HIV感染者/AIDS患者衰弱状况及影响因素分析

目的了解人类免疫缺陷病毒(HIV)感染/艾滋病(AIDS)患者(PLWHA)衰弱现状及其影响因素。方法选取2019年6—8月长沙市某医院≥18岁的PLWHA作为研究对象,采用自行编制的问卷以及蒂尔堡衰弱量表分别评估研究对象的基本情况以及衰弱情况。结果PLWHA衰弱发生率为26.4%,logistics回归分析显示,感染年限>5年的患者发生衰弱的风险为感染年限≤5年患者的2.33倍(95%CI:1.24~4.37,P=0.009);最高HIV载量≥10万拷贝/mL患者发生衰弱的风险为最高HIV载量<10万拷贝/mL患者的1.40倍(95%CI:1.05~1.85,P=0.022);CD4^(+)T淋巴细胞计数<200个/mm 3的患者发生衰弱的风险为CD4^(+)T淋巴细胞计数≥200个/mm 3患者的3.60倍(95%CI:1.96~6.62,P<0.001)。结论HIV感染年限越长、当前CD4^(+)T淋巴细胞计数越低、HIV载量越高的PLWHA更容易发生衰弱。

HIV感染者/AIDS病人关怀策略

在世界范围内，随着HIV感染者人数的迅速增加和陆续发病，不仅造成艾滋病病毒感染者及艾滋病病人（people living with HIV and AIDS，PLWHAs）的劳动能力急剧减弱，也使他们家庭的经济、生活陷入困境，在泰国治疗1例AIDS的医疗费用约为24344泰铢（约合1000美元），相当于每个家庭半年的总收入，而因此导致了51％的家庭采取了缩减开支的策略，在食物和饮料上的开支减少了42％，严重地影响了PLWHAs及其家庭成员的生活质量。研究表明，艾滋病的流行给一个国家和人民带来的灾难是毁灭性的。调查显示，1个PLWHAs造成的社会总的损失达13万元，以我国现有PLWHAs65万人计算，造成的经济损失接近1000亿元。这表明，艾滋病不仅仅是一个医学和公共卫生问题，也是一个社会问题和政治问题，是一个人类共同面对的问题，因此，针对PLWHAs开展关怀活动显得尤为重要。目前，PLWHAs的关怀支持工作已经涉及到越来越广泛的领域，包括社区关怀、医疗关怀、家庭关怀、自我关怀等诸多方面。

中国老年人类免疫缺陷病毒/获得性免疫缺陷综合征患者流行特点及心理状态

目前公开报道的年龄最大的获得性免疫缺陷综合征(AIDS)患者为94岁〔1〕。近年来老年AIDS病毒感染者(PLWHA)越来越多,2005年全球约有4 000万老年PLWHA,其中老年人约280万,占7%〔2~4〕。由于年龄老化、生理功能改变、免疫功能下降等原因,老年人感染AIDS后在流行特点与心理状态方面会与青壮年有所不同,是不可忽视的弱势群体,

伦理学视角下PLWHA隐私权与艾滋病流行控制

总结艾滋病流行现状、艾滋病病毒感染者及艾滋病患者(persons living with HIV/AIDS,PLWHA)对保护隐私权的需求以及现有法律对PLWHA权利、义务的规定。发现艾滋病流行控制效果不理想,PLWHA群体数量不断增长,其普遍存在焦虑、抑郁等心理问题,其面临的处境使他们更注重隐私权的保护。为了在有效控制艾滋病流行的前提下保护PLWHA的隐私权,提出将艾滋病防治工作与保护PLWHA的隐私权结合起来,社会应给予PLWHA群体更多的支持和关爱,同时加强全民艾滋病防护教育等对策。

我国老年女性艾滋病感染现状及相关问题探讨

近年来许多研究发现老年人艾滋病问题日益严峻,澳大利亚2009年报道其老年HIV/AIDS病例构成比与过去10年相比从12～14%增加至23～28%[1].到2015年,美国有大约一半的PLWHA为50岁及以上的老年人[2].艾滋病老龄化的问题不仅出现在国外,随着我国进入人口老龄化社会,艾滋病这一“年轻人的问题”也逐渐老龄化.通常我国对老年人的界定是≥60岁的人群,但是在艾滋病研究领域。

