卫生服务过程中艾滋病相关歧视的干预研究
摘要
【目的】
探讨如何通过对医务人员的干预,促进减少卫生服务过程中的艾滋病相关歧视。
【方法】
本研究是设立了自身对照和空白对照的类实验研究,主要分为三个阶段:1、基线调查/需求评估;2、干预;3、效果评估。共有753名医务人员(对照组300名,干预组453名)和40名服务对象参与了研究。调查采用了问卷和访谈(包括个人深入访谈和小组集中讨论)两种方式。采取了以培训和宣传、参与性规划、建立并实施规章制度和参观交流为主的综合性干预措施。资料分析使用了SPSS13.0软件和Microsoft Office Excel 2003软件。
【结果】
一.个旧市卫生服务过程中与艾滋病相关的歧视行为
分别有47.0%、68.3%、39.3%和58.9%的医务人员曾有过“不知情HIV检测”、“不首先告知患者本人HIV检测结果”、“向配偶和/或亲属强制通知患者的HIV检测结果”、“泄密”的行为。
二.个旧市医务人员对HIV感染者/AIDS患者的态度
对HIV阳性者完全接受的医务人员仅占5.3%、完全不接受的医务人员也只有3.3%。年龄越大,对HIV阳性者的接受程度越高;知识得分越高,接受程度越高;乡镇卫生院医务人员接受程度高于市级医院医务人员;与HIV阳性患者接触多的医务人员的接受程度也高。
83.4%的医务人员愿意为HIV阳性者提供卫生服务;14.3%的医务人员不愿意提供服务。医务人员年龄越大,选择“不愿意”的比例越高;妇产科医务人员选择“不愿意”的比例高于其他科室,儿科医务人员选择“不愿意”的比例低于其他科室;每年接触HIV阳性患者超过10个的医务人员选择“不愿意”的比例最高。对患者健康权认知程度高的医务人员愿意为HIV阳性者提供卫生服务的比例也较高。对HIV阳性者接受程度高的医务人员愿意为HIV阳性者提供卫生服务的比例也高。
三.干预效果
多阶回归分析结果显示经过干预的医务人员的知识总分比没有经过干预的医务人员高1.70分(P＜0.01),经过干预的医务人员对HIV阳性者的接受程度高于未经过干预的医务人员,OR=1.98(P＜0.01);未经过干预的医务人员愿意为HIV阳性患者提供卫生服务的比例低于被干预的医务人员,OR=0.41(P＜0.01)。访谈结果同样显示:与对照组医务人员相比,干预组医务人员能正确看待HIV阳性人群/有感染HIV高危行为人群、能更自如地为HIV阳性患者服务。尽管问卷调查的结果显示干预组和对照组医务人员对患者权利的认知程度在干预前后均无改变,但从访谈结果来看,干预组中已经有医务人员有了保护患者权利的意识。
干预前,没有一家医疗机构提供出与接诊HIV阳性患者有关的规章制度。干预后,对照组的医疗机构仍无与艾滋病相关医疗卫生服务有关的规章制度。干预组的三家医院在干预后均制定了与标准防护和职业暴露有关的规章制度,但仅有一家医院制定了“艾滋病咨询服务流程”。
【结论】
一.个旧市医疗卫生服务过程中的艾滋病相关歧视主要表现为“拒绝提供服务”、“采取不同治疗”、“不知情HIV检测”、“不首先告知患者本人HIV检测结果”、“向配偶和/或亲属强制通知患者的HIV检测结果”以及“泄密”,以后四种行为最为常见,“拒绝提供服务”发生的最少。
二.个旧市卫生服务过程中存在艾滋病相关歧视现象的可能原因有:
1)医务人员对患者权利的忽视;
2)医务人员缺乏与患者交流的技能;
3)医务人员过度关注自身安全,但同时又缺乏自我保护的技能和条件;
4)与固有的文化风俗和行业体制息息相关。
三.医务人员与艾滋病相关的知识、态度、行为的改变与HIV/AIDS流行形势的发展不无关联,但开展专门的研究和干预对于减少卫生服务过程中的艾滋病相关歧视来说是必需的。
四.在个旧市,为医务人员提供必要的安全保障,如标准防护的操作规范以及相关的物质条件的支持,可以在短期内使卫生服务过程中艾滋病相关的歧视行为有所减少。
【Objective】To explore effective intervention on health service providers to reduce HIV/AIDS related discrimination during health care services.
【Methods】This study was a quasi-experiment with self-control and blank-control and 3 phases were included:baseline survey/needs assessment,intervention and evaluation.753 health staff(control group n=300,intervention group n=453) and 40 clients were investigated.Both questionnaire and interview(in-depth interview and focus group discussion) were conducted.During the intervention,training and propagandizing,participatory planning,constituting regulations and visiting were performed.SPSS13.0 software and Microsoft Office Excel 2003 software were used in data analysis.
【Results】
1.HIV/AIDS related discrimination during health care services in Gejiu
Five situations had been found,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)". The first kind of situation rarely happened.Proportion of health staff who had practice other four kinds of behavior was 47.0%、68.3%、39.3%and 58.9%respectively.
2.Attitudes towards people living with HIV/AIDS(PLHA) from health staff in Gejiu
Only 5.3%of health staff would like to contact with PLHA in daily life,and 3.3%of health staff totally wouldn't.83.4%of health staff would like to treat PLHA and 14.3%of health staff would not.Willingness to contact with PLHA in daily life increased according to age,HIV/AIDS related knowledge,and frequency of contact with PLHA.It was also shown health staff in rural health institutions had higher willingness to contact with PLHA.
