【作者】 郭金玲；

【导师】 张亮；

【作者基本信息】 华中科技大学 ， 社会医学与卫生事业管理， 2007， 博士

【摘要】 研究目的了解河南省艾滋病社会疾病负担、经济负担及艾滋病对患者本人及人群健康水平的影响,艾滋病对宏观经济的影响,对个人、家庭和社区的影响,对卫生系统的影响,对目前艾滋病综合防治策略进行卫生经济学评价,从患者及家庭、社会、宏观等不同层次,全面系统探讨艾滋病流行对河南省社会经济所造成的影响,在艾滋病救治、救助、预防控制、社区稳定与发展等方面提出政策性建议。研究方法在分析河南省艾滋病流行现状的基础上,通过现场调查、专题访谈、文献综述等,采取系统分析、卫生经济学方法进行研究。研究结果艾滋病对居民健康的影响:①艾滋病患者在生理、心理、独立性和社会关系四大领域的生存质量得分低于正常人群,在环境、精神宗教个人信仰两大领域的生存质量得分与正常人群无统计学差异。②河南省居民全死因期望寿命值为74.404岁,去艾滋死因后期望寿命为74.459岁。艾滋病对社会的影响:①对患者个人的影响艾滋病(acquired immune deficiency syndrome,AIDS)患者和人类免疫缺陷病毒(human immunodeficiency virus,HIV)感染者(简称HIV/AIDS)在调查前3个月因病休工(学)和卧床平均天数分别为15.3和6.2天;18.6%的HIV/AIDS认为个人婚姻状况受到影响;在受到歧视后1.4%曾有报复行为,37.7%有报复想法。②对家庭的影响HIV/AIDS组有37.3%的家庭有成员因HIV/AIDS去世;HIV/AIDS家庭生活困难的占88.6% ;HIV/AIDS家庭因疾病损伤致贫所占比例为79.9%。③对社区的影响在调查社区中,平均每年每社区集体上访1.1次,平均每次8.2人;有71%的HIV/AIDS对政府救助程度感到满意;20个社区因艾滋病流行造成的孤儿202个,孤老64个;因HIV/AIDS造成的夫妻离婚或长期分居家庭47个,平均每个社区2.4个。艾滋病对卫生部门的影响:①投入情况32家县乡级医疗卫生部门共有建筑物117座,用于防治艾滋病的业务用房面积为13008.2平方米,占总业务用房的14.3%;现有艾滋病防治人员327人,其中专职人员211人,兼职人员116人,平均每人每个工作日的70.9%时间用于艾滋病防治工作;32家防治机构2000元以上艾滋病防治专用设备130台,平均每家4.1台;②预防工作在辖区内对HIV/AIDS宣教咨询129 442人次,平均对每位HIV/AIDS进行宣教咨询9.9次;2004年县乡级医疗机构接受上级医疗机构艾滋病知识培训的平均次数分别为3.83次、9.20次;在艾滋病流行区,村卫生室开展艾滋病健康教育、预防、咨询、治疗和护理工作的比例分别为93.33%、86.67%、93.33%、100.00%、93.33%;③对医疗机构卫生服务利用情况AIDS患者的门诊就诊次数(23.66次/3个月)是HIV感染者的2倍,是对照组的10倍,三者之间门诊就诊次数的差异均有统计学意义。HIV/AIDS组就诊的医疗机构倾向于基层,在乡、村两级医疗机构就诊的病人约占病人总数的95%。AIDS患者的住院次数最高(平均为0.59次/3个月),其次是HIV感染者(平均为0.18次/3个月),HIV/AIDS组的住院次数显著高于对照组,三者之间的差异均有统计学意义。艾滋病对经济的影响:①对患者家庭经济影响HIV/AIDS家庭直接花费为834.6元/年,家庭间接花费为1073.76元/年;家庭疾病负担共计1908.36元/年,家庭疾病负担占家庭收入的36.7%;HIV/AIDS家庭平均年收入合计5196.3元,支出合计6211.8元。②艾滋病社会疾病经济负担研究平均每例DALYS 20.76健康人年,当年DALYS合计59898.84健康人年;社会直接疾病经济负担:全省艾滋病社会直接经济负担约为31118.86万元/年;全省艾滋病总的直接社会经济负担为46678.28万元,全省艾滋病社会间接经济负担合计629653.47万元,两者合计为总的艾滋病社会疾病经济负担676331.76万元。③艾滋病对河南省宏观经济的影响2005年艾滋病全省散发,局部流行造成的人均国内生产总值损失为9.8239元,国内生产总值损失9.54589亿元。河南省艾滋病综合防治效果评价:①母婴阻断:终止妊娠措施,避免1例感染的费用平均46963元,感染后的例均经济损失为214172元,效果成本比值为4.6:1;药物阻断加人工喂养措施效果成本比值为2.5:1;各项措施综合效果成本比值为3.5:1。②艾滋病综合防治效果卫生经济学评价:河南省2003～2005年在艾滋病防治工作中总投入为7.714×108元。避免1例HIV感染的成本为45924.9~229788.5元;挽回一个DALY所需费用为167.82元～9024.45元。研究结论①AIDS患者生存质量降低;②HIV/AIDS对个人、家庭及社区均产生了一定的社会影响,主要体现为对个人就业、婚姻状况及艾滋病所带来的心理歧视和压力等问题。③艾滋病在河南省部分地区的高发增加了政府的经济负担及相应的卫生投入;乡级和村级设点卫生室在防艾过程中发挥了重要作用。④艾滋病对社会经济的影响首先体现在对家庭层面的影响,艾滋病使家庭收入降低,家庭总消费能力降低,家庭消费结构发生变化;每例艾滋病DALYS 20.76健康人年,艾滋病流行区社会疾病负担重;艾滋病流行对河南国内生产总值造成一定的影响。⑤AIDS的母婴传播阻断(母婴阻断)工作是人工干预防控AIDS传播的重要环节,可以使儿童感染HIV的机率大大下降,且具有较高的成本—效果比;⑥艾滋病综合防治效果良好,避免1例HIV感染者及挽回一个DALY所需费用均低于国际公认水平。艾滋病流行已经是社会重大问题,需要政府行动和社会动员;政府策略、行动必须有持久性;应对艾滋病传播流行需要社会动员策略;必须加强公共卫生建设,控制艾滋病流行,促进社会经济可持续发展。更多还原

【Abstract】 Aims:We elucidated the social and economic burdens resulting from AIDS, its influence on patient’s and public health levels, and on macro-economics in Henan province. We also evaluated the influence of AIDS on the society, particularly on AIDS patients, families and community, as well as medical care.We analyzed how AIDS affected social economy of Henan province at three different levels, including patients’family, society and macro-economics. In addition, we put forward constructive advices for AIDS