昆明市五华区HIV感染者/病人管理服务模式探讨

[目的]调查和总结昆明市五华区艾滋病病毒感染者/病人(PLWHA)的综合管理服务模式。[方法]通过现有资料回顾、关键人物深入访谈和相关群体小组访谈的方法,收集和总结昆明市五华区PLWHA综合管理服务的现状和成效。[结果]昆明市五华区基本形成了政府主导,以首诊负责制为切入点,动员社区服务组织开展后续随访服务的PLWHA的综合管理网络。该区对PLWHA的随访率、CD4检测率、自愿咨询检测覆盖率均有所提高。

艾滋病病毒感染者/艾滋病病人配偶/固定性伴HIV感染现状调查

[目的]了解艾滋病病毒(HIV)感染者和艾滋病(AIDS)病人配偶/固定性伴HIV感染现状,探索艾滋病病毒感染者及艾滋病病人(PLWHA)配偶/固定性伴降低性接触传播的有效预防措施。[方法]对已确认的PLWHA的配偶/固定性伴采血进行HIV抗体检测。[结果]对全县可随访到的PLWHA的配偶/固定性伴73例进行了艾滋病毒抗体(抗-HIV)筛查,检出阳性23例,占31.51%。[结论]对PLWHA及其配偶/固定性伴进行健康教育、行为干预,是今后澄江县艾滋病控制工作的重点和难点。定期随访,指导PLWHA做到每次性交时正确使用安全套是减少配偶、性伴间传播HIV的有效方法。

Living Conditions and Palliative Care Needs among End-of-Life Former Commercial Plasma Donors Affected with HIV/AIDS in Rural Henan of China

Objective China began providing antiretroviral therapy to people living with HIV/AIDS （PLWHA） in 2003. This study was to investigate the living conditions, including quality of life and happiness, and need for palliative care of end-of-life PLWHA in rural Henan. Methods One hundred end-of-life AIDS patients were selected from Weishi, Zhenping and Tanghe counties in Henan, using convenience sampling. The World Health Organization Quality of Life for HIV （WHOQOL-HIV） BREF Chinese Version was used to measure the quality of life and the Memorial University of Newfoundland Scale of Happiness （MUNSH） was employed to measure subjective welfare. Qualitative interviews and focus group discussions were undertaken to learn about the palliative care provided and the specific needs of the end-of-life patients. Results Patients’ overall quality of life was moderate （12.62±1.97）. Highest scores were in the spirituality/religion/personal beliefs, higher than the average scores in the Chinese population （P0.01）, while psychological （13.58±2.06） and environment （12.50±3.28） domain scores were similar to the latter （P0.05）. Both independence （12.15±2.15） and physiological （14.04±3.16） domain scores were lower than the average of the people living with HIV/AIDS in other studies （P0.01）; however, all were in the moderate range. The average MUNSH score was 21.00±6.20, which was also moderate. The in-depth interviews indicated that the Henan Provincial Government’s policy of treatment and care had a beneficial impact on end-of-life AIDS patients, although the care components could be improved. Conclusions Living conditions of the end-of-life AIDS patients were moderate, and the HIV/AIDS palliative care model used was beneficial to them. Care could be improved by assisting the family unit as a whole.

How to Effectively Detect and Manage People Living with HIV/AIDS in China:Establishment of a Community-based Model

This study explored a novel systemic community-based model for detecting and manag-ing people living with HIV/AIDS (PLWHA). Both quantitative and qualitative research methods were used in this study. A quantitative questionnaire investigation was conducted in a sample of 1192 subjects which were randomly selected from two areas with high HIV prevalence, Xiangfan City and Shiyan City of Hubei Province, China. Twenty-two medical and health service staffs were inter-viewed by semi-structured questionnaire focusing on awareness, status, problems, and suggestions about community-based Voluntary Counseling and Testing and Provider Initiated Testing and Coun-seling (VCT/PITC). And they were organized to discuss about the aforementioned issues in Xiangfan City and Shiyan City, respectively. Our results showed that the accessibility and availability of the general VCT/PITC were bad. About 28.3% had known and only 4.9% had made use of VCT/PITC. Developing community-based VCT/PITC had some special advantages that can overcome some ex-isting problems to remedy the aforementioned defects. We are led to conclude that, to maximize the availability and uptake rate of the VCT/PITC, we plan to detect PLWHA by developing the commu-nity-based VCT/PITC through 4 paths. Then we establish the community HIV health care center con-stituted of 8 sectors to provide an overall management. Thus, we can effectively detect and manage the PLWHA with a new systemic community-based model.