Willingness to treat PLHA decreased according to age.Health staff who contacted more than 10 HIV positive patients per year were most disinclined to treat PLHA.Proportion of people who would like to treat PLHA was lowest in accoucheur while highest in paediatrician.And the proportion also increased according to perception of health staff to human fights of patients.
It was also found there was positive association between willingness to contact with PLHA in daily life and to treat PLHA.
3.Effects of intervention
Hierarchical multiple regression analysis indicated that intervention group scored 1.70 higher than control group(P＜0.01) in test of HIV/AIDS related knowledge, willingness to contact with and treat PLHA were both higher in intervention group (OR=1.98 and 0.41,respectively).
Results of interview also showed positive change in intervention group on perception of HIV positives and "risk population",willingness to treat PLHA was also increased.Quantitative data didn't suggested positive change on perception of human rights of patients,but there were interviewees from intervention group who talked about protecting patients' rights.
Several rules and regulations of standard precaution and occupational exposal were established at all of the 3 institutions after being intervened.Only one of the institution constituted rules about consultation for PLHA.
【Conclusions】
1.Five situations in which HIV/AIDS related discrimination may occur were found during health care services in Gejiu,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)".
2.Possible causes of HIV/AIDS related discrimination during health care services in Gejiu included:
1) Ignoring of human rights of patients;
2) Being short of communication skills with patients;
3) Over caring of self health and incapable of self-protection;
4) Traditional custom and professional regulation.
3.Special intervention is necessary for reducing HIV/AIDS related discrimination during health care services.
4.Necessary professional protection maybe effective in reduction of HIV/AIDS discriminated practice in health care services.
探讨如何通过对医务人员的干预,促进减少卫生服务过程中的艾滋病相关歧视。
【方法】
本研究是设立了自身对照和空白对照的类实验研究,主要分为三个阶段:1、基线调查/需求评估;2、干预;3、效果评估。共有753名医务人员(对照组300名,干预组453名)和40名服务对象参与了研究。调查采用了问卷和访谈(包括个人深入访谈和小组集中讨论)两种方式。采取了以培训和宣传、参与性规划、建立并实施规章制度和参观交流为主的综合性干预措施。资料分析使用了SPSS13.0软件和Microsoft Office Excel 2003软件。
【结果】
一.个旧市卫生服务过程中与艾滋病相关的歧视行为
分别有47.0%、68.3%、39.3%和58.9%的医务人员曾有过“不知情HIV检测”、“不首先告知患者本人HIV检测结果”、“向配偶和/或亲属强制通知患者的HIV检测结果”、“泄密”的行为。
二.个旧市医务人员对HIV感染者/AIDS患者的态度
对HIV阳性者完全接受的医务人员仅占5.3%、完全不接受的医务人员也只有3.3%。年龄越大,对HIV阳性者的接受程度越高;知识得分越高,接受程度越高;乡镇卫生院医务人员接受程度高于市级医院医务人员;与HIV阳性患者接触多的医务人员的接受程度也高。
83.4%的医务人员愿意为HIV阳性者提供卫生服务;14.3%的医务人员不愿意提供服务。医务人员年龄越大,选择“不愿意”的比例越高;妇产科医务人员选择“不愿意”的比例高于其他科室,儿科医务人员选择“不愿意”的比例低于其他科室;每年接触HIV阳性患者超过10个的医务人员选择“不愿意”的比例最高。对患者健康权认知程度高的医务人员愿意为HIV阳性者提供卫生服务的比例也较高。对HIV阳性者接受程度高的医务人员愿意为HIV阳性者提供卫生服务的比例也高。
三.干预效果
多阶回归分析结果显示经过干预的医务人员的知识总分比没有经过干预的医务人员高1.70分(P＜0.01),经过干预的医务人员对HIV阳性者的接受程度高于未经过干预的医务人员,OR=1.98(P＜0.01);未经过干预的医务人员愿意为HIV阳性患者提供卫生服务的比例低于被干预的医务人员,OR=0.41(P＜0.01)。访谈结果同样显示:与对照组医务人员相比,干预组医务人员能正确看待HIV阳性人群/有感染HIV高危行为人群、能更自如地为HIV阳性患者服务。尽管问卷调查的结果显示干预组和对照组医务人员对患者权利的认知程度在干预前后均无改变,但从访谈结果来看,干预组中已经有医务人员有了保护患者权利的意识。
干预前,没有一家医疗机构提供出与接诊HIV阳性患者有关的规章制度。干预后,对照组的医疗机构仍无与艾滋病相关医疗卫生服务有关的规章制度。干预组的三家医院在干预后均制定了与标准防护和职业暴露有关的规章制度,但仅有一家医院制定了“艾滋病咨询服务流程”。
【结论】
一.个旧市医疗卫生服务过程中的艾滋病相关歧视主要表现为“拒绝提供服务”、“采取不同治疗”、“不知情HIV检测”、“不首先告知患者本人HIV检测结果”、“向配偶和/或亲属强制通知患者的HIV检测结果”以及“泄密”,以后四种行为最为常见,“拒绝提供服务”发生的最少。
二.个旧市卫生服务过程中存在艾滋病相关歧视现象的可能原因有:
1)医务人员对患者权利的忽视;
2)医务人员缺乏与患者交流的技能;
3)医务人员过度关注自身安全,但同时又缺乏自我保护的技能和条件;
4)与固有的文化风俗和行业体制息息相关。
三.医务人员与艾滋病相关的知识、态度、行为的改变与HIV/AIDS流行形势的发展不无关联,但开展专门的研究和干预对于减少卫生服务过程中的艾滋病相关歧视来说是必需的。
四.在个旧市,为医务人员提供必要的安全保障,如标准防护的操作规范以及相关的物质条件的支持,可以在短期内使卫生服务过程中艾滋病相关的歧视行为有所减少。
【Objective】To explore effective intervention on health service providers to reduce HIV/AIDS related discrimination during health care services.
