中小城市妇科门诊管理人员VCT服务态度的调查分析

目的 了解妇科门诊的管理人员对在妇科门诊开展由医务人员主动提供艾滋病咨询检测(VCT)服务的必要性和可行性,探索有效的艾滋病防治策略.方法 采用定性访谈方法,选择主管妇科门诊的管理人员进行个人深入访谈.结果 访谈对象对艾滋病病毒(HIV)检测的重要性表示一致认同,在妇科门诊开展VCT工作应重点针对有生殖道感染或高危行为史的病人,但面临经费不足、病人接受性不高等困难;妇科医务人员需要加强培训,重点是艾滋病基本常识、自我保护方法、国家相关政策和当地服务机构信息.结论 做好大众人群的宣传教育工作和多部门协调的倡导工作,解决检测所需的费用等困难,结合妇科特点开展灵活多变的宣传工作是取得成效的关键.     

新疆维吾尔自治区人民医院VCT检测服务情况分析

目的在新疆维吾尔自治区人民医院,通过开设艾滋病自愿咨询检测(Voluntary counseling and testing,VCT)门诊,向求询者提供艾滋病相关咨询检测服务,并及时发现艾滋病病毒(Human immunodeficiency virus,HIV)感染者和艾滋病病人。方法在VCT门诊对求询者免费进行HIV咨询和抗体检测,对咨询情况和检测结果进行描述和统计分析。结果自2007年开设VCT门诊至2010年底,共向2 546名求询者提供了免费艾滋病咨询,其中接受HIV检测者有1 865人,占73.2%,检测出HIV抗体阳性者160人,阳性率为8.6%。求询原因,男性以吸毒为主,女性则以高危性接触为主。结论新疆维吾尔自治区人民医院VCT门诊求询者HIV感染率较高,有必要在新疆地区充分利用VCT平台,特别是利用大型综合性医院的优势,开展艾滋病相关健康教育、行为干预和HIV检测监测工作。     

流动人口管理者对艾滋病和VCT知识和态度的定性研究

目的 为了解流动人口相关管理人员对艾滋病和自愿咨询检测(VCT)的知识和态度,为开展VCT工作提供依据. 方法 在上海某区采用多阶段抽样,选取流动人口相关管理人员28人,采用个人深入访谈法,了解他们对艾滋病和VCT的相关知识和态度. 结果 该人群对艾滋病防治的知晓率低,但是愿意支持艾滋病宣传干预工作;对艾滋病存有恐惧心理,同时对艾滋病病毒(HIV)感染者有着较为严重的歧视情节;对VCT的知晓率较低,多数人认为周围的流动人口不会感染HIV,没有必要做HIV检测,也存在对检测者的歧视心理. 结论 应进一步加强针对该类人群的艾滋病宣传教育,消除该人群对HIV感染者和检测者的歧视,为流动人口创造好的艾滋病防治环境.     

大连市2008-2013年艾滋病VCT利用情况分析

目的分析2008-2013年大连市艾滋病自愿咨询检测(VCT)服务的利用情况,为制定高危人群干预策略提供依据。方法采用描述性流行病学方法,对VCT门诊求询者的基本信息、人群特征、检测情况进行统计分析。结果 2008-2013年,累计10 078人接受了大连市疾病预防控制中心VCT门诊服务,男性占90.73%,20~29岁年龄组的青年求询者占59.69%。9898名(98.21%)求询者自愿接受了艾滋病病毒(HIV)抗体检测,发现244例HIV新发感染者,HIV抗体检测阳性率为2.47%。新发HIV感染者中,男男性行为人群(MSM)占65.16%,商业异性性接触者占12.70%,非商业非固定异性性接触者和注射吸毒者各占6.56%。43.97%的求询者为重复检测,重复检测者与首次检测者的HIV抗体阳性检出率的差异有统计学意义(χ2=22.98,P0.01)。男男同性性接触者、商业异性性行为者和非商业非固定异性性行为者,HIV抗体阳性检出率的差异有统计学意义(χ2=58.79,P0.01)。4746人接受梅毒检测,梅毒筛查阳性360人,梅毒筛查阳性率为7.59%。梅毒筛查阳性者中MSM占75.28%。结论 VCT服务方式正逐渐被越来越多的高危险人群认同并接受,尤其是MSM。女性高危人群主动利用VCT服务的情况没有明显变化,应将医疗机构的妇科门诊作为女性高危人群干预和宣传的新阵地,进一步探讨出更为有效的干预措施,以控制HIV传播。     

