博茨瓦纳的艾滋病防治经验

一个人口170万,孕产妇HIV感染率高达37.4%的非洲国家,艾滋病使全国人均期望寿命由67岁下降到现在的近40岁,全国有30万人感染了HIV,有11万人需要艾滋病抗病毒治疗,有4万名艾滋病孤儿。政府将控制艾滋病视为社会生存和发展问题,通过多部门合作、综合干预及有效的国际合作,使艾滋病得到了初步有效的控制。     

Evolution of HIV/AIDS response in Brazil: Policy innovations and challenges in the fourth decade of the epidemic

Brazil was the first low‐ and middle‐income country to provide universal treatment access to people living with the acquired immunodeficiency syndrome (AIDS), becoming a widely acclaimed model for best practice to managing this epidemic. However, we know little about important challenges to the key pillars of Brazil's response. This article discusses how the evolution of the country's health system institutions and international advancements in AIDS treatment and prevention affected the national response. Decentralization of health system resources and policy making brought fresh challenges to the centralized governance of the national AIDS program and to civil society, weakening their coordination and advocacy capacity. Regardless, AIDS treatment and prevention strategies in Brazil remain aligned with the current international protocols, but unfortunately have been restricted in some geographic areas and/or populations.     

盈江县农村HIV/AIDS关怀经验

借助联合国儿基会艾滋病预防与关怀项目的实施，对监测出HV/AIDS发病率高和吸毒人员较集中的村寨实施关怀及预防控制工作，取得较好的效果。     

以家庭和社区为基础的农村艾滋病病毒感染者/病人及其家属关怀模式

[目的]探索和建立对农村艾滋病病毒感染者和病人关怀和支持的工作模式,提高目标人群的生活质量,减少艾滋病病毒在感染者家庭夫妻间经性传播及非婚性传播,促进艾滋病的预防控制。[方法]社区(乡村)医生参与干预和关怀的服务;开展自愿咨询检测;培训同伴教育者(志愿者);提供感染者家庭生产支持与救助,孤儿关怀与救助,加强部门间的合作。[结果]项目覆盖24个乡,完成了大量干预、关怀、培训工作,达到了预期的要求。[结论]初步探索出了在农村地区对艾滋病病毒感染者和病人进行关怀和支持的工作模式。     

Help-seeking in a context of AIDS stigma: understanding the healthcare needs of people with HIV/AIDS in China

Despite the rapid increase of HIV infection cases in China, the majority of this population have not yet accessed AIDS-related healthcare services. Most current research in China focuses on HIV prevention and disease control, and pays inadequate attention to the barriers facing HIV-infected individuals in accessing and adhering with healthcare services. This article, as part of a research project on the illness experiences of people with HIV/AIDS in China, aimed to explore these individuals' healthcare experiences, shedding light on the gaps between their needs and existing healthcare services. Data for this qualitative study were collected through individual in-depth interviews with 21 HIV-infected adults in China. The results of data analysis suggest that these individuals' healthcare experiences were greatly affected by social discrimination and the limitations of healthcare resources. While AIDS stigma has reduced the social resources available for this population, HIV-related health institutions were perceived by them as an indispensable source of social support. It is concluded that healthcare institutions, as one of the few places in which HIV-infected people are willing to disclose their HIV positive status, should incorporate social care into healthcare service development and delivery so as to facilitate this population's accessing healthcare services and to address their unmet needs that go beyond the conventional scope of health care. Improving the visibility of people with HIV/AIDS in health care will also have a long-term impact on their own well-being and on HIV prevention in China.     

HIV/AIDS prevention in China: A challenge for the new millennium

China’s first HIV infection was officially reported in 1985 and by the end of 1996, there may have been up to 200,000 people affected nationwide. In 2001, this figure probably exceeded 600,000. By 2003, the predicted number of HIV cases had reached 1.5 million. At least 80,000 individuals now have fullblown AIDS. China may soon have the largest HIV-infected population in the world, possibly 6 million cases by 2005. With infection rates rising at about 30% per year, it is feared this figure might exceed 10 million by 2010. Although the Chinese government was initially slow to accept the problem, in the late 1990s definite changes began occurring. In 2003 Premier Wen Jiabao publicly shook the hand of an AIDS patient and his government promised to introduce a range of free HIV-related services. Large preventive education campaigns are now underway. Unfortunately, there will still be many obstacles in controlling the epidemic and preventing further spread of this disease. Without doubt, China faces a serious predicament in the new millennium, and one which will pose numerous challenges for preventive medicine.     