The Role of Library and Information Science Education in the Development of Community Health Information Services for People Living with HIV/AIDS: Perspectives of Directors and Managers of Public Libraries

This article identifies the role of library and information science (LIS) education in the development of community health information services for people living with HIV/AIDS (PLWHA). Preliminary findings are presented from semi- structured qualitative interviews that were conducted with eleven directors and managers of local branches in the Knox County Public Library (KCPL) System that is located in the East Tennessee region in the United States. Select feedback reported by research participants is summarized in the article about strategies in LIS education that can help local public librarians and others in their efforts to become more responsive information providers to PLWHA. Research findings help better understand the issues and concerns regarding the development of digital and non-digital health information services for PLWHA in local public library institutions.

The Control of Malaria among PLWHA in Calabar, Cross River State, Nigeria

The purpose of the study was to examine RBM programme＇s efforts at controlling malaria among PLWHA and explore their perception of the control strategies. The study was a descriptive survey involving guided interviews of top managers of Roll Back Malaria （RBM） programme. A structured questionnaire was administered to 108 PLWHA attending an HIV/AIDS clinic in a secondary health facility in Calabar. Data were analyzed using descriptive statistics. Thematic analysis revealed that RBM programme strategies include effective case management, promotion of Long Lasting Insecticide Treated Nets （LLINs）, intermittent preventive treatment （IPT） and integrated vector management （IVM）. Complementary results showed that 104 （92%） admitted accessibility to malarial treatment. Although 83 （57.7%） of PLWHA have LLINs, only 63 （42.3%） use them. Majority of the respondents 89 （60%） have not heard of indoor/outdoor residual spraying （IRS）. How to get IRS services and lack of money to buy it were listed as a barrier to its use. Malarial treatment was accessible to PLWHA. The barriers to the use of ITN and IRS could be addressed through free distribution of odorless ITN and IRS to PLWHA. Higher rates of utilization of the products can be achieved through behavioural change communication.

Hospital-based care for people living with HIV/AIDS in Ibadan,South Western Nigeria

Objective:To describe the pattern of admission-defining ailments and outcomes of care among people living with human immunodeficiency virus(HIV) /acquired immune deficiency syndrome(AIDS)(PLWHA) who presented for treatment at a tertiary health care institution in Nigeria.Methods:We reviewed the hospital records of all patients admitted for AIDS and AIDS-related illnesses at the University College Hospital,Ibadan, Nigeria,from January 2005 to January 2006.Results:Seventy-two PLWHA were admitted during the study period.There were 39 females(54.2%) and 33(45.8%) males.Sixty-seven(95%) PLWHA presented with AIDS.Only 12(17%) were already receiving highly active antiretroviral therapy before admission.Forty -three patients(60%) commenced antiretroviral(ARV) therapy on admission.Thirty-three patients(46%) had pulmonary tuberculosis,10(14%) had extrapulmonary tuberculosis,21(29.1%) had diarrhoea-related illnesses,20(28%) had anaemia,and nine(12.5%) presented with coma.Twenty-nine patients(40.3%) were discharged home,and 43(59.7%) died before discharge.Sixty-nine patients(95.6%) were judged to be indigent,and required financial support.The contributory causes of death included pulmonary tuberculosis in 21(48.8%),diarrhoeal diseases in five(11.6%),anaemia in five(11.6%),coma in nine(20.9%), and pneumonia in three(7.1%).Conclusion:Tuberculosis was the major admission-defining ailment among PLWHA.

