农村地区艾滋病防治工作社会支持模式的探索

良好的社会支持有利于提高艾滋病病毒（HIV）感染者伎滋病（AIDS）患者的生活质量。国外的研究表明，以社区为基础的社会支持能使HIV／AIDS患者较好地适应病后角色，对各种预防措施采取合作态度。我国农村地区可利用的社区软资源极为丰富，但社会支持活动的开展少见报道。在安徽省某县艾滋病流行区开展的社会支持研究中，85名HIV感染者／AIDS患者和65名亲属对生活质量总体评价不满意的比例分别为44．7％和53．8％，社会歧视仍广泛存在。由定性访谈可知，多数访谈对象认为，目前农村社区社会支持模式的建立要结合我国农村地区的民俗、民风，应以HIV感染者／AIDS患者为中心，周围邻居为依托，发挥基层医生的作用，并加强爱心家园基础设施及其功能的建设，同时建立完善的救助机制和艾滋病宣传的长效机制。     

农村社区HIV感染者/AIDS病人分级管理模式探讨

加强对艾滋病病毒（HIV）感染者和艾滋病（AIDS）病人的管理，是控制HIV进一步传播的重要措施。我国80％的HIV感染者分布在农村，对HIV感染者／AIDS病人管理主要在社区进行。目前已有地区在探索对HIV感染者／AIDS病人的管理方法，并提出一些好的建议。上蔡县20世纪90年代中期部分农民因不规范有偿供血而感染HIV，且造成二三代传播。截止2005年底，HIV感染者和AIDS病人达6千多人。     

初治HIV感染者同伴支持体验的质性研究

目的了解初治艾滋病病毒(HIV)感染者在参与同伴支持中的体验。方法采用质性研究中的现象学研究方法,对17名参与同伴支持项目的患者进行半结构式深入访谈,了解初治HIV感染者在参与同伴支持中的体验,采用Colaizzi七步分析法对访谈资料进行分析和整理,提炼主题。结果初治HIV感染者同伴支持体验可归纳为3个主题:主题1为获得社会支持(信息支持,情感支持和工具性支持);主题2为多样化的同伴支持形式;主题3为担忧隐私暴露。结论同伴支持者可以通过多种形式为患者提供支持。但是同伴支持在为患者服务的同时也存在一定的隐私暴露的风险。医务人员在将同伴纳入艾滋病医疗服务系统时,需要灵活应用同伴支持,以使同伴支持效果最大化。     

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。     

山东省部分农村外来妇女HIV感染状况调查

目的了解山东省农村外来妇女的艾滋病病毒（HIV）感染状况，为制定艾滋病防治措施提供科学依据。方法对1985年以来，由外省（外国）迁入山东省某县并在当地常住的772名农村妇女进行入户面对面调查，并采集血清检测HIV抗体。结果该县农村外来妇女HIV感染率为2．59％。HIV感染者平均年龄为28．15岁，HIV感染者与非感染者的年龄差异有显著的统计学意义（t=157．7245，P〈0．01）。在HIV感染者中，原籍为云南省的占95．0％；其中尤以德宏州的居多，占94．74％。发现的HIV感染者迁入时间最早者为1999年。并发现有3人已经性接触将HIV传染给配偶，1人经母婴传播将HIV传染给子女。结论山东省农村外来妇女中存在着一定的HIV感染流行，并造成了HIV的二代传播。应该加强对来自艾滋病较高流行省份的农村妇女的HIV综合监测，并对现已发现的HIV感染者做好定期随访、管理，提供必要的医学指导，最大限度地控制艾滋病在山东省农村地区一般人群的进一步传播。     