【Methods】This study was a quasi-experiment with self-control and blank-control and 3 phases were included:baseline survey/needs assessment,intervention and evaluation.753 health staff(control group n=300,intervention group n=453) and 40 clients were investigated.Both questionnaire and interview(in-depth interview and focus group discussion) were conducted.During the intervention,training and propagandizing,participatory planning,constituting regulations and visiting were performed.SPSS13.0 software and Microsoft Office Excel 2003 software were used in data analysis.
【Results】
1.HIV/AIDS related discrimination during health care services in Gejiu
Five situations had been found,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)". The first kind of situation rarely happened.Proportion of health staff who had practice other four kinds of behavior was 47.0%、68.3%、39.3%and 58.9%respectively.
2.Attitudes towards people living with HIV/AIDS(PLHA) from health staff in Gejiu
Only 5.3%of health staff would like to contact with PLHA in daily life,and 3.3%of health staff totally wouldn't.83.4%of health staff would like to treat PLHA and 14.3%of health staff would not.Willingness to contact with PLHA in daily life increased according to age,HIV/AIDS related knowledge,and frequency of contact with PLHA.It was also shown health staff in rural health institutions had higher willingness to contact with PLHA.
Willingness to treat PLHA decreased according to age.Health staff who contacted more than 10 HIV positive patients per year were most disinclined to treat PLHA.Proportion of people who would like to treat PLHA was lowest in accoucheur while highest in paediatrician.And the proportion also increased according to perception of health staff to human fights of patients.
It was also found there was positive association between willingness to contact with PLHA in daily life and to treat PLHA.
3.Effects of intervention
Hierarchical multiple regression analysis indicated that intervention group scored 1.70 higher than control group(P＜0.01) in test of HIV/AIDS related knowledge, willingness to contact with and treat PLHA were both higher in intervention group (OR=1.98 and 0.41,respectively).
Results of interview also showed positive change in intervention group on perception of HIV positives and "risk population",willingness to treat PLHA was also increased.Quantitative data didn't suggested positive change on perception of human rights of patients,but there were interviewees from intervention group who talked about protecting patients' rights.
Several rules and regulations of standard precaution and occupational exposal were established at all of the 3 institutions after being intervened.Only one of the institution constituted rules about consultation for PLHA.
【Conclusions】
1.Five situations in which HIV/AIDS related discrimination may occur were found during health care services in Gejiu,including "refusal to treat on grounds of HIV/AIDS status","different treatment on grounds of HIV/AIDS status","testing without knowledge","refusal to inform a person of the result of a HIV test" and "compulsory notification of HIV/AIDS status to sexual partner(s) and/or relative(s)".
2.Possible causes of HIV/AIDS related discrimination during health care services in Gejiu included:
1) Ignoring of human rights of patients;
2) Being short of communication skills with patients;
3) Over caring of self health and incapable of self-protection;
4) Traditional custom and professional regulation.
3.Special intervention is necessary for reducing HIV/AIDS related discrimination during health care services.
4.Necessary professional protection maybe effective in reduction of HIV/AIDS discriminated practice in health care services.
引文
1.Mann J.Statement at an informal briefing on AIDS to the 42~(nd) session of the United Nations General Assembly.New York,20 October,1987
2.Kegeles SM,Coates TJ,Christopher TA,et al.Perception of AIDS:the continuing saga of AIDS-related stigma.AIDS,1989,3(s1):s253-s258
3.McGrath JW.The biological impact of social responses to the AIDS epidemic.Medical Anthropol,1992,15(1):63-79
4.Lie GT,Biswalo PM.HIV-positive patient's choice of a significant other to be informed about the HIV-test result:findings from an HIV/AIDS counseling programme in the regional hospital of Arusha and Kilimanjaro,Tanzania.AIDS Care,1996,8(3):285-296
5.Fortenberry JD,McFarlane M,Bleakley A,et al.Relationships of stigma and shame to gonorrhea and HIV screening.Am J Public Health,2002,92(3):378-388
6.Herek GM,Glunt EK.An epidemic of stigma.Public reactions to AIDS.Am Psychol,1988,43(11):886-891
