【作者】 文育锋；

【导师】 蒋作君； 叶冬青；

【作者基本信息】 安徽医科大学 ， 流行病与卫生统计学， 2010， 博士

【摘要】 【目的】大众人群对艾滋病相关知识的知晓率及其对艾滋病病毒感染者和患者的歧视程度,是衡量健康教育效果的重要指标。本研究通过调查农村艾滋病流行区大众人群艾滋病相关知识知晓率和对艾滋病病毒感染者和患者歧视态度,探索艾滋病健康教育方法和策略,从而为农村艾滋病预防和控制提供技术支持。【方法】通过整群抽样,从安徽省南方和北方既往以有偿献血造成艾滋病流行的地区,各抽取一个有代表性的县,采用横断面调查的方法,对入选的5355名调查者开展艾滋病知识和态度的调查,并分析艾滋病相关知识知晓率、回答正确率和歧视态度的分布特点。【结果】(1)调查对象平均年龄为29.88±12.33岁,调查对象中农民和学生分别占总人数的39.35%和29.04%,文化程度主要为初中(34.66%)。调查对象男女之间的文化程度、职业以及年龄段差异均有统计学意义。(2)调查对象艾滋病相关知识回答正确率范围从44%到80%。有关艾滋病病毒传播的误区有:44.67%的调查对象认为“蚊虫叮咬”能传播艾滋病病毒,47.36%认为和艾滋病感染者“共用剃须刀”不能传播艾滋病病毒。在艾滋病病毒传播途径各知识点上,男性调查对象回答正确率高于女性,差异有统计学意义;在艾滋病病毒非传播途径各知识点上,仅有“共用毛巾”,“咳嗽和打喷嚏”两个知识点男性回答正确率和女性之间有差异,其中“共用毛巾”(χ2=6.66, p=0.010)男性高于女性,而“咳嗽打喷嚏”(χ2=11.51, p<0.001)女性高于男性,差异有统计学意义。(3)仅16.15%的调查对象8道艾滋病传播途径和非传播途径知识问题回答全部正确,除各年龄组外,不同性别之间(χ2=4.08,p=0.043)、不同职业(χ2=378.45,p<0.001)和不同教育程度(χ2=373.66,p<0.001)之间8道题全部回答正确的比例差异均有统计学意义。(4)调查对象艾滋病知识平均知晓率为66.92%,各年龄组(F=202.31,p<0.001)、不同性别(t=4.00,p<0.001)、不同职业(χ2=277.75,p<0.001)和不同教育程度(χ2=333.54,p<0.001)人群艾滋病知识平均知晓率差异均有统计学意义,其中男性知晓率高于女性,低年龄组知晓率高于高年龄组,文化程度高的人群高于文化程度低的人群,学生、教师人群高于农民和外出务工人员。(5)仅有23.16%的调查对象回答“拒绝给予艾滋病患者和感染者同情和帮助”,但是仍然有高达72.27%的调查对象回答“拒绝从一个感染艾滋病病毒的食品店老板处购买食品”,63.88%的调查对象回答“拒绝和艾滋病患者和感染者共同进餐”。除了项目“是否同意将艾滋病患者或感染者隔离?”外,其它项目男性和女性调查对象歧视态度差异均有统计学意义,其中“如果一个学生感染了艾滋病病毒但尚未发病,他(或她)是否被允许继续上学?”,女性被调查者所持有的歧视态度比男性被调查者低,差异有统计学意义(χ2=5.08, p=0.024);而其它项目女性所持有的歧视态度的比例高于男性,差异均有统计学意义。【结论】安徽省艾滋病流行区大众人群艾滋病知识知晓率仍然较低,对艾滋病病毒感染者者和患者的歧视态度仍然较高,应该待加强艾滋病健康教育,以提高艾滋病知识知晓率和减少和消除对艾滋病病毒感染者和患者的歧视态度。【目的】艾滋病知识掌握程度高低与对艾滋病病毒感染者和患者的歧视态度密切相关。本研究通过调查农村艾滋病流行区艾滋病健康教育不同方式及其种类数与艾滋病知识得分之间的关系,为制定艾滋病健康教育方案,从而充分、合理的利用有限的卫生资源提供决策依据。【方法】采用横断面调查的方式,在既往有偿献血的农村地区,调查了5355名农村居民有关艾滋病预防知识及其知识来源途径,并采用方差分析、非参数统计及单因素和多因素Logistic回归,分析艾滋病知识来源的方式及其种类数与艾滋病知识得分之间的关系。【结果】(1)调查对象获得艾滋病知识的主要来源途径为:“广播电视”(74.19%)、“报刊杂志”(47.90%)、“邻居和朋友”(38.34%)。(2)不同性别间艾滋病知识来源途径在“家庭人员”、“学校和老师”两途径选择上差异有统计学意义;除“乡村健康活动”途径外,不同教育程度、不同年龄组和不同职业人群对其它7种途径的选择比例也存在差异。(3)调查对象艾滋病知识来源途径数平均为3.01±1.74种,年龄<20岁、学生、高中和高中以上文化程度人群艾滋病知识来源途径数较多,本地工人、无文化、>55岁以上人群艾滋病知识来源途径数较少。(4)艾滋病知识来源途径数和艾滋病知识知晓率之间可能存在相关性,其中艾滋病知识来源途径为1种时艾滋病知识得分最低,为8.21±4.23分,艾滋病知识来源途径数为6种时艾滋病知识得分最高,为11.67±3.0分。校正年龄、性别、职业和文化程度后,协方差分析结果显示艾滋病知识来源途径数分别为3、4、5、6、7种时艾滋病知识高于知识途径数分别为1、2和8时的艾滋病知识得分。(5)高分组和低分组人群在“广播电视”、“报刊杂志”、“邻居朋友”、“医务人员”、“卫生防疫人员”、“学校或老师”等6个途径之间选择率差异有统计学意义,高分组的选择率高于低分组。高分组在2~4种来源途径上的人数占总人数的60.98%,而低分组人群在1~2种途径上的人数占总人数的65.43%,两组人群艾滋病知识来源途径种类的分布存在差异,且差异有统计学意义(Z=15.94,p<0.001),高分组艾滋病知识来源数均值高于低分组。(6)通过单因素Logistic回归分析发现,性别(女性)和高年龄为调查对象艾滋病知识得高分的主要危险因素,而促进因素有职业(学生)、高文化程度,以及“电视广播”、“报刊杂志”、“家庭人员”、“邻居朋友”、“医务人员”、“卫生防疫人员”、“学校或老师”和“乡村健康活动”。通过多因素Logistic逐步回归分析法,发现性别(女性)和“家庭人员”对艾滋病知识得分的提高有阻碍作用,而职业(学生)、高文化程度,以及艾滋病知识来源途径中的“电视广播”、“报刊杂志”、“卫生防疫人员”、“学校或老师”和“乡村健康活动”等因素对艾滋病知识得分有促进作用。【结论】艾滋病知识来源途径及其数量和艾滋病知识得分之间可能存在相关性,艾滋病知识来源途径数太少将影响艾滋病知识得分的提高,当艾滋病知识来源途径达到6个时,再增加艾滋病知识途径数并不一定能显著增加艾滋病知识得分;大众传媒和权威的“面对面交流”可能增加受众对象艾滋病知识,但非权威的“面对面交流”如家庭成员内部交流可能阻碍艾滋病知识得分的提高。【目的】艾滋病有关歧视已经成为当前艾滋病病毒感染者和患者获得治疗、关爱和支持的主要障碍。本研究通过分析艾滋病传播途径知识和非传播途径知识与艾滋病歧视之间的关系以及影响歧视的主要因素,探索并提供减少、消除艾滋病歧视的方法和策略。【方法】在既往有偿献血造成艾滋病流行的农村地区开展横断面调查,通过整群抽样,有5355名调查对象入选本次研究,通过调查人群有关艾滋病知识、态度,并分析艾滋病传播途径和非传播途径知识与艾滋病歧视态度之间的关系及其影响艾滋病歧视的主要因素。【结果】(1)16道艾滋病知识问题全部答对的比例为8.53%,艾滋病歧视得0分的占4.41%,男女之间艾滋病知识得分(Z=5.58,p<0.001)和歧视得分(Z=6.22,p<0.001)的分布差异有统计学意义(2)调查对象的艾滋病知识总得分、艾滋病传播途径知识得分、艾滋病非传播途径知识得分和艾滋病歧视态度得分分别为:10.12±3.93、4.67±2.46、5.45±2.63、70±3.26,在不同年龄组、职业和教育程度和性别之间,上述4个指标差异均有统计学意义。其中调查对象中的男性、学生、年龄<20岁和较高的教育程度者与其他人群相比具有较高的艾滋病知识总得分、艾滋病传播途径知识得分和非传播途径知识得分,和较低的艾滋病歧视态度得分。