艾滋病及其病毒携带者的心理健康环境与社会支持

基于以人为本的哲学理念。运用社会支持理论，分析了艾滋病／人类免疫缺陷病毒（HIV／AIDS）感染患者的心理健康环境,阐述社会支持的作用，并提出艾滋病患者开展社会支持的具体方法，即大力开展相关知识培训与教育。营造健康的社会环境，进行心理辅导，提供生活援助等。     

艾滋病患者和感染者的社会支持及其策略分析

目前我国艾滋病患者和感染者(PLWHA)从各方面获得的社会支持明显不足。而提高社会支持是改善患者生理和心理健康最重要的途径之一,通过培养正确的家庭支持,加强医疗护理支持和建立社区支持网络,开展相应的干预措施,可以提高PL-WHA的社会支持,树立重返社会的信心,缓解疾病的症状和压力,提高其生活质量和满意度,对今后的艾滋病的整体防治工作具有重要的意义。     

HIV/AIDS相关继发性羞辱和歧视的研究现状

从HIV/AIDS相关羞辱和歧视的概念出发,综述了HIV/AIDS相关继发性羞辱和歧视的概念、研究现状、产生原因、对家庭成员和社会的影响,提出大力加强艾滋病正确知识的宣传教育,提供广泛的社会支持等干预措施,关注HIV感染者和AIDS患者(PLWHA)的同时,更应重视其家庭成员,用实际行动给予他们医疗物质和心理上的支持,促使他们以积极的态度照顾PL-WHA,才能从真正意义上提高PLWHA的生活质量,减少其高危行为,有利于预防和控制艾滋病的流行。     

艾滋病患者益处发现体验的质性研究

目的 探讨艾滋病患者的益处发现体验，为针对性护理干预提供参考。方法 采用质性研究方法，对18例艾滋病患者进行半结构式访谈。结果 提炼出4个主题，包括个人成长（自我调适，理解与自强）、领悟支持（亲密关系及家人支持，医护人员支持，国家政策及社会支持）、健康相关积极行为的建立（纠正不良生活习惯，主动求助，减少危险性行为及定期复诊，信息共享及互相鼓励）和无益处发现体验。结论 医护工作者应重视艾滋病患者疾病过程中的积极体验，评估患者心理状态、支持情况和应对能力，提供有效帮助，促进益处发现。     

艾滋病病区管理存在的问题及对策

在2006年1月至2007年7月管理229例住院治疗的艾滋病惠者过程中,存在患者违反病区管理制度、自杀、欠费及医护人员人身伤害和职业暴露的问题.提出采取减轻患者心理压力、加强病区管理、争取社会的支持、适当防范及加强对护理人员的培训等对策,以缓解上述问题,改善患者住院条件和医护人员工作环境.     

艾滋病病区管理存在的问题及对策

在2006年1月至2007年7月管理229例住院治疗的艾滋病患者过程中．存在患者违反病区管理制度、自杀、欠费及医护人员人身伤害和职业暴露的问题。提出采取减轻患者心理压力、加强病区管理、争取社会的支持、适当防范及加强对护理人员的培训等对策，以缓解上述问题，改善患者住院条件和医护人员工作环境。     

艾滋病患者社交回避苦恼、情绪社交孤立与焦虑抑郁的关系

目的探讨艾滋病患者情绪社会孤立、社交回避及苦恼与焦虑抑郁的关系,并分析社交回避及苦恼在情绪社会孤立与焦虑抑郁间的中介作用。方法采用焦虑自评量表、抑郁自评量表、情绪-社交孤独量表、社交回避及苦恼量表对202例艾滋病患者进行调查。结果艾滋病患者焦虑和抑郁得分分别为(44.76±10.44)、(51.09±10.84);情绪社交孤立与社交回避苦恼得分分别为(6.37±4.59)、(11.31±6.87)。焦虑、抑郁与情绪社交孤立、社交回避苦恼呈正相关(均P0.01)。社交回避苦恼在情绪社交孤立与焦虑间起完全中介作用(中介效应为0.176),社交回避苦恼在情绪社交孤立与抑郁间起完全中介作用(中介效应为0.231)。结论艾滋病患者焦虑抑郁、情绪社会孤立、社交回避及苦恼较重,情绪社交孤立通过导致艾滋病患者的社交回避苦恼影响其焦虑和抑郁,医院应通过加强艾滋病患者的社会支持,减少其社交回避苦恼,促进其心理健康。     

广西宜州市服务娱乐场所高危人群艾滋病干预安全套使用推广方法初步探讨

目的:探讨服务娱乐场所高危人群艾滋病干预安全套使用推广有效方法。方法:通过政府支持,多部门配合,多种形式,全民普及艾滋病知识,营造良好的社会环境,反复培训业主、服务小姐深入场所面对面灌输防"艾"和安全套知识,促进服务娱乐场所安全套使用推广。结果:服务场所和暗娼安全套使用率明显提高,艾滋病病毒感染率保持较低水平。结论:服务娱乐场所安全使用推广采取综合干预方法具有良好效果。     

我国艾滋病防治工作中的伦理问题及对策

从人们对艾滋病(AIDS)的认识、艾滋病病毒(HIV)检测、对高危人群采取防范措施、切断AIDS感染途径、HIV/AIDS人群隐私保密权和公众知情权、对HIV/AIDS人群进行强制隔离以及对其进行救治等方面综述了我国AIDS防治工作中的伦理问题,提出了相应对策,以唤起社会为HIV/AIDS人群创造一个发挥支持性作用的伦理环境,提高艾滋病的防治效果.     

