社会性别视角下农村留守妇女艾滋病行为干预策略研究
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摘要
目的:了解农村留守妇女对艾滋病知识的需求及KABP特征,及其感染HIV的风险,在对农村留守妇女这一特殊人群艾滋病的感染率、相关知识、态度、行为及影响因素基线研究的基础上,对农村留守妇女采取两种不同的干预措施并评价干预效果,籍以探索适合于农村留守妇女有效防治艾滋病的干预策略。
方法:整群抽样抽取安徽省临泉县的邢塘和田桥、亳州市谯城区的十八里和十九里各两个为作为调查现场,运用自定的问卷对研究对象进行横断面调查。对临泉的2个乡镇年龄介于18-49岁的留守妇女开展社会性别视角的艾滋病干预活动,对谯城区的2个乡镇年龄介于18-49岁的留守妇女开展非社会性别视角的艾滋病干预活动。在干预后运用自定的问卷对研究对象进行横断面调查,并与基线调查结果进行比较分析。使用SPSS统计软件分析数据,主要采用描述性分析、χ2检验、t检验、相关分析和非条件Logistic回归。
结果:大众媒体是农村妇女获取艾滋病知识的主要途径。农村妇女对艾滋病认知总知晓率为50.13%。相对于非留守妇女,留守妇女艾滋病知识得分明显较低(14.50±5.335 vs. 15.22±5.493,P =0.009)。文化程度和家庭收入是与艾滋病知识得分呈正相关,而年龄与艾滋病知识得分呈负相关。农村妇女对PLWHA的歧视得分为10.49±7.170。与非留守妇女相比,留守妇女的歧视得分与其类似10.93±7.062 vs. 10.30±7.210,年龄与歧视得分呈正相关,文化程度与艾滋病知识得分与歧视得分呈负相关。调查表明,相对于非留守妇女而言,留守妇女近一月的婚内性生活频次较低,而多性伴发生率和自报HIV感染率较高,但安全套使用仍然较低。同时,被丈夫感染的留守妇女有多性伴,且不能坚持使用安全套。调查对象干预前VCT利用率仅为1.1%。在干预研究中,不含社会性别视角的艾滋病干预取得了良好的效果,干预后留守妇女艾滋病一般知识、传播知识、非传播知识和安全套知识回答正确率普遍比干预前分别提高了16.5%、8.3%、26.1%和10.7%,对艾滋病感染者和患者的态度有所改变,但高危行为基本没有发生改变,干预前后安全套使用率和VCT利用率没有显著性差异(P >0.01);而含有社会性别视角的干预相对于不含社会性别视角的干预所取得的效果则更为明显,干预后留守妇女艾滋病一般知识、传播知识、非传播知识和安全套知识回答正确率的增幅分别是不含社会性别视角的艾滋病干预的2.3、2.2、2.2和2.1倍;对艾滋病感染者和患者的改变程度要普遍比不含社会性别视角的艾滋病干预效果更为显著,同时高危行为也有所降低,安全套使用率和VCT利用率有所上升。
结论:对于艾滋病的认知,农村留守妇女还存在着一定的误区,特别是对艾滋病非传播途径认知不高。对艾滋病感染者与患者的歧视仍然是较为普遍的。农村留守妇女艾滋病感染的风险明显高于非留守妇女。因此,关注农村留守妇女艾滋病的防控是必要的。社会性别视角下的艾滋病干预措施比不含社会性别视角下的艾滋病干预措施对农村留守妇女的干预效果更为显著。社会性别视角下的艾滋病干预措施是农村留守妇女进行艾滋病预防的一种好方法,针对女性艾滋病预防和控制设计干预要用社会性别视角来设计是十分必要的。我们的经验对在其他地区的相似人群中所开展的艾滋病预防与控制工作有重要的参考价值。
Objective This study aimed to measure the level of HIV-related knowledge and discrimination attitudes against PLWHA among wives left behind (WLB) and wives of non-migrant men (WNM) in rural areas with former commercial blood donors, China. In rural areas of China where commercial plasma donation used to be common, and little is known about sexual behaviors and condom use among WLB by migrating husbands and WNM. This study investigated sexual behaviors and condom use among married women in rural areas of China. To find effective intervention strategies to prevent and treat AIDS among WLB,two different intervention measures based on the prevalence of AIDS, AIDS-related knowledge, attitude, behavior (KAB) and related risk factors among WLB were developed and implemented and the intervention effect was evaluated.