安徽省性病门诊艾滋病VCT项目评价及效果分析

目的 对2006年安徽省性病门诊艾滋病自愿咨询检测(VCT)项目进行评价和分析. 方法 在全省26个性病门诊设置艾滋病咨询室,提供规范的VCT服务,并对33 708名求询者的主要信息进行统计分析和评价. 结果 1年内共为33 708名求询者提供VCT服务,接受艾滋病病毒(HIV)抗体检测的28 666人,检出阳性者295例,阳性率为1.03%;与我国成人总人口感染率水平0.1%比较,经u检验,P＜0.005.但也存在着VCT宣传效果不理想、性乱人群覆盖率较低等问题. 结论 在性病门诊开展VCT服务,可以高效地发现HIV感染者,为促进此项工作的持续开展,应加强VCT网络建设和规范管理.     

山东省艾滋病自愿咨询检测现状分析

目的为了解山东省艾滋病自愿咨询检测(VCT)门诊的建设情况,以及艾滋病咨询、检测工作现状,探讨影响高危人群接受艾滋病VCT服务的因素,为VCT工作的广泛开展提供有价值的信息。方法采用观察法、问卷调查、深入访谈及关键人物座谈进行调查。结果共调查了全省134个艾滋病自愿咨询检测点,其中81.9%的VCT点有专用、保密的咨询室;84.3%的门诊有HIV抗体筛查检测实验室;90%的门诊可以提供艾滋病热线电话咨询。76%的门诊现场开展了一定的工作,但检测前后咨询开展的很少。咨询室的可及性和保密性、人员配备、宣传工作及其他工作还存在问题。结论全省各地市艾滋病VCT门诊室的硬、软件建设均存在不足,尤其咨询人员缺乏,要充分认识VCT工作的重要性和紧迫性,创造条件促进VCT工作的广泛开展。     

艾滋病自愿咨询检测的影响因素

目的了解高危(重点)人群中艾滋病自愿咨询检测(VCT)状况及影响因素,并为今后政府制定高危行为人群的VCT干预对策提供科学依据。方法采用匿名自填问卷的方式,对深圳市特种服务行业女性从业人员进行了有关VCT的认知、态度、行为现状及影响因素的问卷调查。结果61.3%的人不知道VCT免费;95.4%的人没有做过艾滋病病毒(HIV)抗体检测,其中有65.9%的人认为自己不会得艾滋病,没有必要检测;54.6%的人不知道在哪里检测HIV抗体。当怀疑自己感染了HIV时有16.5%的人表示不会去检测,其中有84.4%的人担心被别人知道曾经做过HIV检测而被瞧不起,53.1%的人害怕检测结果阳性,本人和家人遭受歧视。结论社会宣传和干预力度不够,求询者的畏惧心理和侥幸心理、社会歧视是影响高危(重点)人群自愿接受HIV检测的主要原因,应进一步加强对艾滋病知识和"四免一关怀"政策的宣传,把VCT作为在高危(重点)人群中开展行为干预的重点。     

深圳市宝安区流动人口自愿咨询检测服务情况及影响因素

目的分析深圳市宝安区流动人口对艾滋病自愿咨询检测(VCT)服务的利用情况及相关影响因素,为VCT服务的有效开展和卫生资源的合理分配提供依据。方法采用随机整群抽样的方法,抽取流动人口集中的工厂工人5 274人进行匿名自填问卷调查。结果 5 274名流动人口中,有63.65%是男性,平均年龄为30岁,40.74%的人是单身状态,43.97%的人知道VCT服务,11.01%的人曾经做过HIV检测,其中43.55%的人是在接受VCT服务后做的检测,有86.78%的人愿意接受VCT服务。VCT服务接受意愿的影响因素有性别、艾滋病知识知晓率、是否发生过商业性性行为、是否愿意做HIV检测以及是否应该隔离艾滋病病人/感染者。结论迫切需要在流动人口中加强VCT服务的宣传,提高流动人口对VCT的利用率,提高该人群的危险意识,并且针对VCT服务中存在的不足进行改正,使其更能满足流动人口的需求。     

2010-2012年武汉市某艾滋病VCT门诊数据分析

目的对近3年来武汉市某艾滋病自愿咨询检测（VCT）门诊的数据进行分析,为完善VCT服务,为求询者提供更好的健康教育提供依据。方法收集武汉市某VCT示范门诊2010-2012年的数据,对求询者的一般人口学资料、高危因素及HIV和梅毒抗体初筛结果进行统计分析。结果 3年总求询者为3148人,进行艾滋病病毒（HIV）检测3048人,检测率为96.8%,HIV阳性124人,阳性率为4.1%;梅毒检测2529人,梅毒阳性142人,阳性率为5.6%。结论 VCT门诊求询者HIV、梅毒检测率较高,但还应提高VCT服务质量和水平,加大对全人群的艾滋病防治知识宣传力度,控制性传播疾病向普通人群蔓延。     