Comprehensive care: building community alliances for care of people with HIV/AIDS

In this article we suggest that optimal care for people livingwith HIV/AIDS calls for a multidisciplinary and multisectoralapproach, which can be achieved with cooperation between thestatutory and non-statutory service systems. AIDS has both directlyand indirectly focused attention on the limitations of the servicesavailable in our communities, including those provided by theprimary and secondary health sector. However, non-statutorycommunity-based organizations have been providing vital servicesof information, counselling and care, relying on a steady streamof unpaid labour. Community control over its health care systemand environment should be encouraged and local authorities shouldacknowledge the resources provided by non-statutory bodies,supporting such groups both morally and financially. Using theHealthy Cities project network as a framework, we recommendestablishing working relationships to enhance service integration.The creation of service alliances is intended to facilitatecontinuity of care by establishing links within local governmentagencies, and the priority of the alliance should be to developa realistic, comprehensive service plan involving all interestedparties.     

艾滋病患儿高效抗逆转录病毒治疗相关肝毒性

抗逆转录病毒药物引起肝毒性比较常见,而且每类药物肝毒性机制不同.儿童患者HAART相关肝毒性的发生机制与成人患者相似,但发生率要低一些.HAART开始后的早期阶段要加强对肝毒性的监测,及时发现肝功能异常,如果肝酶升高超过10倍正常上限或出现肝炎症状要及时停药,如果肝毒性是由奈韦拉平或阿巴卡韦引起的,停药后不要再次应用,以防致命反应的发生.     

HIV/AIDS education in Tanzania: The experience of at-risk children in poorer communities

This study has investigated human immunodeficiency virus (HIV) knowledge, attitudes and sexual at-risk behaviours of youths from disadvantaged communities of Dar es Salaam, Tanzania. Participants were 800 youths aged 12–15 years within three youth subgroups in these poorer communities: those children attending school; children who were not attending school but who were still residing within their communities; and children who were street children (more than 50% of them being orphans). Participants responded to questionnaires. In general, all youths showed low levels of HIV knowledge, experience with condom use and intention to use condoms. They exhibited moderate perceived behaviour control in using condom and positive subjective norms about the use of condoms, the value of sexual abstinence and having an exclusive sexual partner. Contrary to expectations, there were no significant differences between those in-school and those out-of-school with regard to HIV knowledge, intended condom use, subjective norms about condom use and abstinence. Indeed, the in-school children were more at risk for HIV infection, in that they reported the lowest condom experience and perceived behavioural control in condom use. There were systematic gender differences, in that girls scored lower than boys on all variables. The policy of basing HIV/acquired immunodeficiency syndrome (AIDS) education within the schools of Tanzania has not been as effective as desired. To be effective in “kicking AIDS out of Africa”, we need to re-evaluate the educational strategies being used.     

The Unchecked HIV/AIDS Crisis in Mississippi

While the population of the southern United States is only 37% of the country’s total, this region is experiencing 50% of new HIV diagnoses and 46% of new AIDS diagnoses. Specifically, Mississippi has the highest rates of new infection, the most AIDS deaths, the greatest number of people living with HIV/AIDS, and the fewest resources. Mississippi has the highest death rate in the country: 32.9 per 1,000. A Mississippian with HIV/AIDS is almost twice as likely to die as the average American with the virus (SHARP Report, 2010). Compounding the problem are government policy issues, such as disproportionate program funding; socio-economic issues, such as widespread poverty, housing insecurity, and the lack of access to care; and cultural issues, such as homophobia and social stigma. These factors are reflected in this study which examines the needs of people living with HIV/AIDS in a southern, rural county of Mississippi. From a representative sample of 218 HIV positive individuals, researchers identified the levels of need for housing, transportation, medical care, mental health care, substance abuse treatment, and education. The author discusses the reciprocal influences of these needs and HIV, the need for policy changes at the state and federal levels, and the need for resources that both support people living with HIV/AIDS and curb the rate of new infections.     

