有子女的HIV/AIDS病人告知状况及其影响因素分析
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摘要
目的通过分析有子女的艾滋病病毒(HIV)感染者/艾滋病(AIDS)病人(简称HIV/AIDS病人)的告知情况及其影响因素,为开展进一步的干预支持提供依据。方法采用面对面问卷访谈形式,对广西2 987名HIV/AIDS病人进行调查,选取其中1 073名有子女者的人口学、心理健康、社会支持、治疗信息、病情告知和家庭关系等信息进行统计分析。结果通过不同途径感染HIV的1 073名有子女的HIV/AIDS病人中,938名选择将自己的感染状况告知,其中告知配偶/固定性伴的占76.8%(720名),告知父亲/母亲占21.5%(202名),告知兄弟姐妹占19.1%(179名)。1 073名有子女的HIV/AIDS病人中,不将其感染状况告知子女的主要因素95.0%(1 019名)认为这是个人隐私,92.3%(990名)为羞耻感,91.7%(984名)担心家人遭受社会的歧视,90.9%(975名)希望保护家人。多因素Logistic回归分析结果显示,接受抗病毒治疗者[比值比(OR)=2.94,95%可信区间(CI):1.89～4.59]、知晓配偶或固定性伴有(OR=4.48,95%CI:2.38～8.43)或没有(OR=4.52,95%CI:2.71～7.55)感染HIV者和家中有其他人感染HIV者(OR=0.30,95%CI:0.16～0.57)更倾向于告知。结论目前HIV/AIDS病人受到社会歧视和排斥的倾向仍然严重,使HIV阳性父母在对子女病情告知面临较大的压力和困难,需要专业的干预指导以减少其对子女告知病情的压力并促进儿童心理健康发展。
Objective To provide evidence for further intervention of HIV disclosure by analyzing the status and impacts of parental HIV disclosure to children. Methods 2 987 HIV infected cases received face to face interview in Guangxi. Among them, 1 073 people with children were selected for statistical analysis of the information, including demographic characteristics, mental health, social support, treatment information, disclosure and family relations. Results Most of the cases infected with HIV through different ways disclosed their HIV status to spouses/partners 76.8%(720/938), parent(s) 21.5%(202/938), and brothers/sisters 19.1%(179/938). The main related factors affecting the parents telling their infection status to the children included personal privacy(1019/1073, 94.9%), stigma(990/1073, 92.3%), social discrimination(984/1073, 91.7%), and the willingness to protect the family(975/1073, 90.9%). According to the logistics regression model, the cases receiving ART(OR=2.94,95%CI:1.89-4.59), knowing spouses/partners infected with HIV(OR=4.48,95%CI:2.38-8.43)or not(OR=4.52,95%CI:2.71-7.55), and someone of family members infected with HIV/AIDS(OR=0.30,95%CI:0.16-0.57)were more inclined to disclose. Conclusion Due to the serious discrimination and stigma against HIV infected people, parents still face greater pressure and difficulties in HIV disclosure to their children. Professional intervention is needed for the parents to reduce their pressure on HIV disclosure and promote children′s mental health development.
Objective To provide evidence for further intervention of HIV disclosure by analyzing the status and impacts of parental HIV disclosure to children. Methods 2 987 HIV infected cases received face to face interview in Guangxi. Among them, 1 073 people with children were selected for statistical analysis of the information, including demographic characteristics, mental health, social support, treatment information, disclosure and family relations. Results Most of the cases infected with HIV through different ways disclosed their HIV status to spouses/partners 76.8%(720/938), parent(s) 21.5%(202/938), and brothers/sisters 19.1%(179/938). The main related factors affecting the parents telling their infection status to the children included personal privacy(1019/1073, 94.9%), stigma(990/1073, 92.3%), social discrimination(984/1073, 91.7%), and the willingness to protect the family(975/1073, 90.9%). According to the logistics regression model, the cases receiving ART(OR=2.94,95%CI:1.89-4.59), knowing spouses/partners infected with HIV(OR=4.48,95%CI:2.38-8.43)or not(OR=4.52,95%CI:2.71-7.55), and someone of family members infected with HIV/AIDS(OR=0.30,95%CI:0.16-0.57)were more inclined to disclose. Conclusion Due to the serious discrimination and stigma against HIV infected people, parents still face greater pressure and difficulties in HIV disclosure to their children. Professional intervention is needed for the parents to reduce their pressure on HIV disclosure and promote children′s mental health development.
引文
[1] 中国疾病预防控制中心性病艾滋病预防控制中心性病控制中心.2017年12月全国艾滋病性病疫情[J].中国艾滋病性病,2018,24(2):111.
