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民间报告呼吁解决艾滋病感染者“手术难”
2011年03月01日 16:33来源：财新网
艾滋病感染者组织呼吁，取消“艾滋病定点医院”、将感染者纳入常规医疗体系。全国政协委员王健也将再次在提案中呼吁保障感染者就医权
【财新网】（见习记者蒋昕捷）一项由“中国艾滋病病毒携带者联盟”完成的调查称，“手术难”已成为艾滋病病毒感染者及病人（以下统称感染者）亟待解决的问题之一，希望政府部门推动相关政策法规的落实。
3月1日，全国政协委员、中国中医科学院中医药防治艾滋病研究中心常务副主任王健接受财新记者采访时表示，他也收到了该联盟转来的建议报告，今年两会将继续就此问题提交提案，以保障感染者就医权。
根据国务院2006年初颁布的《艾滋病防治条例》第四十一条，“医疗机构不得因就诊的病人是艾滋病病毒感染者或者艾滋病病人，推诿或者拒绝对其其他疾病进行治疗。”
但前述调查显示，当感染者罹患其他疾病需要进行手术治疗时，常常面临求医无门的艰难处境，有时甚至连息肉切除、外伤清创缝合、骨折复位等基本手术需求也无法得到满足。
——患者常某燃放烟花炸伤右眼，需要做眼球摘除术，术前检查发现其艾滋病病毒（HIV）抗体呈阳性，收治医院遂以不具备隔离消毒条件为由推诿手术。无奈之下，患者来到北京某传染病医院，但该院没有眼科专用设备，无法手术。后来患者右眼球坏死发炎并感染，只得自费购买部分眼科专用设备，通过私人关系邀请其他医院的眼科大夫摘除眼球。
——患者李某因车祸致左胫骨开放性骨折，被送至北京某医院救治。当李某告知医生自己是感染者后，医生只是简单进行了清创、止血和表皮缝合，未进行断骨复位和固定，后将其转到北京某传染病院。
——患者张某（女）因患肾积水，到北京某医院专家门诊就诊，医生认为病情严重，需要立即手术。但当患者主动说明是感染者后，对方随即表示没有能力进行手术，让其转到某传染病院。而该传染病院又缺乏肾脏手术能力。
“中国艾滋病病毒携带者联盟”相关工作人员告诉财新记者，一方面，各地的“艾滋病定点医院”通常是传染病专科医院，不具备综合性医院的救治能力；另一方面，“艾滋病定点医院”的存在反而成为一些医疗机构推诿或者拒绝为感染者提供常规医疗服务的借口。
艾滋病感染者手术难问题由来已久。中国性病艾滋病防治协会会长戴志澄此前接受中央电视台采访时认为，这种现象与医德无关，中国目前还没有对因职业暴露而感染HIV的医务人员进行赔偿、补偿或补助的法律规定，医务工作者对艾滋病的认识也有待普及和提高。
医务人员诊治艾滋病病毒感染者的过程中，存在被含有病毒的针头意外刺破皮肤等职业暴露风险。如果处置得当，感染病毒的几率可大幅度降低。据《楚天都市报》2011年1月报道，2009年以来武汉共发生艾滋病职业暴露事件13起，其中，发生职业暴露的多为护士和外科医生，与艾滋病密切相关的传染科只有一起。所幸的是，在服用阻断药物后，没有一人感染上艾滋病。
在美国，艾滋病感染者已经纳入常规医疗。医务人员一旦发生职业暴露，会在严格的操作规范之下，及时进行药物控制和干预。但王健对财新记者表示，中国很多地方的医疗条件还不足以维护医务人员的安全。
2009年和2010年全国两会期间，身为全国政协委员的王健都提交了关于解决艾滋病人“手术难”问题和切实保障感染者就医权的提案。卫生部在2010年给王健提案的回函中承认，“存在部分医疗机构推诿和拒绝为艾滋病病人手术的问题”，同时表示将加强对医疗机构的培训和管理，研究并制定职业暴露感染艾滋病的补偿机制，同时扩大艾滋病定点医院范围。
“中国艾滋病病毒携带者联盟”相关工作人员表示，近年来在北京、上海、广州、哈尔滨、成都等城市，感染者手术难问题确实有所改观，部分城市还出现了为感染者提供手术服务的少数医疗机构。
不过，该人士称，现有医疗资源不足以彻底解决感染者手术难问题。正因为此，该联盟提出了多项建议，包括由政府部门开展《艾滋病防治条例》第四十一条落实情况的专项检查并在媒体公示；建立医疗机构从业人员职业防护以及职业暴露应急处置办法和合理补偿机制；取消各地卫生行政部门对各级各类“艾滋病定点医院”的指定，将艾滋病治疗纳入常规医疗体系等。
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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The report calls for settlement of civil AIDS "operation difficult"
At 4:33 p.m. on March 1, 2011 Source: Finance new network
AIDS organizations called for the abolition of "AIDS designated hospitals", the infection into the general health care system. Wang Jian of the CPPCC members will also once again called for in the proposal the right to protect the infected doctor
New network】 【Finance (trainee reporter Jiang Xin Jie) one from "China's HIV carriers alliance" to complete the survey said, "surgery is difficult," has become infected with HIV and patients (hereinafter referred to as infected) One of the problems solved I hope the Government departments to promote the implementation of relevant policies and regulations.
