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反思中国人的艾滋病
来源∶39健康网 2010-7-21
根据《中国预防与控制艾滋病中长期规划：1998～2010》的预测，中国大陆的HIV感染者将于2010年超过100万。“规划”的目标是在2010年把HIV感染者控制在150万以内，相当多的专家认为这是一个非常保守的估计。1997年中国相关部门对2000年中国大陆HIV感染者总数进行预测，按照当时最保守的方案预测得出的数字是5万人，中间方案为8万人。即便按最激烈的方案预测，也还不到25万人。 但事实上，2000年中国HIV感染者已经达到60万人左右。把从各种渠道所获得的预测加以综合，我们的估计是：中国大陆HIV感染者在2005年将达到300万人。那么，在2010年，中国HIV感染者的总人数会达到联合国艾滋病协调中心预测的上限1000万人吗?答案在很大程度上要取决于我们在2010年之前能做什么，以及做了什么。
HIV在中国大陆传播的主要渠道是“静脉注射”(卖血、输血、吸毒)，考虑到我国血液和医护管理体制多年处于转型期混乱状态，以及东亚文化传统在对待性行为、家庭关系、个人名誉等方面的保守态度，我们认为，目前估计的“HIV病例从1997年以来每年增长速度为30%”是大大偏低的。一个比较恰当的估计是：1998年以前每年增长100%以上，1998年到2003年按每年增长约60%计算，从2003年以后，根据预防与控制的努力程度，将下调为每年增长30%左右。2010年以后，随着HIV在高危行为群体当中的传播趋于稳定或饱和，增长速度可进一步调低到10%以下。
非洲和南亚的经验表明，艾滋病流行的中期，即“暴发期”，表现为高传播速度和不很高的死亡率，但当传播速度开始放缓时，整个社会将经历一个艾滋病群体的高死亡率时期，直到全部患者都死去，疫病的“流行期”才算告终，进入另一个“潜伏期”。
到目前为止，医学界公认艾滋病是不可治愈的，但可以预防。最重要的预防措施是改变高危群体的行为模式，例如性交方式、毒品和血液的注射方式;对色情业从业人员进行定期检查及合法控制;培养更加宽容和开放的文化氛围与道德意识;寻找各种途径迅速降低治疗药物的成本;普及性卫生知识及发放安全且低成本的性卫生工具等。
艾滋病在中国的传播方式相当独特，以“血液交换”和“医源性”感染为主渠道。如果防治不力，疫情失控的局面是随时可能出现的。防治环节中一个特别严重的问题是，中国的医护人员一方面供不应求，另一方面个人收入又普遍偏低;医疗服务市场极不完善，供求规律远远未能发挥作用。这种局面使得大批“血头”能够比较容易地建立“卖血(贫困人口)-输血(患者)-收费(医院或其它现金渠道)-分赃(血头、医护人员、其他中间环节)”的地下营销体系，其规模甚至可与毒品市场相比。但血液传播的速度和范围远远大于毒品注射，而且通过血液染上艾滋病的人许多都是低危群体的成员，缺乏防范和心理准备，一旦病发，往往已经传染给其他低危群体的成员了。于是，通过血液交换传播的HIV，至少在暴发期的传播速度(年增长率可高达600%)，大大超过经由毒品和性交传播的HIV的传播速度(年增长率通常不高于50%)。
即便如此，假如参与地下血液市场交易的医护人员具备足够的艾滋病预防知识和化验手段，严格遵守“一人一针管一针头”的输血规则，中国的艾滋病疫情也不至于在短短几年内主要通过“卖血-输血”渠道蔓延得如此广泛和剧烈。这里，我们不能不承认，医护人员的道德意识是疫情能否得到控制的关键因素。工作态度、岗位责任、有效检查、监督奖惩……所有这些环节都非常重要，一旦人们丧失了起码的道德意识，那么再完善的规章制度也是形同虚设。发生在河南太康县的案例，就是因为医护人员缺乏道德意识和对生命负责的崇高责任感，导致了患病儿童严重的HIV感染。它表明了这样一个严峻的事实：屈服于金钱诱惑的医护人员，很容易利用他们对患者的强大影响力，建议患者接受来自不安全供血者的血液。
然而，我们也十分明白，改革多年，传统道德体系的瓦解和新道德体系的缺失，造成了所谓“价值真空”的状态，这一状态对提高我们社会医疗服务的质量来说，是致命的。
最后，我们注意到，艾滋病以90%的概率与人群的贫困程度相关联。许多“高危行为”(例如“卖淫”和“卖血”)往往是穷人出于不得已才“选择”的行为。因此，预防我国的艾滋病泛滥不仅仅是医疗体制改革的问题，也不仅仅是如何提高医护人员道德水平的问题，还是如何消除“贫困人口”的社会经济问题。
或许10年之后，当我们比较成功地控制了以“血液交换”和“医源性感染”方式传播的艾滋病疫情，我们也许会突然发现这一“人类死症”又以其它两种方式(毒品与性交)在现代都市的更大人口规模内传播。善于随生物演变而演变，这正是病毒的可怕特征。因此，艾滋病的预防与控制有赖于全社会长期不懈的努力，这一艰苦的过程还远远望不到尽头。
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Reflections on Chinese AIDS
Source: 39 Health Net 2010-7-21
According to "China's AIDS prevention and control of long-term planning: 1998 ~ 2010" forecast, China's HIV infections in 2010, more than 1 million. "Plan" aims to HIV infection in 2010 at 1.5 million within the control of a considerable number of experts believe that this is a very conservative estimate. 1997, 2000, China's relevant departments in China to predict the total number of HIV infections, according to the program was the most conservative forecast that the number of 5 million to 8 million people in the middle of the program. Even by the most intense program of forecasting, but also less than 25 million people. But in fact, in 2000 China's HIV infection has reached 60 million. Obtained from various sources to forecast to be comprehensive, our estimates are: HIV infected people in China will reach 300 million in 2005. So, 在 2010, China's total number of HIV infections will reach the United Nations AIDS coordination center predicted the Shangxian 1000 people do? The answer largely depends 我们 what do 2010, Yi Ji had done.