艾滋病患者与护士对临床护理服务质量评价的对比研究

目的 了解艾滋病临床护理服务质量,为提高艾滋病临床护理服务质量提供依据.方法 采用整群抽样法抽取住院艾滋病患者105例,对其所接受的临床护理服务进行现场观察,并对患者进行满意度调查,评价各项护理措施的执行达标程度及质量.结果 患者对29个条目评价得分均值为3.02～3.51分,评估员对29个条目评分均值为1.00～5.00分,两者对24个条目的评分差异有统计学意义（均P＜0.01）.结论 艾滋病患者对临床护理服务质量评价处于一般水平,患者与护士对临床护理服务质量的感知存在差异.艾滋病临床护理服务质量有待于进一步提高,尤其应加强心理护理和社会文化支持措施.     

La prévention du VIH chez les personnes sourdes au Burundi : état des lieux et perspectives

This article presents the various aspects of HIV/AIDS care for deaf people in Burundi to assess social inequalities in health especially the access to preventive care. Our work is particularly focused on identifying the factors that hinder the access of deaf people to HIV/AIDS care in developing countries such as Burundi. The study is based on a literature review and a qualitative study with stakeholders and beneficiaries. The literature review was conducted on reports or other official documents that were made by various stakeholders involved in the fight against HIV/AIDS. A qualitative approach was made of interviews with deaf people and different implied actors in the fight against AIDS. The informations on HIV/AIDS prevention and education is not readily available to the deaf people. They must depend on a third person to access HIV/AIDS prevention and education campaigns. Faced with communication difficulties, deaf people go to health professionals with support from a member of the family, which raises questions of ethics and respect for privacy. They face unequal access to HIV/AIDS prevention and education and then fall into the category of precarious populations. This work opens new avenues for research on the state of access to health care in general and the prevention of HIV/AIDS among deaf people in particular.     

住院艾滋病患者主要照顾者负性心理的质性研究

目的了解住院艾滋病亲属照顾者在看护期间内的主要压力源及负性心理体验。方法采用个人深度访谈法,收集8名照顾者的资料,用主题分析法进行分析,归纳住院艾滋病患者主要照顾者的压力源种类及其负性心理体验。结果照顾者压力源主要来源包括与艾滋病相关的压力源、与经济相关的压力源及与社会文化相关的压力源;照顾者的负性心理体验主要有怀疑、否认,恐惧、害怕,痛苦、矛盾,愤怒,迷茫无助及社交减少。结论住院艾滋病患者照顾者的压力源来源于多个方面,其负性心理体验复杂,研究者应重视主要照顾者的压力,为其提供有效的干预措施,加强支持系统。     

Addressing the structural drivers of HIV: a luxury or necessity for programmes?

The social, economic, political and environmental structural factors that increase susceptibility to HIV infection and undermine prevention and treatment efforts continue to pose a challenge. The papers in this series highlight the importance of sustaining those efforts to address the structural drivers of the HIV epidemic, and that initiatives to achieve HIV elimination will only come about through a comprehensive HIV response, that includes meaningful responses to the social, political, economic and environmental factors that affect HIV risk and vulnerability. In the context of declining resources for HIV/AIDS, the papers speak to the need to integrate responses to the structural drivers of HIV/AIDS into future HIV investments, with both initiatives to integrate HIV into broader gender and development initiatives, as well as adaptations of current service models, to ensure that they are sensitive to and able to respond to the broader economic and social responsibilities that their clients face.     

Evaluating social outcomes of HIV/AIDS interventions: a critical assessment of contemporary indicator frameworks

Introduction

Contemporary HIV-related theory and policy emphasize the importance of addressing the social drivers of HIV risk and vulnerability for a long-term response. Consequently, increasing attention is being given to social and structural interventions, and to social outcomes of HIV interventions. Appropriate indicators for social outcomes are needed in order to institutionalize the commitment to addressing social outcomes. This paper critically assesses the current state of social indicators within international HIV/AIDS monitoring and evaluation frameworks.

Methods

We analyzed the indicator frameworks of six international organizations involved in efforts to improve and synchronize the monitoring and evaluation of the HIV/AIDS response. Our analysis classifies the 328 unique indicators according to what they measure and assesses the degree to which they offer comprehensive measurement across three dimensions: domains of the social context, levels of change and organizational capacity.

Results and discussion

The majority of indicators focus on individual-level (clinical and behavioural) interventions and outcomes, neglecting structural interventions, community interventions and social outcomes (e.g. stigma reduction; community capacity building; policy-maker sensitization). The main tool used to address social aspects of HIV/AIDS is the disaggregation of data by social group. This raises three main limitations. Indicator frameworks do not provide comprehensive coverage of the diverse social drivers of the epidemic, particularly neglecting criminalization, stigma, discrimination and gender norms. There is a dearth of indicators for evaluating the social impacts of HIV interventions. Indicators of organizational capacity focus on capacity to effectively deliver and manage clinical services, neglecting capacity to respond appropriately and sustainably to complex social contexts.

