【作者】 杜建伟；

【导师】 聂绍发；

【作者基本信息】 华中科技大学 ， 流行病与卫生统计学， 2008， 博士

【摘要】 研究背景自1981年美国报道首例艾滋病以来,HIV在世界范围内迅速传播、蔓延,至今已在189个国家流行。目前我国已报告HIV感染者22万多例,死亡2万多人,估计感染者已达70万例。海南省作为我国改革开放的前沿地区以及旅游城市,艾滋病发病上升迅猛,虽已在全省艾滋病预防和宣传教育方面积累了较丰富的现场经验和理论基础,但对于经济、文化及生活习惯较为落后的黎族地区艾滋病预防监测及健康教育仍十分薄弱,沿用原有的干预措施效果不一定有效,因此开展黎族地区艾滋病健康教育措施的研究对我省艾滋病控制显得尤为重要。研究目的1、通过健康教育,提高吸毒人群艾滋病预防知识知晓率和安全套使用率;通过交换清洁针具,降低吸毒人群共用注射器比例。2、通过对黎族地区流动人口艾滋病知识水平和行为特征调查,探索针对农村的艾滋病控制措施,从源头上切断艾滋病传播途径。3、通过培训乡村医生和村干部,在性活跃人群开展同伴教育并对中学生讲授艾滋病预防知识课程,探讨农村地区艾滋病控制策略。4、通过调查旅游区宾馆安全套及宣传资料的消耗情况,了解安全套使用知识及行为的现状。5、通过在娱乐场所推广使用安全套,建立安全套市场营销体制,改变政府以及社会对艾滋病预防的错误观念,有效阻断艾滋病经性行为传播的途径。研究方法1、选取514名1999年7月至2000年12月进入戒毒所的强制及自愿戒毒人员,进行抗-HIV、抗-HCV、HBsAg和梅毒检测;2、对琼中县及万宁市辖区内居住3个月以上年龄为15-49岁的流动人口共251人进行艾滋病知识调查;3、随机抽取5个自然村进行综合性健康教育干预。对乡村医生进行培训,并在中学生中开设健康教育课程,由项目成员讲授艾滋病、性病预防知识;4、每天固定观察100间双人客房,每间客房放置2只安全套及针对男性和女性人群的两种不同的艾滋病预防知识宣传材料;5、在娱乐场所常规放置安全套和宣传资料,对桑拿、发廊等提供或者可能提供性服务的三陪小姐420人进行艾滋病、淋病、梅毒、衣原体等感染状况检测。研究结果1、静脉注射吸毒占33.85%,其中共用注射器占24.70%,抗-HCV抗体和HBsAg阳性率分别为36.21%和27.01%,显著高于口吸人群。性行为中未使用安全套占66.51%,检出1例HIV阳性;2、黎族村民对性病传播、预防等知识的正确回答率在6.42%-84.40%之间,性行为中安全套使用率为9.09%,过去30天使用率为5.46%,安全套方便获取率为10.00%;3、培训后乡村医生艾滋病知识的正确回答率提高了5.42%-63.64%,其中39.39%乡村医生的艾滋病知识来源于项目培训。中学生对艾滋病预防相关知识的正确回答率提高了25.63%-75.63%,其中艾滋病传播途径和预防措施的正确回答率提高最明显;4、40天共投放安全套8000只,消耗1569只,消耗率为19.61%,使用350只,使用率为4.38%;平均每天客房安全套消耗率为39.23%;5、干预1年后,服务小姐淋病、衣原体和梅毒感染率分别由11.03%、7.58%和3.57%下降到1.27%、0.00%和1.27%,未检出HIV阳性。服务小姐最近一次性行为安全套使用比例从14.25%上升到90.45%。研究结论1、共用注射器和无保护性行为是吸毒人群感染艾滋病的高危因素;2、黎族人群缺乏艾滋病预防知识,是容易受到艾滋病攻击的脆弱人群;3、乡村医生培训是农村艾滋病预防的有效措施;中学生健康教育干预是控制艾滋病的长远措施;4、在旅游区宾馆放置安全套和艾滋病、性病宣传材料对特定人群有较好的健康防护作用;5、娱乐场所推广使用安全套可有效降低性病、艾滋病发病率。本研究的创新点1、在我省首次采用同伴教育、交换针具及市场营销的干预方法,从心理上改变吸毒人群对自身行为的认识,改变了吸毒人群的不良行为。2、首次在海南省黎族地区宾馆房间放置安全套,是开展艾滋病、性病预防方法的初步尝试。更多还原