Factors Associated with Hypovitaminosis D in People Living with HIV/AIDS (PLWHA) Followed up in Porto-Novo in 2019

Background: Vitamin D deficiency is very common among PLWHA compared to the general population and is promoted by several factors. Aim: To identify the factors associated with hypovitaminosis D in people living with HIV/AIDS (PLWHA) followed up in Porto-Novo in 2019. Methods: This was a cross-sectional, descriptive and analytical study. PLWHA who were monitored on an outpatient basis and who gave their consent were included in this work. Subjects unable to answer questions or under ongoing vitamin D supplementation or suffering from chronic liver diseases were not included. Hypovitaminosis D was defined by a blood level of 25 hydroxy-vitamin D less than 30 ng/mL. Results: A total of 270 PLWHA were included in the study. The mean age of the patients was 39.51 ± 6.85 years with a female predominance (73.3%). The frequency of hypovitaminosis D was 56%. Hypertension, low protein intake, anemia and low glomerular filtration rate were associated with vitamin D deficiency. Conclusion: Vitamin D deficiency is common among PLWHA, which justifies routine screening, especially among those at risk.

Assessment of HIV/AIDS Stigma in a Rural Namibian Community

Namibia has been affected by the Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) pandemic with infected and affected persons experiencing stigma at different levels. Despite the high level of knowledge?on HIV/AIDS, stigma remains a challenge. It was for this reason that this paper describes and measures the level of HIV/AIDS stigma in a rural community in Namibia. Mixed methods were used to collect data from 224 participants consisting of 93 people living with HIV/AIDS (PLWHA) who were recruited voluntarily from their support groups, 77 family members nominated by PLWHA participants, 31 community members who were recruited through simple random sampling and 19 opinion leaders who were purposefully selected and four health care workers from an Antiretroviral clinic who were available at the time of this study. Three measurement instruments namely HIV/AIDS Stigma Instrument-PLWHA (HASI-P), Family & Community Stigma Instrument (F&C-SI) and HIV/AIDS Stigma Instrument-Nurse (HASI- N) were used. In-depth interviews were conducted to complement the quantitative results. The study found that stigma manifests in different ways and results revealed that verbal abuse (55%, n = 50, PLWHA), social isolation (73%, n = 67), negative self-perception (33%, n = 30), and household stigma (26% n = 19, family members) were the most common form of stigma experienced by PLWHA. Furthermore health care workers reported stigma of association (50%, n = 2) as care providers for people living with HIV/AIDS. The study concluded that stigma exists although some scores such as fear of contagion and workplace stigma were low. Therefore, interventions in knowledge on basic facts of HIV transmission need to be strengthened. Nonetheless the majority of participants confirmed their willingness to care for sick relatives with HIV and AIDS. This study did not explore stigma of association against caregivers with other participants other than the four health care workers from the antiretroviral clinic. Future researchers can take this further.

Assessing the Relationship between Caregivers Burden and Availability of Support for Family Caregivers’ of HIV/AIDS Patients in Calabar, South East Nigeria

Purpose: This study examined the level of burden and the extent of support on family caregivers of people living with AIDS (PLWHA) in Calabar, South East Nigeria. Methods: A mixed method with cross sectional approach was used. Purposive sampling technique guided the recruitment process and data collection methods included, semi-structured questionnaires and focusing group discussion. 260 respondents participated in the study. The quantitative data were mined with the aid of SPSS and the qualitative data were analysed with the aid of NVivo8 using thematic analysis. Results: Results indicated high level of burden with limited support to caregivers. A Chi-square value of 25.1 was obtained at P < 0.05, suggesting a significant relationship between availability of support and caregivers burden. This relationship was supported by the themes of physical, social, emotional and financial burden for the caregivers. Similarly, information on coping skills, emotional support, financial assistance and help with caregiving themes emerged for social support. Conclusion: In Nigeria, the burden of caring for HIV/AIDS patients has a remarkable impact on family caregivers. This calls for the development of policies that can systematically address the needs of family caregivers in order to ameliorate the negative consequences of caregiving for PLWHA.

脂阿拉伯甘露聚糖抗原检测用于艾滋病病毒感染者和艾滋病患者结核病诊断的研究进展

结核病是艾滋病病毒感染者和艾滋病患者(people living with HIV/AIDS,PLWHA)死亡的主要原因,给其带来巨大的疾病负担,在PLWHA人群中早期筛查结核病,是降低传播、控制其病情发展的关键举措。脂阿拉伯甘露聚糖(lipoarabinomannan,LAM)是MTB的糖脂,可以在结核患者尿液中检测到,LAM有助于快速、准确诊断结核病。本文综述了LAM及其在PLWHA诊断中的应用与局限性,希望为PLWHA结核病的诊断提供参考依据。

