中国医务人员艾滋病污名现状meta分析

HIV/AIDS-related stigma among health care providers in China: a meta-analysis

目的了解中国医务人员(HCPs)艾滋病污名现状,为向HCPs开展减少艾滋病污名干预活动提供科学依据。方法检索中国知网数据库、万方数据库和Pub Med数据库,并辅以文献追溯法收集2001年1月—2017年6月公开发表的关于中国HCPs艾滋病污名现状的相关文献,应用R 3.3.1软件对纳入的文献行meta分析。结果共纳入43篇中、英文文献(中文文献40篇和英文文献3篇),累计研究对象21 335人。meta分析结果显示,有37.59%(95%CI=22.55%~53.96%)和47.02%(95%CI=34.41%~59.83%)的HCPs分别对艾滋病感染者/患者(PLWHA)存在负性刻板印象和恐惧心理;有31.43%(95%CI=18.72%~45.73%)的HCPs认为有权拒绝为PLWHA提供医疗服务;有22.20%(95%CI=12.23%~34.11%)的HCPs拒绝为PLWHA提供一般诊疗/护理服务;有37.96%(95%CI=20.64%~57.01%)的HCPs拒绝提供侵入性诊疗/护理服务;有54.44%(95%CI=45.05%~63.67%)的HCPs赞成对PLWHA实行就医隔离;有59.39%(95%CI=32.13%~83.85%)的HCPs认为应对PLWHA实行强制检测;有37.40%(95%CI=20.08%~56.57%)的HCPs认为可未经PLWHA同意擅自将其病情告知他人。敏感性分析结果显示,本研究结果较为稳定;Egger’s检验和漏斗图结果均显示,除"拒绝提供侵入性诊疗/护理工作"指标外,其余指标存在发表偏倚的可能性均较小。结论中国HCPs艾滋病污名严重,亟需针对此人群开展干预工作。

Objective To assess human immunodeficiency virus/acquired immunodeficiency syndrome（HIV/AIDS）-related stigma among Chinese health care providers（HCPs） and to provide evidences for implementing effective anti-stigma interventions in health care settings. Methods A systematic search was conducted on three databases（China National Knowledge Infrastructure [CNKI], Wangfang and Pub Med databases） for related literatures published from January 2001 through June 2017. A meta-analysis was performed with R 3.3.1 software. Results Totally 43 studies（40 published in Chinese and 3 in English） were included. Of the 21 335 HCPs involved in the studies, 37.59%（95% confidence interval[95% CI]：22.55% – 53.96%） had negative stereotypes about people living with HIV/AIDS（PLWHA） and 47.02%（95% CI：34.41% – 59.83%） of the HCPs were afraid of facing PLWHA; 31.43%（95% CI：18.72% – 45.73%） of the HCPs believed that they have the right to refuse providing medical services to PLWHA and 37.96%（95% CI：20.64% – 57.01%） would be unwilling to perform invasive procedures to PLWHA; 54.44%（95% CI：45.05% – 63.67%） and 59.39%（95% CI：32.13% –83.85%） of the HCPs agreed to isolate PLWHA in the hospital and to have them tested mandatorily; 37.40%（95% CI：20.08% – 56.57%） of the HCPs thought they could disclose PLWHA＇s condition to others without their consent. Sensitivity analysis revealed that the results of the meta-analysis were stable, and the results of Egger′ test and funnel plot demonstrated no significant publication bias for the indicators studied, except for being unwilling to perform invasive procedures to PLWHA. Conclusion Stigma towards PLWHA is serious among HCPs in China and interventions for reducing the stigma should be conducted among the HCPs.