7.UNAIDS.Protocol for the identification of discrimination against people living with HIV.Geneva,Switzerland,2000:4
8.2005年中国艾滋病疫情与防治工作进展.中华人民共和国卫生部,联合国艾滋病规划署,世界卫生组织.2006.1.24
9.廖菁,李绍兴,林昭春,等.社区居民性病艾滋病知识、行为调查.中国健康教育,1998,14(11):12-13
10.林昭春,李绍兴,马渝根,等.社区人群STD/HIV认知水平调查.中国性病艾滋病防治,1999,5(2):67-68
11.刚玉君,刘淑华,张志广,等.村民对HIV携带者及AIDS歧视现象的探讨.现代预防医学,2002,29(1):128
12.郑莉,郑世凡,张云,等.一个社区干预前后对HIV/AIDS社会歧视转变的分析.中国艾滋病性病,2003,9(3):165-167
13.高建华,郑锡文,施小明,等.农村既往有偿供血社区居民AIDS相关歧视和耻辱调查.中国艾滋病性病,2004,10(3):175-177
14.Beedham H,Wilson-Barnett J.HIV and AIDS care:consumers' views on needs and services.J Adv Nurs,1995,22(4):677-686
15.Bird ST,Bogart LM,Delahanty DL.Health-related correlates of perceived discrimination in HIV care.AIDS Patient Care STDS,2004,18(1):19-25
16.Napravnik S,Royce R,Walter E,et al.HIV-1 infected women and prenatal care utilization:barriers and facilitators.AIDS Patient Care STDs,2000,14(8):411-420
17.Hogan NM.The impact of HIV-stigma & discrimination on VCT participation & disclosure.Workshop for Health Ⅸ,Beijing,24-26 February,2003
18.YANG Y,ZHANG KL,CHAN KY,et al.Institutional and structural forms of HIV-related discrimination in health care:A study set in Beijing.AIDS Care,2005,17(s2):s129-s140
19.http://www.yncdc.cn
20.杨树勤.卫生统计学(第三版).北京:人民卫生出版社,1997
21.赵清波,徐勇勇.如何确定抽样研究所需的样本量.中华预防医学杂志,2001,35(3):203-204
22.黄雪斐,管利民,朱卫平,等.317名城市医院医护人员对艾滋病的认知行为调查.浙江预防医学,2000,12(6):24
23.李勤,朵林,毛辉,等.昆明地区孕产妇、医务人员HIV母婴垂直传播相关知识、态度对比分析.卫生软科学,2003,17(4):32-35
24.Ezedinachi,ENU,Ross,MW,Meremiku,M,et al.The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria:a controlled trial.Public Health,2002,116(2):106-112
25.金丕焕.医用统计方法(第二版).上海:复旦大学出版社,2003
26.张文彤.SPSS11统计分析教程.北京:北京希望电子出版社,2002
27.陈峰.医用多元统计分析方法.北京:中国统计出版社,2000
28.王济川,郭志刚.Logistic回归模型——方法与应用.北京:高等教育出版社,2001
29.Malcolm A,Aggleton P,Bronfman M,et al.HIV-related stigmatization and discrimination:its forms and contexts.Critical Public Health,1998,8(4):347
30.Jacoby A.Felt versus enacted stigma:a concept revisited.Soialc Science Medicine,1994,38(2):269-274
31.Understanding and responding to HIV/AIDS related stigma in the health sector.Pan American Health Organization,2003
32.张孔来,刘民.定性研究方法在流行病学研究中的应用.中华流行病学杂志,2000,21(1):72-73
33.Kass NE,Faden RR,Fox R,et al.Homosexual and bisexual men's perceptions of discrimination in health services.Am J Public Health,1992,82(9):1277-1279
34.Kelly JA,Lawrence JS,Hood HV,et al.Nurses' attitudes towards Aids.J Contin Educ Nurs,1988,19(2):78-83
35.Capitanio,JP and Herek,GM AIDS-related stigma and attitudes toward injecting drug users among black and white Americans.Am Behav Sci.1999,42(7):1148-1161
36.http://www.cdc.gov/hiv/stats/hasrlink.htm
37.Boston G.Diversity classes next for hospital.Atlanta J Constitution,1999,3F
38.Gostin LO.The AIDS litigation project.A national review of court and human rights commission decisions,part Ⅱ:discrimination.JAMA,1990,263(15):2086-2093
39.Bunting SM.Sources of stigma associated with women with HIV.ANS Adv Nurs Sci,1996,19(2):64-73
40.Levin BW,Driscoll JMJ,Fleischman AR.Treatment choice for infants in the neonatal intensive care unit at risk for AIDS.JAMA,1991,265:2976-2981
41.Chan R,Khoo CL,Lam MS,et al.A knowledge,attitudes,beliefs and practices survey on HIV infection and AIDS among doctors and dental surgeons in Singapore.Ann Acad Med Singapore,1997,26(5):581-587
42.Evans JK,Bingham JS,Pratt K,et al.Attitudes of medical students to HIV and AIDS.Genitourin Med,1999,69(5):377-380
43.Blaxter M.The meaning of disability:a sociological study of impairment.Heinemann,London,1976
44.施美菊.宝山区医务人员性病艾滋病防治培训现状调查.职业与健康,2001,12(11):13-14
45.夏国美.反歧视:现代社会必须提升的文明.社会观察,2004(12):8-9
46.Herek GM,Capitanio JP.Public reactions to AIDS in the United States,a second decades of stigma.Am J Public Health,1993,83(4):574-577
47.Centers of Disease Control and Prevention.HIV-related knowledge and stigma-United States.MMWR Morb Mortal Wkly Rep,2000,49(47):1062-1064
48.Bermingham S,Kippax S.HIV-related discrimination,a survey of New South Walesgeneral practitioners.A ust N Z J Public Health,1998,22(1):92-97
49.Paul N.Discrimination against people living with HIV/AIDS in India:educated persons as perpetrators.J of Infect,2006,Article in Press
50.Schulman DI.AIDS discrimination:its nature,meaning and function.Nova Law Review,1988,12(3):1113,1114-1119
51.UNAIDS.World AIDS Campaign 2002-2003.A conceptual framework and basis for action:HIV/AIDS stigma and discrimination
52.Busza JR.Promoting the positive:responses to stigma and discrimination in Southeast Asia.AIDS Care,2001,13(4):441-456