treatment, salvation, prevention, control and community stability and development.Methods:In this study, adopted systems analysis, brain storming and other methods were utilized on the basis of analysis of AIDS epidemic status through field investigation, special topic interview, literature reading and studying.Results:The influences of AIDS on resident health: 1. The QOL scores of AIDS sufferes were lower than those of normal model in four fields including physiological domain, psychological domain, level of independent domain and social relationship. However, there was not statistical significance in the fields of environment, as well as spinituality, religion and personal belief between two groups. 2. The life-span of total population in Henan province was 74.404 years, and the expected life-span without AIDS was 74.459 years.The influences of AIDS on society: 1. to individuals: The average days of their stopping working and rest at bed for HIV/AIDS suffers were 15.3 and 6.2 days, respectively, 3 months before investigation, including 18.6% with affected marriage,1.4% with discrimination, and 37.7% with retaliatory behavior. 2. to family: 37.3% of the families had member died of HIV/AIDS, 88.6% were difficult to survive,and 79.9% were destitute for the illness. 3. to community: during the investigation, there were 1.1 time visitation per year and per community averagely, and 8.2 interviewers averagely every time. 71% of HIV/AIDS were satisfied with the extent of governmental salvation. In 20 communities, there were 202 orphans, 64 lonely elders because of the prevalence of AIDS. There were 47 divorced and limited divorced families because of the prevalence of AIDS, averagely, 2.4 per community.The influences of AIDS on sanitarian branches:1. major outcome: 32 county and township medical and sanitarian branches had 117 building services totally.Among which 13008.2 m2 was used in the prevention of AIDS, accounting for 14.3% totally. There were 327 healthcare staff who worked in the prevention of AIDS. 70.9% of the time per day was devoted to AIDS prevention. There were totally 130 AIDS prevention equipments which costed above 2 thousands Yuan in 32 prevention branches. 2. the devotion in AIDS prevention: 129442 people received education on HIV/AIDS prevention, and each HIV/AIDS patient received 9.9 times of education. There were 3.83 and 9.20 times to have education on AIDS in country and rustic medical branches respectively. In AIDS epidemic area, the ratio of rustic medical centers which implemented education, prevention, consultation, treatment and nursing for AIDS were 93.33%, 86.67%, 93.33%, 100.00%, and 93.33%, respectively.The influences of AIDS on economy: 1. the influences on domestic economy of patients: domestic costs of HIV/AIDS were 834.6 Yuan per year. The loss was amount to 89.48 Yuan monthly, and the indirect domestic costs were 1073.76 Yuan per year. The domestic illness burden was total 1908.36 Yuan, accounting for 36.7% of domestic incomes. The average income and expenditure per year in HIV/AIDS family were total 5196.3 and 6211.8 Yuan respectively. 