娱乐场所服务小姐中性病、艾滋病危险因素调查

目的：了解娱乐场所服务小姐性病艾滋病（STD／AIDS）知识知晓程度，危险行为特征和性传播感染（STI）流行状况，为制定STD／AIDS）防治对策和干预策略提供依据。方法：运用问卷调查对娱乐场所服务小姐进行一对一深入访谈，同时采集标本进行STI感染状况检测，结果：娱乐场所服务小姐对STD／AIDS危险性认识不够，相关STD／AIDS预防知识缺乏；受多种因素影响，不能做到每次性活动中坚持使用安全套，没有养成良好的自我卫生保健习惯；STI感染率高，结论：应在服务小姐中进行STD／AIDS知识的健康教育和行为干预，预防STD／AIDS的传播和流行。     

HIV / AIDS control programme: lessons from the VHAI-EC joint initiative

The Voluntary Health Association of India (VHAI), with financial support and technical advice from the European Commission, developed the HIV/AIDS Control Programme. The program began in January 1995. Its overall goal was to strengthen the capacities of nongovernmental organizations (NGOs) in initiating and developing HIV/AIDS interventions at the grass-roots level. Program strategies include capacity building within NGOs for effective HIV/AIDS efforts, primary prevention of HIV/sexually transmitted disease (STD) transmission through information and education and promotion of safer sex, promotion of condom use, improvement of STD control in primary health care, and advocacy and social mobilization in support of persons affected by HIV/AIDS. VHAI first invited project proposals from NGOS in Manipur, Assam, West Bengal, Bihar, Kerala, and Andhra Pradesh. Then it held a workshop for interested NGOs on policy and funding criteria. 24 NGOs were selected in the first round from all the above states, except Andhra Pradesh. The intended audiences included youth, women, migrant workers, intravenous drug users, commercial sex workers, tribals, and students. The selected projects consisted of awareness generation, needle exchange, blood safety, condom promotion, and counseling. Training programs addressed project management, counseling, and training of health personnel (medical practitioners, health workers, peer educators, and paramedical workers). State-specific communication strategies involved traditional and folk media, a condom key chain, workshops for journalists, and meetings with members of the Legislative Assembly. VHAI is developing a comprehensive communication package for lobbying and advocacy activities. The May-June 1996 mid-term evaluation found that the program helped state VHAs to work more closely with member NGOS and non-member groups and that NGOs did become familiar with HIV/STD prevention and control. NGOS had inadequate experience in project management. NGOs were able to mobilize communities, to take on innovative interventions, and to network effectively.     

AIDS and the social side of health

The presence of AIDS in epidemic proportions in the African context can directly and indirectly affect the health of the majority of people. AIDS highlights the social side of health, those factors of a social nature that enhances or potentially weakens the health status of individuals and whole communities. Attention solely on a limited range of social behaviors or health activities may obscure this fact with the consequence that the spread of HIV/AIDS is not controlled. Focus is turned in this paper to the stress in AIDS policies and programs on terminal illness more than on terminal life. This approach, if not altered, can increase the vulnerability of persons who live with AIDS. The influence that the subordination of women exerts on the spread of HIV infection calls into question the traditions of male sexuality. The adverse effects of HIV on the health of men as well as women suggest the urgent need for re-assessment of the concepts of maleness held in the region. Change in male attitudes and behavior may require change in legislation and a resocialization to a new orientation in male/female relationship. The health of family members may be endangered because of the demands of the care-giving role. Traditional community mechanisms for coping with illnesses may be inadequate in the face of an epidemic. Rather than the pursuit of strategies to assist categories of selected persons, such as widows or orphans, whole affected communities will need to be approached as weakened families. It is questioned whether the health care system can adequately respond to the health requirements of the many when resources are drained, health care providers are overburdened, and primary health care is fragmented because of AIDS. The social dimension of health makes it imperative that policy and program measures to stop AIDS be a collective, balanced social and biomedical scientific effort.     