(3)在不同职业、文化程度、年龄段和性别的人群中相关系数R1(艾滋病传播途径那知识得分和艾滋病歧视得分的相关系数)、R2(艾滋病非传播途径知识得分和艾滋病歧视的分的相关系数)之间差异有统计学意义。其中在年龄<20岁的人群中相关系数R1小于R2(Z=5.385, p<0.001),而在年龄30~40、>50岁组中,相关系数R1大于相关系数R2 (Z=2.508, p=0.012; Z=4.533, p<0.001);在外出务工人群和学生中相关系数R1小于相关系数R2 (Z=5.671, p<0.001; Z=5.542, p<0.001; Z=4.744, p<0.001),而在当地农民人群中相关系数R1大于R2(Z=6.280, p<0.001);在不同文化教育程度中,文盲和小学文化人群相关系数R1大于R2(Z=4.724, p<0.001; Z=3.325, p<0.001),而在初中、高中及高中以上人群中,相关系数R1小于相关系数R2(Z=2.557, p=0.011; Z=4.794, p<0.001; Z=3.103, p=0.003);同时,在男性人群中相关系数R1小于R2(Z=2.855, p=0.004),但是在女性人群中R1大于R2(Z=5.426, p<0.001)。(4)性别、职业(学生)、“共用剃须刀”、“共用注射器”、“游泳或洗澡”、“共用毛巾或衣物”、“蚊虫叮咬”、和“艾滋病能治好吗”是与躲避相关的艾滋病歧视的保护因素,而性别和“性生活”则是危险因素。(5)职业(学生)、“共用注射器或针头”、“血液和血制品”、“共餐”、“游泳或洗澡”和“患艾滋病能治好吗?”,这些因素都是歧视态度中指责的保护因素。(6)职业(学生)、“握手”、“共餐”、“游泳或洗澡”、“共用毛巾或衣物”、“咳嗽或打喷嚏”、“怀孕期间母婴传播”、“性生活”等变量为歧视态度中社会拒绝的保护因素,而年龄、“血液和血制品”为危险因素外。(7)职业(学生)、“共用剃须刀”、“共用注射器和针头”、“游泳和洗澡”、“共餐”、“共用毛巾或衣物”、“咳嗽或打喷嚏”、“蚊虫叮咬”、“艾滋病能治好吗?”和“表面健康的人是否可能是艾滋病感染者?”等因素是歧视态度中羞耻有关的保护因素。而性别、“怀孕期间母婴传播”和“性生活”为危险因素。【结论】艾滋病知识得分低,针对艾滋病病毒感染者和患者歧视得分高;其中在年龄<20岁、学生、男性、初中以上人群艾滋病非传播途径知识与歧视得分的相关性大于传播途径知识与歧视得分的相关性,而农民、女性、初中以下文化程度以及年龄30~40、>50岁组人群中艾滋病传播途径知识与歧视态度得分之间的相关性大于艾滋病非传播途径知识得分与歧视态度得分之间的相关性。职业和“游泳、洗澡”两个因素是艾滋病歧视中躲避、拒绝、指责和羞耻四种表现的共同保护因素,其他相关因素为危险因素。更多还原

【Abstract】 [Objective]HIV/AIDS health education has been implemented for several years in HIV/AIDS epidemic rural areas, the general population’s awareness of HIV/AIDS and related attitudes toward people living with HIV or AIDS are the important indexes to measure effects of the HIV/AIDS health education. To explore the strategies and methods of the HIV/AIDS health education, the investigation was conducted among the general population in AIDS epidemic rural areas. And provide the technical support to prevent and control HIV/AIDS epidemic in rural areas.[Methods]We conducted a cross-sectional survey in the HIV epidemic rural areas where the people living with HIV or AIDS were infected by the former blood and plasma collection. 5355 participants were enrolled and investigated the knowledge, attitudes toward HIV/AIDS, and analyzed the characteristic of the distribution of the awareness of HIV/AIDS and the related attitudes toward the people living with HIV or AIDS.[Results](1)The mean age of the participation was 29.88±12.33 years, 39.35% and 29.04% of participants were farmers and students, respectively. 34.66% were junior higher school education.(2) The range of the correct answer rates of HIV/AIDS knowledge were from 44% to 80%, and there were higher proportion of the misunderstand on the HIV transmission and non-transmission, such as 44.67% of the respondents believed that HIV was transmitted though mosquitoes bites and 47.36% believed that sharing the razor and utility with an HIV-infected person could transmit HIV. The male respondents’correct answer rates were significant higher than female’s in the HIV transmission mode and in HIV un-transmission mode: sharing towel, sneezing and coughing.(3) The correct answer rate of all 8 questions was 16.15%. Except the age group, these correct answer rate were statistically significant different among the genders(χ2=4.08,p=0.043), occupations(χ2=378.45,p<0.001)and education level (χ2=373.66,p<0.001).(4) The average awareness of HIV/AIDS was 66.92%, and the awareness were significant different among age group (F=202.31,p<0.001), gender (t=4.00,p<0.001), occupational (χ2=277.75,p<0.001) and education level (χ2=333.54,p<0.001) . the awareness of male was higher than that of female, young participants higher than old participants, the higher education degree was higher than low education degree, and the students, teacher were higher than parents and migrant workers.