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　　在艾滋病防控体系中，有一个被称为“前沿侦察兵”的神秘环节，这就是遍布全国的艾滋病监测哨点。那么，这些哨点如何布局？如何收集相关信息？如何跟踪高危人群？疾控部门及监测点做了大量不为人知的工作。在世界艾滋病日到来之际，本报记者深入其中，为您揭开神秘面纱。

　　摸清艾滋病感染的流行和变化趋势，是艾滋病监测哨点的功能，疾控中心人员形象地称其为艾滋病防控前沿阵地的“侦察兵”。

　　目前，我省已设置67个艾滋病监测哨点，重点监控8类高危人群，遍布17个市。11月30日，记者走进济南一处国家级艾滋病监测哨点，了解了哨点监测的过程。

　　哨点相对隐蔽，化验单专人保管

　　一个红丝带的标志，两行显眼的红色大字：国家级艾滋病监测哨点。这是挂在济南市中心医院皮肤科门诊大厅的一个牌子。

　　11月30日中午，记者走进这个哨点时，除了看到这个监测哨点的标志，还看到了贴在下面的一个友情提示：我科是国家艾滋病监测哨点，免费提供艾滋病抗体监测。如果需要帮助，您可与科内医护人员联系而无需挂号。

　　“这是为了方便存有疑虑的患者就诊，解除他们的心理压力，保护他们的隐私。”该科主任杨秀莉说。她指着蓝色牌子下面的一个红色笑脸标志，上面写着：增进交流，互相理解。“我们是为病人服务，就要尽可能地做好周到的服务。”

　　据杨秀莉介绍，该哨点2003年前后设置，针对前来就诊的人群进行监测。“主要针对性活跃期的青年男女，有的是主动要求检测，尤其是到艾滋病日前后，前来检测的更多。一般来说，男性多于女性。”

　　按照规定，这是一处性病门诊男性就诊者监测哨点。这个门诊相对隐蔽，处于皮肤科门诊的最里面，门诊内有专门的男性就诊室。

　　“这也是保护病人隐私的做法。”杨秀莉说，另外，病人的化验单还将由专人保管，“放在其他病人看不到的地方，不会泄露病人病情隐私。”

　　调查问卷在隐蔽空间填写，敏感问题可拒答

　　需要进行检测的患者，在与医护人员进行联系后，要填写一份性病门诊男性就诊者调查问卷。

　　“填写的时候当然是需要隐蔽空间的，其中有些项目是可以拒答的，比如‘最近三个月，你与小姐(暗娼)发生过性行为吗’这样的隐私问题病人可以不填，但是一般来说如实填写的较多。”杨秀莉介绍。

　　她拿出一份调查问卷，记者发现上面的问题有20多个，其中包括监测地点、调查对象基本资料、对艾滋病的了解情况、最近三个月的性行为情况，以及接受预防艾滋病服务情况等。

　　“比较系统地了解病人的整体情况，这会对艾滋病的感染原因和流行变化趋势有一个了解。”杨秀莉说。

　　前来检测的病人，不少是事先对病情已有了解，也有一些人是从其他地方转过来的，“现在病人分流渠道很多，很多男科医院或者皮肤病医院都有病人前去，应该说我们的门诊量一直比较稳定，跟这个分流也有关。”她说。

　　一般来说，每个月疾控中心人员会来采集病人血样，然后拿去检测。“我们是临床服务，不管男女老少，来者不拒，除了采血检查，还提供咨询服务，回答病人的疑问，这是我们的宗旨。”

　　重点监测8类高危人群，青年学生为新增群体

　　目前，全省像这样的哨点有67个，每个哨点都会根据自己的针对对象做抽样检测。

　　监测哨点的监测对象是八类高危人群。“一类是性病门诊男性患者，全省有17个点;二是女性性工作者，全省也是17个点;三是男男性行为者，有8个点;四是流动人口，有3个点;五是孕产妇，有17个点;六是吸毒者，有2个点;七是男性长途汽车司乘人员，有1个点；八是青年学生，有2个点。”省疾控中心艾滋病所监测专家廖玫珍介绍。

