1、The Challenges for HIV/AIDS Prevention 防治艾滋病的挑战,Global Health Action, U.S.A National Population and Family Planning Commission, China June 12-13, 2004, Nanjing, China 美国全球卫生行动组织 中国国家人口和计划生育委员会 六月12日13日 中国 南京,What can be done about the HIV/AIDS epidemic?艾滋病流行, 我们能做什么?,HIV prevention预防艾滋病 Care and sup
2、port for HIV-infected people对艾滋病患者的关爱和支持 Build capacity to continue the fight against HIV/AIDS构建持续对抗艾滋病的能力,HIV/AIDS Prevention 艾滋病的防治,Strong Leadership 强有力的领导机制 Community involvement 社区参与 Behavior change 行为改变 Safe blood supply 安全血液供应 Reducing stigma 减少羞辱,HIV/AIDS Prevention 艾滋病的防治,Creating supportin
3、g environment创建支持环境 Preventing mother-child HIV transmission预防母婴传染 Voluntary testing and counseling自愿检测和咨询 Treatment of sexually transmitted infection性病治疗 Building capacity提高能力,Strong Leadership 强有力的领导机制,From UNGASS Declaration of Commitment UNGASS 承诺的宣言 Leadership by Governments in combating HIV/AI
4、DS is essential; 政府的领导至关重要 The efforts of Government should be complemented by the full participation of civil society, the business community and the private sector政府的努力,必须结合民间社团, 工商业界和个人来共同参与完成,HIV/AIDS Prevention 艾滋病的防治,Information/education/communication宣传/教育/交流 Mass media大众传媒 School-based AIDS
5、education学校为基础的AIDS教育 Peer counseling for sex workers在性工作者中开展同伴咨询,HIV/AIDS Prevention 艾滋病的防治,95% of the HIV infections prevalent in Africa are attributable to unsafe sex非洲95%的艾滋病感染是由不安全的性为造成 25% in Eastern Europe 25%的感染者在东欧 90% or more in parts of South America and the developed countries of Western
6、 Pacific 90% 或更多的感染者在南美和西太平洋地区的发展中国家,AIDS Cases by Mode of Exposure (US through June 2001)艾滋病案例分类表（美国2001年6月）,Behavior Change 行为改变,Promote behavior changes that reduce risk of HIV infection and transmission提倡行为改变, 减少HIV感染和传染的风险 Create normative environments that sustain change建立正常的可持续改变的环境,Strategie
7、s for Individual Level Behavior Change 针对个人的战略,Provide information about HIV提供HIV相关信息 “HIV prevention counseling” for risk reduction “HIV 防治咨询”来降低风险 Training for negotiating abstinence and condom use禁欲和避孕套使用商谈的培训 Use models for decision making around risk behaviors用示范来做风险行动的决定 Provide opportunity to
8、 learn HIV status testing利用检测提供的机会来了解HIV状况,HIV Prevention 艾滋病防治,Abstinence 禁欲 Be Faithful 忠实use aCondom 使用避孕套,Blood Safety血液安全,It is estimated that between 5% and 10% of all HIV infections worldwide have been acquired through transfusion of contaminated blood and blood products 估计全世界有5% -10% 的感染是通过输
9、入受污染的血和血制品造成的,Goals of Voluntary HIV Testing and Counseling 自愿检测和咨询的目标,Prevention of HIV transmission预防HIV传播 “Normalization” of HIV将HIV正常化 Challenging stigma through promoting awareness通过广泛开展宣传挑战羞辱 Early uptake of prevention and treatment services早期预防和治疗服务 Medical services 医疗服务 Emotional and social
10、support 情感和社会支持 Legal advice; future planning 法律建议和远景规划,The Challenges 挑战,Lack of safe donors and unsafe blood donations缺乏安全献血者以及不安全的献血 Lack of screening缺乏监测 Inappropriate testing不当检测 Blood used inappropriately or incorrectly不当用血,Reducing Transfusion-Associated HIV Transmission降低输血感染,Prevent unneces
11、sary transfusions防止不必要的输血 Blood banking血库 Recruit low risk blood donors招募低风险的献血者 Screen blood for HIV 艾滋病血液筛选 The appropriate and rational use of blood适当合理用血,Mother-Child HIV Prevention 母婴艾滋病防治,Mother-Child HIV transmission (MTCT) is the largest source of HIV infection in children below the age of 1