永州市老年HIV感染者/AIDS病人艾滋病相关认知、态度、行为调查

目的了解永州市老年HIV感染者／AIDS病人（PLWHA）艾滋病相关的认知、态度、行为（KAP），为今后老年艾滋病防控提供依据。方法从全国艾滋病疫情报告系统中下载1993—2013年现住址为永州市的现存活的老年人HIV感染者和AIDS病人的历史卡片。在自愿的原则下，用自拟的调查问卷对研究对象进行一对一问卷调查。用EpiData3．1软件录入数据，并进行数据逻辑检查。运用SPSS18．0进行资料的统计学分析。结果共收集340份有效问卷。结果显示：HIV确诊阳性后首次CD4＋T淋巴细胞计数检测结果〈200个／mm3的男性116例，占51．56％，女性35例，占33．02％，HIV确诊阳性时的平均年龄59．4J4（55．00～64．00）岁。老年PLWHA对AIDS相关知识的知晓情况偏低，总体知晓率为59．77％，其中“蚊虫叮咬会传播艾滋病吗？”回答正确率最低，为48．22％。确诊阳性后对自己的态度感到后悔和难过的分别占34．25％、30．34％。HIV阳性确诊前有发生过商业性行为的214人，发生率64．07％；98．54％不使用和偶尔使用安全套；58．68％商业性行为的场所发生在路边和出租屋，其次在发廊、洗脚屋；71．22％的商业性伴年龄在30—50岁间；性交易额88．41％的为50元及以下。确诊后商业性行为发生率18．92％，不使用和偶尔使用安全套占85．71％。结论永州市绝大部分老年PLWHA是50岁以后感染HIV病毒的；不安全性行为和艾滋病防治知晓率低下是老年人感染HIV的主要风险因素。

老年HIV感染者/AIDS病人自我羞耻感、歧视水平及影响因素研究

目的了解永州市老年HIV感染者/AIDS病人(PLWHA)自我羞耻感和歧视水平现状,并分析其影响因素,为今后老年艾滋病防控提供依据。方法从全国艾滋病疫情报告系统中下载1993-2013年现住址为永州市的现存活的老年HIV感染者和AIDS病人的历史卡片。在自愿的原则下,用自拟的调查问卷对研究对象进行一对一问卷调查。结果共收集318份有效问卷。结果显示,老年PLWHA的自我感知的羞耻和歧视的得分总分为(31.01±9.03),其中社交距离、自责、偏见三个维度得分分别是(9.79±3.33)、(12.69±3.01)、(8.53±2.94)。在不同特征老年PLWHA自我感知的羞耻和歧视的得分中:汉族的PLWHA的自我感知的羞耻和歧视的得分总分明显高于瑶族和其他族,差异有统计学意义(F=21.085,P<0.001),且汉族的PLWHA在社交距离、自责、偏见分量表的得分也明显高于其他民族;离异/丧偶的PLWHA的自我感知羞耻和歧视的总分最高,其次是在婚/同居,未婚的PLWHA的总分得分最低,差异有统计学意义(F=5.052,P<0.05);独自一人居住的PLWHA的自我感知的羞耻和歧视总分得分最高,并且在社交距离和偏见分量表中,独自一人居住的PLWHA的得分最高。随着年可支配收入的增加,感到的羞耻和歧视程度越高,差异有统计学意义(F=8.968,P<0.05)。对于现在所从事的工作情况,羞耻和歧视总分得分由高到低依次为:在家休养、在家搞种植、打工或做生意,差异有统计学意义(F=8.635,P<0.05)。配偶和子女对PLWHA的HIV感染情况知晓的自我感知的羞耻和歧视得分最高,其次是配偶知道、家人都不知道、所有子女知道,得分最低的是所有子女知道感染情况,差异有统计学意义(F=6.500,P<0.05)。结论不同民族、婚姻状况、居住状况、每年可支配收入情况、目前的工作状况和家庭成员对患者感染状况的知晓情况对老年PLWHA自我羞耻感及歧视水平有影响。其中,汉族、年可支配收入高的、离异/丧偶的、独自一人居住的、在家休养的、配偶和子女知晓PLWHA的HIV感染情况的老年PLWHA自我羞耻感及歧视水平得分最高。