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防控艾滋：高危人群干预遇难点
http://www.sina.com.cn 2009年12月22日04:27 大众网-大众日报
□本报记者 杨润勤 本报通讯员 张明玉屈振尧
被干预者不配合成了干预难点
截至今年10月31日，我省已累计报告艾滋病病毒感染者和艾滋病病人1805例，其中艾滋病病人死亡 246例。今年前10个月，我省新增艾滋病病毒感染者和病人428例。艾滋病病毒感染者中，经性传播的比例高达64.6% 。高危行为干预是预防性传播的有效措施，然而，在干预过程中，许多被干预者不配合成了难点。
“第 22个‘世界艾滋病日’刚过，我们没有把防控艾滋病当成‘一阵风’，许多工作正在深入扎实进行，比如对高危行为的干预。”济南市历城区疾病预防控制中心艾滋病防治科科长潘荣建日前告诉记者。他说，历城区地处济南东部经济区，又是城乡接合部，流动人口多，性病发病率偏高，存有艾滋病感染扩散的风险。近年来，他们加大力度对高危行为进行干预。
据介绍，自 2005年开始，该中心成立高危人群干预工作队伍，依托中央补助地方项目支持，开展高危行为干预。艾防人员深入到辖区内的发廊、酒店、桑拿浴室等公共场所进行干预和检测咨询，2005 年首创了为娱乐场所从业人员免费接种3针乙肝疫苗的干预工作方法。由于乙肝的传播特性与艾滋病有一定相似处，通过为她们接种乙肝疫苗，首先是可以宣传预防知识，其次是可以预防相关疾病，通过提醒她们来接种疫苗，增加和她们交流的机会，了解她们的身体、工作状况，从而达到干预的目的。
潘荣建说，从2008年起，在中美合作艾滋病防治项目的支持下，他们在全省首次采用同伴推动抽样法(RDS)、针对女性多性伴人群(CSW)的专题调查，初步掌握了 CSW 人群的规模、特征、活动场所和区域，印制了 RDS检测联系卡、宣传手册等。CSW 人群作息时间与常人不同，为此，设立了 24 小时咨询服务热线0531-66864306，方便CSW 人群随时联系。
被干预者“不愿去”成难点中重点
潘荣建透露，一般的干预过程是，先与娱乐场所的业主取得联系，同意后艾防人员前往。召集起CSW 人群，先讲防艾知识，告诉她们必须100% 使用安全套。接着，防艾人员提问，艾滋病是通过什么方式传染的？有的被干预者回答，一是血液，二是母婴传播，三是性。回答正确，防艾人员给她一个小礼物。同伴见有礼物，争相回答问题，包括如何正确使用安全套等，气氛活跃了，防艾人员动员她们到艾防所查体。但大部分人不愿去，给干预带来了困难。
“不愿去”是难点也是重点。济南市疾病预防控制中心主任马衍辉介绍，济南市高危行为干预的重点，除了男男同性性行为人群及其他一些人群外，娱乐场所的从业人员是一大群体。4年多来，防艾人员一直进行干预，应当看到，通过这项工作的进行，娱乐场所从业人员的艾滋病防治知识得到了提高，自我防护意识得到了加强，对于艾滋病的预防起到了很大的作用。截至目前，全市大约干预了1万多人次。
还有什么办法劝其检查？济南市疾病预防控制中心艾滋病防治所所长王美花说，在被干预的人员中，文化程度参差不齐，性格脾气差异较大，谈吐举止更是因人而异。因此，面对这样的人群，干预人员们首先做的是，了解她们的内心世界，倾听她们的心声。在取得信任之后，获得她们的真实信息，这样干预工作才能有的放矢。比如，有一位20岁的女子，反叛心理很强，在干预中满不在乎。经了解，她由于不服父母的管教，而离家出走，来到娱乐场所工作。后来，经过干预人员的劝解，她来到艾滋病防治所进行了检测，并表示愿意改变目前自己的行为，好好树立起生活的目标。
马衍辉分析，在对高危行为的干预中最突出的难题是，有些娱乐场所服务人员觉得自己没有事，不愿到艾滋病防治所检测。由于法规的缺失，他们也不能强行让其去检测。下一步疾控部门希望能与其他部门合作，提高对高危人群的干预覆盖率。
亟待扩展对高危人群的干预覆盖
我省有关防艾专家坦言，最近的监测数据显示，性服务人群在过去 12个月中接受过艾滋病检测的比例为 30.7% ，知晓率检测结果为98.1% ；艾滋病预防干预服务覆盖的比例为70.40% ，她们最近一次发生商业性行为时使用安全套的比例为 80.6% ，最近一个月坚持使用安全套的比例为58.4% 。“这说明我们针对娱乐场所女性性服务人群的干预是有效果的。”
高危人群干预是预防控制艾滋病的重要措施之一，也是艾滋病综合防治工作的重要内容。如果对一个高危人群的干预覆盖率低，将很难扭转该人群艾滋病病毒感染快速上升的局面。因此，亟待扩展对高危人群的干预覆盖。
Prevention and control of HIV: the victims point of intervention in high-risk groups
http://www.sina.com.cn 2009 Nian 12 Yue 22 Ri 04:27 Dazhong Net - Volkswagen Daily
□ newspaper reporter and correspondent Zhang Mingyu Qu Zhen Yao Yang Runqin
Were to intervene, they do not match became difficult to intervene
As of October 31, our province has reported a cumulative total of HIV infected persons and AIDS patients in 1805 cases, of which 246 cases of AIDS deaths. In the first 10 months of new HIV infections in our province, and 428 cases of patients. HIV-infected persons, through sexual transmission is as high as 64.6%. High-risk behavior intervention is an effective measure to prevent sexually transmitted, however, intervene in the process, many of those who do not meet the intervention has become difficult.