12、5 years母婴之间传染是15岁以下儿童感染艾滋病的主要来源 AIDS epidemic has claimed the lives of nearly 3 million children, and another 1 million are living with HIV todayAIDS 已夺去近300万儿童的生命, 另有100万HIV感染者 Nine out of ten of all HIV-infected babies have been born in Africa十分之九的HIV感染的婴儿生于非洲 About 12 million women of childbearin
13、g age are HIV-positive大约一千二百万育龄妇女呈HIV阳性,Mother-Child HIV Prevention 母婴艾滋病防治,Antenatal care 产前护理 Voluntary counseling/education and testing自愿咨询/教育和测试 Antiretroviral drug treatment 抗逆转录药品治疗 Safe delivery 安全分娩 Safe infant feeding 安全婴儿喂养 Continuing care for women and their families对妇女及其家庭后续护理 Positive a
14、nd non-judge-mental attitudes of health workers卫生保健人员积极和不带评判的心态,Barriers to HIV Prevention 预防HIV的障碍,Individual level个人层次 Ignorance无知 Denial否认 Attitude of helplessness无助的态度 Incapacity to change behavior无行为改变能力 Lack of power in relationships联系乏力 Lack of income-generating skills缺少创收技能 Addiction: drugs/
15、sex沉溺于毒品/性,Community level社区层次 Stigma羞辱 Lack of supplies供给缺乏 Lack of trained personnel缺乏训练有素的人员 Cultural expectations文化期望 Lack of guidelines缺乏指导 Mistrust of governments不信任政府 Lack of leadership缺乏领导机制 Unsafe medical practices不安全的医疗实践,Care and Support for Persons Infected with HIV 对艾滋病感染者的关爱和支持,Major c
16、omponents:主要部分: Psychosocial support社会心理支持 Palliative care抚慰关怀 Prevention of opportunistic infection tuberculosis预防机会感染如肺结核 Antiretroviral therapy抗逆转录治疗,Integrating STD/HIV Services into Reproductive Health Settings STD/HIV和生殖健康服务相结合,What Do We Mean by Integration?Managers can view the integration o
17、f STD/HIV services into reproductive health settings as a continuum running from an informal to a more formal combination of two or more services 结合意味着什么?管理着者可以把STD/HIV服务结合到生殖健康看作一个持续地从一个非正式到更正式将两个或更多服务结合在一起的过程,Integrating STD/HIV Services into Reproductive Health Settings STD/HIV和生殖健康服务相结合,Family p
18、lanning and other reproductive health programs can play a significant role in addressing the HIV prevention and care needs of women计划生育和生殖健康服务在预防HIV和关心妇女需求方面能起重大作用 Existing reproductive health services provide an idea opportunity to address womens broader sexual health need 现有的生殖健康服务为强调妇女广泛的性健康需求提供了
19、一个理想的机会,Principal Focus 原则性着重点,A client focus服务对象为重点 A provider and service delivery focus服务提供者为重点 An organizational focus组织为重点 A program focus项目为重点,Integration at the Service Delivery Point 服务提供者为重点的结合,Integration means delivering two or more types of services (previously provided separately) as a
20、single, coordinated and combined service结合意味着将提供两种或多种形式的服务(以前提供优服务时是分开的)当作一种,相互协调及合并的服务 The integration of HIV/STI prevention into family planning counseling can be considered a key aspect of informed choice将HIV/性传播感染预防结合到计划生育咨询可以看做是知情选择的关键部分,Integrating STD/HIV Services into Reproductive Health Set
21、tings STD/HIV和生殖健康服务相结合,Integrated counseling helps clients to:结合咨询将帮助服务对象: Make informed, realistic, and achievable sexual and reproductive health decisions做出知情的, 现实的, 可达到的性和生殖健康决定 Explore and assess their own risk of infection, and initiate preventive health behaviors 探索和评估他们受感染的风险, 启动预防性的健康行为,Int
22、egrating STD/HIV Services into Reproductive Health Settings STD/HIV和生殖健康服务相结合,Negotiate safer sexual behavior, and prevent infection协商安全的性行为, 预防传染 Make treatment choices that meet their personal and sexual health needs做满足他们个人的和性健康需求的治疗选择 Clarify concerns related to sexuality明确有关性行为的考虑 Improve their