Integrating HIV / AIDS care in family welfare services: the PSS experience

In India, participants of a consultative meeting in early February 1994 in Haryana State on STD (sexually transmitted disease) and AIDS prevention in family welfare programs and those at a December 1994 workshop in Jaipur State on integration of RTI (reproductive tract infections)/STD/HIV prevention activities into family welfare programs agreed on the need to broaden the scope of family welfare programs to include RTI/STD/HIV prevention and control. The meeting participants examined 4 case studies on the issue of RTI and STDs in the context of family welfare programs. One case study reviewed activities of the New Delhi-based Parivar Seva Sanstha (PSS), which provides comprehensive reproductive health services. All PSS staff have received training in HIV prevention. In Madras, PSS initiated a pilot project to integrate RTI/STD services into its mainstream family planning services. It tailored experiences of the Colombian Family Welfare Association (PROFAMILIA) to fit PSS project objectives. Formative research revealed that both men and women seek STD diagnosis and treatment services from the private sector despite the high costs and poor quality of care. Based on these findings and the PROFAMILIA experiences, PSS developed a model for integrated services for implementation, evaluation, and eventual replication. PSS has increased its focus on the use of condoms for contraception and HIV/STD prevention. All female clients now have access to standard screening, diagnosis, and treatment. PSS will create a new clinic offering reproductive health services for males. It will also develop systems for partner referral and community-based programs to provide education and motivation for family planning and RTI/STD/HIV prevention. Operational research will provide insight into the needs and perceptions of the population, process evaluation of the project, and RTI/STD/HIV control. Based on the case studies, certain ideas for future actions emerged (e.g., a major advocacy drive) as well as ideas for training, education, counseling, and social marketing and research and evaluation.     

HIV / AIDS,STDs and the workplace

Even though the workplace is ideal for promoting HIV/STD (sexually transmitted disease) prevention to benefit workers and employers, many workplaces are not convinced that they should be involved in HIV/AIDS and STD education, prevention, and support. They do not realize that time and money spent on health programs save them money. Perhaps they do not feel obligated to protect the health of their employees. The AIDS epidemic adversely affects society and the economy at both the macro and micro level. AIDS tends to strike the productive age group, thereby seriously affecting the workplace. In many Sub-Saharan African countries, at least 20% of the urban workforce may be infected with HIV. Persons living with HIV include top management, skilled professionals, general hands, and farm laborers. HIV/AIDS costs for formal employment are assumed through reduced productivity; increased costs of occupational benefits and social security measures; loss of skilled labor, professionals, and managerial expertise as well as the experience among workers; increased costs of training and recruitment; and low morale from stigmatization, discrimination, and subsequent industrial relation problems. Needed are comprehensive HIV/AIDS and STD workplace programs that ensure the rights of persons with HIV and compassionate treatment of these persons. Trade union or other labor representatives, management, and appropriate government departments should work together and build on existing health legislation and policy to bring about effective negotiation and policy development concerning AIDS and employment. Training of peer educators, support services (counseling, STD referral and/or treatment), community action, management commitment, monitoring and evaluation, and supportive workplace conditions make for effective comprehensive workplace programs. Successful programs operate in fishing villages in Tanzania, tea plantations in India, the University of Papua New Guinea, and Ugandan army camps.     

The fight against sexually transmitted diseases in Ivory Coast: what strategies can we use in the face of HIV/AIDS?

