中国流动人口的艾滋病预防和控制(综述)
当前,艾滋病在全世界流行广泛,自从1985年,中国发现第一例艾滋病人后,艾滋病在我国也蔓延迅速,目前已进入快速增长期[1].
在艾滋病的传播与流行中,全世界艾滋病预防和控制同仁们已共同认识到,流动人口数量和规模日益增长是一个非常重要的促进因素,中国情况也不例外。本文 将从流动人口的概念、我国人口流动迁移的历史过程、现阶段我国流动人口的特点、艾滋病对我国流动人口的威胁及其防治对策等方面进行综述。
一、 流动人口的概念
由于人口流动的原因、过程及结局的多种多样,导致产生了一些内涵相近而外延有别的关于流动人口的概念,为了使国内外流动人口艾滋病预防和控制工作协调一致,我们应该对这些概念有统一的认识。
1.移动人口(mobile population)。这个概念在国际上较通用,它泛指因各种职业或安全原因从一个地区向另一个地区运动的人,它包括国际与国内移民、职业流动(如司机)、外出旅游、难民等,不论是合法或非法的,也不论是长期或短期的[2].
2.流动人口(floating population)。这个概念目前主要用于中国[2],它特指人们在没有改变原居住地户口的情况下,到户口所在地以外的地方从事务工、经商、社会服务等各种经济活动,即所 谓“人户分离”,但排除了旅游、上学、访友、探亲、从军等情形。至于在多大的空间、时间范围的人户分离才算流动人口,则要根据实际工作来确定标准[3]. 如我国《流动人口计划生育工作管理办法》规定,对农村的同一乡(镇)或者城镇的同一县(市)之内流动不在管理之列[4].
3.迁移人口或移民(migrant population)。这个概念在国内外都指人们从一个地区向另一个地区运动,目的是重新选择定居点,包括志愿与非志愿、合法与非合法等情形[2].在 中国,迁移不同于流动,通常应伴随着原居住地户口改变到新居住地户口,包括上学、调动工作、参军、复员等[3].本文以下所指“流动、流动人口”则引用 “人户分离”的概念。
二、 现阶段流动人口的特征
随着我国社会主义市场经济的不断发展,流动人口数不断上升,据1995年全国1%人口抽样资料推算,我国流动人口共有5349.7万。根据国家《关于流动人口的宏观调控研究》[3]分析,我国现阶段流动人口主要特征有:
1. 地域分布特征。
在本县市内流动的有1121.1万(占20.9%),本省内跨县市流动的有2459.2万(占46.0%),跨省流动的有1769.5万(占33.1%)。
2.年龄性别特征。
流动人口以男性为主,占57.64%,女性占42.36%,性别比是136,高于同期全国总人口性别比104.绝大部分流动人口为青壮年,15-65岁人口占86%,15-34岁人口占71%.
3.文化程度。
高中及以上文化水平占17%,初中文化水平占41%,小学及以下文化水平占41%,其他占1%.
4.职业特征。
在流动人口中,41%从事生产工人(如建筑、工矿企业)、运输工人和其它有关职业,占第1位;19%从事农林木渔劳动,占第2位;16%从事商业工作,占第3位。
三、艾滋病对流动人口的影响
相对固定人口而言,流动人口是一个特殊的群体,但是,人口的流动本身与艾滋病并无因果关系,而是人口流动与艾滋病病毒传播因素相结合,才真正导致了艾滋病病毒的加速传播[6].从现有文献分析得出,艾滋病对我国流动人口的影响主要表现为:
1.预防知识缺乏进城打工者知道血液传播、性传播途径的分别是79%、84%[7],流动服务小姐知道艾滋病传播途径的分别为73%-78%[8].
2.高危行为发生较多。吴尊友、贾曼红等在云南进行的多项调查表明,酒吧、发廊服务小姐分别有80%、83%承认提供性服务[9];服务小姐卖淫时及与男朋友发生性行为时使用避孕套的比例分别是41.3%、11.7%[10]廖苏苏等报告,1997年海南路边店女服务员在上一次发生性行为时使用避孕套的人为 53%,虽然较1995年调查的结果22%有提高,但依然很低[11].3.性病、艾滋病发病较高一项对江苏省某市5892名返乡建筑工人的体检报告,性病检出率为4.34%;暂住人口的性病检出率为6.41%,驾驶员为2.71%,而本市同年度性病发病率为28.80/10万[12].云南省某县 1190名长途汽车司机中1.51%HIV阳性[13].徐臣等对1,517名村民进行外出流动与艾滋病病毒感染的研究,结果有外出史者的艾滋病病毒感染率15.6%显著高于无外出史者的8.8%[14].山西省1995-1999年发现的艾滋病病毒感染者中,66.7%为流动人口[15].