综合医院皮肤性病科开展艾滋病防治模式探讨

我国第一代艾滋病病毒(HIV)感染者已开始步人艾滋病期，在出现症状后病人须寻求医治。还有一些新近感染HIV的病人，难以获得有效的医疗卫生服务(缺乏经济支持和专业科室)及社区的帮助。HIV感染者/艾滋病(AIDS)患者对医疗服务的需求在所有需求中居首位，反映了他们希望解决基本医疗服务的迫切性。我国80％的HIV感染者在农村，一些地区缺乏艾滋病治疗机构，     

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。     

我国部分地区HIV感染者HCV协同感染状况的调查研究

目的 了解我国部分地区艾滋病病毒(HIV)感染者体内丙型肝炎病毒(HCV)的协同感染状况.方法 以我国北京、河南、广西部分地区的HIV感染者为研究对象,通过访谈了解病人的基本状况,采集病人的EDTA抗凝静脉血,对感染者的HIV感染状况、CD4细胞数、HIV病毒载量及HCV感染状况进行检测,分析我国部分地区HIV感染者中HCV的协同感染状况.结果 共收集到HIV感染者血液249份,其中有34.14%的感染者同时感染HCV.统计学分析显示,河南地区的HIV感染者同时感染HCV的比例显著高于北京和广西地区;经静脉吸毒和输血传播感染HIV的病人同时感染HCV的几率相近,但都明显高于性传播;感染了HCV的HIV感染者体内的病毒载量要显著高于未感染HCV的HIV感染者,但CD4细胞数没有显著差别.结论 HCV协同感染率在不同的HIV感染者人群中存在差异,而且这种协同感染会影响感染者HIV病毒载量,因此在观察HIV感染者疾病进程及考虑治疗措施时,应充分考虑HCV协同感染的影响.     

村卫生所应对艾滋病能力研究

我国艾滋病(AIDS)已进入快速增长期,河南省1995年报告首例艾滋病病毒(HIV)感染者,截至目前已经报告HIV感染者3万余例。由于河南省HIV感染者/AIDS病人多以20世纪90年代中期以前非法采血感染,感染时间一致、发病集中、医疗资源匮乏成为农村地区艾滋病的特点。针对这一特点,2004年     

广西农村60岁以上老年男性HIV感染因素调查

目的了解广西老年男性艾滋病病毒（HIV）感染者/病人的商业性行为特征,为老年人的艾滋病（AIDS）和性病防治策略和措施的制定提供科学依据。方法选择累计报告60岁以上老年男性HIV感染者/病人占当地所有HIV感染者和病人比例较高的某6个县作为本次调查的地区,分别对农村地区存活的60岁以上老年男性HIV感染者和病人进行问卷调查,每个县调查20例以上。结果接受调查的149名60岁以上老年男性HIV感染者和病人中,有35.4%（35/99）的人与配偶仍有性生活,26.3%（26/99）的人目前仍与配偶或同居者平均每月发生1～4次性行为,而最近1次与配偶或同居者发生性行为时48.1%（13/27）的人没有使用安全套。90.6%（135/149）的老年男性HIV感染者和病人曾与商业性伴发生过性行为,81.5%（110/135）的人在与商业性伴发生性行为时从未使用安全套。30.2%（45/149）的人使用过壮阳药。结论在广西农村老年男性人群中,商业性性行为是最主要的HIV感染途径,发生商业性行为时不使用安全套是感染HIV的主要原因,服用壮阳药在一定程度上增加了农村老年男性发生商业性行为的次数,同时也增加了感染HIV的风险。     

HIV disclosure and nondisclosure among migrant women from sub-Saharan Africa living in Switzerland

