卫生服务过程中艾滋病相关歧视的干预研究

【作者】 汪媛；

【导师】 张孔来； 张开宁；

【作者基本信息】 中国协和医科大学 ， 流行病学与卫生统计学， 2006， 博士

【摘要】 【目的】探讨如何通过对医务人员的干预,促进减少卫生服务过程中的艾滋病相关歧视。【方法】本研究是设立了自身对照和空白对照的类实验研究,主要分为三个阶段:1、基线调查/需求评估;2、干预;3、效果评估。共有753名医务人员(对照组300名,干预组453名)和40名服务对象参与了研究。调查采用了问卷和访谈(包括个人深入访谈和小组集中讨论)两种方式。采取了以培训和宣传、参与性规划、建立并实施规章制度和参观交流为主的综合性干预措施。资料分析使用了SPSS13.0软件和Microsoft Office Excel 2003软件。【结果】一.个旧市卫生服务过程中与艾滋病相关的歧视行为分别有47.0%、68.3%、39.3%和58.9%的医务人员曾有过“不知情HIV检测”、“不首先告知患者本人HIV检测结果”、“向配偶和/或亲属强制通知患者的HIV检测结果”、“泄密”的行为。二.个旧市医务人员对HIV感染者/AIDS患者的态度对HIV阳性者完全接受的医务人员仅占5.3%、完全不接受的医务人员也只有3.3%。年龄越大,对HIV阳性者的接受程度越高;知识得分越高,接受程度越高;乡镇卫生院医务人员接受程度高于市级医院医务人员;与HIV阳性患者接触多的医务人员的接受程度也高。83.4%的医务人员愿意为HIV阳性者提供卫生服务;14.3%的医务人员不愿意提供服务。医务人员年龄越大,选择“不愿意”的比例越高;妇产科医务人员选择“不愿意”的比例高于其他科室,儿科医务人员选择“不愿意”的比例低于其他科室;每年接触HIV阳性患者超过10个的医务人员选择“不愿意”的比例最高。对患者健康权认知程度高的医务人员愿意为HIV阳性者提供卫生服务的比例也较高。对HIV阳性者接受程度高的医务人员愿意为HIV阳性者提供卫生服务的比例也高。三.干预效果多阶回归分析结果显示经过干预的医务人员的知识总分比没有经过干预的医务人员高1.70分(P＜0.01),经过干预的医务人员对HIV阳性者的接受程度高于未经过干预的医务人员,OR=1.98(P＜0.01);未经过干预的医务人员愿意为HIV阳性患者提供卫生服务的比例低于被干预的医务人员,OR=0.41(P＜0.01)。访谈结果同样显示:与对照组医务人员相比,干预组医务人员能正确看待HIV阳性人群/有感染HIV高危行为人群、能更自如地为HIV阳性患者服务。尽管问卷调查的结果显示干预组和对照组医务人员对患者权利的认知程度在干预前后均无改变,但从访谈结果来看,干预组中已经有医务人员有了保护患者权利的意识。干预前,没有一家医疗机构提供出与接诊HIV阳性患者有关的规章制度。干预后,对照组的医疗机构仍无与艾滋病相关医疗卫生服务有关的规章制度。干预组的三家医院在干预后均制定了与标准防护和职业暴露有关的规章制度,但仅有一家医院制定了“艾滋病咨询服务流程”。【结论】一.个旧市医疗卫生服务过程中的艾滋病相关歧视主要表现为“拒绝提供服务”、“采取不同治疗”、“不知情HIV检测”、“不首先告知患者本人HIV检测结果”、“向配偶和/或亲属强制通知患者的HIV检测结果”以及“泄密”,以后四种行为最为常见,“拒绝提供服务”发生的最少。二.个旧市卫生服务过程中存在艾滋病相关歧视现象的可能原因有:1)医务人员对患者权利的忽视;2)医务人员缺乏与患者交流的技能;3)医务人员过度关注自身安全,但同时又缺乏自我保护的技能和条件;4)与固有的文化风俗和行业体制息息相关。三.医务人员与艾滋病相关的知识、态度、行为的改变与HIV/AIDS流行形势的发展不无关联,但开展专门的研究和干预对于减少卫生服务过程中的艾滋病相关歧视来说是必需的。四.在个旧市,为医务人员提供必要的安全保障,如标准防护的操作规范以及相关的物质条件的支持,可以在短期内使卫生服务过程中艾滋病相关的歧视行为有所减少。更多还原

【Abstract】 【Objective】To explore effective intervention on health service providers to reduce HIV/AIDS related discrimination during health care services.【Methods】This study was a quasi-experiment with self-control and blank-control and 3 phases were included:baseline survey/needs assessment,intervention and evaluation.753 health staff(control group n=300,intervention group n=453) and 40 clients were investigated.Both questionnaire and interview(in-depth interview and focus group discussion) were conducted.During the intervention,training and propagandizing,participatory planning,constituting regulations and visiting were performed.SPSS13.0 software and Microsoft Office Excel 2003 software were used in data analysis.【Results】1.HIV/AIDS related discrimination during health care services in GejiuFive situations had been found,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)". The first kind of situation rarely happened.Proportion of health staff who had practice other four kinds of behavior was 47.0%、68.3%、39.3%and 58.9%respectively.2.Attitudes towards people living with HIV/AIDS(PLHA) from health staff in GejiuOnly 5.3%of health staff would like to contact with PLHA in daily life,and 3.3%of health staff totally wouldn’t.83.4%of health staff would like to treat PLHA and 14.3%of health staff would not.Willingness to contact with PLHA in daily life increased according to age,HIV/AIDS related knowledge,and frequency of contact with PLHA.It was also shown health staff in rural health institutions had higher willingness to contact with PLHA.Willingness to treat PLHA decreased according to age.Health staff who contacted more than 10 HIV positive patients per year were most disinclined to treat PLHA.Proportion of people who would like to treat PLHA was lowest in accoucheur while highest in paediatrician.And the proportion also increased according to perception of health staff to human fights of patients.It was also found there was positive association between willingness to contact with PLHA in daily life and to treat PLHA.3.Effects of interventionHierarchical multiple regression analysis indicated that intervention group scored 1.70 higher than control group(P＜0.01) in test of HIV/AIDS related knowledge, willingness to contact with and treat PLHA were both higher in intervention group (OR=1.98 and 0.41,respectively).Results of interview also showed positive change in intervention group on perception of HIV positives and "risk population",willingness to treat PLHA was also increased.Quantitative data didn’t suggested positive change on perception of human rights of patients,but there were interviewees from intervention group who talked about protecting patients’ rights.Several rules and regulations of standard precaution and occupational exposal were established at all of the 3 institutions after being intervened.Only one of the institution constituted rules about consultation for PLHA.【Conclusions】1.Five situations in which HIV/AIDS related discrimination may occur were found during health care services in Gejiu,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)".2.Possible causes of HIV/AIDS related discrimination during health care services in Gejiu included:1) Ignoring of human rights of patients;2) Being short of communication skills with patients;3) Over caring of self health and incapable of self-protection;4) Traditional custom and professional regulation.3.Special intervention is necessary for reducing HIV/AIDS related discrimination during health care services.4.Necessary professional protection maybe effective in reduction of HIV/AIDS discriminated practice in health care services.更多还原