医护人员对HIV感染者接受态度调查

目的了解某艾滋病高流行地区从事临床工作的医护人员对人类免疫缺陷病毒（HIV）感染者／艾滋病（AIDS）患者（简称PHA）的接受态度及影响因素。方法抽取该市2所市级综合性医院4所乡镇中心卫生院753名医护人员进行自填式问卷调查。结果绝大多数医护人员对HIV感染者／AIDS患者的接受程度处于中等水平。年龄、知识得分、医院级别、医护人员与HIV／AIDS的接触频率与医护人员的接受程度之间有关联。结论在对临床医护人员进行有关减少艾滋病偏见与歧视的培训或倡导工作中，应加强医护人员有关艾滋病临床知识、职业暴露和自我防护等方面的专业培训；加强对综合性医院以及青年医生的教育；加强对HIV／AIDS高频率接触的医护人员的心理咨询。     

The Role of the Pharmacist in the Management of HIV/AIDS

HIV/AIDS currently affects about 31 million people worldwide. Many infected people do not receive proper care because of a lack of resources or education about current treatment options. Even where treatments are available, they are often not optimal because of poor adherence, adverse events or resistance.In developed countries, HIV/AIDS is quickly becoming a chronic disease requiring long term care. Disease management concepts are being adapted to this disease, but are not yet fully successful because of the lack of definitive guidelines and disjointed delivery of care. Also, alternative caregivers have not been actively recognised by traditional providers, resulting in even less continuity of care.A new community-based model for healthcare delivery for people with HIV/AIDS is required. A potential model uses the pharmacy, now termed a community care centre, as the focal point for care delivery. A new healthcare team, including a doctor/physician, pharmacist and nutritionist would coordinate treatment selection and delivery. Other healthcare providers could be added as required.In addition, the pharmacist would act as a data manager for the team. They would collect and report data on medication and over-the-counter drug usage, compliance, adverse events and lifestyle behaviours. These data would be provided to other team members in real-time to create a coordinated management plan.The pharmacist would also act as a community resource for information on HIV/AIDS to help dispel myths and misinformation about the disease. They can be a provider of testing services and counselling, as well as preventative methods and information.This model is being discussed and implemented by a small number of providers in the US. Considerable study will be required to prove its economic and therapeutic value to HIV/AIDS treatment.     

Prevalence of, and factors associated with, HIV/AIDS-related stigma and discriminatory attitudes in Botswana

Botswana has the highest prevalence of HIV in the world. The epidemic of HIV/AIDS is often accompanied by stigma and discrimination that create the circumstances for spreading HIV. To facilitate the design of effective programmes to fight the high prevalence of HIV/AIDS-related stigma and discriminatory attitudes, this study examined survey data on the prevalence of, and factors associated with, such attitudes in Botswana. While most respondents showed discriminatory attitudes towards a teacher or a shopkeeper with HIV/AIDS, only 11% of 4,147 respondents reported unwillingness to care for a family member with HIV/AIDS. The more tolerant attitudes towards a family member with HIV/AIDS appeared to be promoted by the fact that family members have been and continue to care for their sick members through a government project called Community Home-based Care aimed at relieving public hospitals of HIV/AIDS patients. Since the burden of caring for sick relatives rests on the shoulders of women, they portrayed more tolerant attitudes towards HIV/AIDS patients. Young people and those who believed a person could get HIV infection by sharing a meal with an HIV/AIDS patient had discriminatory attitudes towards people with HIV/AIDS. The national information, education and communication programme needs to be strengthened to reach more people for HIV/AIDS education. Finally, programmes that aim to promote more tolerant attitudes towards people with HIV/AIDS may be more effective if the human rights of those with HIV/AIDS are promoted and respected.     