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[6] Kaleeba N,KalibalaS,Kaseje M,et al.Participatory evaluation of counseling,medicine and social service of the AIDS Support Organization(TASO) in Uganda[J].AIDS Care,1997,9(1):13-26.
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[9] Dane B.Disclosure:the voices of Thai women living with HIV/ AIDS[J].Intern Soc Work,2002,45(2):185-204.
[10] Rwemisisi J,Wolff B,Coutinho A,et al.'What if they ask how I got it?' Dilemmas of disclosing parental HIV status and testing children for HIV in Uganda[J].Health Policy Plan,2008,23(1):36-42.
[11] Dematteo D,Harrison C,Arneson C,et al.Disclosing HIV/AIDS to children:the paths families take to truth telling[J].Psychol Health Med,2002,7(3):339-356.
[12] Thorne C,Newell ML,Peckham CS.Disclosure of diagnosis and planning for the future in HIV-affected families in Europe[J].Child Care Health Dev,2000,26(1):29-40.
[13] Zhou Y,Zhang L,Li X,et al.Chinese parents with HIV tell their children the truth?A qualitative preliminary study of parental HIV disclosure in China[J].Child Care Health Dev,2013,39(6):816-824.
[14] Qiao S,Li X,Stanton B.Practice and perception of parental HIV disclosure to children in Beijing,China[J].Qual Health Res,2014,24(9):1276-1286.
[15] Conserve DF,Eustache E,Oswald CM,et al.Disclosure and impact of maternal HIV+ sero-status on mothers and children in rural Haiti[J].Matern Child Health J,2014,18(10):2309-2315.
[16] Liamputtong P,Haritavorn N.To tell or not to tell:disclosure to children and family among Thai women living with HIV/AIDS[J].Health Promot Int,2014,7(17):1-10.
[2] 杨翌,张孔来,李泽荣,等.艾滋病病毒感染者和病人告知情况分析[J].疾病控制杂志,2005,9(3):202-204.
[3] Armistead L,Morse E,Forehand R,et al.African- American women and self-disclosure of HIV infection:rates,predictors and relationship to depressive symptomatology[J].AIDSBehav,1999,3(3):195-204.
[4] Petrak JA,Doyle AM,Smith A,et al.Factors associated with self-disclosure of HIV sero-status to significant others[J].Br J Health Psychol,2001,6 (Pt 1):69-79.
[5] Hays RB,Mckusick L,Pollack L,et al.Disclosing HIV sero-positivity to significant others[J].AIDS,1993,7(3):425-531.
[6] Kaleeba N,KalibalaS,Kaseje M,et al.Participatory evaluation of counseling,medicine and social service of the AIDS Support Organization(TASO) in Uganda[J].AIDS Care,1997,9(1):13-26.
[7] Siegel K,Krauss BJ.Living with HIV infection:adaptive tasks of seropositive gay men[J].J Health SocBehav,1991,32(1):17-32.
[8] Paxton S.The paradox of public HIV disclosure[J].AIDS CARE,2002,14(4):559-567.
[9] Dane B.Disclosure:the voices of Thai women living with HIV/ AIDS[J].Intern Soc Work,2002,45(2):185-204.
[10] Rwemisisi J,Wolff B,Coutinho A,et al.'What if they ask how I got it?' Dilemmas of disclosing parental HIV status and testing children for HIV in Uganda[J].Health Policy Plan,2008,23(1):36-42.
[11] Dematteo D,Harrison C,Arneson C,et al.Disclosing HIV/AIDS to children:the paths families take to truth telling[J].Psychol Health Med,2002,7(3):339-356.
[12] Thorne C,Newell ML,Peckham CS.Disclosure of diagnosis and planning for the future in HIV-affected families in Europe[J].Child Care Health Dev,2000,26(1):29-40.
[13] Zhou Y,Zhang L,Li X,et al.Chinese parents with HIV tell their children the truth?A qualitative preliminary study of parental HIV disclosure in China[J].Child Care Health Dev,2013,39(6):816-824.
[14] Qiao S,Li X,Stanton B.Practice and perception of parental HIV disclosure to children in Beijing,China[J].Qual Health Res,2014,24(9):1276-1286.
[15] Conserve DF,Eustache E,Oswald CM,et al.Disclosure and impact of maternal HIV+ sero-status on mothers and children in rural Haiti[J].Matern Child Health J,2014,18(10):2309-2315.
[16] Liamputtong P,Haritavorn N.To tell or not to tell:disclosure to children and family among Thai women living with HIV/AIDS[J].Health Promot Int,2014,7(17):1-10.