Methods Cluster sampling was used and Xingtang and Tianqiao in Linquan County and Shibali and Shijiuli in Qiaocheng district in Bozhou city in Anhui Province were selected as investigation sites and a cross-sectional study was carried out. The AIDS intervention activities in gender perspective were applied among the rural left-behind women aged 18 to 49 in the two towns in Linquan, while the AIDS intervention activities in non-gender perspective were applied in the two towns in Linquan.A cross-sectional study was carried out when the two intervention activities were over.Data was analyzed by the statistical software SPSS, mainly by descriptive analysis and Chi-square test. Data were independently entered twice and checked by Epidata 3.1 software and then transformed into a Statistical Package for the Social Sciences (SPSS) data file and analyzed using the SPSS version 10.1 for Windows, SPSS Inc, Chicago, IL. Data were evaluated in frequency and percentages ratios, and using Chi-square (χ2) and t-tests. The significance level was defined asα= 0.05. Univariate and Multivariate analysis were performed to estimate factors associated with HKS and DAS. No-conditional multi-Logistic regression analysis was used to analyze the correlation for multiple sexual partners.
Results Mass media was the major sources of the total respondents’information about HIV/AIDS. The total rate of questions about knowledge about HIV/AIDS answered correctly was 50.13%. Compared to wives of non-migrant men, left behind wives had lower HKS (P=0.009), with HKS being 14.50 (standard deviation (SD) 5.335) vs. 15.22(SD 5.493), respectively. Higher education level and family income per capita were positively correlated with higher HKS, while older age was negatively associated with higher HKS. The total DAS among the total respondents was 10.49(SD 7.170). Compared to wives of non-migrant men, left behind wives had similar DAS, with DAS being 10.93 (SD 7.062) vs. 10.30(SD 7.210), respectively. Older age were positively correlated with higher DAS, while lower education level and HKS were negatively associated with higher DAS. The results showed that WLB had a significantly lower mean frequency of sexual intercourse with their husbands in the previous month, a higher rate of multiple sexual partners, a higher rate of self-reported HIV infection, and a lower rate of condom use when compared to WNM. Also, HIV-infected WLB infected by their husbands had multiple sex partners and did not use condoms consistently. In the research of intervention, the AIDS intervention without gender perspectives obtained good results, after intervention the correct answere rates of the rural left-behind women on the AIDS general knowledge, transmission knowledge, nontransimitted knowledge and the knowledge about condoms were generally increased by 16.5%, 8.3%, 26.1% and 10.7% respectively than those before intervention, the attitudes towards PLWHA showed a slight change, but the high-risk behavior remained largely unchanged, the condom use rate and VCT utilization ratio had no significant difference (P>0.01) before- and after intervention; however the results obtained after the intervention in gender perspective were even more obvious than those obtained without gender perspective, after the intervention in gender perspective the increasing ranges of the correct answere rates of the rural WLB on the AIDS general knowledge, transmission knowledge, nontransmitted knowledge and the knowledge about condoms were 2.3, 2.2, 2.2 and 2.1 times respectively than those without gender perspective; the change extent of attitudes towards PLWHA by the intervention in gender perspective brought in a generally more obvious result than that without gender perspective, at the same time the high-risk behavior went down as well as the condom use rate and the VCT utilization ratio increased.
Conclusion There were widespread misconceptions about HIV infection and routes of HIV non-transmission, and their discrimination attitudes against PLWHA were very common among the respondents. Rural women need more HIV/AIDS knowledge to correct their misconceptions about HIV infection and transmission, and HIV-related discrimination reduction should be an important component of HIV prevention approaches. This research provides additional insight that may be used to develop effective HIV prevention strategies in rural areas of China. The intervention effects on the rural left-behind women by the AIDS intervention measures in gender perspective were more obvious than those without gender perspective. The intervention results indicate that the AIDS intervention measures in gender perspective are good methods for the rural WLB to prevent AIDS and it is quite necessary that the female AIDS prevention and intervention measures should be designed in gender perspective. Our experiences have important reference value to the prevention and control against AIDS/HIV in other areas.