HIV transmission in mainland China, the main channel is "intravenous injection" (Blood, blood transfusion, drug use), taking into account our many years of blood and health care management system in transition, chaos, and the East Asian cultural traditions in dealing with sexuality, family relations, personal reputation and so the conservative approach, we believe that the current estimate of "HIV cases since 1997, annual growth rate of 30%" is extremely low. A more appropriate estimate is: prior to 1998 more than 100% annual growth, 1998 to 2003 by about 60% of annual growth, since 2003, according to the prevention and control effort, will be reduced to 30% annual growth . After 2010, with the high-risk behavior in HIV transmission among populations stable or saturation, the growth rate can be further reduced to 10%.
Africa and South Asia's experience shows that the AIDS epidemic in the medium term, that "the outbreak period", characterized by high transmission speed and is not very high mortality rate, but when the spread started to slow down, the entire community will experience a group of high AIDS death rate period, until all patients had died, the disease's "epidemic of" regarded as an end, enter another "latency."
So far, the medical profession recognized that AIDS is not curable, but can be prevented. The most important preventive measure is to change the behavior high-risk groups, such as sexual intercourse means the injection of drugs and blood; on the sex industry who carry out regular inspection and legal control; culture more tolerant and open culture and moral awareness; to find the kinds of ways to quickly lower the cost of therapy; universal health knowledge and dissemination of safe and low-cost sexual health tools.
Mode of transmission of AIDS in China is unique and the "blood exchange" and "nosocomial" infections as the main channel. And if the poor, the epidemic out of control situation that may occur at any time. Prevention and control segments of a particularly serious problem is that China's shortage of medical staff on the one hand, the other personal income has generally low; very imperfect health care market, supply and demand play a role far. This situation makes a large number of "blood heads" can more easily establish a "Blood (poor) - blood transfusion (patients) - charge (hospital or other cash sources) - spoils (blood head, health care workers, other intermediate links)" in Mass marketing system, its size could even be compared with the drug market. However, the speed and extent of blood-borne far greater than the drug injection, but also by the blood of people infected with AIDS, many are low-risk groups, and lack of prevention and psychological preparation Once illnesses, often have been transmitted to members of other low-risk groups the. Thus, through the exchange of blood-borne HIV, at least in the outbreak of the propagation speed (up to 600% annual growth rate), significantly more than drugs and sex by the spread of HIV transmission speed (usually no higher than 50% annual growth rate).
Even so, if the participation of health care workers underground blood-market transactions have sufficient knowledge of AIDS prevention and testing means, strictly abide by the "one person, one needle of a needle," blood transfusion rules, China's AIDS epidemic will not have in a few years, mainly through " Blood - Transfusion "channels were so wide spread and intense. Here, we must acknowledge that health care is the moral consciousness of the epidemic can be contained in the key factor. Work attitude, job responsibilities, effective inspection, monitoring incentives ... ... All these aspects are very important, once people lose their moral sense at least, it is useless for further improvement of the rules and regulations. Taikang County in Henan case, because the lack of moral awareness and medical personnel responsible for the lives of the noble sense of responsibility, resulting in HIV-infected children with severe illness. It shows that such a grim fact: succumb to the temptation of money the medical staff, it is easy to use their strong influence on the patients, the proposed patient to receive safe blood donors from the blood.
However, we also fully understand the reform years, the collapse of traditional moral systems and the lack of a new moral system, causing the so-called "value vacuum" state, the state health service in enhancing the quality of our society is, is fatal.
Finally, we note that the probability of AIDS and 90% of the population associated with poverty. Many "high-risk behavior" (such as "prostitution" and "Blood") is often poor because of last resort "choice" behavior. Therefore, prevention of spread of AIDS is not just our health care system issues, not merely how to improve ethical standards in health care issues, or how to eliminate the "poor" socio-economic problems.
Perhaps 10 years later, when we compare the success in controlling the "blood exchange" and "nosocomial infection" means the spread of the AIDS epidemic, we may suddenly find the "human death syndrome" Youyi other two methods (drugs and sex) in the larger population size of modern cities to spread. Good with the evolution of biological evolution, this is the terrible features of the virus. Therefore, AIDS prevention and control of the whole society depends on long-term unremitting efforts, the arduous process is far from sight of the end.
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