【作者】 何忠虎；

【导师】 季成叶；

【作者基本信息】 北京大学 ， 儿少卫生与妇幼保健学， 2008， 博士

【摘要】 研究背景:艾滋病的流行对儿童青少年群体影响显著,其中艾滋病致孤儿童所受冲击最为严重。成为艾滋病孤儿对他们的健康发展、社区的经济状况与社会稳定都构成了直接威胁。但目前,我国尚未对此危机给予足够关注,艾滋病孤儿的生活现状、身心健康与生活质量方面的脆弱性未被充分揭示。针对艾滋病孤儿的健康需求,探索适宜的健康干预模式十分重要,但国内外尚无相关研究报道。此外,在全国开展学校预防艾滋病健康教育四年后,有必要对我国青少年艾滋病相关知、信、行现况进行调研,为制定与完善相关策略提出科学建议,并借此全面反映艾滋病流行对我国儿童青少年的影响。研究目的:1.评价艾滋病孤儿身心健康状况及生活质量,揭示其健康需求,为制定我国艾滋病孤儿危机应对策略提供依据。2.探索符合我国艾滋病高发区实际情况的受艾滋病影响儿童健康干预模式。3.调查青少年艾滋病相关知、信、行现况,评价我国学校预防艾滋病专题教育效果,为完善和进一步制定相关政策提供依据和建议。研究方法:1.按照性别、年龄1∶1配对设计选取河南省柘城县186名8~15岁艾滋病致孤儿童与普通家庭儿童,通过比较其生活状况、生长发育与营养水平、心理健康与生活质量方面的差异,探讨孤儿身心健康方面的脆弱性并揭示其健康需求。2.自行编制“受艾滋病影响儿童生活技能健康教育”教案,对柘城县第二中学104名学生进行生活技能健康干预,选择同年级105名学生作为对照组进行干预效果评价。3.自行编制“中学生艾滋病相关知识、态度、行为调查问卷”,对北京市、郑州市和唐山市24所中学的6487名10~20岁初、高中学生的艾滋病相关知、信、行水平进行调研与分析。研究结果:1.艾滋病致孤儿童与当地普通家庭儿童生长发育与营养水平均较低下,但孤儿组BMI(体重指数)z评分与肩胛下皮褶厚度更低。孤儿在心理健康和生活质量方面存在显著脆弱性,体现为更低的自尊水平、更高的抑郁水平,且在家庭生活、学校生活、生活环境、自我认知维度及认知成分的主观生活质量更低。分析发现上述不足主要存在于男性孤儿中。低自尊与抑郁等不良心理状态是成为艾滋病孤儿的必然结果,对降低儿童生活质量起到重要作用。2.以艾滋病相关知识、关爱态度以及自尊和自信为主要干预内容的参与式生活技能健康教育在受艾滋病影响儿童中具有良好的可接受性、可行性和有效性。通过干预,目标人群艾滋病知识、关爱态度及自尊、自信水平显著提高。性别比较发现,男生自尊、自信基线水平低于女生,干预后提高程度与女生相同,但绝对水平仍低于女生。3.我国青少年艾滋病知识水平较低,知识面狭窄。对HIV携带者的远离和歧视态度较为明显,且存在建立在社会赞许度压力下的“超我态度”与真实行为模式间的脱节。青少年性行为和成瘾物质滥用的发生率较低,但增长速度和婚前性行为的诸多不良后果不容忽视。唐山市中学生知识、态度水平显著高于北京和郑州,危险行为比例却同样较高。男生知识水平高于女生、态度水平与女生一致而危险行为更多,提示男生知、信、行关联强度弱于女生。研究结论:1.成为艾滋病孤儿给儿童的身心健康与生活质量造成了严重的负面影响,且在男性孤儿中体现得更为明显。应全面提高我国贫困地区儿童总体生活水平,探索能够满足艾滋病孤儿身心健康发展需要的抚养模式,应以学校为基地在受艾滋病影响儿童中开展艾滋病教育与心理健康干预等健康促进工作。2.以参与式教学为主要形式,以生活技能教育为途径,以艾滋病知识、态度、自尊与自信为主要内容的健康干预模式可在我国艾滋病高发区受艾滋病影响儿童中进一步探索和推广。在干预设计和实施过程中对男生应给予更多关注。3.艾滋病预防教育必须深入、系统,应增加态度、行为相关的教育内容比重。在艾滋病防治重点地区,短期项目不能取代系统的课堂教育;而艾滋病低流行区则应自主开展更多涉及积极态度与危险行为的教育活动。在教育实践和政策制定过程中应考虑性别差异,可针对男、女生设计不同的教育内容和形式。本研究创新与不足:1.本研究在国内首次采用艾滋病孤儿与普通家庭儿童配对设计,对孤儿的生活现状、身心健康与生活质量进行综合评价。在此基础上,首次在我国艾滋病高发农村地区的受艾滋病影响儿童中开展健康教育干预研究。同时,进行了截至目前国内样本量最大的青少年艾滋病知、信、行现况调研,对我国学校预防艾滋病专题教育效果进行评价。2.本研究为基于学校开展的横断面研究,在代表人群的广泛性与因果推断能力方面存在一定不足,需在不同儿童青少年群体中进行追踪随访研究,以对本研究结论加以验证并挖掘更多关键信息。同时,需通过随访,对健康干预的中长期效果进行评价。更多还原