方法:整群抽样抽取安徽省临泉县的邢塘和田桥、亳州市谯城区的十八里和十九里各两个为作为调查现场,运用自定的问卷对研究对象进行横断面调查。对临泉的2个乡镇年龄介于18-49岁的留守妇女开展社会性别视角的艾滋病干预活动,对谯城区的2个乡镇年龄介于18-49岁的留守妇女开展非社会性别视角的艾滋病干预活动。在干预后运用自定的问卷对研究对象进行横断面调查,并与基线调查结果进行比较分析。使用SPSS统计软件分析数据,主要采用描述性分析、χ2检验、t检验、相关分析和非条件Logistic回归。
结果:大众媒体是农村妇女获取艾滋病知识的主要途径。农村妇女对艾滋病认知总知晓率为50.13%。相对于非留守妇女,留守妇女艾滋病知识得分明显较低(14.50±5.335 vs. 15.22±5.493,P =0.009)。文化程度和家庭收入是与艾滋病知识得分呈正相关,而年龄与艾滋病知识得分呈负相关。农村妇女对PLWHA的歧视得分为10.49±7.170。与非留守妇女相比,留守妇女的歧视得分与其类似10.93±7.062 vs. 10.30±7.210,年龄与歧视得分呈正相关,文化程度与艾滋病知识得分与歧视得分呈负相关。调查表明,相对于非留守妇女而言,留守妇女近一月的婚内性生活频次较低,而多性伴发生率和自报HIV感染率较高,但安全套使用仍然较低。同时,被丈夫感染的留守妇女有多性伴,且不能坚持使用安全套。调查对象干预前VCT利用率仅为1.1%。在干预研究中,不含社会性别视角的艾滋病干预取得了良好的效果,干预后留守妇女艾滋病一般知识、传播知识、非传播知识和安全套知识回答正确率普遍比干预前分别提高了16.5%、8.3%、26.1%和10.7%,对艾滋病感染者和患者的态度有所改变,但高危行为基本没有发生改变,干预前后安全套使用率和VCT利用率没有显著性差异(P >0.01);而含有社会性别视角的干预相对于不含社会性别视角的干预所取得的效果则更为明显,干预后留守妇女艾滋病一般知识、传播知识、非传播知识和安全套知识回答正确率的增幅分别是不含社会性别视角的艾滋病干预的2.3、2.2、2.2和2.1倍;对艾滋病感染者和患者的改变程度要普遍比不含社会性别视角的艾滋病干预效果更为显著,同时高危行为也有所降低,安全套使用率和VCT利用率有所上升。
结论:对于艾滋病的认知,农村留守妇女还存在着一定的误区,特别是对艾滋病非传播途径认知不高。对艾滋病感染者与患者的歧视仍然是较为普遍的。农村留守妇女艾滋病感染的风险明显高于非留守妇女。因此,关注农村留守妇女艾滋病的防控是必要的。社会性别视角下的艾滋病干预措施比不含社会性别视角下的艾滋病干预措施对农村留守妇女的干预效果更为显著。社会性别视角下的艾滋病干预措施是农村留守妇女进行艾滋病预防的一种好方法,针对女性艾滋病预防和控制设计干预要用社会性别视角来设计是十分必要的。我们的经验对在其他地区的相似人群中所开展的艾滋病预防与控制工作有重要的参考价值。
Objective This study aimed to measure the level of HIV-related knowledge and discrimination attitudes against PLWHA among wives left behind (WLB) and wives of non-migrant men (WNM) in rural areas with former commercial blood donors, China. In rural areas of China where commercial plasma donation used to be common, and little is known about sexual behaviors and condom use among WLB by migrating husbands and WNM. This study investigated sexual behaviors and condom use among married women in rural areas of China. To find effective intervention strategies to prevent and treat AIDS among WLB,two different intervention measures based on the prevalence of AIDS, AIDS-related knowledge, attitude, behavior (KAB) and related risk factors among WLB were developed and implemented and the intervention effect was evaluated.