Meeting the needs of people with AIDS: local initiatives and Federal support

The Health Resources and Services Administration (HRSA), one of the seven agencies of the Public Health Service, is working to meet some of the resource and patient service needs engendered by the epidemic of acquired immune deficiency syndrome (AIDS). Those actions derived from, and support the continuation, expansion, and replication of, initiatives at the community and State levels. HRSA is carrying out many of the recommendations of the Intragovernmental Task Force on AIDS Health Care Delivery by enhancing the AIDS training of health care personnel in prevention, diagnosis, and care and by counseling and encouraging the expansion of facilities outside hospitals to care for AIDS patients. The agency, through its pediatric AIDS demonstration projects, is working on models for the care of children with HIV infections. The needs of AIDS patients are being addressed through a drug therapy reimbursement program; demonstration grants to 13 projects to promote coordinated, integrated systems of care in the community; and grants for the development of intermediate and long-term care facilities for patients. Ten regional education and training centers, funded in 1987 and 1988, will increase the supply of health care providers prepared to diagnose and treat persons with HIV infections. Programs will be conducted for several thousand providers over the next 3 years, using such modalities as televised programs and train-the-trainer courses. The centers will also offer support and referral services for providers.     

An epidemiologic update on the HIV/AIDS epidemic in Minnesota

Since 1982 a cumulative total of 7,073 Minnesotans have been diagnosed with HIV or AIDS and reported to the Minnesota Department of Health. The annual number of new infections has been relatively stable at just under 300 per year since 1996. Due in large part to advances in antiretroviral medications, more Minnesotans were known to be living with HIV/AIDS at the end of 2002 (4,598 people) than ever before. Men who have sex with men, racial/ethnic minorities (particularly, African Americans and Hispanic men), and individuals in urban areas continue to be disproportionately affected by HIV/AIDS. The proportion of cases attributable to heterosexual contact has gradually increased over the past 20 years. Marked increases over the past several years in the number of new HIV infections diagnosed among African-born persons is a trend of concern in the evolving HIV/AIDS epidemic in Minnesota.     

Integrating HIV / AIDS into First Nations health services

Some members of First Nations believe that HIV/AIDS does not affect Aboriginal populations. They instead believe that it is a White man's disease which affects only homosexuals. The mandate of the Manitoba Regional HIV/AIDS Steering Committee (MRASC) in Canada is to incorporate HIV/AIDS-related education and care into provincial health services for Aboriginal people, people living in Canada before Europeans arrived. The committee acts as an advisory group to the Assembly of Manitoba Chiefs Health Committee and the Medical Services Branch of Health Canada, making recommendations upon the development and coordination of an integrated program. One major focus of the program is to strengthen community-based resources so that service providers can provide prevention education in the framework of their ongoing activities. Most of the local health workers have received basic information and training in community education about HIV/AIDS-related issues. MRASC encourages First Nation people to talk to them and use available teaching through community workshops, classes, group discussions, lectures, and video programs. One-to-one counseling is also provided at individual clients' requests.     

基于农村社区HIV/AIDS患者关怀支持活动模式的研究

目的探讨基于农村社区HIV/AIDS患者关怀支持活动模式。方法以农村社区为基础,由艾滋病防治专家、志愿者、社区医务人员、患者家属等组成关怀支持团队,通过开展培训、社区宣传教育、心理支持、患者交流、营养支持活动,为HIV/AIDS患者提供情感关爱和心理支持。结果本活动目标人群为150例HIV/AIDS患者,平均年龄为(44.61±10.78)岁,男性65人,女性85人。活动结束后抽取目标人群60例,采用《生存质量测定量表简表》测量其生存质量情况。活动前生存质量总分为(74.30±12.64)分,活动后总分为(84.95±16.31)分,差异有统计学意义(P<0.01)。结论建立以社区为基础的关怀支持体系,对充分发挥社区在艾滋病控制方面的参与功能、互助功能、整合功能及动员社会力量控制艾滋病传播方面有重要意义。     

A new paradigm for HIV care: ethical and clinical considerations

Although dramatic advances in clinical treatment have greatly improved the lives of many people with HIV/AIDS, many other patients do not have information about or access to these treatments because of health care providers' presumptive judgments about patients' ability to adhere to medical regimens. The authors contend that with sufficient support and education most patients, even those with difficult social and medical problems, can be helped to initiate and maintain HIV treatment in accordance with current clinical standards. This commentary delineates a new paradigm for HIV care in which patients and providers collaborate on individualized plans to establish patients' readiness for treatment, ensure maintenance of treatment, and make use of the social services necessary to accomplish these goals. Providers have an ethical responsibility to do everything possible to see that patients who might benefit from new HIV treatments have a fair opportunity to do so, and health systems have a responsibility to facilitate this process. Substantial progress toward meeting these responsibilities can be made within the current health care environment.     