【Abstract】 Background:AIDS epidemic in the world has brought about a tremendous impact on children and adolescents especially AIDS orphans. AIDS orphans in China still have not been attached enough concern. Their vulnerabilities of living situation, physical/psychological health and life quality have not been fully revealed. Exploringappropriate health intervention mode to them is very necessary. Meanwhile, it is also important to investigate their HIV-related knowledge, attitude and behavior to provide scientific suggestions for the further formulation of relevant policies and eliminate the negative impact of HIV/AIDS on young people.Objectives:1. To evaluate AIDS orphans’physical/psychological health and quality of life, confirm their health needs, and provide basis for coping strategy of AIDS orphans crisis.2. To explore health intervention mode to children affected by HIV/AIDS which is suitable to the actual situation of the areas with high AIDS epidemic level.3. To investigate HIV-related knowledge, attitude and behavior status in quo of China’s adolescents, primarily evaluate the special school education of HIV prevention project, and provide basis for further amendatory of relevant strategies.Methods:1. Adopting 1∶1 matching design according to gender and age, we selected 93 pairs of AIDS orphans and non-orphans aged 8~15 years from Zhecheng county of Henan Province. The orphans’vulnerabilities and heath needs were evaluated by comparing the living conditions, growth and nutrition level, psycological health and life quality.2. We designed the“life skills-based health education plans for children affected by HIV/AIDS ", and provided this health intervention to 104 students of No.2 middle school of Zhecheng country. Another 105 students were enrolled as control group to evaluate the educational effect.3. We designed“HIV-related knowledge, attitude and behavior questionnaire for middle school students ", using which, we investigated 6487 middle school students aged 10~20 years from 24 middle schools of Beijing, Zhengzhou and Tangshan.Results:1. No significant differences in morphological indicators between orphans and non-orphans except BMIZ and subscapular skinfold thickness. However, the vulnerabilities in psychological health and life quality of AIDS orphans were notable and lower self-esteem, higher depression level were found in them, which mainly existed in boy orphans. Lower self-esteem level and depression were proved to be inevitable consequences of AIDS orphanhood which played an important role of lower life quality.2. The participatory life skills education mainly focusing on HIV-related knowledge, care attitude, self-esteem and self-confidence was proved to have ideal acceptability, feasibility and effectiveness. The students’knowledge, attitude, self-esteem and self-confidence level increased significantly after the intervention. The boys’self-esteem and self-confidence level were both lower than girls before and after the intervention.3. China’s adolescents had a relatively low level of HIV-related knowledge. Avoidance and discriminatory attitudes towards PLWHAs were obvious.“Super-ego attitude” which established under the pressure of social approval should arouse special concerns because it could lead to disjunction between attitude and actual behavior. Sexual intercourse behavior and substance abuse in the adolescents were fewer than abroad similar studies, but the growth rates of premarital sex and its adverse consequences could not be ignored, such as unintended pregnant and forced sex.Students of Tangshan had significantly higher knowledge and attitude level than Beijing and Zhengzhou, but the proportions of risk behaviors were also higher. Boys had higher knowledge level, equal attitude level and more risk behaviors than girls, suggesting that the association among KAB in boys was weaker than girls.Conclusion:1. Being orphaned by AIDS would cause a series of negative impacts on children especially to boy orphans. The primary thing is to comprehensively improve the overall living standards of the children in poverty-stricken areas and explore the appropriate foster mode which can meet the children’s needs of the normal physical and psychological development. Meanwhile, school-based HIV prevention education and psychological health intervention would be appropriate strategy.2. Participatory life skills education mainly focusing on HIV-related knowledge, care attitude, self-esteem and self-confidence could be spread among children affected by HIV/AIDS. More attention should be attached on boys in design and implementation of the intervention.3. HIV prevention school education in China should definitely be more deepin and systematic to provide comprehensive and convincing knowledge to the students. In key areas of HIV prevention, short-term programs can not replace the systematic classroom education and repeatability of objects and contents should also be avoided. In the areas with low epidemic level, more education activities which mainly focus on attitude and behavior should be implemented. Gender differences should also be seriously considered in the education.更多还原