　　“这些高危人群的监测点是慢慢增加的。”廖玫珍说，我省艾滋病监测哨点是1995年开始建立，最初只有2类监测对象，分别针对性病门诊男性患者和女性性工作者。“这些年来，高危人群逐渐扩大范围，监测范围也随之扩大，今年春天又增加了青年学生这一监测对象。”

　　增加监测点范围是根据每年艾滋病感染者疫情报告的特点和变化而定的，比如如果在疫情报告中发现了某个感染群体的增多，就会随之增加新的监测点。“比如发现长途汽车司机感染者，就在胜利油田增加了监测点。而这几年随着性开放观念的蔓延，青年学生在校性行为增多，受感染的几率增大，因此国家就增加了青年学生监测点。”

　　“艾滋病监测哨点的功能就是通过抽样检测，为艾滋病的流行趋势和变化提供数据支持。”廖玫珍介绍，就像是前沿阵地的侦察兵，通过它们的侦察，可以了解到病情的变化。“这个跟平常的临床服务和艾滋病检测工作不同，它们的工作是面对病人做出诊断。”

　　暗娼感染梅毒比例上升明显

　　“今年一个比较突出的变化是，我们发现在某城市一个暗娼监测点所监测的400个暗娼中，感染梅毒的比例上升明显，监测报告显示今年已经达到了10%。”廖玫珍说，这跟这个群体吸食新型毒品有关，比如冰毒、摇头丸等，吸食毒品的暗娼使用安全套的比例较低，因此感染梅毒的几率大大上升。

　　“尽管目前这一群体感染艾滋病毒的发现率很低，但是感染梅毒就加大了感染艾滋病毒的风险，一旦性工作者感染了艾滋病毒，危害将是惊人的。发现这一趋势，对于我们下一步开展防治干预工作提出了警示。”廖玫珍说。

　　据她介绍，监测哨点的工作集中于每年的4月初到7月底，“从4月1日起，我们就开始进行抽血检测，比如到某个医院的性病门诊采集男性性病患者血样，拿回去进行进一步检测”。

　　当然这并非全民式的监测，只是针对这一段时间内的400名患者进行，“比如说不到7月底已经到了400名患者，那就达到了监测要求，不再采集血样。”

　　提起监测哨点工作的难度，廖玫珍说，最大的障碍是隐私问题，“这些群体很多都是隐蔽性的，比如男同性恋、暗娼等，他们是不想向外人公开的，做起工作来难度很大。”

　　“比如男同的监测哨点，最初建立时，一个患者也没有，后来经过去男同经常聚集的场所暗访，做工作，并且跟男同的民间组织联系，局面才逐步打开了。”廖玫珍说，这是一项很辛苦的工作，需要工作者主动去寻找高危人群，并劝说他们去检测，“尽管是免费检测，但还是有些人宁愿自己掏钱去医院检测，也不愿到我们这里来。毕竟社会的偏见和压力还是很大。” (郭静)

AIDS is the respect the key principles of anti-AIDS
 Source: Finance new network at 9:24 on December 1, 2010 coverage of Beijing: Long Zhou Park


French AIDS Assistance Association uphold the principle that people with AIDS, not judge life, respect for individual identity of each

Commentary:

AIDS is one of the most feared disease, but AIDS-related discrimination and sometimes even more terrible than AIDS itself.

Christian Andelieao is France's biggest anti-AIDS organization AIDS Assistance Association, the French director of international projects. In France, he has been committed to the fight against AIDS discrimination.

Christian Andre:

Difficulty lies in the fight against AIDS, many HIV AIDS is not only to face discrimination, but also the identity of the discrimination that people face, such as immigration, drug users and MSM groups. Many people face a double discrimination.