艾滋病流行地区艾滋病感染者/艾滋病病人随访模式探讨

目的通过艾滋病感染者/艾滋病病人(以下简称HIV/AIDS)随访服务提供方和接受方的视角,初步了解随访干预的影响因素,探讨在吸毒严重的艾滋病流行地区的随访模式。方法采用半结构化访谈的方法对4名主管艾滋病工作人员,14名随访责任人、40名HIV/AIDS进行个人深入访谈,每人约1~1.5小时。结果政府重视、政策支持、"四免一关怀"政策、社区维持治疗、随访工作人员数量、HIV/AIDS的流动、歧视、家庭支持、违法犯罪被公安抓获、交通不便等是影响HIV/AIDS随访的主要因素。结论社区为基础的随访模式不仅可以充分发挥人力资源优势,降低社会歧视,方便提供心理支持,减少HIV/AIDS暴露的机会,还可以及时地随访到外出流动而失访的HIV/AIDS。社区药物维持治疗门诊(MMT)在HIV/AIDS随访当中也发挥了重要作用。建议在艾滋病流行地区迅速采用以社区为基础的随访模式,发挥MMT的随访管理作用,加强与公安部门的合作,在监管场所随访HIV/AIDS。     

Bringing the mountain to Mohammed: a mobile dental team serves a community-based program for people with HIV/AIDS

In spite of the direct referral system and family-centered model of primary oral health care linking medical and dental care providers, most HIV-positive patients at the Columbia Presbyterian Medical Center received only emergency and episodic dental care between 1993 and 1998. To improve access to dental care for HIV/AIDS patients, a mobile program, called WE CARE, was developed and colocated in community-based organizations serving HIV-infected people. WE CARE provided preventive, early intervention, and comprehensive oral health services to minorities, low-income women and children, homeless youths, gays and lesbians, transgender individuals, and victims of past abuse. More efforts to colocate dental services with HIV/AIDS care at community-based organizations are urgently needed.     

农民接受艾滋病病毒检测意向和结果告知范围的研究

目的 研究农村居民接受艾滋病病毒(HIV)自愿检测意向和检测结果告知范围。方法 运用两阶段整群抽样方法,调查l057名15-49岁的农村居民,采用匿名问卷表,面对面和耳机听问题答卷的方式。结果 在听说过HIV的653名调查对象中,575名(88．1％)有接受HIV检测的意向。其中,90．2％愿意将检测结果告知配偶,77．1％愿告诉其他家庭成员,54．8％愿告诉朋友,50．8％愿告诉邻居。logistic回归分析提示,与接受检测意向有关联的因素为男性,HIV／AIDS知识水平较高。结论 HIV／MDS知识知晓程度影响居民接受HIV检查意向,应开展HIV／AIDS知识的健康教育,提高农村居民对AIDS的警觉性。     

Relationship between physicians and HIV patients: influence on adherence and quality of life