(5) There was only 23.16% of the participants refused giving the sympathy or help to PLWHAs, but still 72.27% disagreed to buy food from a HIV-infected shopkeeper or seller, and 63.88% disagreed to share a meal with people living with HIV or AIDS. Except the item:“If a person has HIV, should he or she be quarantine”, the female respondents’proportion of the negative attitudes was significantly lower than the male respondents’in the item:“If a student has HIV but is not sick, should he or she be allowed to continue attending school”(χ2=5.08, p=0.0242). And in the others items, the female respondents held negative attitudes towards PLWHA were significantly higher than the male respondents’.[Conclusions] The general population awareness of HIV/AIDS was still lower and the discrimination or stigma toward the population living with HIV/AIDS remained severely. In order to improve the awareness of HIV/AIDS and deduce or eliminate the discrimination or stigma toward people living with HIV/AIDS, it is necessary to strength the HIV/AIDS health education. [Objective]HIV/AIDS knowledge is closely related to discriminatory or stigma attitudes toward the people living with HIV or AIDS. In this study, we explored the relation of the HIV/AIDS prevention knowledge and its sources among the general population in AIDS epidemic rural areas, so as to provide the strategies of the HIV/AIDS health education about AIDS which can fully and reasonable use the limited health sources.[Methods]The cross-sectional survey about AIDS prevention knowledge and its sources of knowledge was conducted, and there were 5355 rural residents were enrolled in this study in rural areas where there were HIV/AIDS epidemic caused by the former paid blood donors. The variance, non-parametric statistics, univariate and multivariate Logistic regression were used to analyze the relation between the AIDS health education methods and their species number with the HIV/AIDS knowledge scores.[Results](1) The main sources of AIDS knowledge of the participations was received through: radio and television (74.19%), newspapers and magazines (47.90%), neighbours and friends (38.34%).(2) The knowledge sources of HIV/AIDS from the family member, schools and teachers were statistically significant different between the male and female participants. Except the rural health activities, the others seven knowledge sources of HIV/AIDS were statistically significant different among the different educational levels, age groups and occupation.(3) The participation gained the knowledge of HIV/AIDS from the sources of 3.01±1.74. The participants in these groups of less than 20 year old students, senior high school and above educational groups have more knowledge sources of HIV/AIDS, and in local workers, illiterates, the age more than 55 years groups, the participants had less knowledge sources of HIV/AIDS, the difference were statistically significant.