山东省高危人群艾滋病感染情况调查

目的调查山东省艾滋病高危人群艾滋病病毒(HIV)感染状况及相关危险行为信息,以期分析未来山东省艾滋病流行趋势,为制定艾滋病防治措施和决策提供依据。方法采用现况调查方法对既往有偿供血(浆)集中地区有偿供血(浆)人员、娱乐场所中从事商业性性服务的小姐(商业性服务者)以及20世纪90年代中期有偿供血者较集中地区的综合医院门诊就诊病人分层后,对这3类人群分别进行艾滋病生物学、行为学调查。结果共收集3 199份血液标本,HIV阳性率检出率为1.03%(33/3 199)。其中有偿供血员阳性检出率最高为3.22%,商业性性服务者为0.39%,综合医院门诊就诊病人为0.065%,3类人群间HIV抗体阳性检出率有显著性差异(χ2=59.39,P<0.01)。商业性性服务者中有性病史者占31.2%,与客人发生性行为时安全套的使用率为42.0%。既往有偿供血者中单供血浆者占50%,其HIV阳性检出率为8.64%。结论山东省艾滋病高危人群中HIV感染率较高的仍然是既往有偿供血人群中的单献血浆者。商业性性服务者人群中也存在一定的HIV感染率,该人群接触人员复杂,对HIV向一般人群扩散起着重要作用,因而一般人群已经受到HIV感染的威胁。     

Factors Associated with Utilization of a Free HIV VCT Clinic by Female Sex Workers in Jinan City,Northern China

Based on our previous qualitative exploration, this research presents the second phase in our study of factors associated with utilization of a free HIV VCT clinic in Jinan City, Northern China, by female sex workers (FSWs). A total of 970 FSWs from entertainment venues were interviewed and prospectively followed to determine who ultimately sought and received VCT at the clinic, compared to those who did not. Simple and multiple logistic regressions were performed on factors drawn from the Ecological Perspective, hypothesized to be associated with utilization of testing at the VCT clinic. Despite 69% of FSWs expressing willingness to attend the VCT clinic, only 11% were actually tested. The multiple logistic regression model that provided best goodness of fit included the covariates of willingness to attend the VCT clinic (Adjusted OR 3.13, 95% CI: 1.62–6.59), low perceived HIV infection risk (Adjusted OR 0.64, 95% CI: 0.35–1.11), low fear of FSWs status disclosure in the clinic (Adjusted OR 0.55, 95% CI: 0.31–0.94) and influence of acquaintances (Adjusted OR 0.52, 95% CI: 0.29–0.89) and peers (Adjusted OR 2.45, 95% CI: 1.40–4.50). This is the first study in China to follow FSWs longitudinally to measure factors related to VCT utilization. The low utilization of VCT services by participants in our study is similar to prior reports throughout China. FSWs’ access to VCT service is associated with intrapersonal, institutional, and particularly, interpersonal factors. Based on these findings, we recommend emphasis on confidentiality of services, VCT education for influential peers, and introduction of HIV rapid testing on site.     

Factors Related to Female Sex Workers’ Willingness to Utilize VCT Service: A Qualitative Study in Jinan City, Northern China

While national HIV prevalence remains low in China, female sex workers (FSWs) have become infected at high rates. Free voluntary HIV counseling and testing (VCT) has been offered in recent years; however, its utilization rate is low. This study explored factors related to FSWs’ willingness to utilize a VCT clinic. Qualitative interviews informed by the Ecological Perspective were conducted to interview 17 FSWs and 12 managers from 23 selected entertainment establishments in Jinan, the capital of Shandong province in northern China. While the majority of FSWs professed willingness to use VCT services, they described barriers to actual utilization of services which included: misunderstandings about HIV; low perceived risk and HIV prevalence; mistrust of the free VCT; and especially anxiety about the implications of possible test results. This research suggests that increasing FSWs’ utilization of VCT will require increased knowledge of HIV and VCT, and acceptance of testing and on-site VCT services.     

Short-term effect of a cultural adaptation of voluntary counseling and testing among female sex workers in China: a quasi-experimental trial.