OBJECTIVE: To assess the influence of the relationship between people living with HIV/AIDS and health care providers on treatment adherence and quality of life. METHODS: Qualitative study conducted in Mexico, in 2003, with informants recruited from HIV/AIDS support groups, non-governmental organizations, and infectious disease clinics in public hospitals. A total of 40 people living with HIV/AIDS and five support group leaders were interviewed. Data were collected using sociodemographic questionnaires and in-depth interviews exploring the experience of living with HIV/AIDS, including treatment, disease perception, quality of life, physical and emotional health, and relationship with physicians. Responses were recorded, transcribed and organized thematically based on codes using an inductive analysis. RESULTS: Most respondents aged between 26 and 45 years. The main obstacles to care were related to lack of risk awareness and information among people living with HIV/AIDS and physicians. Physicians proved not to be well trained on HIV/AIDS care. During the follow-up care, most problems were related to inadequate treatment adherence mainly caused by poor communication with physicians and discrimination in public services. CONCLUSIONS: Overall the problems identified were related to information deficiencies, physicians' lack of training and paternalism, and social stigmatization of people living with HIV/AIDS associated with the epidemic.     

"I know what I'm facing"

By May 1991, 6700 reported cases of AIDS existed in Zimbabwe and many included those in the labor force. Around 25% of the cases were infants. Moreover about 500,000 may actually have been HIV seropositive with an estimated 90% being of working age for an HIV seroprevalence of about 10% in the labor force. 50% of the 10 million inhabitants of Zimbabwe were 15 years old. In 1990, 18% of 1000 pregnant women screened in Harare were HIV positive. Furthermore, 51% of patients screened at an urban genitourinary clinic in 1990 tested HIV positive whereas, in 1987, only 18% tested HIV positive. The extended family can no longer cope with the problems created by the AIDS epidemic, so the community must support HIV positive people and AIDS patients. For example, grandparents or other relatives must often take in the children of parents who have died from AIDS. Indeed, the emotional turmoil in learning of one's own or a loved one's HIV infection can be overwhelming. The Ministry of Health has founded the AIDS Control Programme which includes counseling as an important component. This division trains health workers in counseling individuals and families afflicted with AIDS and provides pamphlets for primary health care workers. 1 thing that it emphasizes is that clients need time to deal with the situation. Yet many health workers do not have the time. More and continued integration between social workers and health providers is needed. A woman from the AIDS Counselling Trust suggests that counseling for mothers of infants with AIDS can begin with a small group in hospital wards, such as what has been done in Mutare, Zimbabwe. Further self help groups can be connected with clinics. Zimbabwe can also go the way of Zambia and provide home based care services and mobile units.     

湖北省相关社区组织参与艾滋病防治项目活动模式调查分析

目的：调查分析湖北省社区组织（community-based organizations,CBO）参与艾滋病防治项目活动模式,为制定更为规范的 CBO 参与艾滋病预防干预、关怀支持模式与策略提供参考。方法自行设计调查表格,汇总分析46个 CBO 相关内容。结果对暗娼人群干预以同伴教育为主;男男性行为（MSM）人群干预在社区开展自愿咨询监测、扩大艾滋病病毒检测;吸毒人群干预以家庭走访、动员吸毒者家属教育;对艾滋病病毒感染者/艾滋病患者的关怀与支持以提供医疗和心理关怀,构建社区支持网络,开展生产自救为主要模式。结论 CBO 目前已针对不同类型的艾滋病相关高危人群形成了有针对性的干预模式,并开展了大量有效的干预活动,取得了明显成效,为卫生管理部门和专业机构分担了工作任务,达到了取长补短的作用。     

孕妇艾滋病知识认知现状调查与分析

目的：了解本区内孕产妇对艾滋病预防相关知识的知晓程度,为更好的对孕产妇开展艾滋病健康教育工作提供依据。方法随机抽取2013年11月在新疆乌鲁木齐市妇幼保健医院建卡或围产期保健的孕妇300例进行调查。结果被调查人群对艾滋病知识的总知晓率较低为77．00％（231/300）,调查对象对于目前可以通过干预措施阻止艾滋病母婴垂直传播不清楚,对与艾滋病感染者深接吻会传染艾滋病知晓率只有33．67％,与艾滋病感染者共用牙具剃须刀会传染艾滋病知晓率69．67％,蚊虫叮咬不会传播HIV知晓率43．67％。结论由于少数民族地区的特殊性,语言沟通能力的局限性,孕产妇获得预防艾滋病知识的渠道比较局限,少数民族地区孕产妇艾滋病健康教育有待进一步加强。     