March 1, the CPPCC National Committee member of China Academy of Traditional Chinese Medicine Research Center, deputy director of AIDS Wang Jian to accept a new interview, said Choi, who also received the recommendations forwarded by the Union address, two sessions this year will continue to submit this issue proposals to protect the right of HIV medical care.
In early 2006 the State Council promulgated the "AIDS Prevention Act," 第四十一条, "Medical institutions shall not seek treatment for patients infected with HIV or AIDS patients, procrastinate or refuse their treatment of other diseases."
But the above survey shows that those suffering from other diseases when infected with the need for surgical treatment, often no one to turn the difficult situation facing the doctor, and sometimes even polypectomy, trauma, debridement, fracture reduction surgery and other basic needs can not be met.
- Patients often injured in a fireworks display right eye enucleation needs to be done, preoperative examination revealed the AIDS virus (HIV) antibody positive, admitted to the hospital then submitted the ground conditions do not have the isolated buck sterilization surgery. In desperation, the patient went to a Beijing hospital of infectious diseases, but the hospital did not ophthalmic equipment, not surgery. Necrosis in patients with right eye was inflamed and infected, only part of ophthalmic equipment privately purchased, through private relationship to invite other hospitals enucleated eye doctor.
- Lee in a car accident in patients with open tibial fractures caused by the left, was sent to a Beijing hospital. When Lee told a doctor that they are infected, the doctor simply had debridement, hemostasis, and skin sutures, not the broken bones reset and fixed, once it go to a Beijing hospital for infectious diseases.
- Patients Zhang (female) suffering from hydronephrosis, an expert in a hospital in Beijing clinic, doctors believe that a serious condition and requires immediate surgery. However, when patients take the initiative that is infected, the other party can not afford the surgery went on to say, let go to a hospital for infectious diseases. The operation of the hospital for infectious diseases and lack of ability of the kidney.
"China's HIV carriers Union" relevant financial new staff told reporters, on the one hand, around the "AIDS designated hospitals" are usually infectious disease specialist hospitals, general hospitals do not have the treatment capacity; the other hand, "AIDS designated hospitals "Instead, the existence of a number of medical institutions procrastinate or refuse to provide routine medical services infections excuse.
AIDS is difficult surgical problem a long time. Chinese Association of STD and AIDS Prevention Dai Zhicheng had accepted an interview with China Central Television that this phenomenon has nothing to do with medical ethics, the Chinese have not yet infected with HIV due to occupational exposure of medical personnel, compensation or benefits of the law, medical workers AIDS awareness has yet to be universal and improved.
Diagnosis and treatment of HIV-infected medical personnel who process, there is a virus of the needle pierce the skin and other occupational exposure to accident risk. If you dispose of properly, the risk of infection can be greatly reduced. According to "Metropolis Daily" in January 2011 reported that since 2009, Wuhan, occupational exposure incidents occurred in 13 cases of AIDS, of which occupational exposure occurs mostly nurses and surgeons, is closely related to the epidemiology of AIDS and only one. Fortunately, taking blocking drugs, no one person infected with AIDS.
In the U.S., AIDS has been incorporated into routine medical care. Medical personnel in the event of occupational exposure will be under strict practices, drug control and timely intervention. However, Wang Jian, told reporters on the new financial, medical conditions in many parts of China is not enough to maintain the safety of medical staff.
2009 and 2010, during the two sessions, as a member of the CPPCC National Committee Wang Jian have submitted a settlement of people with AIDS "operation difficult" issues and the right to effective protection of infected medical care proposal. Ministry of Health in 2010 reply letter proposal to Wang Jian, acknowledged that "there is some prevarication and denial of medical operations for the AIDS problem", also said medical institutions will strengthen the training and management, research and development of occupational exposure to HIV compensation mechanism, while expanding the scope of designated hospitals for AIDS.
"China's HIV carriers alliance", said the staff members in recent years in Beijing, Shanghai, Guangzhou, Harbin, Chengdu and other cities, infection is difficult, indeed, a difference operation, part of the city also appeared to provide surgical services infections a small number of medical institutions.
However, the sources said, the existing health care resources are insufficient to solve the difficult problem of surgical infection. Because of this, the Alliance made a number of recommendations, including by government departments to carry out "AIDS Prevention Act," 第四十一条 the implementation of the special inspection and publicity in the media; the establishment of medical institutions and the occupational exposure of occupational protection measures and emergency response reasonable compensation mechanism; cancel the local health administrative departments at all levels, various kinds of "AIDS in designated hospitals," the designation of AIDS treatment into routine health care system and so on.
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