53.黄家亮.论社会歧视的社会心理根源及其消除方式.思想战线,2005,31(5):89-93
54.Pinfold V,Huxley P,Thornicroft G,et al.Reducing psychiatric stigma and discrimination:evaluating an educational intervention with the police force in England.Soc Psychiatry Epidemiol,2003,38(6):337-344
55.Klein SJ,Karchner WD,O'Connell DA.Interventions to prevent HIV-related stigma and discrimination:findings and recommendations for public health practice.J Public Health Management Practice,2002,8(6):44-53
56.Easley CE,Marks SP,Morgan Jr RE.The challenge and place of international human rights in public health[J].American Journal of Public Health,2001,91(12):1922-1925
57.Herek GM,Mitnick L,Burris S,et al.Workshop report:AIDS and stigma:a conceptual framework and research agenda.AIDS Public Policy J,1998,13(1):36-47
58.杜克琳,张开宁.贫困人群医疗救助——理论、案例及其操作指南.北京:人民卫生出版社,2002
59.http://www.chinacourt.org
60.中国妇女剩余健康促进——从需求评估到政策发展。朱明若,北京:中国社会出版社,2005
1. Goffman E. Stigma: Notes on the management of spoiled identity. Simon and Schuster, New York, Penguin, Harmondsworth, 1963: 3
2. Gilmore N, Somerville MA. Stigmatization, scapegoating and discrimination in sexually transmitted diseases: overcoming 'them' and 'us'. Social Science and Medicine, 1994, 39(9): 1339-58
3. Jones EE, Farina A, Hastorf AH, etc. The Dimensions of Stigma, Chapter 2, Social stigma: the psychology of marked relationships. New York: W. H. Freeman and Company, 1984: 303
4. Herek GM, Glunt EK. An epidemic of stigma. Public reactions to AIDS. American Psychology, 1988,43(11): 886-91
5. Herek GM, Mitnick L, Burris S, etc. Workshop report: AIDS and stigma: a conceptual framework and research agenda. AIDS Public Policy Journal, 1998 ,13(1): 36-47
6. Mara Adelman, Larry Frey, Jim Query. Living together with AIDS. Social Support Processes in a Residential Facility. In V. Derlega and A. Barbee (Eds.), HIV and Social Interaction. Thousand Oaks, CA: Sage, 1999
7. Fortenberry JD, McFarlane M, Bleakley A, etc. Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 2002, 92(3):378-38
8. Derlega VJ, Barbee AP. HIV and social interaction. SAGE Publications, 1998:165-192
9. UNAIDS. World AIDS Campaign 2002-2003. A conceptual framework and basis for action: HIV/AIDS stigma and discrimination. 2002: 10
10. UNAIDS. Protocol for the identification of discrimination against people living with HIV. Geneva, Switzerland, 2000: 4
11. Scambler G, Hopkins A. Generating a model of epileptic stigma: the role of qualitative analysis. Social Science and Medicine, 1990, 30(11): 1187-1194
12. Jacoby A. Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. Social Science and Medicine, 1994, 38(2):269-74
13. Scambler G. Epilepsy. Tavistock, London, 1989: 56
14. Understanding and responding to HIV/AIDS-related stigma and discrimination in the health sector. Pan American Health Organization, 2003: 12
15.Anne Malcolm,Peter Aggleton,Mario Bronfman,etc.HIV-related stigmatization and discrimination:its forms and contexts.Critical Public Health,1998,8(4):347-370
16.AIDS-related stigma.AIDS Action,2001:1
17.郑莉,郑世凡,张云,等.一个社区干预前后对HIV/AIDS社会歧视转变的分析.中国艾滋病性病,2003,9(3):165-167
18.Mann J.Statement at an informal briefing on AIDS to the 42~(nd) session of the United Nations General Assembly.New York,1987
19.Lie GT,Biswalo PM.HIV-positive patient's choice of a significant other to be informed about the HIV-test result:findings from an HIV/AIDS counseling programme in the regional hospital of Arusha and Kilimanjaro,Tanzania.AIDS Care,1996,8(3):285-296
20.Fortenberry JD,McFarlane M,Bleakley A,et al.Relationships of stigma and shame to gonorrhea and HIV screening.American Journal of Public Health,2002,92(3):378-388
21.Kegeles SM,Coates TJ,Christopher TA,et al.Perception of AIDS:the continuing saga of AIDS-related stigma.AIDS,1989,3:s253-s258
22.McGrath JW.The biological impact of social responses to the AIDS epidemic.Medical Anthropology,1992,15:63-79
23.UNAIDS.Protocol for the identification of discrimination against people living with HIV.Geneva,Switzerland,2000:10
24.UNAIDS.Protocol for the identification of discrimination against people living with HIV.Geneva,Switzerland,2000:23
25.Segurado AC,Mirand SD,Latorre MDO,etc.Evaluation of the care of women living with HIV/AIDS in Sao Paulo,Brazil.AIDS Patient Care and STDS,2003,17(2):85-93
26.Amirkhanian YA,Kelly JA,McAuliffe TL.Psychosocial needs,mental health,and HIV transmission risk behavior among people living with HIV/AIDS in St Petersburg,Russia.AIDS,2003,17(16):2367-2374
27.Napravnik S,Royce R,Walter E,etc.HIV-1 infected women and prenatal care utilization:barriers and facilitators.AIDS Patient Care and STDs,2000,14(8):411-420.