Uphold the principles of our organization is not judged AIDS, do not judge their way of life, do not evaluate their status, do not reveal their prevalence. Respect each individual's identity, the key principles need to spread throughout society.

The slogan of this year's World AIDS Day is "universal relief, protection of human rights" should be the elimination of discrimination in the meaning of the slogan of the question. Andelieao said, if you can not fight for basic rights for AIDS patients, it is difficult to effectively promote the fight against AIDS.

Christian Andre:

This is not just a political issue to fight for the rights. In order to promote the fight for rights of action to fight AIDS is to eventually eliminate the disease. Without these rights, it will be difficult to effectively against Ai.

Andelieao Aid Association also presented in cooperation with government experience. In his view, governments, medical institutions and patients and other stakeholders need to join together, and discuss countermeasures. Although each participant has its own limitations, but the cooperation would create common ground, to play a greater energy to develop a comprehensive anti-AIDS policy.

Secret AIDS sentinel surveillance: monitoring of young students for the new object
At 10:19 on December 1, 2010 Source: Qilu Evening News

Editor's note ◎ ◎

AIDS prevention and control system, known as a "forward scout" the mysterious link, this is all over the country's HIV sentinel surveillance. So how these sentinel layout? How to collect relevant information? How to track high-risk groups? Disease control departments and the monitoring sites have done a lot of work unknown. World AIDS Day approaching, our reporter in depth which, for you to be unveiled.

Find out the prevalence of HIV infection and the trend is the function of HIV sentinel surveillance, CDC staff to call for AIDS prevention and control of the image of the forward position of the "Scout."

Currently, the province has set up 67 HIV sentinel surveillance, focusing on monitoring high-risk groups Class 8, over 17 municipalities. November 30, Jinan, a reporter walked into the national AIDS sentinel surveillance, sentinel surveillance to understand the process.
 

Sentinel is relatively hidden, laboratory single hand care

Symbol of a red ribbon, the two prominent red lines read: National HIV sentinel surveillance. This is hanging in the hall of the Jinan Central Hospital, a dermatology clinic brand.

November 30 at noon, when a reporter walked into the sentinel, sentinel surveillance in addition to seeing the signs, also saw a stick in the following Tips: Division I national AIDS surveillance sentinel, free HIV antibody monitoring. If you need help, you can contact with the Division staff without registration.

"This is for the convenience of patients suspicious of treatment, the psychological pressure to lift them and protect their privacy." The director of Yang Xiuli said. She pointed to the blue brand following a red smiley face sign that read: enhance exchanges and mutual understanding. "We are services for patients, it is necessary to do good service as much as possible."

According to Yang Xiuli introduced after the year 2003 set the sentinel for monitoring the crowd to come to treatment. "The main activity of the young men and women targeted, some initiative to detect, particularly to AIDS before and after detection of more to come. In general, more men than women."

According to regulations, this is a male STD clinic attenders sentinel surveillance sites. The clinic is relatively hidden, in the dermatology clinic of the inside, there are specialized outpatient clinic for men.

"This is the protection of patient privacy practices." Yang Xiuli said another patient's lab test will be kept by hand, "put out of sight of other patients, the disease will not disclose patient privacy."

The questionnaire filled in hidden spaces, may refuse to answer sensitive questions

The need for testing of patients, after contact with the medical staff, to fill in a male STD clinic attenders questionnaire.

"When the course is the need to fill in hidden space, which can refuse to answer some of the projects, such as 'the last three months, you and Miss (CSWs) had sex up' the privacy of such patients can not fill, but in general fill out for the more. "Yang Xiuli introduced.

She took out a questionnaire, the reporter found more than 20 above issues, including monitoring locations, the survey of basic information to understand the situation of AIDS, the last three months of sexual behavior, and accept the situation and other HIV prevention services .

"A more systematic understanding of the patient's overall situation, this will cause HIV infection trends and an understanding of fashion." Yang Xiuli said.

