专家呼吁把艾滋病当成慢性病来治


专家呼吁把艾滋病当成慢性病来治

 
 
 
 
 

专家呼吁把艾滋病当成慢性病来治
本报记者 滕兴才

中青在线-中国青年报    2009-03-21

    艾滋病防治工作需要从非常态、非常规的特殊体制转入常态化、常规化,融入现行社会体制。这是中国社会科学院社会政策研究中心日前完成的研究报告《中国艾滋病防治相关政策分析》提出的主要观点。
    这份报告是研究者深入云南、四川、河南和北京等地调研后形成的,其中,云南和四川是毒品传播特别是少数民族地区毒品传播的代表,河南是血液传播的代表,而北京则是正日趋增多的男男性行为传播的代表地。

    艾滋病人群日益“特殊化”

    报告的主撰写人、社会政策研究中心副主任杨团研究员日前在接受中国青年报记者采访时表示,现行艾滋病防治模式已经带来若干问题,突出表现就是艾滋病及受影响人群日益“特殊化”,这成为我国艾滋病防治可持续发展的重大制约瓶颈。

    报告解释说,所谓“特殊化”,是指针对艾滋病病种及受影响人群,从上到下建立了专门的管理机构,指定专门的医疗单位,配备专门的医务人员,出台专门的关怀救助政策,从预防干预、医疗救治到救助帮扶,自成体系。例如研究人员在河南的调查发现,艾滋病重点村普遍设有两个卫生所,一是专门针对艾滋病病毒感染者和艾滋病病人的,一是主要服务于普通村民常规疾病的。两者可谓职责清晰、对象分明。

    报告分析认为,把艾滋病及受影响人群日益“特殊化”,排除在现行社会体制之外,其危害至少有三:

    第一,偏离现有防治体系,资源配置效率降低。过分突出艾滋病的特殊性,反而导致艾滋病的慢性传染病属性越来越淡化,防治工作的政治属性越来越强化。而且,还会导致地方政府投入越来越少,完全依赖国际合作项目和中央转移支付,资源配置和防治需求严重脱节。其结果是,艾滋病防治人力、物力、财力越来越受限,有限的资源被大量消耗在多部门协调和低效率的专项工作上。

    第二,形成不正常的“特权阶层”。与普通传染病病人相比,由于宣传方式特殊、看病场所特殊、救助待遇特殊,久而久之,艾滋病患者和医务人员都会形成一种与常人不一样的感觉。具体而言,艾滋病患者认为自己不同于普通病人,政府应给我免费药物,直接纳入最低生活保障,帮我恢复生产生活秩序。艾滋病医生也觉得自己与其他医生不一样,我是救治艾滋病病人的,政府得保证我不出事,还得给我发奖金。

    第三,不利于引导一部分艾滋病患者改变报复社会的危险行为。艾滋病的性传播方式主要通过个人行为,难以用强迫的方式控制。要减少一部分艾滋病患者的有意性传播,必须改变将艾滋病易感人群陷于危险境地的文化、价值和做法。艾滋病防治“特殊化”的做法,破坏了整个人群对艾滋病防治的理解和广泛提高认识,感染者和易感人群之外的绝大多数人并不认为特殊政策与自己有关,由此导致的对艾滋病患者的社会歧视和社会排斥效果与早期将艾滋病污名化相去不远。因为,当普通人自发、自觉地与艾滋病人划清界限、将其边缘化时,艾滋病易感人群就陷入被大众社会抛弃的危险境地。

    艾滋病防治可纳入现有的医疗和保险体系

    报告提出艾滋病防治常态化的主要思路是:将艾滋病防治工作融入现行社会体制,在医疗卫生、社会保障、残疾人服务等现行公共服务体系中进行同步规划、同步实施,实现常态化运行、常规化管理。

    报告认为,艾滋病是慢性传染病,因此,抵御艾滋病既需要医疗体系,又需要公共卫生预防体系。将艾滋病防治融入医疗卫生体系,不仅有利于艾滋病病人的治疗,而且有利于易感人群的早预防、早发现、早治疗。