HIV/AIDS control in Africa: the importance of epidemiological and health promotion approaches

HIV infection and AIDS are disproportionately afflicting ThirdWorld countries, especially the countries of Africa, where substantialadult communities and villages are literally being annihilated.Because there is no known cure for HIV/AIDS, and because ofthe high costs of current antiviral therapy (e.g. AZT), it isa cost-effective use of health resources for the economicallypoor countries of Africa to use health promotion/ educationto intervene and control the incidence of HIV infection andAIDS. Crucial to any effective health promotion effort is athorough knowledge about the epidemiological specifics and distributionof HIV/AIDS in Africa, the known at-risk segments of the population,and the known at-risk conditions (e.g. male–female relationships,stress) and behaviours (e.g. peer and other pressures to engagein unprotected sex) for HIV infection. For health promotionto be successful it has to be unrelentingly applied to all at-riskgroups in African societies, region-specific and culturallysensitive, and it has to acquire active cooperation from allmembers of the community of African nations.     

The impacts of AIDS movements on the policy responses to HIV/AIDS in Brazil and South Africa: A comparative analysis

Abstract

Brazil and South Africa were among the first countries profoundly impacted by the HIV/AIDS epidemic and had similar rates of HIV infection in the early 1990s. Today, Brazil has less than 1% adult HIV prevalence, implemented treatment and prevention programmes early in the epidemic, and now has exemplary HIV/AIDS programmes. South Africa, by contrast, has HIV prevalence of 18% and was, until recently, infamous for its delayed and inappropriate response to the HIV/AIDS epidemic. This article explores how differing relationships between AIDS movements and governments have impacted the evolving policy responses to the AIDS epidemic in both countries, including through AIDS programme finance, leadership and industrial policy related to production of generic medicines.     

Policy responses to HIV/AIDS in Central Asia

The countries of Central Asia (Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan) are confronted with one of the fastest growing HIV/AIDS epidemics worldwide, largely driven through injecting drug use. This article, based on a review of academic and grey literature, explores how they have responded. We find major similarities and differences across the region. At one extreme is Turkmenistan, which denies that there is any problem, does not offer harm reduction services or HIV/AIDS treatment and does not report any meaningful data to the international community. Uzbekistan is also pretty closed to outside influences, has discontinued its opioid substitution project and shares with Turkmenistan the legal prohibition of male-to-male sex. Kyrgyzstan originally led many progressive approaches in the region and, like neighbouring Tajikistan, has received substantial assistance by international agencies, in particular the Global Fund. Kazakhstan, with a much higher gross domestic product per capita, has taken on the financing of harm reduction activities through its national budget and has liberalised its drug policies. Yet, across the region punitive approaches to injecting drug use and people living with HIV/AIDS persist as do stigma and discrimination, while coverage with harm reduction programmes and treatment services is still low although with substantial variation across countries.     

The influence of health knowledge in shaping political priorities: Examining HIV/AIDS knowledge and public opinion about global health and domestic policies

Abstract

Public opinion polls have historically indicated that the US public favours domestic over global priorities. It is not known what influence health knowledge has in shaping public opinion about domestic and global health policy. This study examines how knowledge of HIV/AIDS is related to the rated importance of domestic and global health issues. Participants were recruited to participate in an electronic survey (N = 995) and were predominantly White (86.3%), married (61.9%) and female (71.8%). HIV/AIDS knowledge was significantly associated with both domestic (β = 0.12, p < 0.05) and global health (β = 0.14, p < 0.01) priorities after controlling for sociodemographic variables. In addition, global health was found to act as a mediator between HIV/AIDS knowledge and perceived importance of domestic issues. Study findings suggest that those with greater HIV/AIDS knowledge rate global health issues higher, which in turn affects ratings of more domestic issues. This research has implications for ways to gain support for implementation of public health policy through increasing health knowledge.     