23、sexual and reproductive health knowledge, and promote sharing of that information增进性和生殖健康知识, 提倡共享信息,How Managers to Do to Integrate Activities 管理者如何开展结合活动,Analyzing the Strategic Issues分析战略性的问题 Assessing the Magnitude of the STD/HIV Problem评估STD/HIV问题的机制 Assessing the Level of Risk Among Clients评估服务
24、对象的风险水平 Assessing Whether STD/HIV Services are Already Available评估STD/HIV服务是否已经存在 Assessing the Consequences of Integrating Services评估结合服务的后果,How Managers to Do to Integrate Activities 管理者如何开展结合活动,Selecting Appropriate STD/HIV Strategies挑选适宜的STD/HIV战略 General population一般人群 Specific groups特殊人群,Gener
25、al Population一般人群,Providing access to condoms at affordable prices提供支付得起的避孕套的途径 Providing prompt and appropriate services for the management of STDs对STD管理提供及时和适宜的服务 Establishing syndromic diagnosis and treatment programs建立症状诊断和治疗项目 Promoting responsible sexual behavior through IEC activities通过宣传,教育和
26、交流提倡负责任的性行为,Specific Groups特殊人群,Introducing STD/HIV risk assessment as part of detection and treatment services and establishing referral systems for STD laboratory diagnosis and treatment将STD/HIV风险评估作为检查和治疗的一部分, 为STD实验室诊断和治疗建立引荐系统 Promoting frequent visits to health services by people at risk of ac
27、quiring and transmitting STDs/HIV向易获得和传播STD/HIV的危险人群提倡经常去接受健康服务 Providing targeted education and service delivery activities for people at high risk对高危人群提供有针对性的教育和服务 Providing screening services to help prevent and treat maternal and congenital syphilis and neonatal blindness提供检测服务以帮助预防和治疗母性及遗传性的梅毒和
28、新生儿失明,How Managers to Do to Integrate Activities 管理者如何开展结合活动,Assessing the Operational Issues评估操作性问题 Operational similarities and differences between providing your existing services and STD/HIV activities在提供现有的服务和开展STD/HIV活动是操作的相似性和不同处 Service delivery settings you currently use and whether they ar
29、e appropriate for implementing STD/HIV activities现有服务场所对于开展STD/HIV是否合适,Assessing the Operational Issues 评估操作性问题,Reproductive health services you currently offer所提供的现有生殖健康服务 Range of STD/HIV services that might be appropriate for you to integrate into your existing services适合结合进现有服务的STD/HIV服务范围,How M
30、anagers to Do to Integrate Activities 管理者如何开展结合活动,Analyzing the Result of Your Strategic and Operational Assessments分析战略的和操作性的评估结果 Strengthening Management Systems强化管理系统 Assessing the Capacity of your Human Resources System评估人力资源系统的能力,How Managers to Do to Integrate Activities 管理者如何开展结合活动,Assessing
31、the Capacity of Your Logistics Systems评估后勤系统的能力 Assessing the Capacity of Your Management Informational System评估管理信息系统的能力 Assess other Management Areas评估其他管理领域,How Managers to Do to Integrate Activities 管理者如何开展结合活动,Future Opportunities and Strategies未来机会和战略,References 参考文献,Alison Ellis and Saul Helf
32、enbein. Integrating STD/HIV Services into Reproductive Health Settings, The Managers Electronic Resource Center, Management Science for Health Richard A Keenlyside. The Challenges for HIV/AIDS Prevention, Presented at the Centers for Disease Control and Prevention for the participants from International Health Management Course of Global Health Action, Atlanta, August 21, 2003,