Methods Cluster sampling was used and Xingtang and Tianqiao in Linquan County and Shibali and Shijiuli in Qiaocheng district in Bozhou city in Anhui Province were selected as investigation sites and a cross-sectional study was carried out. The AIDS intervention activities in gender perspective were applied among the rural left-behind women aged 18 to 49 in the two towns in Linquan, while the AIDS intervention activities in non-gender perspective were applied in the two towns in Linquan.A cross-sectional study was carried out when the two intervention activities were over.Data was analyzed by the statistical software SPSS, mainly by descriptive analysis and Chi-square test. Data were independently entered twice and checked by Epidata 3.1 software and then transformed into a Statistical Package for the Social Sciences (SPSS) data file and analyzed using the SPSS version 10.1 for Windows, SPSS Inc, Chicago, IL. Data were evaluated in frequency and percentages ratios, and using Chi-square (χ2) and t-tests. The significance level was defined asα= 0.05. Univariate and Multivariate analysis were performed to estimate factors associated with HKS and DAS. No-conditional multi-Logistic regression analysis was used to analyze the correlation for multiple sexual partners.
Results Mass media was the major sources of the total respondents’information about HIV/AIDS. The total rate of questions about knowledge about HIV/AIDS answered correctly was 50.13%. Compared to wives of non-migrant men, left behind wives had lower HKS (P=0.009), with HKS being 14.50 (standard deviation (SD) 5.335) vs. 15.22(SD 5.493), respectively. Higher education level and family income per capita were positively correlated with higher HKS, while older age was negatively associated with higher HKS. The total DAS among the total respondents was 10.49(SD 7.170). Compared to wives of non-migrant men, left behind wives had similar DAS, with DAS being 10.93 (SD 7.062) vs. 10.30(SD 7.210), respectively. Older age were positively correlated with higher DAS, while lower education level and HKS were negatively associated with higher DAS. The results showed that WLB had a significantly lower mean frequency of sexual intercourse with their husbands in the previous month, a higher rate of multiple sexual partners, a higher rate of self-reported HIV infection, and a lower rate of condom use when compared to WNM. Also, HIV-infected WLB infected by their husbands had multiple sex partners and did not use condoms consistently. In the research of intervention, the AIDS intervention without gender perspectives obtained good results, after intervention the correct answere rates of the rural left-behind women on the AIDS general knowledge, transmission knowledge, nontransimitted knowledge and the knowledge about condoms were generally increased by 16.5%, 8.3%, 26.1% and 10.7% respectively than those before intervention, the attitudes towards PLWHA showed a slight change, but the high-risk behavior remained largely unchanged, the condom use rate and VCT utilization ratio had no significant difference (P>0.01) before- and after intervention; however the results obtained after the intervention in gender perspective were even more obvious than those obtained without gender perspective, after the intervention in gender perspective the increasing ranges of the correct answere rates of the rural WLB on the AIDS general knowledge, transmission knowledge, nontransmitted knowledge and the knowledge about condoms were 2.3, 2.2, 2.2 and 2.1 times respectively than those without gender perspective; the change extent of attitudes towards PLWHA by the intervention in gender perspective brought in a generally more obvious result than that without gender perspective, at the same time the high-risk behavior went down as well as the condom use rate and the VCT utilization ratio increased.
Conclusion There were widespread misconceptions about HIV infection and routes of HIV non-transmission, and their discrimination attitudes against PLWHA were very common among the respondents. Rural women need more HIV/AIDS knowledge to correct their misconceptions about HIV infection and transmission, and HIV-related discrimination reduction should be an important component of HIV prevention approaches. This research provides additional insight that may be used to develop effective HIV prevention strategies in rural areas of China. The intervention effects on the rural left-behind women by the AIDS intervention measures in gender perspective were more obvious than those without gender perspective. The intervention results indicate that the AIDS intervention measures in gender perspective are good methods for the rural WLB to prevent AIDS and it is quite necessary that the female AIDS prevention and intervention measures should be designed in gender perspective. Our experiences have important reference value to the prevention and control against AIDS/HIV in other areas.
引文
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