    其次,艾滋病感染者和艾滋病病人属于社会弱势群体,比一般人群更需要得到社会保障制度的支持和来自社区和家庭的关爱。而这些制度采取的都是普惠制,并非只针对某一群体。因此,艾滋病感染者和艾滋病病人能以很低的个体成本利用这些普惠的政策和制度,用这些制度解决就业、养老、医疗、康复、入学等问题。

    2005年,世界卫生组织已经将艾滋病正式列为残疾的一种。报告认为,我国应尽快将艾滋病病毒感染者和艾滋病病人按照慢性病患者纳入残疾、损伤与康复的关注范畴。

    少数民族地区艾滋病防治任重道远

    报告研究者2007年和2008年多次在四川凉山彝族自治州、云南德宏傣族景颇族州进行深入的实地调研,这两地也正是两省乃至全国受毒品和艾滋病危害的重灾区。以云南德宏州为例,2004年年底全州有吸毒人员25285名,占全州总人口的2.41%,占当年全省吸毒人员的37.1%,占当年全国吸毒人员的3.2%;累计检测出艾滋病病毒感染者8124例。经过3年禁毒防艾人民战争的努力,吸毒人员年均新滋生率连续控制在1%以下,现有吸毒人员从 2004年的25285 名减少到2007 年的15314名,3年减少近万人。

    但报告也提醒,凉山、德宏等毒品危害严重地区多紧临境外毒源地,受毒品和艾滋病的危害时间长、程度深,吸毒人员基数大(如凉山、德宏两州现有吸毒人员都在1.5万人以上,累计检测出的艾滋病病毒感染者均超过8000例),再加上海洛因成瘾者戒断易、巩固难(吸毒人员戒毒后复吸率可高达70%~90%),禁毒防艾工作经费严重不足、使用效率总体不高等因素影响,禁毒防艾斗争形势不容乐观。报告特别强调,其中最不容乐观的是,民族地区青少年已成为当地受毒品和艾滋病危害最严重的群体,在现有吸毒人员中有超过一半是20岁以下的青少年,这其中又有大约一半是艾滋病病毒感染者。报告认为,他们是制约禁毒防艾工作引向深入的重大瓶颈。

    杨团表示,“艾滋病流行严重的少数民族地区,由于早婚、再婚和跨国婚姻现象普遍,经由婚内性传播蔓延艾滋病的社会结构风险尚未引起足够的重视。”
 

Experts have called for the AIDS as a chronic disease to rule
Our reporter only滕兴

Zhongqing online - China Youth Daily, 2009-03-21

     AIDS prevention and control work required from the very state, non-specific system into the normal, conventional, and integrated into the existing social system. This is the Center for Social Policy Studies, Chinese Academy of Social Sciences recently completed a research report "China's AIDS-related policy analysis," the main opinion.
     The report is thorough researcher of Yunnan, Sichuan, Henan and Beijing, after the formation of research, one of Yunnan and Sichuan are the spread of drugs, especially in ethnic minority areas on behalf of drug spread, Henan are representative of blood-borne, and Beijing is being growing number of male transmission of male representatives to.

     AIDS, the growing crowd, "specialization"

     The report's main author, Social Policy Research Center Deputy Director Yang Tuan Fellow In a recent interview with China Youth Daily reporter that the current AIDS prevention and control mode has already brought a number of issues, outstanding performance is affected by AIDS and the growing crowd, "specialization", This became our country AIDS major constraint to sustainable development bottleneck.

     The report explained that the so-called "specialization" refers to diseases and for AIDS affected people, from top to bottom set up a special management body and the appointment of specialized medical units, equipped with specialized medical personnel, introduction of specialized care aid policy from preventive interventions, medical treatment to the relief aid, its own system. For example, researchers found in Henan AIDS village in general has focused on two clinics, one specifically for HIV-infected persons and AIDS patients, is mainly to serve the common villagers of conventional disease. Both functions can be described as clear, distinct object.