In the AIDS era, sexually transmitted diseases (STDs) have become a major health problem in developing countries, particularly in Africa. Delays in the diagnosis and treatment of such infections may result in complications, many of which primarily affect women. Epidemiological studies in Abidjan have shown that more than 10% of the pregnant women attending antenatal clinics present STDs potentially serious for their own health or that of their infants (gonorrhea, chlamydia infection, genital ulcers or active syphilis). There is evidence that STDs increase the transmission of HIV and that improving the syndromic management of STDs reduces the incidence of HIV infection. This provides a strong argument in favor of controlling STDs in areas of high HIV prevalence. In Ivory Coast, as in other African countries, a STD control program has been integrated into the AIDS control program since 1992, as recommended by the World Health Organization. During the first six years of the STD program, considerable progress was made in some areas, but not without difficulty. Simple syndrome-based decision trees have been adopted for the management of STDs in primary health care. Clinical studies have shown these therapeutic algorithms to be effective. At the same time, effective and affordable drugs for treating STDs were added to the list of essential drugs in Ivory Coast, after an international invitation to tender. The entire staff of the public health sector in Abidjan has been trained in syndromic STD management. Training is now being extended to other parts of Ivory Coast, including the private health sector and, in particular, private nurses. The surveillance of syndromic STDs, mainly genital ulcers in both sexes and urethral discharge in men, facilitates monitoring and evaluation of the STD program, following health care activities and adapting orders for drugs for treating STDs to real needs. In the near future, some parts of the STD program will be strengthened, particularly the management of sexual partners of STD patients and reduction of the cost of STD treatment for pregnant women.     

Containing the cost of care for people living with HIV/AIDS: an examination of the Medicaid managed care approach

This article examines Medicaid managed care's potential impact on people living with HIV/AIDS. The incongruence of the philosophy behind providing health and social services to people living with HIV/AIDS and with the philosophy behind the medical model of managed care is discussed. Health and social policy issues that various states have had to face concerning Medicaid managed care's administration of health benefits for people living with HIV/AIDS are examined. Research on managed care is employed to extrapolate potential managed care models that states might use to administer the health benefits for people living with HIV/AIDS. Finally, policy and research agendas are proposed to begin investigating Medicaid managed care's potential impact on people living with HIV/AIDS.     

Control of mother-to-child transmission of infectious diseases in Brazil: progress in HIV/AIDS and failure in congenital syphilis

In Brazil, syphilis and HIV infection are considered serious public health problems. However, in practice, epidemiological surveillance, prevention measures, and prenatal care seem to be more effective in the control of mother-to-child transmission of the HIV than in the control of transmission of the Treponema pallidum. Here we discuss the differences in surveillance, prenatal care, and care of the newborn. Important differences were identified. It is concluded that there is an urgent need to establish prevention of mother-to-child transmission of syphilis as a public health priority, using an integrated approach including women's health, children's health, primary health care, and STD/AIDS programs on all governmental levels. These issues also need to be discussed with all stakeholders involved. Important aspects related to the problem are the training of public health professionals, as well as the participation of the community. The elimination of congenital syphilis does not require expensive drugs, and diagnostic tools, but a long-term sustainable approach.     

流入地流动人口中的HIV感染者管理:原则和框架

随着流动人口中艾滋病病毒(HIV)感染者和艾滋病病人的不断增加,完善感染者和病人管理已刻不容缓地摆在我们面前。流动人口中的感染者管理重点和难点在流入地,而资料表明广东省是中国最主要的流动人口流入地,积极探讨流入地流动人口中的HIV感染者管理模式对广东省具有非常迫切的现实意义。该文在文献回顾和综述的基础上,从感染者管理的角度对该问题进行了一定的探讨,提出了流入地流动人口中HIV感染者管理的六大原则和框架,并制定了关键的工作流程和模式,以期找到解决问题的突破口。     

Rapid appraisal methodology for 'health for all' policy formulation analysis

BACKGROUND: Although in the last 20 years, the WHO 'Health for All' principles have been widely used in national, regional and local health policy documents, there is still a gap in the literature regarding how to appraise or compare them, which weakens the social accountability process. METHODOLOGY: A new, rapid approach to analyse the formulation of health policies is proposed. It is based on the selection of a small number of tracers and the development of a gold standard to be completed with input from a review of the literature, and opinions of expert panel members. This methodology has been empirically applied to the health strategies of two Spanish regions (Catalonia and Valencia). RESULTS: A framework for analysis was produced containing three dimensions: timing (early or late policy options), action level (individuals or social focus) and equity (social class, gender and ethnic groups). The health problems selected as tracers were HIV/AIDS, traffic injuries and ageing-related disabilities. In the two regions studied, the policies formulated for HIV/AIDS and age-related disabilities provide interventions late in the evolution of the health problem. The strategy established in the region of Valencia is more community-oriented than in Catalonia. Neither region had implemented specific policies regarding social class, gender or ethnic groups. INTERPRETATION: The methodology proposed here makes it possible to map the formulation of Health Strategies, compare different geographical areas and even forecast the policies' usefulness. The simplicity of the method, together with the fact that citizens and politicians alike can easily understand its results are major advantages. For the framework to be fully useful, it will be necessary to build evidence-based policy databases.     

