我国跨境流动人口艾滋病综合预防的思考

中国是全球化进程中的重要参与者,由于其政治经济的完善与发展,大量跨境人口流动的趋势无法避免.跨境流动人口有别于一般意义上的人口流动,新的社会网络、家庭结构和人际关系正在形成,由此大多数跨境流动人口成为感染艾滋病的脆弱人群,各类社会问题交织增加了跨境流动人口艾滋病预防的复杂性,而他们却难以获得所需的信息和服务.建议以社会流行病学为理论指导,采取健康教育措施,整合资源开展跨境流动人口艾滋病综合防治.     

娱乐场所女性性服务者两种行为干预模式效果的比较

目的探讨中国欧盟性病艾滋病防治合作项目、100％安全套使用项目对娱乐场所女性性服务者高危行为的干预效果。方法应用性病艾滋病干预效果的多角度评价方法,全面比较两种干预模式的效果。结果中国欧盟性病艾滋病防治合作项目试点女性性服务者自述患7种疾病（梅毒、淋病、衣原体感染、肝炎、霉菌病、滴虫病、盆腔炎）、同时患2种以上性病的患病率要高于100％安全套使用项目试点（P〈0．01）;对于正确认识：（1）蚊虫叮咬不会导致感染艾滋病病毒;（2）在性伴射精后清洗阴道,会感染艾滋病病毒;（3）你可能通过与艾滋病病毒感染者／病人发生性关系而感染艾滋病病毒等知识方面,中国欧盟性病艾滋病防治合作项目社区女性性服务者明显好于100％安全套使用项目社区（P〈0．01）,前者也更愿意到社区卫生服务中心就诊和参加艾滋病自愿咨询检测。结论中国欧盟性病艾滋病防治合作项目干预模式有利于女性性服务者正确掌握艾滋病防治知识和对自身患病状况的认识,使她们表现出更加积极的求医态度和行为。     

跨国流动人群及HIV／STD相关危险行为

跨国流动人群的流动性和特殊的行为特征,使跨国性网络遍布全世界,并大大增加了感染和传播艾滋病/性病的风险。文章综述了不同跨国流动人群的现状、人口学特征、易造成HIV亚型的跨国传播、性行为特征和艾滋病/性病的感染现状,对跨国流动人群开展综合干预具有重要意义。     

The transposition of the Patients’ Rights Directive in Finland—Difficulties encountered

The Directive on the application on patient rights’ in cross-border healthcare (2011/24/EC) was transposed in Finland by the Act on Cross-Border Health Care (1201/2013), which entered into force on 1 January 2014.A new reimbursement model for cross-border health care costs was designed. The Finnish legislator considered the chosen reimbursement model to correspond both with the aims of the Directive as well as to the functioning of the national health care scheme. The European Commission, however, initiated the first infringement procedure against Finland already in January 2014.In spring 2015, the Government launched a Regional government, health and social services reform, which would fundamentally transform the organizing, production and financing of health care services in Finland. Consequently a Government bill (HE 68/2017 vp) to change the existing reimbursement model for cross-border health care costs was delivered to the Parliament on 1 June 2017.In this article, Finland’s implementation process of the Directive is reviewed. Special attention is drawn to the argumentation concerning the reimbursements of cross-border health care costs. The differences of views on reimbursements can generally illustrate the conflicting objectives to expand access to cross-border health care services and to ensure financial sustainability of states thereof.     

Surveillance-Based Program Planning

Objective

to analyze the Integrated Behavioral & Biological Surveillance (IBBS) 2011 data for designing a condom utilization program.

Introduction

The IBBS is part of the Indonesian MoH HIV Surveillance System, which include Serological Surveillance, Behavioral Surveillance, Reproductive Tract Infection Survey, and monthly HIV/AIDS facility-based (hospitals, HCs, VCT Sites) monthly reports. The IBBS 2011 was conducted in 11 provinces (22 districts/municipalities) encompassing eight Most At Risk Populations (MARPs) – injection drug users, transsexuals, men who have sex with men, youths, inmates, mobile men, direct female sex workers (FSWs), and indirect FSWs. Data of 442 direct FSWs of the Jayapura Municipality and Jayawijaya District (Papua Province) showed that 406 (91.85%) have sex with partners who did not use condoms. Of these 406 FSWs 60 (14.78%) were HIV positive and 231 (56.89%) were STD positive.