No study to date has focused specifically on the reasons for and against disclosure of HIV-positive status among sub-Saharan migrant women. Thirty HIV-positive women from 11 sub-Saharan countries living in French-speaking Switzerland participated in semi-structured individual interviews. The reasons women reported for disclosure or nondisclosure of their HIV serostatus were classified into three categories: social, medical, and ethical. The women identified the stigma associated with HIV as a major social reason for nondisclosure. However, this study identifies new trends related to disclosure for medical and ethical reasons. Being undetectable played an important role in the life of sub-Saharan migrant women, and analysis revealed their medical reasons for both disclosure and nondisclosure. Disclosure to new sexual partners occurred when women had a more positive perception about HIV and when they believed themselves to be in a long-term relationship. Women reported nondisclosure to family members when they did not need help outside the support provided by the medical and social fields. The results on ethical reasons suggested that challenging stigma was a reason for disclosure. Since the women' perceptions on HIV changed when they came to see it as a chronic disease, disclosure occurred in an attempt to normalize life with HIV in their communities in migration and to challenge racism and discrimination. Our findings can help health providers better understand the communication needs of sub-Saharan migrant women with respect to HIV/AIDS and sexuality and offer them adequate disclosure advice that takes into account migration and gender issues.     

An examination of the HIV serostatus disclosure process among Haitian immigrants in New York City

Little is known about the HIV serostatus disclosure experience of Haitian immigrants in the USA. We employed the disclosure processes model to examine the disclosure experience of 21 HIV-positive Haitian immigrants in New York City. Data were collected through in-depth interviews conducted between May 2012 and January 2013 with participants from four community-based organizations providing HIV/AIDS services. Analysis of the interviews yielded several enablers relevant to reasons for disclosure including participants being in a close relationship with someone they trusted or felt comfortable with, and the need for support and understanding about the illness. Some of the barriers to HIV serostatus disclosure were fear of being stigmatized, rejected. For participants who had disclosed to significant others in the USA and in Haiti, they reported that they experienced both positive and negative outcomes including social support, emotional relief, encouragement to take their medication, and on some occasions mistreatments, isolation, and stigma. The strategies participants employed during the disclosure event also revealed the additional challenges immigrants face when deciding to disclose their HIV serostatus to family members living in their country of origin. These findings suggest the need to develop culturally appropriate interventions to address the disclosure needs of ethnic minorities residing in the USA.     

Serostatus disclosure among adults with HIV in the era of HIV therapy

Serostatus disclosure is an important component of secondary HIV prevention with potential benefits for both the individual by experiencing increased social support and society by reducing HIV transmission risk behaviors. This cross-sectional study assessed disclosure patterns to sex partners, family members, and friends by sociodemographic and HIV-related factors among an urban, Midwestern U.S. HIV clinic population (n = 809); a majority of whom were African American and male with a mean age of 41 years. Almost three quarters (n = 596) of the sample was currently receiving HIV therapy, with 68% (n = 404) successfully suppressing their HIV viral loads. Among sexually activity individuals, 97% reported disclosing their serostatus to sex partners. This high rate of disclosure to sex partners suggests that social desirability may play a role in this self-reported measure. Approximately half of the sample (n = 359) disclosed to at least one family member and 60% (n = 474) disclosed to at least one friend. Disclosing to family members occurred more often among participants who were unemployed and endorsed depressive disorder symptoms (p < 0.05 for all). Disclosing to friends occurred more frequently among women, Caucasians and those who completed higher levels of education (p < 0.001 for all). HIV disclosure and disease severity were unassociated. Given the chronic nature of HIV care, additional research is needed to develop interventions to facilitate timely disclosure of HIV serostatus.     

Rate, pattern and barriers of HIV serostatus disclosure in a resource-limited setting in the Niger delta of Nigeria