Conclusions

Current indicator frameworks cannot adequately assess the social outcomes of HIV interventions. This limits knowledge about social drivers and inhibits the institutionalization of social approaches within the HIV/AIDS response. We conclude that indicator frameworks should expand to offer a more comprehensive range of social indicators for monitoring and evaluation and to include indicators of organizational capacity to tackle social drivers. While such expansion poses challenges for standardization and coordination, we argue that the complexity of interventions producing social outcomes necessitates capacity for flexibility and local tailoring in monitoring and evaluation.     

From GRID to gridlock: the relationship between scientific biomedical breakthroughs and HIV/AIDS policy in the US Congress

Introduction

From the travel ban on people living with HIV (PLHIV) to resistance to needle exchange programmes, there are many examples where policy responses to HIV/AIDS in the United States seem divorced from behavioural, public health and sociological evidence. At its root, however, the unknowns about HIV/AIDS lie at biomedical science, and scientific researchers have made tremendous progress over the past 30 years of the epidemic by using antiretroviral therapy to increase the life expectancy of PLHIV almost to the same level as non-infected individuals; but a relationship between biomedical science discoveries and congressional responses to HIV/AIDS has not been studied. Using quantitative approaches, we directly examine the hypothesis that progress in HIV/AIDS biomedical science discoveries would have a correlative relationship with congressional response to HIV/AIDS from 1981 to 2010.

Methods

This study used original data on every bill introduced, hearing held and law passed by the US Congress relating to HIV/AIDS over 30 years (1981–2010). We combined congressional data with the most cited and impactful biomedical research scientific publications over the same time period as a metric of biomedical science breakthroughs. Correlations between congressional policy and biomedical research were then analyzed at the aggregate and individual levels.

Results

Biomedical research advancements helped shape both the level and content of bill sponsorship on HIV/AIDS, but they had no effect on other stages of the legislative process. Examination of the content of bills and biomedical research indicated that science helped transform HIV/AIDS bill sponsorship from a niche concern of liberal Democrats to a bipartisan coalition when Republicans became the majority party. The trade-off for that expansion has been an emphasis on the global epidemic to the detriment of domestic policies and programmes.

Conclusions

Breakthroughs in biomedical science did associate with the number and types of HIV/AIDS bills introduced in Congress, but that relationship did not extend to the passage of laws or to hearings. When science matters, it cannot be separated from political considerations. An important implication of our work has been the depoliticizing role that science can play. Scientific breakthroughs helped to transform HIV/AIDS policy from a niche of liberal Democrats into bipartisan support for the global fight against the disease.     

医疗服务过程中艾滋病相关的耻辱与歧视

人类免疫缺陷病毒/艾滋病(HIV/AIDS)相关的耻辱与歧视已成为目前HIV/AIDS防治工作的最主要问题之一,特别是在医疗卫生服务过程中更引起了研究者和全社会的重视。本文对国内外卫生服务过程中HIV/AIDS相关的耻辱与歧视的现状、造成的影响以及目前的对策进行了概述,并对其原因进行了初步分析。     

城乡医务人员HIV/AIDS职业暴露防护知识调查分析

目的了解城乡医务人员HIV/AIDS职业暴露和防护知识的知晓情况,为防护知识培训提供依据.方法自行设计问卷对湖北省某县7个乡镇及某市的医务人员338名(乡镇180名、城市158名)进行HIV/AIDS职业暴露及防护知识调查.结果城乡医务人员对HIV/AIDS职业暴露及防护知识的知晓率偏低;乡镇医务人员在部分防护能力及暴露后的应对知识方面与城市医务人员比较,差异有显著性意义(P<0.05, P<0.01).结论加强城乡医务人员HIV/ALDS职业暴露及防护知识的培训,扩展乡镇医务人员培训面,以提高基层卫生工作者HIV/AIDS职业暴露的防护能力和暴露后的及时应对,减少HIV/AIDS感染的发生是目前迫切的任务.     

艾滋病临床医师教育培训的历史沿革和未来发展趋势

在2003年国家宣布“四免一关怀”政策后建立了艾滋病临床医师的培训制度,在艾滋病医师严重匮乏的阶段,采用了“手把手”的培训模式,解决了在艾滋病高发地区分发国家免费抗病毒药的问题;随着 HIV 病毒感染逐渐向普通人群蔓延,对具有一定医学背景的学员进行培训,加深对艾滋病的认识,能解决一些艾滋病患者常见的问题;加深学员对艾滋病的认识。在艾滋病患者要求多元化阶段,重点培训学员的机会性感染的诊疗,降低了艾滋病机会性感染在当地的流行率和病死率。艾滋病临床培训的未来趋势是对国内各综合医院的医师进行培训,艾滋病非指征性疾病的患者将入住综合医院接受更好的治疗。