     Report contains an analysis of the view that the AIDS and the affected population growing, "specialization", excluded from the existing social institutions, the harm has at least three:

     First, the deviation from the existing control system, the allocation of resources and reducing efficiency. Undue prominence to the specificity of AIDS, but AIDS, chronic diseases lead to more and more watered down property, prevention and treatment work to strengthen more and more political property. Moreover, local governments will lead to more and more into less, entirely dependent on international cooperation projects and the central transfer payments, resource allocation and control of a serious discrepancy between the demand. As a result, AIDS prevention and control of human, material and financial resources more and more restricted, limited resources from being consumed by the substantial multi-sectoral coordination and the low efficiency of the special work.

     Secondly, the formation of abnormal, "the privileged class." Compared with ordinary patients with infectious diseases, the modes of publicity because of the special places of special treatment, special treatment relief over time, AIDS patients and medical personnel and ordinary people will create a different feeling. In particular, consider themselves different AIDS ordinary sick, the Government should give me free drugs, directly into the minimum subsistence guarantee to help restore production and life of my order. AIDS doctors and other doctors feel that they are not the same, my AIDS patients are treated, the Government must ensure that I will not go wrong, will have to give my hair bonuses.

     Third, is not conducive to guide AIDS patients as part of the society to change the dangerous acts of retaliation. AIDS and sexually transmitted mainly through individual acts, it is difficult to control by coercion. To reduce the number of AIDS patients with sexually transmitted intention must be changed to AIDS in a susceptible population at risk of culture, values and practices. AIDS prevention and control, "specialization" approach and undermine the entire crowd on AIDS prevention and improve understanding and extensive knowledge of infected and susceptible population outside of the vast majority of people do not think with their own special policies related to the resulting AIDS and social discrimination and exclusion and early effects of AIDS stigma that order of magnitude. Because, when ordinary people spontaneously, consciously people with AIDS to draw boundaries to their marginalization, the AIDS on vulnerable groups into society abandoned by the public at risk.

     AIDS prevention and control can be integrated into existing medical and insurance system

     AIDS report normalized main ideas are: The AIDS prevention work into the existing social system, in health, social security, disabled services in the existing public service system to synchronize the planning, synchronization implementation, achieve normal operation, the conventional management.

     The report holds that AIDS is a chronic infectious disease, therefore, resist the AIDS health care system is necessary, and necessary public health prevention system. AIDS prevention and control will be integrated into the medical and health system is not only conducive to the treatment of AIDS patients, but also conducive to the early susceptible prevention, early detection, early treatment.

     Secondly, the AIDS-infected people and AIDS patients belong to socially vulnerable groups, than the general population more in need of the social security system support and from the community and home care. And these systems are taken GSP is not only a particular group. Therefore, the AIDS-infected people and AIDS patients to a very low cost of individual use of these policies and Pratt & Whitney system, using these systems to solve the employment, pension, medical care, rehabilitation, school and other issues.

     In 2005, the World Health Organization has officially classified as AIDS as a disability. The report holds that our country should be as soon as possible HIV-infected persons and AIDS patients with chronic diseases included in accordance with the disability, injury and rehabilitation of areas of concern.

     AIDS in ethnic minority areas a long way to go

     Researchers report in 2007 and 2008 several times in Sichuan Liangshan Yi Autonomous Prefecture, Yunnan Dehong Dai and Jingpo states to conduct in-depth field research, these two provinces and even the whole country is also affected by the drug hazards and AIDS-stricken area. Dehong Prefecture in Yunnan Province as an example, the end of 2004 Jeonju has 25,285 drug addicts, accounting for the state 2.41 percent of the total population, accounting for drug addicts in the province was 37.1 percent, accounting for the national drug users 3.2% ; cumulative AIDS virus detected in 8124 cases of infection. After 3 years of war the people of AIDS anti-drug efforts, a new breeding ground for drug addicts at an average annual rate of continuous control at 1% or less, the existing drug addicts from 2004 to 25,285 reduced to 15,314 in 2007, nearly 3 years to reduce the people.

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