The disclosure of HIV serostatus is a difficult emotional task creating opportunity for both support and rejection. In this study, we evaluated the rate, patterns and barriers to HIV serostatus disclosure. A pre-tested interviewer-administered questionnaire from 187 HIV infected people residing in a resource-limited setting in the Niger Delta of Nigeria was analysed. Of the 187 HIV seropositive patients studied, 144 (77.0%) had disclosed their HIV-serostatus while 43 (23.0%) had not. Results showed that the patients had disclosed their HIV-serostatus to: parents (22.3%), siblings (9.7%), pastors (27.8%), friends (6.3%), family members (10.4%) and sexual partners (23.6%) (P = 0.004). Females were more likely (59.7%) to disclose their HIV serostatus compared with males (40.3%) (P = 0.003). Mothers were twice as likely (65.6%) to be confided in compared with fathers. Barriers to HIV serostatus disclosure included fear of stigmatization, victimization, fear of confidants spreading the news of their serostatus and fear of accusation of infidelity and abandonment (P = 0.002). Married respondents were more likely to disclose their status. Better-educated respondents with tertiary education were more likely to disclose their HIV-serostatus. Expectation of economic, spiritual, emotional and social support was the major reason for disclosure. The ratio of disclosure to non-disclosure among patients with non-formal education was (2.6:1.0), primary education (2.3:1.0), secondary education (3.3:1.0) and tertiary education (10.0:1.0). Disclosure of HIV serostatus can foster economic social and economic support. There is need for the re-intensification of interventional measure that combines provider, patients and community education particularly in the aspect of anti-stigma campaign, partner notification and skill building to facilitate appropriate HIV serostatus disclosure.     

Do People Know I’m Poz?: Factors Associated with Knowledge of Serostatus Among HIV-Positive African Americans’ Social Network Members

We examined how functional social support, HIV-related discrimination, internalized HIV stigma, and social network structure and composition were cross-sectionally associated with network members’ knowledge of respondents’ serostatus among 244 HIV-positive African Americans in Los Angeles. Results of a generalized hierarchical linear model indicated people in respondents’ networks who were highly trusted, well-known to others (high degree centrality), HIV-positive, or sex partners were more likely to know respondents’ HIV serostatus; African American network members were less likely to know respondents’ serostatus, as were drug-using partners. Greater internalized stigma among respondents living with HIV was associated with less knowledge of their seropositivity within their social network whereas greater respondent-level HIV discrimination was associated with more knowledge of seropositivity within the network. Additional research is needed to understand the causal mechanisms and mediating processes associated with serostatus disclosure as well as the long-term consequences of disclosure and network members’ knowledge of respondents’ serostatus.     

HIV-disclosure in the context of vertical transmission: HIV-positive mothers in Johannesburg, South Africa

HIV-disclosure among childbearing women remains poorly understood, particularly in sub-Saharan Africa. This paper chronicles disclosure experiences of 31 women attending prevention of mother-to-child HIV transmission services in Johannesburg. Data collection entailed repeat in-depth interviews over a nine-month period. Virtually all women (93.5%) had told at least one person (usually a partner), most voluntarily and within a week of the test result. Secondary disclosure was most likely with female family members, through indirect means and involuntary. Confidentiality breach by primary targets likely contributed to the observed high rates of involuntary secondary disclosure and negative secondary disclosure experiences. For most mothers, voluntary disclosure was driven by the desire to ensure adequate infant care and avoid vertical HIV transmission. The impact of disclosure was not always clear-cut. While most primary disclosure experiences were ultimately constructive, secondary disclosure more likely led to rejection, stigmatization and the withholding of financial support. Our data illustrate the influence of social contextual factors on disclosure patterns and impact. For these mothers, socio-cultural norms, the current media and political environment surrounding HIV/AIDS, household composition and social networks and childbearing status shaped disclosure experiences; sometimes constraining disclosure circumstances and sometimes creating a safe space to disclose. Programmatic implications are also discussed.     