Editorial

Worldwide, more than 8500 people are newly infected with HIV each day and there are 21 million cumulative HIV/AIDS cases worldwide, 90% in developing countries. HIV infection and AIDS are firmly entrenched and spreading in India. World Health Organization projections suggest that India may have the highest number of HIV-positive cases by 2000. The double challenge is therefore presented of preventing personal infection and caring for others who are infected. While AIDS research is making some progress, it is clear that the war against HIV/AIDS will be long. Global efforts to prevent the spread of HIV infection are beginning to show positive results, with evidence of the slowing down of the HIV infection rate and the stabilization of the spread reported from some areas. Coordination, commitment, and social policy together with alternative people-oriented and socioculturally appropriate strategies must be brought to bear against the epidemic in India. The country's HIV/AIDS surveillance and blood banking systems also must be improved. Finally, efforts must be taken to ensure that all people have access to care.     

2011年北京市昌平区4类人群艾滋病监测结果分析

目的了解北京市昌平区4类人群艾滋病知识及相关高危行为,为艾滋病综合防治、制定干预策略提供科学依据。方法根据北京市哨点监测方案要求,对4类人群进行问卷调查和HIV及梅毒抗体检测。结果男男性接触者（MSM）、暗娼（FSW）、性病门诊就诊者（STD）3类人群艾滋病知识知晓率较高,流产妇女（ABR）艾滋病知识知晓率较低,差异具有统计学意义（P〈0.01）。HIV抗体阳性检出率：MSM为9.50%,其他人群未检出;梅毒抗体阳性检出率最高的是MSM人群为6.90%,其次是STD人群为1.9%。结论应加强对流产妇女艾滋病知识的宣传,提高其艾滋病知识知晓率。各类人群高危行为存在多样性,应进一步加强健康教育和干预工作力度,控制艾滋病性病的传播流行。     

A Peer-Led AIDS Prevention Program for Students in an Alternative School

ABSTRACT: School-based programs designed to measure health risk behavior and reduce the risk of sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV) infection have not addressed adequately the needs of adolescents outside of mainstream schools. In Florida, these youth represent a sizable proportion of the population and have been shown to be at increased risk for acquiring sexually transmitted diseases and human immunodeficiency virus. This article describes a peer-led STD/HIV intervention for students in a dropout prevention program in Dade County, Florida. Trained peer counselor/educators (PCEs) led schoolwide activities and classroom sessions covering STD/HIV information, community health resources, communication and negotiation skills, and safer sex strategies. Teachers and students rated the PCEs effective in promoting discussion and serving as sources of information about AIDS and community health resources. Pre/post intervention questionnaire results demonstrated an increase in AIDS awareness and discussion among students as well as an increase in condom use. Based on this social influences approach, peer education appears to be a promising health education strategy for students in dropout prevention programs.     

HIV / AIDS in South-East Asia: an update

As of July 1, 1996, 1,393,649 cumulative AIDS cases in adults and children had been reported to the World Health Organization (WHO) from 193 countries since the beginning of the pandemic. HIV infection is a serious public health and developmental problem in southeast Asia, with the WHO estimating more than 3.7 million people to be infected with HIV in the region. This infection extends into the general population and is not confined among people who practice high risk behaviors. As of July 1, 1996, Thailand, India, and Myanmar had reported the largest number of AIDS cases: 41,230, 2940, and 1093, respectively. However, WHO estimates that 2.5 million people are actually infected in India, 800,000 in Thailand, 350,000 in Myanmar, and 95,000 in Indonesia. While Bhutan and North Korea have not yet reported AIDS cases, people in Bhutan have been diagnosed with HIV infection. The health and socioeconomic impact of HIV/AIDS, national plans and programs, the 100% condom use program in Thailand, peer education among sex workers in Calcutta, WHO support for country responses, advocacy and support, promoting appropriate HIV prevention strategies and interventions, HIV/AIDS care as part of primary health care, HIV/AIDS and STD surveillance, and the future role of WHO are discussed.     