四、我国流动人口的艾滋病预防和控制对策
流动人口的艾滋病预防和控制问题已引起我国政府和国内国际组织的充分重视。1997年,卫生部与联合国艾滋病署及其发起组织一起编写了《迎战艾滋病 ——中国艾滋病现状和需求报告》,将人口流动作为促进艾滋病流行的潜在危机和社会因素,并强调:只有把降低危险性的努力和降低易感性的行动结合在一起,控制艾滋病病毒传播的效果才能更广泛、深入[16].1998年,国务院印发了《中国预防与控制艾滋病中长期规划(1998—2010年)》,明确提出“到 2002年,……营业性娱乐、服务场所及流动人口聚集的场所和组织出国人员较多的单位要必备有关的宣传材料。”。2000年1月,卫生部召开了“中国流动人群与艾滋病性病防治对策研讨会”,就当前存在的问题、近年的工作经验教训及今后的工作方向达成了共识。
当前及今后一个时期,我国流动人口的艾滋病预防和控制工作应着重在以下几个方面采取措施:
1.加强部门组织间协调合作2000年4月,国务院召开了防治艾滋病性病协调会议,李岚清副总理在会上指出:“预防和控制艾滋病是一项需要社会综合治 理的系统工程,必须依靠政府领导、有关部门及全社会的参与、相互配合才能完成。”。流动人口的艾滋病预防和控制工作应与现有的管理体系结合起来,如公安部 门对暂住人口的治安管理、劳动部门对外来劳动力的培训用工管理、计划生育部门对流动人口的生育管理、卫生部门对流动人口的预防与疾病管理等,还应发挥工会、妇联、产业协会、性病艾滋病防治组织等各种非政府组织的作用。
2.摸清人口流动规律由于“人户分离”现象的增多,1984年,我国第三次人口普查中首次调查了“人口流动迁移项目”,其后进行的1990年第四次人 口普查与1995年全国1%人口抽样调查也继续关注流动人口内容。2000年11月1日,我国开始了第五次人口普查,更为突出的是,人口迁移流动是本次调 查的重点项目之一[17].这些工作能揭示人口流动的内在规律,为政府各部门制定相关政策提供科学依据。
3.加强综合宣传教育如上所述,在艾滋病的流行与传播中,农村人口与流动人口是性病艾滋病的重点人群。通过对大量流动人口流出的农村地区从中学开始进 行广泛、深入、持久的健康教育,提高农村人口的艾滋病预防意识和自我保护能力,一定会对流动人口的艾滋病预防和控制工作起到积极的推动作用。此外,利用铁 路对流动人口艾滋病健康教育的行之有效做法应继续坚持[18],并积极探索适合流动人口特点的多种教育形式。
4.扩大高危人群干预范围对流动人口中的静脉吸毒者、卖淫嫖娼者等艾滋病高危人群,应积极借鉴国外证明普遍有效的干预措施,结合我国国情研究在高危人群中开展干预工作的政策和措施,抓紧试点,总结经验,尽快遏止住艾滋病、性病在人群中快速传播的势头。
5.完善感染者与病人管理随着流动人口中艾滋病病毒感染者与艾滋病人的不断增加,对他们的健康教育与健康咨询、定点医疗服务以及监测等多方面实际问题 已刻不容缓地摆在我们面前,鉴于目前我国的现状,有关人员提出完善立法、避免歧视、加强管理等建议,既是感染者和病人获得人道主义关怀和基本人权的需要, 也是避免艾滋病病毒通过流动人口传播、保护广大人民群众健康利益的需要。
At present, the AIDS epidemic in the world wide, since 1985, China was found after the first cases of AIDS, AIDS has spread rapidly in China, has entered a period of rapid growth [1].
In the spread of AIDS and the epidemic, AIDS prevention and control throughout the world have a common understanding of colleagues that the number and size of the floating population is growing to promote a very important factor in the situation in China is no exception. This article from the concept of the floating population, China's population history of the process of migration flows, at this stage, the characteristics of China's floating population, AIDS on the threat of China's floating population and its control measures, etc. were reviewed.
First, the concept of floating population
Because the causes of population movements, a variety of process and outcome, resulting in a number of similar connotation and extension of other floating population on the concept of floating population in order to make domestic and international AIDS prevention and control of coherence of these concepts, we should a unified understanding.
1. Mobile population (mobile population). This concept more common in the international arena, it refers to a variety of employment or security reasons, from one region to another movement, which includes international and internal migration, occupational mobility (such as drivers), travel, refugees, regardless of legal or illegal, either long-term or short-term [2].