AIDS stigma in health services in the Eastern Caribbean

Stigma obstructs HIV/AIDS prevention and care worldwide, including in the Caribbean, where the prevalence of AIDS is second only to sub-Saharan Africa. To contextualise the experience of AIDS stigma in health services in Grenada and Trinidad and Tobago, we conducted eight focus groups with 51 people living with HIV/AIDS (PLHA), families, and service providers. Quasi-deductive content analysis revealed consonance with Western and Northern conceptualisations of AIDS stigma wherein stigma is enacted upon marginalised populations and reinforced through psycho-sociological processes comparing 'in' and 'out' groups. Socially constructed to be physically contagious and socially deviant, PLHA are scorned by some service providers, especially when they are perceived to be gay or bisexual. PLHA and providers identified passive neglect and active refusal by hospital and clinic staff to provide care to PLHA. Institutional practices for safeguarding patient confidentiality are perceived as marginally enforced. Interventions are needed to reduce provider stigma so the public will access HIV testing and PLHA will seek treatment.     

Who is providing ambulatory care to Medicaid beneficiaries with acquired immunodeficiency syndrome in New York State?

This study examined the number of ambulatory care providers treating individuals with the acquired immunodeficiency syndrome who were Medicaid beneficiaries in New York State in 1988 and examined the distribution of this care across various practice settings. The study population was identified retrospectively in the New York State Medical HIV/AIDS Research Data Base and included a cohort of 5535 individuals with the acquired immunodeficiency syndrome who were enrolled in Medicaid in 1988 for at least 6 months after being diagnosed as having the disease and who had at least one ambulatory care encounter during the year. Ambulatory care for the study group was provided by more than 700 hospital or freestanding clinics and more than 3000 private physicians in 1988. Many sites had low caseloads; 47% of the clinics and 68% of the physicians treating this population saw only one or two patients with the acquired immunodeficiency syndrome who were enrolled in Medicaid. More than half the patients in the study group were seen most frequently in clinics for their ambulatory care during 1988. These data provide reassurance that a wide network of providers is involved in the care of patients with the acquired immunodeficiency syndrome who are Medicaid beneficiaries in New York.     

North Dakota law allows confinement on HIV suspicion

Governor Schafer of North Dakota signed Senate Bill 2282, imposing stringent measures to help emergency services providers determine the HIV status of people they encounter when responding to crimes and medical crises. Under the new law, people who expose police officers, firefighters, paramedics, or health care providers to body fluid can be confined for up to five days while awaiting HIV testing. AIDS advocates and civil liberty's lawyers have challenged this measure, claiming that it serves no legitimate public health purpose. The new legislation authorizes certain personnel to petition a judge for a blood test of an individual who caused exposure. People who request the test must show probable cause of significant exposure. Data from the Centers for Disease Control and Prevention (CDC) indicates that the probability of a police officer in North Dakota being exposed to HIV is quite low. However, police officers wanted greater reassurance that any body fluids to which they are exposed were not HIV-positive.     

Rural School Nurses'Attitudes about AIDS and Homosexuality

ABSTRACT: The AIDS epidemic has spread to rural areas of the United States. Conservative rural communities are facing the challenge of having children with HIV entering school. School nurses, as the only health care providers in the schools, are in a strong position to facilitate the education of children with HIV and to provide AIDS education to students, faculty, and parents. School nurses' knowledge and attitudes about AIDS and people with AIDS influence their effectiveness in prevention activities and care of HIV-infected children. This study examined the relationship between specific demographic, practice, and cultural variables and rural school nurses' attitudes about AIDS and homosexuality. Sixty-nine school nurses responded to a mailed questionnaire as part of a larger study of rural nurses. Results indicate attitudes about homosexuality were related to nurses' homosexual knowledge and religious beliefs while attitudes about AIDS were related to nurses' willingness to care for people with AIDS and feeling prepared to do so.(J Sch Health. 1997;67(8):341–347)