforming the experience of living with HIV/AIDS and a process of normalisation is taking place. Despite the resource-limited context and, often, lack of family and community support, patients see the ARVs as ‘life saving’ and express their long-term commitment to adhere to the drug regimen as well as their trust in health professionals.     

“No‐one’s driving this bus” – qualitative analysis of PrEP health promotion for Aboriginal and Torres Strait Islander gay and bisexual men

Objective : HIV prevention tools such as pre‐exposure prophylaxis require equitable access and uptake to protect all at‐risk populations. This project assessed the perceived barriers to accessible HIV prevention for Aboriginal and Torres Strait Islander gay and bisexual men (GBM) and evaluated the presence of health promotion for pre‐exposure prophylaxis (PrEP) for this population from the perspective of service providers. Methods : Eighteen semi‐structured interviews with healthcare providers, researchers and AIDS Council employees were qualitatively analysed for themes and concepts related to PrEP‐specific health promotion. Results : Respondents noted AIDS Councils and affiliated sexual health clinics had been instrumental in promoting PrEP to at‐risk GBM. However, many Aboriginal gay and bisexual men who are not well connected with these communities and services may not have been exposed to this health promotion and therefore have not accessed PrEP effectively. Conclusions : Aboriginal community and gay community controlled health organisations need to collaborate to ensure they deliver effective and tailored health promotion to Aboriginal communities. Implications for public health : The rising HIV notification rates in Aboriginal Australians is an example of the health gap experienced by First Nation people. Effective HIV prevention is required to ensure this gap does not widen further, and that Australia meets its goal of preventing all new HIV infections. However, these efforts will be hampered by ineffective health promotion of HIV prevention tools, such as PrEP, for Aboriginal Australians.     

Talking About,Knowing About HIV/AIDS in Canada: A Rural‐Urban Comparison

Purpose: To explore information exchange about HIV/AIDS among people living in rural and urban communities and to assess the value of social capital theory, as well as demographic factors, in predicting community members’ knowledge of HIV/AIDS and their likelihood of having talked about the disease. Method: A random‐digit dial telephone survey was conducted in 3 rural regions and matched urban communities in Canada during 2006 and 2007. A total of 1,919 respondents (response rate: 22.2%) answered questions about their knowledge of and attitudes toward HIV/AIDS, their social networks, whether they were personally acquainted with a person with HIV/AIDS (PHA), and whether they had ever talked to anyone about HIV/AIDS. Findings: Rurality was a significant predictor of HIV/AIDS knowledge and discussion. Even after controlling for factors such as age and level of education, respondents living in rural regions were less knowledgeable about HIV/AIDS and were less likely to have spoken with others about the disease. Social capital theory was not as strongly predictive as expected, although people with more bridging ties in their social networks were more likely to have discussed the disease, as were those who knew a PHA personally. Conclusion: Rural‐dwelling Canadians are less likely than their urban counterparts to be knowledgeable about HIV/AIDS or to talk about it, confirming reports by PHAs that rural communities tend to be silent about the disease. The findings support policy recommendations for HIV education programs in rural areas that encourage discussion about the disease and personal contact with PHAs.     

“I don't want to look like an AIDS victim”: A New Zealand case study of facial lipoatrophy

The development of antiretroviral (ARV) drugs to treat HIV has turned what was once a death sentence into a chronic disorder. However, a focus on absence of disease in the form of an undetectable viral load and the dismissal of the so‐called “cosmetic” complications of the disease ignores perceptions of health and well‐being of those living with HIV. Facial lipoatrophy is a stigmatising side effect of treatment for HIV as it betrays the presence of the virus within the body. The study took a longitudinal qualitative approach, interviewing 11 people twice over a period of 1 year on their experience of living with HIV. Two participants were given cameras and asked to take photos which represented what it was like for them to live with this condition and were interviewed four times at four monthly intervals. This paper looks at one man's struggle to conceal or veil his facial lipoatrophy. His story is presented in the form of “selfies” and extracts from in‐depth interviews. It tells of an emotional (ongoing) journey of frustration, anger, excitement, depression and resignation which had a profound effect on his sense of social and psychological well‐being. This suggests a more holistic approach to treating people living with HIV is needed. While an undetectable viral load is indeed vital, it should not be seen as the only essential outcome of treatment.     