2. The floating population (floating population). This concept is currently mainly used in China [2], it refers specifically to people in the place of residence did not change the original account of the circumstances, the location of the accounts to engage in outside work, business, social services and other economic activities, the so-called "person households separation, "but ruled out the tourism, school, friends, relatives, military service and other circumstances. As for how much space, time range of people to be separated from the floating population households, according to the actual work will be to determine the standard [3]. Such as China's "floating population management of family planning work" provides the same in rural township (town) the same town or county (city) administration is not within the list of flows [4].
3. Transfer of population or migration (migrant population). Both at home and abroad, the concept refers to people from one region to another campaign aimed at re-select the settlements, including the voluntary and non-voluntary, such as legal and non-legal cases [2]. In China, different from the flow of migration, should normally be place of residence along with the original account to a new place of residence to change the account, including the school, to mobilize the work of the army, demobilization, etc. [3]. In this paper, the following referred to "the flow of the floating population" is invoked "human family separation" concept.
Second, at this stage, the characteristics of the floating population
As China's socialist market economy, increasing the number of floating population, in 1995, according to one percent national population sample of data, we estimate that China's total of 53.497 million floating population. According to state "the floating population on the macro-control study" [3] analysis of the floating population in China at this stage the main features are:
1. Geographical distribution.
Flow in the counties and cities are 11,211,000 (20.9%), the province has跨县City, the movement of 24,592,000 (or 46.0%), inter-provincial flow of 17,695,000 (33.1%).
2. Age-sex characteristics.
Floating population in male-dominated, accounting for 57.64%, accounting for 42.36% of women, sex ratio is 136, higher than the corresponding ratio of the total population of 104. The vast majority of the mobile population of young adults 15-65-year-old population accounts for 86%, 15-34 years old accounted for 71% of the population.
3. Education.
And above high school level of education, 17%, 41% junior high school level of education, primary and secondary educational level below 41%, other 1%.
4. Occupational characteristics.
In the floating population, 41% of workers engaged in production (such as construction, industrial and mining enterprises), transport workers and other related occupations, accounting for No. 1; 19% engaged in agriculture, forestry, wood and fishery workers, accounting for the first two; 16% work in business, accounting for No. 3.
Third, AIDS, the impact of the floating population
Relatively fixed population, the floating population is a special group, but the mobility of the population and AIDS itself, there is no causal relationship, but population movements and the spread of HIV combination of factors really led to the acceleration of the spread of HIV [6 ]. from analysis of existing literature, AIDS on the impact of China's floating population mainly as follows:
1. To prevent migrant workers lack of knowledge know that blood-borne and sexual transmission of 79 percent, respectively, 84% [7], mobile service, Miss know the route of transmission of AIDS was 73% -78% [8].
2. More high-risk behavior occurs. Wu Zunyou, Jarman red in the number of surveys conducted in Yunnan shows, bars, hair salon services, 80%, respectively, Miss, 83% admitted to provide services [9]; services when Miss prostitution and having sex with her boyfriend to use condoms the proportion is 41.3%, respectively, 11.7% [10] Liao Susu reports, Hainan in 1997 on the roadside shop waitress in the use of a condom when having sex with the man-made 53%, while in 1995 the results of the survey have a 22 percent increase but still very low [11] .3. venereal disease, a higher incidence of AIDS in a city, Jiangsu Province, 5892 to return the medical reports of construction workers, sexually transmitted diseases, detection rate of 4.34 percent; temporary residents of the detection rate of sexually transmitted diseases 6.41%, 2.71% for the driver, and the incidence of sexually transmitted diseases for the same year the city 28.80/10 million [12]. county of Yunnan Province in 1190 long-distance truck drivers 1.51% HIV positive [13].徐臣such as 1, 517 villagers go out to flow and the study of HIV infection, resulting in the history of those who go out to the 15.6 percent HIV infection rate was significantly higher than that without going out the history of the 8.8% [14]. Shanxi Province in 1995-1999 found that HIV-infected persons, 66.7% for the floating population [15].
Fourth, China's floating population of the AIDS Prevention and Control Measures
Floating population of AIDS prevention and control problem has been caused by our government and domestic and international organizations full attention. In 1997, the Ministry of Health and UNAIDS and its sponsoring organizations with the preparation of the "face of AIDS - AIDS in China report the status and needs" to population movement as a potential risk of the AIDS epidemic and social factors, and stressed: Only the risk reduction efforts and actions to reduce susceptibility to combine control of the effect of the spread of HIV would be more extensive and in-depth [16] .1998, the State Council issued "China's AIDS prevention and control of long-term program (1998-2010)" clearly, "By 2002, ... ... business entertainment, service establishments and mobile population and organizations gather more units to go abroad to staff the necessary publicity materials.". In January 2000, the Ministry of Health held a "China's mobile population of sexually transmitted diseases and AIDS prevention and control countermeasures Seminar", on the current problems, the work of recent years, lessons learned and future direction of work to reach a consensus.