28.Bird ST,Bogart LM,Delahanty DL.Health-related correlates of perceived discrimination in HIV care.AIDS Patient Care and STDS,2004,18(1):19-25
29.李勤,朵林,毛辉,等.昆明地区孕产妇、医务人员HIV母婴垂直传播相关知识、态度对比分析.卫生软科学,2003,17(4):32-35
30.http://www.39.net/eden/xjb/azb/hzsh/50818.html
31.http://news.sina.com.cn/c/2005-03-20/02386134909.shtml
32.Beedham H,Wilson-Barnett J.HIV and AIDS care:consumers' views on needs and services.Journal of Advanced Nursing,17:21-27
33.UNAIDS.World AIDS Campaign 2002-2003.A conceptual framework and basis for action:HIV/AIDS stigma and discrimination.2002:14
34.Busza JR.Promoting the positive:responses to stigma and discrimination in Southeast Asia.AIDS Care,2001,13(4):441-456
35.Ezedinachi ENU,Ross MW,Meremiku M,etc.The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria:a controlled trial.Public Health,2002,116:106-112
36.庄贵华,吴谦,王学良,等.对西安市医务人员艾滋病认知状况的调查,中国健康教育.2002,18(2):65-69
37.施美菊.宝山区医务人员性病艾滋病防治培训现状调查.职业与健康,2001,17(11):13-14
38.李秀兰,陈征,丁丽英,等.对北京护理人员HIV/AIDS的知识、态度调查后HIV/AIDS医源性暴露风险评估.中国健康教育,2002,218:73-75
39.http://www.39.net/eden/xjb/azb/hzsh/54246.html
2.Kegeles SM,Coates TJ,Christopher TA,et al.Perception of AIDS:the continuing saga of AIDS-related stigma.AIDS,1989,3(s1):s253-s258
3.McGrath JW.The biological impact of social responses to the AIDS epidemic.Medical Anthropol,1992,15(1):63-79
4.Lie GT,Biswalo PM.HIV-positive patient's choice of a significant other to be informed about the HIV-test result:findings from an HIV/AIDS counseling programme in the regional hospital of Arusha and Kilimanjaro,Tanzania.AIDS Care,1996,8(3):285-296
5.Fortenberry JD,McFarlane M,Bleakley A,et al.Relationships of stigma and shame to gonorrhea and HIV screening.Am J Public Health,2002,92(3):378-388
6.Herek GM,Glunt EK.An epidemic of stigma.Public reactions to AIDS.Am Psychol,1988,43(11):886-891
7.UNAIDS.Protocol for the identification of discrimination against people living with HIV.Geneva,Switzerland,2000:4
8.2005年中国艾滋病疫情与防治工作进展.中华人民共和国卫生部,联合国艾滋病规划署,世界卫生组织.2006.1.24
9.廖菁,李绍兴,林昭春,等.社区居民性病艾滋病知识、行为调查.中国健康教育,1998,14(11):12-13
10.林昭春,李绍兴,马渝根,等.社区人群STD/HIV认知水平调查.中国性病艾滋病防治,1999,5(2):67-68
11.刚玉君,刘淑华,张志广,等.村民对HIV携带者及AIDS歧视现象的探讨.现代预防医学,2002,29(1):128
12.郑莉,郑世凡,张云,等.一个社区干预前后对HIV/AIDS社会歧视转变的分析.中国艾滋病性病,2003,9(3):165-167
13.高建华,郑锡文,施小明,等.农村既往有偿供血社区居民AIDS相关歧视和耻辱调查.中国艾滋病性病,2004,10(3):175-177
14.Beedham H,Wilson-Barnett J.HIV and AIDS care:consumers' views on needs and services.J Adv Nurs,1995,22(4):677-686
15.Bird ST,Bogart LM,Delahanty DL.Health-related correlates of perceived discrimination in HIV care.AIDS Patient Care STDS,2004,18(1):19-25
16.Napravnik S,Royce R,Walter E,et al.HIV-1 infected women and prenatal care utilization:barriers and facilitators.AIDS Patient Care STDs,2000,14(8):411-420
17.Hogan NM.The impact of HIV-stigma & discrimination on VCT participation & disclosure.Workshop for Health Ⅸ,Beijing,24-26 February,2003
18.YANG Y,ZHANG KL,CHAN KY,et al.Institutional and structural forms of HIV-related discrimination in health care:A study set in Beijing.AIDS Care,2005,17(s2):s129-s140
19.http://www.yncdc.cn
20.杨树勤.卫生统计学(第三版).北京:人民卫生出版社,1997
21.赵清波,徐勇勇.如何确定抽样研究所需的样本量.中华预防医学杂志,2001,35(3):203-204
22.黄雪斐,管利民,朱卫平,等.317名城市医院医护人员对艾滋病的认知行为调查.浙江预防医学,2000,12(6):24
23.李勤,朵林,毛辉,等.昆明地区孕产妇、医务人员HIV母婴垂直传播相关知识、态度对比分析.卫生软科学,2003,17(4):32-35
24.Ezedinachi,ENU,Ross,MW,Meremiku,M,et al.The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria:a controlled trial.Public Health,2002,116(2):106-112
25.金丕焕.医用统计方法(第二版).上海:复旦大学出版社,2003
26.张文彤.SPSS11统计分析教程.北京:北京希望电子出版社,2002
27.陈峰.医用多元统计分析方法.北京:中国统计出版社,2000
28.王济川,郭志刚.Logistic回归模型——方法与应用.北京:高等教育出版社,2001
29.Malcolm A,Aggleton P,Bronfman M,et al.HIV-related stigmatization and discrimination:its forms and contexts.Critical Public Health,1998,8(4):347
30.Jacoby A.Felt versus enacted stigma:a concept revisited.Soialc Science Medicine,1994,38(2):269-274
31.Understanding and responding to HIV/AIDS related stigma in the health sector.Pan American Health Organization,2003
32.张孔来,刘民.定性研究方法在流行病学研究中的应用.中华流行病学杂志,2000,21(1):72-73