(4) There were relations between the knowledge sources of HI/AIDS with the awareness of the HIV/AIDS. The knowledge scores (8.21±4.23) were lowest, when the participants gained the HIV/AIDS knowledge only from one resource, and the scores were highest when the sources (11.67±3.0) of knowledge from 6 sources. The results indicated that the scores of AIDS knowledge with sources of 3,4,5,6,7 kinds were significant higher than these with 1,2 and 8 kinds of AIDS information sources.(5) The choose rates of radio/television, newspapers/magazines, neighbours and friends, medical staff, Preventive medical staff, schools/teachers were significant difference between the high score group and low score group. There were 60.98% high scores participants gained the HIV information from 2,3 and 4 channels, while 65.43% low socres participants distributed in the 1,2 channels. The means of the HIV information channels were statistically significant difference between two groups(Z=15.94, p<0.001).(6) The Binary Logistic regression analysis showed that gender(female) and high age were the major risk factors to increase the AIDS knowledge scores, but the promote factors were low age, sex(male), occupation(student), higher education level, as well as television broadcasting, newspapers and magazines, home workers, neighbours friends, medical personnel, health workers, school teachers and rural health activities. Multivariate Logistic regression analysis by with the stepwise method were found that gender (female) and getting the HIV/AIDS knowledge from family member were the obstacles to the improvement knowledge scores, but these factors of occupation (student), high education level, as well as the source of AIDS knowledge from the television channels, newspapers and magazines, health workers, school or teachers and rural health activities and other factors can promote the HIV/AIDS knowledge scores.【Conclusion】AIDS knowledge sources and its forms number maybe related to the HIV/AIDS knowledge score. The number of the HIV/AIDS knowledge source was too less to improve HIV/AIDS knowledge score higher, when the number of the HIV/AIDS knowledge source reached to 6 forms, add AIDS knowledge source does not necessarily increased significantly AIDS knowledge scores. The mass media and authoritative face-to-face communication can increased the audience AIDS prevention knowledge, the face-to-face communication but not authority, such as family members communication may hinder the increasing the HIV/AIDS knowledge scores. [Objective]HIV/AIDS-related stigma became an obstacle to the implementation of treatment, care, and support programs for people living with HIV/AIDS (PLWHA). This study tested the relation between the knowledge of the HIV transmission and non-transmission with the negative attitudes toward PLWHA and the impact factors to the stigma toward HIV/AIDS. Explored and provided the strategies or methods to reduce and eliminate the stigma toward the PLWHA.[Methods]We conducted a cross-sectional survey in the HIV epidemic rural areas where the PLWHA were infected by the commercial plasma donation in the past years. 5355 participants were enrolled and investigated the knowledge, attitude of HIV/AIDS, and analyzed the relationship between the AIDS transmission and non-transmission knowledge with negative attitudes toward the PLWHAs in different subpopulations.[Results](1)The correct answer rate to 16 questions of the HIV/AIDS knowledge was 8.53%, and the total 4.41% of the participants gained the 0 score of the HIV/AIDS stigma. The distribution of the scores of HIV/AIDS knowledge and the stigma were significant different between the gender.