Current and next period, China's floating population of AIDS prevention and control work should focus on the following measures:
1. To strengthen inter-organizational coordination and cooperation in April 2000, the State Council convened a coordination meeting of sexually transmitted diseases, AIDS, the Deputy Prime Minister Li pointed out at the meeting: "the prevention and control of AIDS is a need for comprehensive management of social engineering, we must rely on the leadership of the Government , the relevant departments and the participation of society as a whole and helping each other to complete. ". Floating population of AIDS prevention and control should be with the existing management system to combine, such as public security departments of the temporary residents of law and order management, labor departments of labor to foreign labor management training, family planning departments in the reproductive management of the floating population, health departments of the floating population management and disease prevention, but also role of trade unions, women's federations, industry associations, organizations, AIDS prevention and treatment of sexually transmitted diseases such as the role of non-governmental organizations.
2. To find out the laws of population movement as a result of "human family separation" phenomenon of the increase in 1984, China's third census in the first survey of the "migration of population mobility project", followed by the fourth national census in 1990 and 1995 National sample survey of 1% of the population also continue to pay attention to the contents of the floating population. 1 November, 2000, China's fifth census began, more prominent is that migration flows are the focus of this survey is one of [17]. That the work can reveal the inherent law of population movements, for the Government various departments to develop relevant policies to provide a scientific basis.
3. Strengthen publicity and education, as mentioned above, and the spread of the AIDS epidemic, the rural population and the floating population is the focus of AIDS groups. Through a large number of floating population outflow from secondary schools in rural areas began to conduct extensive, in-depth, long-lasting health education, AIDS prevention to raise awareness of the rural population and self-protection ability, it will be the floating population of AIDS prevention and control of a positive impetus to the work of role. In addition, the use of rail for the floating population of AIDS health education should continue to adhere to well-established practice [18], and actively explore the characteristics of the floating population for a variety of forms of education.
4. To expand the scope of intervention in high-risk populations in the floating population of intravenous drug users, AIDS, prostitution, such as high-risk population, should actively learn from foreign countries generally proved effective interventions, combined with China's national research carried out in high-risk population policies and interventions measures to step up pilot projects, sum up experience, as soon as possible遏止住AIDS, sexually transmitted diseases spread quickly among the crowd momentum.
5. Improve the management of patients infected with the floating population with HIV infection and AIDS continues to increase in their health education and health counseling, medical services, as well as fixed-point monitoring of various practical problems such as no time to lose in front of us , given the current status of our country, the officer made the improvement of legislation to prevent discrimination, to strengthen the management proposals, both infected and patient care and basic human rights for humanitarian needs, but also to prevent HIV spread through the movement of population to protect the health of the masses interests.
康生丹四代新药,化学名—三合皂甙分类引述
艾滋病免疫重建的重要意义是挽救生命的根本 点击 213
从食品植物研究开发的治疗艾滋病新药三合皂甙〔康生丹四代〕介绍 点击 567
从食品植物研究开发的治疗艾滋病新药三合皂甙 点击 245
从食品植物研究开发的治疗艾滋病新药介绍 点击 189
艾滋病的中药 点击 56
论HIV不是AIDS的病因机制 点击 78
康生丹颗粒简介 点击 67
美国营养学家推崇“抗炎饮食”同于中医之食疗 点击 123
康生丹颗粒基础研究 点击 59
艾滋病预防及国外食疗研究 点击 61
艾滋病感染者能活多久 点击 232
专家:艾滋病早治疗能多活30年以上“隐形”感染者进入晚期才被确诊 点击 99
T细胞、T细胞亚群、 调节性(或抑制性)T细胞在艾滋病康复中的研究 点击 89
你知道为什么害怕“艾滋病”这三个字么?艾滋病不同感染期症状 点击 1118
康生丹颗粒〈ksd〉对免疫抑制模型小鼠免疫功能影响实验研究-公布 点击 27
食疗与艾滋病研究-康生丹颗粒〈一〉 点击 159
艾滋病未来康复的动向分析 点击 227
艾滋病人的药膳 点击 43
首次公布康生丹提高艾滋病患者CD4的图片 点击 1379