2. the economic burden of AIDS: DALYS reached 59898.84 Yuan yearly, an average of DALYS was 20.76 year. The social direct economic burden in Henan province was around 311.1886 million Yuan per year, and total economical costs were 466.7828 million Yuan. The indirect economic burden was amount to 6.29653 billion Yuan. Under current prevalent conditions, the total social economic burden for AIDS patients was 6.76331 billion Yuan. 3. the influences on macro-economy in Henan province: In 2005, AIDS was scattered in the whole province, the epidemics in local area led to the loss of personal GPD 9.8239 Yuan, and loss of GPD was 954.589 million Yuan.Evaluation of general AIDS prevention in Henan province: 1. baby-mother interdiction: It costed 46963 Yuan averagely to end pregnancy and avoid 1 case of HIV infection. If 1 case was infected, the economic loss would be 214.172 thousand Yuan averagely. The effect-cost ratio was 4.6:1, and the ratio of medical interdiction and manual feed was 2.5:1. The general effect-cost ratio was 3.5:1. 2. evaluation on general prevention of AIDS according to the sanitation and economy: the total devotion of AIDS prevention from 2003 to 2005 was 771.4 million Yuan. The cost of avoiding 1 case of HIV infection was 45.9249-229.7885 thousand Yuan. The cost of saving a DALY was 167.82-9024.45 Yuan. Conclusion:1.AIDS suffers got lower scores than healthy controls.The quality of life was also decreased. 2. HIV/AIDS, to some extent, affected individual, family and community totally, mainly manifested in mental discrimination and pressure resulted from individual employment, marriage situation and so on. 3. HIV infection increased the government economic burden and corresponding sanitary devotion in high accidence areas in Henan province. Local medical centers played an important role in the prevention of AIDS. 4. the influence of AIDS infection on social economy was mainly limited at family level. The domestic income and total domestic consume were decreased, the consuming structure also changed greatly. The social economic burden of AIDS was high in high-accidence areas of Henan province. AIDS prevalence, to some extent, affected Henan’s GPD. 5. baby-mother interdiction was the most important step in AIDS prevention, which could decrease greatly the infection ratio in children with high cost-effect ratio. 6. efficacy of comprehensive treatment is suggestive. The costs of avoiding 1 case with HIV infection and rescue of 1 case with DALY was lower than that at an international level.Prevalence of the AIDS is a major social problem, governmental action and social mobilization shall be taken to prevent it. Importantly, governmental strategies and actions shall also be persistently. Social actions and strategies can deal with the prevalence of the AIDS. Therefore, public healthy construction needs to be strengthened to control the prevalence of the AIDS and improve persistent development of social economy.更多还原