【作者】 敬新苗；

【导师】 贺加；

【作者基本信息】 第三军医大学 ， 社会医学与卫生事业管理， 2010， 硕士

【摘要】 研究背景青少年是艾滋病预防的重点人群之一。根据联合国艾滋病规划署和世界卫生组织共同发布的《2007年世界艾滋病报告》,2009年全球艾滋病病毒携带者人数为3340万(3110万-3580万),仅2009年,就有270万(180-410万)新感染者出现,其中40%为15--24岁的年轻人[1]。中国的艾滋病感染者也以青壮年为主体。农村校外青少年是这个群体中特定的一部分。农村校外青少年,辍学或从中小学毕业后,脱离了学校教育,进入社会,由于受教育水平的限制一定时间内难以进入社会主流而在社会边缘徘徊[2]。这部分青少年正处于性生理发育的活跃期,在当前性观念和生活方式改变的环境下,使他们易于成为艾滋病感染的脆弱人群。研究目的探索在农村校外青少年中开展参与式艾滋病健康教育模式。分析通过参与式艾滋病健康干预,农村校外青少年艾滋病知识、态度、行为的转变,评价实施效果,为艾滋病防制工作提供科学依据。研究方法本课题选择重庆市北碚区天府镇10个自然村的15—24岁不在学校读书的农村青少年作为研究对象,按村逐级整群抽样的方式,使用自行设计印制的调查问卷进行健康教育前后调查,对项目实施过程及效果进行评价。研究结果基线调查显示:农村校外青少年艾滋病知识知晓率低,对日常生活接触是否传播艾滋病、艾滋病的预防措施缺乏必要的了解。农村校外青少年对婚前性行为持肯定态度,超过70%的农村校外青少年会同意恋爱对象提出的性要求。对艾滋病感染者和病人歧视观点普遍存在,仅有14.46%的青少年愿意与艾滋病感染者正常交往。未婚农村校外青少年中45.97%有过异性性行为经历,男女比例分别为58.99%和36.91%,两者有显著差异。在发生过性行为的农村校外青少年中,使用安全套的比例为21.65%;29.93%(47人,男性41人,女性6人)的青少年报告曾发生过金钱与性的交易。4.72%(15人)校外青少年承认曾使用过摇头丸等毒品。同时,农村校外青少年缺乏相应的技能,利用艾滋病防治服务低,绝大部分农村校外青少年不知道在什么机构可以获得性、避孕和艾滋病检测等信息,甚至从来没有向所信任的人寻求过相关健康问题的建议,与父母和同伴之间很少有关于性与生殖健康的交流。健康教育干预后:农村校外青少年的艾滋病知识的总知晓率由57.09%提高到82.36%(p<0.01);愿意和艾滋病病人/感染者正常交往的由14.46%提高到67.93%,会接受同学递的烟和出于礼貌接受陌生人的礼物分别由93.00%、79.87%下降到54.36%、55.34%,提议用安全套尴尬的由77.33%下降到39.04%;最近一次性行为中使用安全套的由28.76%提高到61.63%,性行为中经常使用安全套的由23.29%提高到45.93%(p<0.01)。到疾控部门接受艾滋病检测的由1.25%上升到23.13%(p<0.01)。结论农村校外青少年存在较高的艾滋病感染危险;应用参与式研究健康教育模式对农村校外青少年进行预防艾滋病健康教育,可有效提高其艾滋病的相关知识水平、改变其相关态度和行为意向。而长期的行为改变还需持续的健康促进活动和社区政策支持才能实现。建议1、完善并落实学校健康教育政策和制度,在初中普及艾滋病预防知识和技能,增加青少年对艾滋病威胁的认知。2、加强对网吧、娱乐场所的管理,净化社会环境,为青少年的健康成长营造文明的社会氛围;3、规范烟、酒销售,落实不向未成年人销售烟、酒的政策,倡导健康的行为生活方式,提倡不吸烟、适量饮酒,并丰富农村社区文化生活,为农村校外青少年提供更为丰富的娱乐活动选择。4、建立青少年咨询电话、网络、诊所等,为青少年、特别是农村校外青少年提供有针对性、个性化的生殖健康、艾滋病预防服务。5、加大艾滋病的宣传力度,纠正人们对艾滋病感染者和病人的错误认知,消除青少年利用服务的障碍。6、在农村校外青少年中开展艾滋病健康教育工作的同时,应注意改善农村校外青少年的生产技能,提供/介绍务工机会,提高其经济收入水平,为农村校外青少年更好地利用服务建立必要的经济基础。更多还原