33.Kass NE,Faden RR,Fox R,et al.Homosexual and bisexual men's perceptions of discrimination in health services.Am J Public Health,1992,82(9):1277-1279
34.Kelly JA,Lawrence JS,Hood HV,et al.Nurses' attitudes towards Aids.J Contin Educ Nurs,1988,19(2):78-83
35.Capitanio,JP and Herek,GM AIDS-related stigma and attitudes toward injecting drug users among black and white Americans.Am Behav Sci.1999,42(7):1148-1161
36.http://www.cdc.gov/hiv/stats/hasrlink.htm
37.Boston G.Diversity classes next for hospital.Atlanta J Constitution,1999,3F
38.Gostin LO.The AIDS litigation project.A national review of court and human rights commission decisions,part Ⅱ:discrimination.JAMA,1990,263(15):2086-2093
39.Bunting SM.Sources of stigma associated with women with HIV.ANS Adv Nurs Sci,1996,19(2):64-73
40.Levin BW,Driscoll JMJ,Fleischman AR.Treatment choice for infants in the neonatal intensive care unit at risk for AIDS.JAMA,1991,265:2976-2981
41.Chan R,Khoo CL,Lam MS,et al.A knowledge,attitudes,beliefs and practices survey on HIV infection and AIDS among doctors and dental surgeons in Singapore.Ann Acad Med Singapore,1997,26(5):581-587
42.Evans JK,Bingham JS,Pratt K,et al.Attitudes of medical students to HIV and AIDS.Genitourin Med,1999,69(5):377-380
43.Blaxter M.The meaning of disability:a sociological study of impairment.Heinemann,London,1976
44.施美菊.宝山区医务人员性病艾滋病防治培训现状调查.职业与健康,2001,12(11):13-14
45.夏国美.反歧视:现代社会必须提升的文明.社会观察,2004(12):8-9
46.Herek GM,Capitanio JP.Public reactions to AIDS in the United States,a second decades of stigma.Am J Public Health,1993,83(4):574-577
47.Centers of Disease Control and Prevention.HIV-related knowledge and stigma-United States.MMWR Morb Mortal Wkly Rep,2000,49(47):1062-1064
48.Bermingham S,Kippax S.HIV-related discrimination,a survey of New South Walesgeneral practitioners.A ust N Z J Public Health,1998,22(1):92-97
49.Paul N.Discrimination against people living with HIV/AIDS in India:educated persons as perpetrators.J of Infect,2006,Article in Press
50.Schulman DI.AIDS discrimination:its nature,meaning and function.Nova Law Review,1988,12(3):1113,1114-1119
51.UNAIDS.World AIDS Campaign 2002-2003.A conceptual framework and basis for action:HIV/AIDS stigma and discrimination
52.Busza JR.Promoting the positive:responses to stigma and discrimination in Southeast Asia.AIDS Care,2001,13(4):441-456
53.黄家亮.论社会歧视的社会心理根源及其消除方式.思想战线,2005,31(5):89-93
54.Pinfold V,Huxley P,Thornicroft G,et al.Reducing psychiatric stigma and discrimination:evaluating an educational intervention with the police force in England.Soc Psychiatry Epidemiol,2003,38(6):337-344
55.Klein SJ,Karchner WD,O'Connell DA.Interventions to prevent HIV-related stigma and discrimination:findings and recommendations for public health practice.J Public Health Management Practice,2002,8(6):44-53
56.Easley CE,Marks SP,Morgan Jr RE.The challenge and place of international human rights in public health[J].American Journal of Public Health,2001,91(12):1922-1925
57.Herek GM,Mitnick L,Burris S,et al.Workshop report:AIDS and stigma:a conceptual framework and research agenda.AIDS Public Policy J,1998,13(1):36-47
58.杜克琳,张开宁.贫困人群医疗救助——理论、案例及其操作指南.北京:人民卫生出版社,2002
59.http://www.chinacourt.org
60.中国妇女剩余健康促进——从需求评估到政策发展。朱明若,北京:中国社会出版社,2005
1. Goffman E. Stigma: Notes on the management of spoiled identity. Simon and Schuster, New York, Penguin, Harmondsworth, 1963: 3
2. Gilmore N, Somerville MA. Stigmatization, scapegoating and discrimination in sexually transmitted diseases: overcoming 'them' and 'us'. Social Science and Medicine, 1994, 39(9): 1339-58
3. Jones EE, Farina A, Hastorf AH, etc. The Dimensions of Stigma, Chapter 2, Social stigma: the psychology of marked relationships. New York: W. H. Freeman and Company, 1984: 303
4. Herek GM, Glunt EK. An epidemic of stigma. Public reactions to AIDS. American Psychology, 1988,43(11): 886-91
5. Herek GM, Mitnick L, Burris S, etc. Workshop report: AIDS and stigma: a conceptual framework and research agenda. AIDS Public Policy Journal, 1998 ,13(1): 36-47