This study evaluates the efficacy of cultural adaptation of a voluntary counseling and testing (VCT) intervention, in increasing condom use and decreasing rates of sexually transmitted diseases (STDs) among a group of female sex workers (FSWs) in Guangxi, China. This intervention is modeled after the "state-of-the-science" VCT program that was developed and evaluated by the Center for Disease Control and Prevention's Project RESPECT. Four hundred FSWs were assigned to either an intervention group receiving the VCT intervention or a control group receiving standard of care STD testing and treatment. Data were collected at baseline and 6 months postintervention. Outcome measures included HIV/STD related knowledge and perceptions, condom use, and history of STDs. Five common STDs were screened and tested through clinical examination and laboratory testing to serve as biomarkers. After controlling for potential confounders and baseline differences, the VCT intervention group was significantly higher than the control group in HIV/STD related knowledge (p < .0001) and consistent condom use with clients (odds ration [OR] = 2.23; 95% confidence interval [CI] = 1.26-3.96) at 6 months follow-up. In addition, the intervention group had a significantly lower infection rate of STDs than the control group at follow-up (OR = 0.44; 95% CI = 0.24-0.80). This quasi-experimental trial provides evidence that the brief VCT intervention, through appropriate cultural adaptation, can be efficacious in increasing condom use and reducing STD infection rate among FSWs in China.     

Does the use of HIV testing and counseling services influence condom use among low-paid female sex workers in Guangxi,China?

HIV testing and counseling (HTC) are increasingly used in China during routine medical care visits to health facilities. However, limited data are available regarding the association between the utilization of HTC services and condom use among low-paid female sex workers (FSWs) who are at high risk of HIV infection but are hard to reach. A cross-sectional study was conducted among 794 low-paid FSWs in a city of Guangxi Zhuang Autonomous Region in 2011. Results showed that 71.7% of low-paid FSWs had utilized HTC services in the previous year and 65.7% reported having used a condom during the last sexual intercourse with their clients. Multivariate logistic regression analysis showed that utilizing HTC services was significantly and positively associated with the condom use. It also indicated that low-paid FSWs who were older, married, had higher education, earned less money, had high number of clients, had a history of sexually transmitted diseases, or had little or no HIV knowledge were less likely to use a condom during the last sexual encounter. The study suggests that HTC services need to be scaled up and made more accessible for this vulnerable population.     

云南省目标人群寻求和接受艾滋病自愿咨询检测服务的困难和障碍调查

目的了解阻碍云南省高危人群寻求和接受艾滋病自愿咨询检测（VCT）服务的影响因素,为改进现行的咨询检测服务体系和服务质量,提高VCT服务在高危人群中覆盖率提供科学依据。方法采用个人深入访谈和问卷调查相结合的方法,对云南省艾滋病流行水平和VCT服务水平不同的4个县（市）区的注射吸毒者、暗娼、男男性行为者和男性流动人口进行了调查,对VCT服务提供方进行个人深入访谈。对访谈资料进行归纳、整理和分析,用EPI和SPSS软件进行问卷资料的录入和分析。结果目标人群寻求和接受VCT服务的困难和障碍如下：（1）艾滋病本身的不可治愈性以及沉重的医疗负担;（2）社会恐惧和歧视;（3）VCT服务质量不高,服务方式单一;（4）对艾滋病及其相关服务的宣传不到位;（5）治疗、关怀和支持措施的落实不到位;（6）VCT服务资源投入不足,服务的主动性不够。结论（1）建立以咨询为基础的检测服务体系,完善转介服务网络,提高服务的可及性;（2）正面宣传艾滋病,加强对咨询检测和治疗、关怀服务的宣传;（3）加强对咨询检测工作的投入,建立和完善咨询检测工作的考核和激励机制,维护队伍的稳定,提高咨询检测服务质量。     

艾滋病门诊自愿咨询检测者HIV感染状况分析

目的了解艾滋病(AIDS)门诊自愿咨询检测(VCT)者艾滋病病毒(HIV)感染状况。方法对VCT人员的监测资料、HIV/AIDS患者的流行病学和临床资料进行统计分析。结果1 553例VCT者中共检测出37例HIV/AIDS患者。咨询者中以不洁性接触史(33.29%)、输血/血液制品(17.38%)及静脉吸毒(14.68%)的比例较高。结论静脉吸毒、输血/血液制品和性乱人群等是引起HIV传播的重要因素,在现有的医疗卫生服务条件下,实施可持续的VCT服务和综合关怀工作,可起到降低HIV传播风险及积极的预防干预作用。     