From pharmaceuticals to alternative treatments for HIV/AIDS: What is the potential?

The current approach for dealing with the global AIDS pandemic focuses on technology, particularly pharmaceuticals. However, most of the world’s PLWHA (people living with HIV/AIDS) have little or no access to these expensive treatments. Additionally, such technologies have not proven themselves adequate in addressing AIDS in global terms. When the health of communities is prioritised, rather than the interests of pharmaceutical companies and biomedicine, alternative strategies and policies can be considered. These strategies include seriously investigating traditional medicines in other cultures, rather than adopting an uncritical assumption that the biomedical approach is preferable. The limited research available suggests that some alternative treatments could indeed turn out to be useful in treating HIV/AIDS. However, without Western support for rigorous evaluation and development of local alternative therapies, the potential of these treatments for HIV/AIDS will continue to be dismissed. Additionally, the rights of communities to self-determination, and PLWHA to the best possible primary health care, whether in rich or poorer nations, will also be diminished.     

人本主义对艾滋病防控策略的影响

艾滋病是全球面临的一个重大公共卫生问题和社会问题。对艾滋病感染者和艾滋病病人的歧视,必然导致这部分人不敢公开到正规机构接受咨询检测和治疗,从而成为潜在的传染源,造成艾滋病的扩散蔓延。在艾滋病的防控策略中引入人本主义精神,能够营造全社会关注、支持与参与艾滋病防控的良好氛围,最终实现控制艾滋病的目标。     

Country watch: India

Linking more than 3000 health and development organizations, the Voluntary Health Association of India (VHAI) is one of the largest networks in the country. In 1990 VHAI began incorporating HIV/STD-related activities into its broader programs. An existing infrastructure for intersectoral collaboration in the areas of community health promotion, public policy, information and documentation, and communications facilitated inclusion of the new activities. Several VHAI departments collaborate in offering training courses, workshops, and seminars at the state and community levels to involve nongovernmental organizations and professional groups in HIV/STD prevention and counseling. More than 950 persons have been trained so far, including trainers of primary health care workers, family physicians, medical practitioners, social scientists, teachers, community volunteer workers, and youth leaders. Local experts act as training resource persons; materials produced locally, abroad, and by VHAI itself are used. Training facilities are offered free of charge to member organizations; VHAI also awards fellowships for field training and financial support for approved projects. VHAI suggests intervention measures to governmental and nongovernmental organizations related to drug users, youth, truck drivers, blood donors, and people living with HIV/AIDS. The information, documentation, and communications departments provide members with a wide variety of information, education, and communication (IEC) materials that can be translated into local languages: posters, folders, flip charts, stickers, and folk songs. VHAI advocacy issues that have been highlighted through the press include: confidentiality, protection against discrimination, the right of all persons to health care, and the need to make properly-equipped STD clinics available. VHAI has established sub-networks in Tamil Nadu (155 organizations) and Manipur (55 organizations) states. VHAI has found that incorporating HIV/STD activities into its general health education programs is more cost-effective than having a vertical program.     