"Article 22 'World AIDS Day' has just passed, we do not take prevention and control of AIDS as a 'wind', a lot of work is being carried out in-depth solid, such as high-risk behavior intervention." Licheng District of Jinan City, Center for Disease Control and Prevention Section, AIDS prevention and control Long PAN Rong-Jian told reporters a few days ago. He said, Licheng District, Jinan is located in the eastern economic zone, but also occupies a rural and urban areas, mobile population, illnesses, high, there is the risk of the spread of HIV infection. In recent years, they make greater efforts to intervene in high-risk behavior.
According to reports, since 2005, the Center was established at high risk intervention team, relying on central government grants to support local projects to conduct high-risk behavior intervention. Ai anti-personnel to go into the area of hair salons, hotels, saunas and other public places to intervene and testing consulting, first in 2005 free of charge for the entertainment of employees of hepatitis B vaccine 3 doses of vaccine intervention methods of work. As the propagation characteristics of hepatitis B and AIDS have certain similarities, for their hepatitis B vaccine through, first, can promote prevention knowledge, followed by related diseases can be prevented through vaccination to remind them to increase and their opportunities to communicate, to understand their physical, occupational status, to achieve the purpose of the intervention.
PAN Rong-Jian said that from 2008 onwards, in the Sino-US cooperation in AIDS prevention and support for projects, they peer in the province first time driven sampling (RDS), multiple sexual partners for women's groups (CSW) of the special survey, a preliminary master CSW population size, characteristics, activities, places and regions, produced RDS detect contact cards, brochures and so on. CSW rest time and the ordinary people of different groups, for which the establishment of a 24-hour hotline 0531-66864306 consulting services to facilitate the crowd not hesitate to contact CSW.
Were to intervene, "do not want to go" into difficulty in the focus of
PAN Rong-Jian revealed that the intervention of the general process is first to get in touch with owners of entertainment venues, the consent of anti-personnel to Ai. CSW to bring together people, talk about AIDS Prevention knowledge, told them to be 100 percent condom use. Then, AIDS Prevention personnel questions, AIDS is transmitted by what means? Some were to intervene, to answer, first blood, second mother to child transmission and the third is sexual. Answered correctly, AIDS Prevention staff gave her a small gift. Companions saw a gift, competing to answer questions, including how to use condoms and so on, the atmosphere lively, and AIDS Prevention personnel to mobilize them to go to Ai Bosho checkup. But most people do not want to go to the interference caused difficulties.
"Reluctant to go" is a difficult point is the focus. Center for Disease Control and Prevention, Jinan City, Yanhui Ma, director of presentations, Jinan City, the focus of high-risk behavior intervention, in addition to male and male homosexual sex a number of other groups of people and things, places of entertainment is a great group of employees. Four years, the AIDS Prevention staff have been to intervene, it should be noted that through the conduct of this work, entertainment professionals, has been improved AIDS knowledge, self-protection consciousness has been strengthened, for AIDS prevention has played a significant role. Up to now, the city of about 1 million visits to intervene.
There is any way to persuade them to check? Center for Disease Control and Prevention, Jinan City, director of AIDS prevention, Wang Mei-hua said that staff has been intervention, education uneven, personality temperament quite different manners conversation is vary. Therefore, the face of such populations, intervention personnel are the first to do is to understand their inner world, to listen to their voices. After obtaining the trust to obtain their true information, so that interventions can be targeted. For example, there is a 20-year-old woman, a strong psychological rebellion, in the intervention not care. The understanding, she was not satisfied with parenting, but run away from home, work came to entertainment. Later, after intervention personnel, persuasion, she went to AIDS were tested by, and expressed its willingness to change the current behavior of their own, well establish the goal of life.
Ma Yanhui analysis, pairs of high-risk behavior interventions in the most prominent problem is that some entertainment service personnel feel that they do not matter, unwilling to AIDS prevention and control of the test. Due to the lack of laws and regulations, they can not force allowed to go testing. Next Disease Control Department would like to cooperate with other departments to improve coverage in high-risk groups to intervene.
Acute need to expand coverage of the intervention of high-risk groups
Province of experts on AIDS Prevention frankly, the most recent monitoring data show that sex workers in the past 12 months had received HIV testing compared to 30.7%, awareness test results was 98.1%; AIDS prevention intervention service coverage ratio of 70.40 %, their most recent case happened when the use of condoms in commercial sex ratio of 80.6%, the recent month, insisted on using condoms compared to 58.4%. "This shows that we focused on entertainment female sex workers interventions are effective."
High-risk population intervention is an important measure for prevention and control of AIDS, is one of a comprehensive AIDS prevention and control of the important content. If the intervention of a low coverage of high-risk groups, it will be difficult to reverse the rapid rise of AIDS virus infection situation. Therefore, the acute need to expand coverage of the intervention of high-risk groups.
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