Methods

Items of the Direct FSW Questionnaire, IBBS 2011, were examined and items that would yield information regarding content and method of HIV prevention interventions by means of condoms were identified. The Stata12 software was used to inspect/codebook the variables related to the selected items, to recode numeric data into categorical data, to generate one-way and two-way tables, and to produce pairwise correlations (and their significance levels).

Results

The Direct FSWs IBBS 2011 data of the Jayapura Municipality and Jayawijaya District showed that there are significant positive correlations between condom use behavior variables of FSWs (i.e., to know, to possess, to buy, and to offer male condoms) and variables of last-sex encounter condom use by customers, and between the latter and HIV and STD lab results. The correlations were low, however, of the condom use behavior variables and variables that are related to comprehensive knowledge of HIV prevention, condom use by more steady sex partners (e.g., husbands, boyfriends, other males) and female condom utilization, and during last-week and last-month sex transactions. The data analyses also indicated details of the distribution of the FSWs, with their condom use behaviors, according to individual characteristics, CIE (communication, information & education) intervention utilization, condom acquirement, and sexual behavior.

Conclusions

The condom utilization campaigns ought to focus on continuous reminders (instead of education programs) about how to persuade customers and other sex partners to use condoms, or to allow FSWs to use female condoms, and about where to go for HIV/STD testing and treatment. The condom promotion drives should use posters, TV ads, and field/health workers, The program should also make certain that good quality condoms be made avaible by local managers (of brothels, hotels, bars, etc.) and local vendors (drugists, stands, mobile carts).     

女性性服务工作者艾滋病知识水平与信息获得途径的相关关系

目的 分析女性性服务工作者艾滋病知识水平与获得途径的关系,以寻求有效的知识传播方式.方法 对3 528名女性性服务工作者进行问卷调查,采用相关分析、多重线性回归分析和方差分析方法,比较各种不同知识获得途径及途径多寡对掌握艾滋病知识的影响.结果 艾滋病知识得分平均为19.93±6.187,通过电视广播途径获得艾滋病知识的人最多为69.5％,其次是卫生宣传栏为53.5％;学校课程、健康书籍与艾滋病知识得分的相关系数分别为0.258和0.156,标准化回归系数也排在前2位;回归分析显示学校课程、健康书籍、亲属教育、报刊杂志、卫生宣传栏是影响艾滋病知识得分的主要因素;艾滋病知识得分与获得途径得分存在正相关,相关系数为0.197.结论 学校课程、健康书籍、报刊杂志、亲属教育、卫生宣传栏是适合在女性性服务工作者中传播艾滋病知识的有效方式,多种方式相结合效果更好.     

济南市MSM和暗娼人群AIDS相关知识和危险行为调查

目的 了解男男性行为者(MSM)和暗娼(FSW)两类高危人群艾滋病相关知识和危险行为状况.方法 在知情同意的前提下,对MSM人群和暗娼进行面对面的问卷调查及采样检测.结果 调查MSM人群656人,平均年龄(26.28±6.79)岁,艾滋病知识知晓率81.38%,最近6个月有85.98%的人与男性发生过肛交性行为,每次都使用安全套的占28.37%,艾滋病病毒(HIV)感染率2.17%,梅毒感染率为8.68%.调查FSW人群405人,平均年龄(23.98±4.56)岁,文化程度较低,艾滋病知识知晓率71.22%,最近5次与嫖客发生性行为时全部使用安全套的占78.27%,经偏相关分析,仅场所与其有关(偏相关系数r'=-0.2180,P＜0.01).路边店、出租屋的FSW安全套使用率较低.检测53人,HIV抗体均阴性.结论 济南市艾滋病有从MSM和FSW人群向普通人群扩散的潜在危险.建议加大对高危人群行为干预工作的力度.     

低收入女性性服务人员人格特征及行为相关性研究

目的探讨女性性服务人员(FSWs)的人格特征及其对行为的影响。方法用五项人格问卷修订版(NEO-PI-R)对227名FSW进行测试,选择236名宾馆女性服务人员作为对照;同时对FSW开展行为调查。结果 FSW在外向性、开放性、顺同性和谨慎性维度及相应特质的得分,明显低于对照组,而在神经质维度及相应特质的得分明显高于对照组。FSW中艾滋病知识得分与开放性维度、顺同性维度有统计学意义,安全套使用频率与神经质维度、外向性维度的得分有统计学意义。结论 FSW的个性特征与普通女性服务人员有明显的差异,而且人格特征与行为具有相关性。