Drug use among female sex workers in Hanoi, Vietnam

AIMS: To describe the drug use practices among female sex workers (FSWs) in Hanoi and to identify factors associated with their drug injecting. DESIGN, SETTING AND PARTICIPANTS: A two-stage cluster survey of 400 FSWs was conducted from June to September, 2002. Participating FSWs were both establishment- (160) and street-based (240), who were practising in seven urban and one suburban districts of Hanoi. MEASUREMENTS: Subjects were interviewed face to face using a structured questionnaire. FINDINGS: Among the middle-class FSWs, 27% used drugs, of whom 79% injected. Among low-class FSWs, 46% used drugs and 85% injected. Among drug-using FSWs, 86% had started using drugs within the past 6 years. Among drug-injecting FSWs, 81% had started injecting within the past 4 years. Cleaning of injecting equipment was not common among those who shared. Having drug-injecting 'love mates', drug-using clients, longer residence in Hanoi, more clients and not currently cohabiting were found to be independently associated with drug injecting among FSWs. CONCLUSIONS: The high prevalence of injecting drug use among FSWs makes them susceptible to HIV infection, and is a threat to their clients. There is a strong relationship between drug-using FSWs and male drug-using clients and non-client partners. Intervention to prevent drug use initiation among non-drug-using FSWs and harm reduction among drug-using FSWs are urgently needed.     

北京市城郊两区娱乐服务场所暗娼艾滋病相关危险行为调查分析

目的了解北京市城郊两个区娱乐服务场所的暗娼艾滋病相关危险行为现状,评估暗娼感染艾滋病的风险,为在暗娼中开展行为干预提供科学依据。方法采用方便抽样方法对娱乐场所进行抽样,对场所内暗娼进行面对面问卷调查及采血检测。结果调查341名暗娼,最近一周商业性伴数中位数为3人。最近一次与商业性伴和固定性伴发生性关系时,使用安全套的比例分别为72.9%和49.3%;最近一月与商业性伴和固定性伴每次都用安全套的比例分别为44.1%和26.7%。城区暗娼商业性伴数高于郊区,最近一次与商业性伴使用安全套的比例和最近一月与商业性伴每次都用安全套的比例,均小于郊区。2.9%的暗娼吸毒。最近一年出现性病相关症状的比例为41.1%,其中到正规医院就诊的占75.7%。无一例感染艾滋病,梅毒快速血浆反应素环状卡片试验和梅毒螺旋体抗体阳性检出率分别为1.17%和12.1%。结论北京市城郊两区娱乐服务场所暗娼中存在引起艾滋病感染和流行的危险行为因素,且城区暗娼感染艾滋病的风险高于郊区。提示应加强娱乐服务场所的艾滋病干预工作,尤其是应把城区作为干预工作的重点。     

High acceptability of HIV voluntary counselling and testing among female sex workers: impact of individual and social factors

Objectives

Voluntary counselling and testing (VCT) for HIV infection is an important tool for prevention of HIV infection and AIDS in high‐risk groups. Our goal was to describe the acceptability and consequences of VCT among a stigmatized and vulnerable group, female sex workers (FSWs), in Conakry, Guinea.

Methods

Acceptance of the test and return for test results at baseline and consequences of testing 1 year later were described. The perceived risk of HIV infection and perceived benefits and barriers to testing were examined using quantitative and qualitative methods.

Results

All 421 FSW participants agreed to undergo VCT and most participants (92%) returned for their results. The main reason cited for VCT acceptance was the wish to know their HIV status. However, some managers of FSW worksites urged FSWs to be tested, curtailing FSWs' free decision‐making. One year later, status disclosure was common (90% of the 198 individuals who knew their results among those who participated in the follow‐up part of the study). Positive consequences of testing were far more frequently reported than negative consequences (98% vs. 2%, respectively). Negative life events included banishment from the worksite (one case) and verbal abuse (two cases).

Conclusion

Acceptability of VCT appears high in the FSW population in Conakry as a consequence of both perceptions of high individual risk and social pressures.     

The meaning and challenge of voluntary counselling and testing (VCT) for counsellors — report of the Kenya Association of Professional Counsellors (KAPC) conference for sub-Saharan Africa

A large number of voluntary counselling and testing (VCT) sites are being opened in sub-Saharan Africa. The services provided by these sites are playing an increasingly important role in the prevention of HIV/AIDS. The sites offer many possibilities and it is crucial that they provide the optimum services for clients. Counselling is an integral part of these services, yet it receives little attention. Counsellors need to be consulted if the optimum services are to be provided, but they are rarely consulted for their professional opinion. Accordingly, the Kenya Association of Professional Counsellors (KAPC) organised a 3-day conference in September 2002 to provide counsellors, drawn from the sub-Saharan region, with a forum to identify VCT-related issues and discuss their implications. The main aim of the conference was for counsellors to arrive at a consensual position regarding HIV/AIDS and what improvements they thought could be made for the VCT services to clients. The counsellors identified the issues that they considered important and this paper presents those issues together with recommendations regarding improvements.