Observations of sexually transmitted disease consultations in India

Objectives: To assess the quality of sexually transmitted disease (STD) case management provided in public and private health facilities in selected areas of Madras, Tamil Nadu, India, in order to make recommendations for improving the quality of care and promote the syndromic approach to STD treatment.Methods: Structured observations of consultations for STDs in health care facilities. Scoring of the observations according to standards for history taking, examination, treatment and provision of basic health promotion advice allows evaluation of STD case management.Results: With STD treatment adequacy scored against Indian national guidelines (which recommend aetiologic treatment), history taking, examination and treatment were satisfactory in 76 out of 108 (70%) of observed consultations. However, if STD treatment adequacy is scored with respect to the syndromic approach towards selected STD (male urethritis and non herpetic genital ulcer for both sexes), only 8 out of 81 (10%) of the patients were satisfactorily managed. During 32 out of 108 (30%) of the consultations, advice on the use of condoms in order to prevent STD or HIV/AIDS was given. Instructions regarding how to use condoms were offered to seven (6%) patients and condoms were only provided to one patient (1%). Patients were urged to refer their partner(s) for treatment during 29 (27%) of consultations. A criterion of adequate use of the STD consultation for health promotion, requiring both promotion of condoms and encouragement to refer partner(s) for treatment, was met during 13 (12%) of consultations.Conclusions: Monitoring and improving the standards of care at facilities at which STDs are treated have become key roles of STD/HIV/AIDS programmes. The present report suggests that in Madras the activities of medical practitioners who treat STD patients are far from ideal at present. Improvements would involve simplifying existing treatment guidelines by promoting the syndromic approach to STD management, continuing education programmes for health care providers in the public and private sectors and repeat assessments and feedback of the quality of STD care.     

Mobile health units and STD control

Sexually transmitted diseases (STDs), especially genital ulcers, facilitate HIV transmission. Prevention and control of STDs could reduce HIV transmission in sub-Saharan Africa where the STD prevalence is still high. The principles of primary health care (PHC) should guide coordinated or integrated AIDS and STD programs in sub-Saharan Africa. WHO recommends implementing the following AIDS prevention and control activities: district-based epidemiological surveillance, education and communication efforts, blood safety, nursing care, counseling, and activities targeting youth, women, and workers at risk. PHC funding is still low in sub-Saharan Africa, even though health professionals have been involved in intensive efforts to mobilize and coordinate national and international financial support for AIDS control programs. Expenditures on infrastructure and training beyond current practical levels are needed to achieve WHO recommendations. The POD from the Shanning Group can address sub-Saharan Africa's problems with using mobile clinic/laboratory facilities. The major problems are cost and difficult terrain. The POD is a modular demountable unit that can be removed from the vehicle for use as a self-supporting facility. The vehicle is then free for other uses. The POD's uses span from a simple examination and STD treatment facility to a sophisticated laboratory conducting basic STD testing as well as HIV and hepatitis ELISA testing. In fact, the POD can serve both roles simultaneously. The Shanning Group also has an audio-visual POD which can present STD educational material to a wide audience.     

Assessing the National HIV/AIDS Strategy Evaluation

The report is a useful compilation of data on Australia's HIV/AIDS epidemic and the response to it. The report produces firm evidence for endorsing Australia's success in limiting the spread of HIV by a number of routes. Australia has been successful in preventing iatrogenic spread, spread through commercial sex and spread through injecting drug use. In the latter case however, the hepatitis C epidemic cautions against complacency. The report, unfortunately, does not recognise very serious weaknesses in the evidence it uses as a basis for its endorsement of current efforts against HIV in the male homosexual community and the general heterosexual community. The report recognises failure of current policies in Aboriginal and Torres Strait Islander communities and recognises the threat posed here by HIV but recommends no major policy change. There is some recognition of the limitation of the data, but no recommendation for increased surveillance. The report ignores methods of prevention other than public health education. In my view, there is sufficient evidence to recommend routine neonatal circumcision, at least in Aboriginal and Torres Strait Islander communities. There is a clear need for a more effective approach to STD control, particularly in these communities. ^19,24–28 Adequate STD and HIV control may well require contact tracing and surveillance using traditional public health methods. Measurement of objective indicators of the success of HIV prevention campaigns needs to be improved with more comprehensive collection of data on HIV and STD incidence and condom sales, stratified by relevant covariates. Survey evidence of behavioural change should be collected from those too young to be affected by the selective mortality factor. The international comparisons await a proper statistical study which may be able to identify the elements of an effective approach to AIDS. In future reviews of the effectiveness of Australia's response to AIDS, all methods of limiting the spread of the epidemic should be considered objectively. It is unacceptable for the AIDS program to be declared optimal simply because it accords with current public health ideology.