HIV status disclosure to families for social support in South Africa (NIMH Project Accept/HPTN 043)

Literature on HIV status disclosure among persons living with HIV/AIDS (PLWHA) is dominated by research on the rates, barriers and consequences of disclosure to sexual partners, because of the assumed preventive health benefits of partner disclosure. Disclosure of HIV status can lead to an increase in social support and other positive psychosocial outcomes for PLWHA, but disclosure can also be associated with negative social outcomes including stigma, discrimination, and violence. The purpose of this article is to describe the HIV status disclosure narratives of PLWHA living in South Africa. Thirty in-depth interviews were conducted with 13 PLWHA (11 women, 2 men) over a three-year period. We explored disclosure narratives of the PLWHA through questions about who they chose to disclose to, how they disclosed to these individuals, and how these individuals reacted. Narratives focused on disclosure to family members and contained relatively little discussion of disclosure to sexual partners. Participants often disclosed first to one trusted family member, and news of the diagnosis remained with this person for a long period of time, prior to sharing with others. This family member helped the PLWHA cope with the news of their diagnosis and prepared them to disclose to others. Disclosure to one's partner was motivated primarily by a desire to encourage partners to test for HIV. Two participants described overtly negative reactions from a partner upon disclosure, and none of the PLWHA in this sample described very supportive relationships with their partners after disclosure. The critical role that family members played in the narratives of these PLWHA emphasizes the need for a greater focus on disclosure to families for social support in HIV counseling protocols.     

Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men

HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. An online cross-sectional study was conducted among MSM in eight Chinese cities in July 2016. Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing (including HIV self-testing) history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. A minority (20.6%, 346/1678; 17.8%, 287/1608) of men received HIV serostatus disclosure from their most recent regular and casual male partners, respectively. Multivariate analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular [adjusted OR (aOR) = 1.92, 95% CI 1.50–2.44] and casual (aOR = 2.34, 95% CI 1.80–3.04) male partners compared to never self-tested participants. Compared to participants who had not received HIV status disclosure from regular partners, participants who received disclosure from regular male partners had higher likelihood in experiencing post-test violence (aOR = 5.18, 95% CI 1.53–17.58). Similar results were also found for receiving HIV serostatus disclosure from casual partners. This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.     

Gay men's casual sex encounters: discussing HIV and using condoms

Some gay men disclose their HIV serostatus to enable them to decide to discard condoms in at least some casual encounters. In this paper we consider under what circumstances this occurs. We draw on data from the Sydney Men and Sexual Health cohort study, including both structured and semi-structured interviews. We find that casual sexual encounters among gay men are complex events, involving a broad range of types of partner and circumstance. A significant minority of men disclose their HIV serostatus; 36.3% of those who discussed their serostatus with casual partners engaged in unprotected anal intercourse (UAI) with those partners, while only 9.9% of those who did not discuss their serostatus engaged in UAI with those partners. We also find that disclosure of HIV serostatus, discussion and use of condoms during casual encounters are affected by the particular circumstances of those encounters, including the degree of familiarity between casual partners.     

Prevalence and correlates of HIV serostatus disclosure: a prospective study among HIV-infected postparturient women in Barbados

This study was undertaken to determine the prevalence of self-disclosure of HIV status among the postparturient HIV-infected women and to describe the correlates of disclosure in this population. Subjects for this study include all known HIV-infected postparturient women in Barbados who delivered during 1997 through 2004. Sociodemographic data are routinely collected from all HIV-infected postparturient women. Data on disclosure were collected through one-to-one interview of the consenting women included in this study. One hundred thirtynine women were studied. Forty women (28.8%) had self-disclosed their HIV status to other people including their current sex partner. Among women who did not disclose their HIV status to anybody, 30 (30%) gave fear of stigmatization as the reason for nondisclosure, while 23 (23%) did not disclose their status as they feared abnormal reaction from their current sex partner and possible violence directed at them. Women who had disclosed their HIV status were more likely to use condoms during all sexual encounters, less likely to have had subsequent pregnancy from a different sex partner, were more likely to have a partner who had been tested for HIV, and were themselves more likely to be attending the centralized HIV clinic for follow-up and care compared to those who did not disclose. A substantial proportion of HIV-infected postparturient women never disclosed their result to a partner or a close relative. Lack of disclosure may have limited their ability to engage in preventive behaviors or to obtain the necessary emotional support for coping with their serostatus or illness.