【Abstract】 Study BackgroundAIDS has spread in 189 countries in the world quickly after it was found in the United States in 1981.In China,220 thousand HIV carriers have been reported up to now, among which 20 thousand have died,and the number of infection estimated has reached 700 thousand.In the past the emphasis of AIDS control in Hainan was put on developed economic and tourism areas such as Haikou and Sanya City.The control measures not only prevented AIDS from transmition in the province but also provided good experience for health education of AIDS prevention.But the AIDS prevention is very weak in the rural areas,especially undeveloped economy,culture and life style areas just like Li Minority villages.So it is imperative to take AIDS control measures fit for Li Minorities because the former methods of AIDS health education could not be effective in this population.Objectives of Study1.To increase the knowledge of AIDS prevention and the rate of condom use of the drug users by health education;to decrease the rate of sharing syringe in drug users by exchange and selling of syringe in the market.2.To explore the measures of AIDS control to sex workers coming from rural areas and cut off the transmittion route of HIV from the source,and understand knowledge level and behavior characteristics of AIDS of floating population in Li Minority areas.3.To explore the tactics of AIDS control in undeveloped rural areas through training village doctors,companion education in the population having active sex activities and teaching knowledge of AIDS prevention in the middle schools.4.To understand the current situation of the knowledge of condom use by investigating the consumption condition of the condom use and promotion information in the hotels of tourism region.5.To establish the system of selling condom in the market and cut off transmittion route of AIDS by sexual activities through spreading the use of condom in the entertainment places.Material and Method1.514 study objectives were mandatory and voluntary drug users stoping drug use in the house of detention and were detected the HIV,HCV,HBsAg and syphilis.2.251 study objectives were floating population aged from 15 to 49 having stayed beyond three months in Qiongzhong County and Wanning City.3.5 villages selected randomly from Qicha Town in Changjiang County and Nanqiao Town in Wanning City respectively were intervented by comprehensive health education of AIDS and STD prevention by training the rural doctors and the middle school students in the study areas.4.100 rooms were observed everyday.Two condoms and two kinds of promotion information were placed per room.5.420 sex workers distributed in the entertainment places of urban areas in Danzhou City were examined for HIV infection.Results1.Vein injection was accounted for 33.85%in the drug use,in which 24.7%sharing syringes.The positive rates of anti-HCV antibody and HBsAg were higher than the oral drug users remarkably.66.51%of the drug users did not use condoms in sexual activities.1 HIV positive was found in the drug users.2.The correct answer rates of AIDS and STD prevention in the villagers were from 6.42%to 84.40%.There were only 10 villagers using condoms in sexual activities, accounting for 9.09%,and 6 persons using condoms in the last month,accounting for 5.46%,and 11 could get condoms conveniently,accounting for 10.00%.3.The correct answer rates of AIDS knowledges of village doctors increased 5.42-63.64 percents after training of the program.The correct answer rates of questions increased 25.63-75.63 percents after training the middle school students of AIDS prevention,in which transmission route and preventive measures of AIDS increased 75.63 and 70.42 percents respectively.4.8000 condoms were put in the hotels.The consumption rate was 19.61%and the use rate was 4.38%.The condom consumption rate per room was 39.23%.5.The infection rates of NG,CT and syphilis of sex workers decreased from 11.03%, 7.58%and 3.57%to 1.27%,0.00%and 1.27%respectively after interventions.No HIV positive was found.The rate of condom use of the sex workers in the last sexual activity increased from 14.25%to 90.45%.Conclusion1.Sharing syringes and sexual activities without using condoms are the mian high risk factors of AIDS infection in drug users.2.Li Minorities are weak population affected by AIDS easily because of lack of knowledges of AIDS prevention.3.Health education of village doctors and middle school students will be long-term measure of AIDS control in Li Minority.4.Placing the condoms and the promotion information in the hotels does protective effects to certain population.5.Popularizing condom use in entertainment places can decrease the rates of AIDS and STD infection.Creative points of the study 1.Firstly using methods of copanion education,exchange and selling of syringe in markets in Hainan Province which can change the former single and uninteresting health education.The method can help drug users to understand harms of drug use and AIDS and to change the high risk behaviours.2.Firstly putting the condoms in the room of hotels to prevent AIDS in Hainan Province.The method can not only prevent AIDS and STD infection effectively but also change incorrect sexual behaviours of Li Minorities.更多还原