“I’m Sure She Chose Me!” Accuracy of Children’s Reports of Mothers’ Favoritism in Later Life Families*

Abstract: We used data from 769 mother‐child dyads nested within 300 later life families to explore the accuracy of adult children’s perceptions of mothers’ patterns of favoritism in terms of closeness and confiding. Adult children were generally accurate regarding whether their mothers preferred a specific child, but often had difficulty identifying whom mothers favored. Multivariate analyses indicated that overall accuracy of children’s reports was positively related to similarity of religious participation and negatively related to parental status of the adult child and family size. Because parental favoritism may affect adult children psychologically and have implications for later life care for parents, family practitioners should be aware of mothers’ patterns of favoritism and the sometimes inaccurate perceptions adult children have concerning this favoritism.     

The effect of improving preschool teacher/child ratios: an “experiment in nature”

The present study examines the effect of an improved staff ratio in New Zealand kindergartens on interactions between children and teachers. Four kindergartens which acquired a third teacher were compared with four contrast kindergartens which continued with their usual staffing of two teachers. Data were collected from each kindergarten on three occasions. Fourteen children from three-teacher kindergartens and 21 children from two-teacher kindergartens were observed for 30 minutes, in November before the third teacher was introduced, and in March and July after the third teacher had started working in half of the kindergartens. Staff members were also observed on the three occasions for an hour. The introduction of a third teacher was associated with a statistically significant reduction in children's negative behaviour to peers. Children played more positively with peers, talked more and interacted more with teachers after the third teacher started but these differences were not statistically significant. Teacher behaviour showed fewer changes than child behaviour after a third teacher was introduced, but teachers in third teacher kindergartens made more non-verbal initiations to children, talked more to parents, were more involved in children's play and talked to each other more with the extra staff member. It was concluded that a third teacher did improve the quality of the preschool but that other confounding factors associated with “experiments in nature” (such as subject attrition) prevented more definitive findings.     

Behavioral interventions for the primary prevention of HIV infection among homosexual and bisexual men

Behavioral intervention is the most urgent priority in preventing the further spread of HIV. To maximize the efficacy of AIDS prevention and to most efficiently allocate resources, it is imperative that variables contributing to preventive behavior change be accurately identified, and interventions be critical evaluated prior to widespread dissemination. We review studies regarding homosexual/bisexual men in terms of: 1) epidemiological trends in HIV transmission; 2) models of behavior change organized around the initiation, consolidation, and maintenance of change, and; 3) preventive intervention outcomes. We conclude with recommendations for effective primary prevention programs.Peggy L. Peterson is affiliated with the School of Social Work, Social Development Research Group, University of Washington. Address correspondence and reprint requests to: 146 North Canal St., Suite 211, XD-50, Seattle, WA 98103.David G. Ostrow is affiliated with the University of Michigan.David J. McKirnan is affiliated with the University of Illinois at Chicago.     

湖北省2011-2013年艾滋病VCT结果分析

目的了解湖北省2011-2013年艾滋病自愿咨询检测(VCT)情况,为制订防治对策提供依据。方法对333个VCT门诊求询者的人口学信息、求询者类型和原因以及HIV抗体筛查情况进行统计分析。结果湖北省2011-2013年共有176 163人接受了VCT服务,173 832人接受了HIV抗体筛查,筛查率98.68%,筛查阳性率为0.77%。求询者中以主动求询者为多,占90.12%,不同年份主动求询者所占比例,经检验其差异有统计学意义(χ2=342.774,P0.05)。三年平均筛查阳性率以男男性行为史者最高,达10.26%。结论开展娱乐场所外展服务和在医疗机构中开展医务人员主动提供HIV检测咨询(PITC)工作,提高HIV/AIDS早期发现能力。     

2016—2020年南充市艾滋病自愿咨询检测结果分析

目的了解南充市2016—2020年25706人次艾滋病自愿咨询检测(VCT)的求询者感染状况及分布特点,为更好地开展VCT工作、制定艾滋病防治对策提供科学依据。方法以2016—2020年在南充市VCT门诊接受VCT服务并登记上报的求询者作为研究对象,从艾滋病综合防治信息系统中下载2016—2020年南充市的VCT数据库,采用SPSS 17.0统计软件进行χ²检验、趋势卡方检验及Logistic回归分析。结果2016—2020年南充市接受VCT的求询者25706人次,HIV阳性899人次,阳性率为3.50%,近五年间阳性率差异有统计学意义(χ²=81.949,P<0.001);求询者男女性别无差异,求询者不同性别、年龄、婚姻状况和文化程度的总HIV抗体检测阳性率差异有统计学意义(P均<0.001),求寻原因中男男性行为史者HIV抗体检测阳性率较高为19.15%(χ²=872.205,P<0.001);多因素Logistic回归分析显示,男性、性活跃人群、离异或丧偶、文盲及小学和男男性行为史者是求询者发生HIV感染的易感因素,近五年阳性检出率总体呈上升趋势。50岁及以上男性接受艾滋病VCT服务阳性率总体有逐年上升趋势(χ²=31.747,P<0.001)。结论南充市VCT主要求询者是20~50岁年龄段,有效提高VCT咨询服务质量,是发现HIV感染者并提供有效干预的重要途径之一。应有针对性的加强性活跃人群特别是中老年男性、文化程度低、未婚/离异或丧偶、MSM等重点目标人群的宣传教育、行为干预及检测。     