6. Mara Adelman, Larry Frey, Jim Query. Living together with AIDS. Social Support Processes in a Residential Facility. In V. Derlega and A. Barbee (Eds.), HIV and Social Interaction. Thousand Oaks, CA: Sage, 1999
7. Fortenberry JD, McFarlane M, Bleakley A, etc. Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 2002, 92(3):378-38
8. Derlega VJ, Barbee AP. HIV and social interaction. SAGE Publications, 1998:165-192
9. UNAIDS. World AIDS Campaign 2002-2003. A conceptual framework and basis for action: HIV/AIDS stigma and discrimination. 2002: 10
10. UNAIDS. Protocol for the identification of discrimination against people living with HIV. Geneva, Switzerland, 2000: 4
11. Scambler G, Hopkins A. Generating a model of epileptic stigma: the role of qualitative analysis. Social Science and Medicine, 1990, 30(11): 1187-1194
12. Jacoby A. Felt versus enacted stigma: a concept revisited. Evidence from a study of people with epilepsy in remission. Social Science and Medicine, 1994, 38(2):269-74
13. Scambler G. Epilepsy. Tavistock, London, 1989: 56
14. Understanding and responding to HIV/AIDS-related stigma and discrimination in the health sector. Pan American Health Organization, 2003: 12
15.Anne Malcolm,Peter Aggleton,Mario Bronfman,etc.HIV-related stigmatization and discrimination:its forms and contexts.Critical Public Health,1998,8(4):347-370
16.AIDS-related stigma.AIDS Action,2001:1
17.郑莉,郑世凡,张云,等.一个社区干预前后对HIV/AIDS社会歧视转变的分析.中国艾滋病性病,2003,9(3):165-167
18.Mann J.Statement at an informal briefing on AIDS to the 42~(nd) session of the United Nations General Assembly.New York,1987
19.Lie GT,Biswalo PM.HIV-positive patient's choice of a significant other to be informed about the HIV-test result:findings from an HIV/AIDS counseling programme in the regional hospital of Arusha and Kilimanjaro,Tanzania.AIDS Care,1996,8(3):285-296
20.Fortenberry JD,McFarlane M,Bleakley A,et al.Relationships of stigma and shame to gonorrhea and HIV screening.American Journal of Public Health,2002,92(3):378-388
21.Kegeles SM,Coates TJ,Christopher TA,et al.Perception of AIDS:the continuing saga of AIDS-related stigma.AIDS,1989,3:s253-s258
22.McGrath JW.The biological impact of social responses to the AIDS epidemic.Medical Anthropology,1992,15:63-79
23.UNAIDS.Protocol for the identification of discrimination against people living with HIV.Geneva,Switzerland,2000:10
24.UNAIDS.Protocol for the identification of discrimination against people living with HIV.Geneva,Switzerland,2000:23
25.Segurado AC,Mirand SD,Latorre MDO,etc.Evaluation of the care of women living with HIV/AIDS in Sao Paulo,Brazil.AIDS Patient Care and STDS,2003,17(2):85-93
26.Amirkhanian YA,Kelly JA,McAuliffe TL.Psychosocial needs,mental health,and HIV transmission risk behavior among people living with HIV/AIDS in St Petersburg,Russia.AIDS,2003,17(16):2367-2374
27.Napravnik S,Royce R,Walter E,etc.HIV-1 infected women and prenatal care utilization:barriers and facilitators.AIDS Patient Care and STDs,2000,14(8):411-420.
28.Bird ST,Bogart LM,Delahanty DL.Health-related correlates of perceived discrimination in HIV care.AIDS Patient Care and STDS,2004,18(1):19-25
29.李勤,朵林,毛辉,等.昆明地区孕产妇、医务人员HIV母婴垂直传播相关知识、态度对比分析.卫生软科学,2003,17(4):32-35
30.http://www.39.net/eden/xjb/azb/hzsh/50818.html
31.http://news.sina.com.cn/c/2005-03-20/02386134909.shtml
32.Beedham H,Wilson-Barnett J.HIV and AIDS care:consumers' views on needs and services.Journal of Advanced Nursing,17:21-27
33.UNAIDS.World AIDS Campaign 2002-2003.A conceptual framework and basis for action:HIV/AIDS stigma and discrimination.2002:14
34.Busza JR.Promoting the positive:responses to stigma and discrimination in Southeast Asia.AIDS Care,2001,13(4):441-456
35.Ezedinachi ENU,Ross MW,Meremiku M,etc.The impact of an intervention to change health workers' HIV/AIDS attitudes and knowledge in Nigeria:a controlled trial.Public Health,2002,116:106-112
36.庄贵华,吴谦,王学良,等.对西安市医务人员艾滋病认知状况的调查,中国健康教育.2002,18(2):65-69
37.施美菊.宝山区医务人员性病艾滋病防治培训现状调查.职业与健康,2001,17(11):13-14
38.李秀兰,陈征,丁丽英,等.对北京护理人员HIV/AIDS的知识、态度调查后HIV/AIDS医源性暴露风险评估.中国健康教育,2002,218:73-75
39.http://www.39.net/eden/xjb/azb/hzsh/54246.html