Perceived social support of HIV/AIDS orphans: a review

HIV/AIDS orphans are a vulnerable and disadvantaged group. The HIV/AIDS orphans’ crisis is an emerging problem of developing societies. Existing research, literature, and findings on perceived social support (PSS) of HIV/AIDS orphans in the world till date have been compiled with the aim of presenting the current status of research, major findings, and gaps in this area. A thorough review of published empirical studies from PubMed, PsycINFO databases, online publications of several organizations, web searches, and several online journals related to PSS of HIV/AIDS orphans have been reviewed. HIV/AIDS orphans from 6 to 18 years, whose either or both parents had died due to HIV/AIDS or were staying with HIV-positive parents were selected for this purpose. Six out of eight studies found low level of PSS in HIV/AIDS orphans and two studies found peer-group intervention very effective to improved PSS in HIV/AIDS orphans. They severely experience negative emotions, behavioral problems, higher levels of psychological difficulties, and poor academic performances due to the reasons like drawn out-of-school, living with an unaffectionate caretaker, inadequate care, child labor, physical and sexual abuse, stigma, and discrimination. The psychological health of HIV/AIDS orphans is at risk, and prevention and intervention efforts are missing for improving their psychological outcomes. The review recommends that a rigorous research needs to be prioritized so that the programs and policymakers that are attempting to work for their well-being may get helpful information to design evidence-based interventions.     

HIV／AIDS患者健康教育需求分析

目的 分析HIV／AIDS患者的健康教育需求，为有针对性开展健康教育提供参考。方法 应用调查表，调查,2004年5月至2006年4月间在我区发现的42例HIV／AIDS患者，分析探讨其健康教育需求内容及方式。结果 HIV／AIDS患者最想了解HIV／AIDS治疗及管理等服务机构、其次为药物的疗效和副作用、CD4免疫细胞检测及意义、临床症状和治疗方法、心理支持系统与自我疏导方式、AIDS夫妻及家人间的预防等；最希望获取知识途径是工作人员上门随访宣传教育。结论 健康教育应以受众的心理特点、需求和现有知识水平为依据，按他们最欢迎的方式和最需要的内容进行宣传教育会提高健康教育工作的效果。     

134例HIV/AIDS感染特征分析

为探讨HIV/AIDS的早期诊断,规范基层医疗机构HIV/AIDS转诊治疗,本研究对1998-2005年柳州地区住院的HIV/AIDS病例的感染、临床特征及转归进行调查.     

为了孩子的明天--在学校开展预防艾滋病健康教育的做法

对云南省部份学校进行的预防艾滋病健康教育工作进行总结：（1）采用参与性工作思路，对学校预防艾滋病健康工作进行分析、定位，并与正常学校工作相联系；(2)应用参与性教学方法和同伴教育，进行三级培训；(3)把生活技能培训与健康教育相结合；(4)建立全省师资网络、扩展培训；(5)把健康教育辐射到家庭及社区；(6)推进学生素质教育。     

山东省艾滋病感染者子女现况调查

[目的]了解山东省艾滋病感染者子女的分布和生存状况。[方法]2005年3～4月，对山东省全部HIV感染者的18岁及其以下子女的一般情况、就学情况、HIV感染状况及其家庭的相关情况进行了调查：[结果]调查HIV感染者子女208人，分布在13个市、38个县（市、区）、142个家庭；做过HIV抗体筛查的128人，阳性1人；46人因家庭经济困难而辍学，调查142个家庭，28个家庭有2名HIV感染者，1个有3名HIV感染者;95个家庭年人均收入低于1000元。[结论]HIV感染者子女分布比较广泛，受教育情况、家庭经济状况相对较差，政府和社会有关部门应为他们提供更多的关怀和帮助。     

在HIV/AIDS中筛查结核病的现状及问题分析

目的：了解在HIV/AIDS转诊到结核病防治机构进行结核病筛查的工作现状、问题并探讨问题产生的原因,为相关政策制定与修订提供依据。方法：通过定性研究,对艾滋病高流行地区3县区的领导和技术人员进行个人深入访谈。结果：在HIV/AIDS病人中进行结核病筛查主要问题有,第一,HIV/AIDS病人中筛查结核病筛查率难以保证;第二,HIV/AIDS病人中筛查结核病时在诊断上存在一定的困难;第三,在HIV/AIDS病人中筛查结核病时可能存在交叉感染,大部分防治机构未采取有效的措施预防交叉感染。结论：通过随访责任人加强HIV/AIDS随访率,提高HIV/AIDS中结核病诊断水平,加强结核病感染控制等加强HIV/AIDS中结核病的识别和诊断。