Critical perspectives on the ‘end of AIDS’

This special symposium critically examines optimistic promises about an imminent ‘end of AIDS,’ currently circulating in global health discourse and policy. We aim not simply to interrogate the discourse surrounding calls to end AIDS, but to also explore the broader practices, contexts, and policy landscapes that have transformed the global HIV response during the fourth decade of the epidemic and allowed this discourse to gain such political traction. In this introduction we preview the collection’s five substantive papers, which delve beneath the ‘end of AIDS’ rhetoric, bringing greater realism as well as resolve together with empirical evidence about the state of efforts to end AIDS in diverse locations and populations. Taken together, these papers critique not the hope that one day AIDS may come to an end, but the means by which current policy expects to arrive at such ends, particularly in the absence of realistic, sustained commitments to extending treatment, prevention, and broader support in highly under-resourced places and populations.     

Changes in adolescents' sexuality between 1970 and 1990 in West-Germany

Based on two studies (using semistructured interviews) of 16- and 17-year-old West German urban adolescents, the first in 1970N * 602) and the second in 1990 (N * 415), this paper traces the changes in young people's sexual behavior and attitudes during the past two decades: (i) The marked trend in the 1960s towards having coitus and petting at an ever earlier age does not seem to have continued; the changes noted in the incidence of heterosexual experiences since 1970 are minimal. (ii) Boys feel themselves less at the mercy of their sexual urges than they used to and tend to link sexuality with love and a steady relationship more than they did 20 years ago; there was a similar though less pronounced change among girls. (iii) Girls now get less pleasure and satisfaction out of sexual encounters, and in heterosexual situations take the initiative and control more than they used to. (iv) There is no evidence that the problem HIV/AIDs had a marked influence on the changes described. Results of the comparative studies are discussed in the context of current developments in man/woman relationships and the debate on gender issues.This research was supported by a grant from Bundesministerium für Forschung und Technologie, Aids-Forschungsförderung/Sozialwissenschaften (BGA V-003-89). Extended version of a paper read at the Eighteenth Annual Meeting, International Academy of Sex Research, July 7th to 11th, 1992 in Prague, Czechoslovakia. Translated by Dr. phil. Jane Wiebel, Hamburg. A short version of this paper was published inNordisk Sexologi (Schmidtet al., 1992b).     

Reframing “participation” and “inclusion” in public health policy and practice to address health inequalities: Evidence from a major resident‐led neighbourhood improvement initiative

There is a need for greater conceptual clarity in place‐based initiatives that seek to give residents of disadvantaged neighbourhoods more control over action to address the social determinants of health inequalities at a local level. In this article, we address this issue as it relates to the concepts of participation and inclusion. We draw on qualitative data generated during the first phase of the Communities in Control Study, a longitudinal multisite independent evaluation of the impact of Big Local on the social determinants of health and health inequalities. Big Local is a resident‐led area improvement initiative in England, funded by the UK Big Lottery Fund. Initiatives focused on community empowerment are increasingly prominent in public health policy and practice globally. Approaches emphasise the promotion of greater control over decisions and action among individuals, groups, and communities, particularly those living in disadvantaged circumstances. However, when it comes to participation and inclusion in taking action and making decisions, the field is characterised by conceptual confusion. This risks undermining the impact of these initiatives. While participation and inclusion are necessary conditions for empowerment and collective control, they are not necessarily sufficient. Sufficiency requires attention to the breadth of participation (i.e., to inclusion) and to the depth of participation (i.e., the extent to which it is experienced as empowering and ultimately enables the exercise of collective control over decisions and actions). In observing how different Big Local resident‐led partnerships across England are tackling the day‐to‐day challenges of engaging with their communities, we reveal the potential for policy and practice of reframing, and therefore clarifying (to highlight the different roles they have) the concepts of participation and inclusion in terms of depth and breadth.