Come to test patients, many already know in advance of the disease, some people turn from elsewhere, "the diversion channel of the patients are now many, many men and hospital patients have to go the hospital or skin, it should be said that we of outpatients have been relatively stable, with the shunt is also relevant. "she said.

In general, CDC staff every month to collect blood samples of patients, and then take it detected. "We are of clinical services, whether young and old, indiscriminately, in addition to blood examination, and also offers consulting services, answering patient's questions, it is our aim."

8 classes focus on monitoring high-risk groups, new groups of young students

Currently, the province such as this there are 67 sentinel, each sentinel will do according to their own sampling and testing for the object.

Sentinel surveillance to monitor eight categories of objects are at high risk. "One is male STD clinic patients, the province has 17 points; Second, female sex workers, the province is 17 points; Third, MSM, 8 points; Fourth, mobile population, there are three point; Fifth, maternal, 17 points; six are drug addicts, there are 2 points; seven male long-distance bus and passengers, there is a point; eight young students, with 2 points. "provincial disease control Center for AIDS monitoring expert Liao Meizhen introduced.

"These high-risk groups monitoring point is slowly increased." Liao Meizhen said the province is HIV sentinel surveillance sites established in 1995, initially only 2 classes to monitor the object, respectively, for male STD clinic patients and female sex workers. "Over the years, gradually expanding the scope of high-risk groups, also expanded the scope of monitoring, this spring has increased the monitoring of young students of this object."

Increase the scope of monitoring points is based on the annual report on AIDS epidemic features and variations may be, for example if a disease report found an increase in the infection group, will follow the addition of new monitoring points. "For example, bus drivers found infected to an increase in the Shengli oil field monitoring sites. Rather is open to the concept of the past few years with the spread of sexual behavior of young students in the school increased the probability of infection increases, so increases the state monitoring points of young students. "

"AIDS sentinel surveillance function is through sampling, as the AIDS epidemic trends and provide data to support change." Liao Meizhen introduction, like a frontier scout, through their reconnaissance, I can understand the disease changes. "This with the usual work of clinical services and HIV testing is different from their work in the face of the patient to make a diagnosis."

Syphilis infection among female sex workers has risen significantly

"This year a more prominent change is that we found a female sex workers in a city monitored by the monitoring points in 400 female sex workers, the proportion of syphilis increased significantly, monitoring reports has reached 10% this year." Liao Meizhen said that with this groups taking the new drug-related, such as ice, ecstasy, etc., taking drugs lower proportion of condom use among female sex workers, thus greatly increased risk of syphilis infection.

"Although this group found that HIV infection rate is very low, but infected with syphilis to increase the risk of HIV infection, once the sex workers infected with HIV, harm would be staggering. That this trend, our Next carry out the work of prevention and treatment interventions as a warning. "Liao Meizhen said.

According to her, sentinel surveillance work focused on the early April each year to the end of July, "From April 1 onwards, we began to blood testing, such as STD clinic to a hospital blood sample collection male STD patients, take back for further testing. "

Of course this is not a universal monitoring, but this time for the 400 patients, "such as less than the end of July has reached 400 patients, it reached the monitoring requirements, no blood samples."

Mention the difficulty of monitoring sentinel work, Liao Meizhen said that the biggest obstacle is privacy, "these groups, many of which are hidden, such as gay men, prostitutes, etc., they are not open to outsiders, very difficult work to start . "

"For example, the monitoring of sentinel with men, first established when a patient does not, then go through the regular gathering place for men with unannounced visits, to do work, and with the male contact with civil society organizations, the situation was gradually opened up." Liao Meizhen said that this is a very hard job, you need to take the initiative to find workers in high-risk groups, and persuade them to detect, "even though testing is free, but still some people would rather their money go to the hospital testing, do not want to us come. After all, social prejudice and pressure is still very large. "(Guo)