【Abstract】 BackgroundThe youngsters are one of the groups mostly in need of the prevention of AIDS. According to The World AIDS Report of 2006 released jointly by the Planning Department of AIDS in the United Nations and the World Health Organization, up to 2006, the number of people who got infected with HIV throughout the whole world is 39.5 million, while in 2006 alone, the increased number of HIV positive people was 4.3million, among which the young people aging from 15 to 24 account for 40 per cent. Similarly, the young people composed the majority of the people infected with HIV in china, among whom the rural out-of-school youth and children constituted the particular sector. The rural out-of-school youth and children are referred to as those who dropped out of school after graduation from primary school or junior middle school. Being seperated from school education, these young people enter the soceity by hovering in the margins of society rather than by merging into the mainstream of it due to the limitation of education level. This part of the young people are at the sexually active period of physiological development, therefore they become vulnerable groups liable to infected with AIDS due to the changes in the sexual attitudes and lifestyles.ObjectivesThe present study is aimed at exploring the mechanisms for the participatory health education on AIDS among the rural out-of-school youth and children. On the basis of analyzing the youths’changes in knowledge, attitude and behaviour concerning AIDS after the intervention of participatory health education, the study will evaluate the effect of the implementation of the above mechanisms and then propose the scientific guidance for the prevention and control of AIDS. MethodsThe subjects in the present study are the out-of-school youngsters aging from 15 to 24 from ten natural villages in Tianfu Town of Beibei in Chongqing.By cluster multistage sampling and utilizing the self-designed questionnairs before and after the investigation, the researcher evaluates the process and the effect of the project.ResultsThe survey reveals that the rural out-of-school youths have a low knowledge score about AIDS, that is, they lack of certain knowledge concerning the prevention of AIDS and feel dark about whether the daily contact will result in the transmission of HIV. This particular group of youths has positive attitudes towards premarital sex and over 70 percent of them will accept the sexual demands by the love partners. Most of them hold prejudice toward the infectors and patients of aids virus. Thus, only 14.46 percent of the youths will be willing to keep in contact with the infectors of HIV. Among the unmarried rural out-of-school youngsters, 45.97 percent of them have heterosexual sex, in which the male and the female accounts for 58.99% and 36.91% respectively, showing a significant gender difference. Meanwhile, 21.65% of them use condom and 29.3% of them ( 47 people in total, 41 male youths and 6 female youth) admitted involving in the transaction of money and sex and 4.75% of them (15 people) acknowledged the use of ecstasy and other drugs. Sad to say, these youths are ignorant of the methods of AIDS prevention and control, not even learning about where to get the instructions on sex, contraception and the testing of AIDS. Even worse, they seldom ask the people they trust for the suggestions on the concerned health problems. No wonder they seldom exchange views concerning sex and reproductive health with their parents or partners.After the intervention of health education on AIDS: knowledge score of HIV/AIDS of rural out-of-school youth and children increased from 57.9% to 82.36%( p<0.01);the rate of willing to communicate the HIV infector or AIDS patients increased from 14.46% to 67.936%;the willingness of accepting cigarettes from schoolmates decreased from 93.00% to 54.36% and willingness to accept gifts from strangers out of courtesy decreased from 79.87% to 55.34%;embarrassment of offering to use condom decreased from 77.33% to 39.04;condom use in the latest sexual intercourse increased from 28.76% to 61.63% and regular use of condom in sex increased from 23.29% to 45.93% (p<0.01); the number of people willing to have HIV testing at the disease control department increased from 1.25% to 23.13% (p<0.01).ConclusionsThe rural out-of-school youths are at high risk of being infected with HIV. Utilizing the participatory method to carry out health education on AIDS for them can effectively increase the knowledge score; change the attitudes and behaviour concerning AIDS. But to implement the long-term behaviour change needs persistent promoting activity and community support.Suggestions1. It is urgent to improve and implement the school health education policies and systems and to spread knowledge and skills about AIDS prevention in junior high school so as to increase the youths’knowledge score of the threats of AIDS.2. It is essential to reinforce the supervisor over the management of the internet cafe and other entertainment places for the sake of purifying the social surroundings and creating civilized atmosphere for the youths’growth.3. It is necessary to strictly regulate tobacco and alcohol sales and carry out the policy of denying the juvenile the purchase of tobacco and alcohol. We should advocate a healthy lifestyle, which consists of no smoking and moderate alcohol. At the same time we can multiply cultural life in the rural communities so as to provide more options for recreational activities for the youths.4. It is of great need to set up consultation telephone, internet, and clinics for the youths, especially for the rural out-of-school youths and provide targeted and personalized services concerning reproductive health and AIDS prevention.5. We should enhance the publicity about AIDS and correct people’s misconceptions about HIV infectors and AIDS patients and eliminate the obstacles of taking advantage of the related service.6. On top of the health education on AIDS among the rural out-of-school youths, it is important to improve their production skills and provide or introduce more job opportunities so as to increase their income. In return, it provides an essential financial basis for the rural out-of-school youths to utilize the service more effectively.更多还原