静脉吸毒者艾滋病自愿咨询检测的影响因素及对培训核心同伴推广检测的态度

Barriers and enabling factors of voluntary HIV counseling and testing among injection drug users and their attitudes towards peer opinion leader-led HIV testing through diffusion of positive AIDS care messages

目的探讨静脉吸毒者接受艾滋病自愿咨询检测服务的影响因素;了解静脉吸毒者和关键知情人对利用培训核心同伴传播相关信息推广检测的态度,为最大限度地早期发现感染者、有效防治艾滋病提供依据。方法采用定性研究方法,对四川省达州市大竹县和通川区静脉吸毒者及关键知情人进行了定性访谈。结果目前静脉吸毒者的艾滋病自愿咨询检测仍面临许多障碍,诸如怕暴露吸毒行为、担心出现阳性结果、害怕社会歧视、害怕被公安部门制裁、担心结果被泄露和认为不可能感染艾滋等。检测动因是关注自身健康、怕传播给家人、受家人同伴影响和希望得到误工费等。所有被调查者均一致认为培训核心同伴传播相关信息是提高检测的有效办法。结论静脉吸毒者接受艾滋病自愿咨询检测存在一定的障碍及动因,应尽可能消除障碍,并利用动因来创建艾滋病自愿咨询检测的友好环境;静脉吸毒者和关键知情人对通过培训核心同伴宣传相关信息提高检测率均持积极态度。

Objective To assess the barriers and enabling factors of voluntary HIV counseling and testing among injection drug users and their attitudes towards community peer opinion leader-led advocacy in expanding voluntary HIV counseling and testing service in Sichuan Province,China. Methods Chinese governmental legislation and policy documents were reviewed andin-depth interviews were conducted with key informants in Dazhou,Sichuan Province. Results Gaps between the policies and the practice were significant,as exemplified by the co-existence of supportive policy driven by free testing and substantial barriers to accessing voluntary HIV counseling and testing services. Injection drug users and key informants expressed intensive barriers to accessing voluntary HIV counseling and testing,such as fear of disclosure of drug use,fear of positive result,fear of discrimination,fear of punishments from the police,lack of confidentiality,and low perceived HIV risk. Factors that enabled testing included positive peer or family influences,as well as health concerns for self or spouse/sex partners,including worry about mother-to-child transmission. All participants formed a consensus that community peer opinion leader-led advocacy in expanding voluntary HIV counseling and testing services was a feasible approach. Conclusion Effective interventions are urgently needed to overcome these barriers and improve the uptake of available HIV testing. Community peer opinion leader-led advocacy as a means of expanding voluntary HIV counseling and testing services should be further investigated.