(2)HIV transmission knowledge score (TKS), non-transmission knowledge score (non-TKS) and negative attitude scores (NAS) were significant difference among the gender, occupation, age and education groups. The male, students,“<20 year age”and highly educated groups had higher HIV knowledge scores, TKS, non-TKS and lower NAS than others groups. The AIDS non-transmission knowledge had more closed with the negative attitudes than the AIDS transmission knowledge in male, age <20 years, migrant workers, students, junior high school and above junior high school groups. But in female, 30 ~ 40 years and >= 50 years, illiteracy, primary schools education groups, the relationship of the AIDS non-transmission knowledge had less closed with the negative attitudes towards PLWHAs than the AIDS transmission knowledge.(3)These factors, such as the knowledge of whether the HIV could transmitte by sharing shaver blade, sharing needles, sharing the towels, sharing public swimming pools, mosquito’s bites, sex contacting and whether the AIDS could be cure, and the sex and the students of the occupation were the protect factors and associated with the avoidance of the stigma against HIV/AIDS. But the sex and the sex contacting with HIV were risk factors with the avoidance of the stigma against HIV/AIDS.(4) The students of the occupation, and the HIV/AIDS knowledge of whether sharing needles, receiving blood from an infected person, sharing meals, sharing public swimming pools, and wether the AIDS can be cured were the protected factors and associated with the abuse of stigma against AIDS/HIV.(5) The age, the students of the occupation, and the HIV/AIDS knowledge of whether shaking hands, sharing meals, sharing public swimming pools, sharing the towels, Sneezing and coughing, Mother-to-child transmission during pregnancy, and sex contacting can transimitte HIV were the protect factors and associated with the denial of stigma against AIDS/HIV. The age and the receiving blood from an infected person were risk factor for the denial of stigma.(6) The sex, the students of the occupation, and the HIV/AIDS knowledge of whether sharing shaver blade, sharing needles, sharing public swimming pools, sharing meals, sharing the towels, Sneezing and coughing, Mother-to-child transmission during pregnancy, sex contacting can transimitte HIV, and whether the AIDS can be cured, and a man looks health can be a PLWHA were protected factors and sex contacting were the protect factors and associated with the shame of stigma against AIDS/HIV. The sex and Mother-to-child transmission during pregnancy were risk factor for the shame of stigma.[Conclusion]1. The AIDS non-transmission knowledge had more closed with the negative attitudes than the AIDS transmission knowledge in male, age <20 years, migrant workers, students, junior high school and above junior high school groups. But in female, 30 ~ 40 years and >= 50 years, illiteracy, primary schools education groups, the relationship of the AIDS non-transmission knowledge had less closed with the negative attitudes towards PLWHAs than the AIDS transmission knowledge.2. The occupation with students, and the HIV/AIDS knowledge of whether sharing public swimming pools were the protected factors abuse, avoidance, denial and shame of stigma against AIDS/HIV.更多还原