要把艾滋病当作慢性病治疗
|
|
| |
| |
| http://www.youth.cn 2010-10-11 10:20:00 中国青年网 |
| |
|
艾滋病防治工作需要从非常态、非常规的特殊体制转入常态化、常规化，融入现行社会体制。这是中国社会科学院社会政策研究中心日前完成的研究报告《中国艾滋病防治相关政策分析》提出的主要观点。细说艾滋病是如何传播的
这份报告是研究者深入云南、四川、河南和北京等地调研后形成的，其中，云南和四川是毒品传播特别是少数民族地区毒品传播的代表，河南是血液传播的代表，而北京则是正日趋增多的男男性行为传播的代表地。艾滋病人群日益“特殊化”
报告的主撰写人、社会政策研究中心副主任杨团研究员日前在接受中国青年报记者采访时表示，现行艾滋病防治模式已经带来若干问题，突出表现就是艾滋病及受影响人群日益“特殊化”，这成为我国艾滋病防治可持续发展的重大制约瓶颈。
报告解释说，所谓“特殊化”，是指针对艾滋病病种及受影响人群，从上到下建立了专门的管理机构，指定专门的医疗单位，配备专门的医务人员，出台专门的关怀救助政策，从预防干预、医疗救治到救助帮扶，自成体系。例如研究人员在河南的调查发现，艾滋病重点村普遍设有两个卫生所，一是专门针对艾滋病病毒感染者和艾滋病病人的，一是主要服务于普通村民常规疾病的。两者可谓职责清晰、对象分明。报告分析认为，把艾滋病及受影响人群日益“特殊化”，排除在现行社会体制之外，其危害至少有三：
第一，偏离现有防治体系，资源配置效率降低。过分突出艾滋病的特殊性，反而导致艾滋病的慢性传染病属性越来越淡化，防治工作的政治属性越来越强化。而且，还会导致地方政f投入越来越少，完全依赖国际合作项目和中央转移支付，资源配置和防治需求严重脱节。其结果是，艾滋病防治人力、物力、财力越来越受限，有限的资源被大量消耗在多部门协调和低效率的专项工作上。
第二，形成不正常的“特权阶层”。与普通传染病病人相比，由于宣传方式特殊、看病场所特殊、救助待遇特殊，久而久之，艾滋病患者和医务人员都会形成一种与常人不一样的感觉。具体而言，艾滋病患者认为自己不同于普通病人，政f应给我免费药物，直接纳入最低生活保障，帮我恢复生产生活秩序。艾滋病医生也觉得自己与其他医生不一样，我是救治艾滋病病人的，政f得保证我不出事，还得给我发奖金。
第三，不利于引导一部分艾滋病患者改变报复社会的危险行为。艾滋病的性传播方式主要通过个人行为，难以用强迫的方式控制。要减少一部分艾滋病患者的有意性传播，必须改变将艾滋病易感人群陷于危险境地的文化、价值和做法。艾滋病防治“特殊化”的做法，破坏了整个人群对艾滋病防治的理解和广泛提高认识，感染者和易感人群之外的绝大多数人并不认为特殊政策与自己有关，由此导致的对艾滋病患者的社会歧视和社会排斥效果与早期将艾滋病污名化相去不远。因为，当普通人自发、自觉地与艾滋病人划清界限、将其边缘化时，艾滋病易感人群就陷入被大众社会抛弃的危险境地。艾滋病防治可纳入现有的医疗和保险体系
报告提出艾滋病防治常态化的主要思路是：将艾滋病防治工作融入现行社会体制，在医疗卫生、社会保障、残疾人服务等现行公共服务体系中进行同步规划、同步实施，实现常态化运行、常规化管理。
报告认为，艾滋病是慢性传染病，因此，抵御艾滋病既需要医疗体系，又需要公共卫生预防体系。将艾滋病防治融入医疗卫生体系，不仅有利于艾滋病病人的治疗，而且有利于易感人群的早预防、早发现、早治疗。
其次，艾滋病感染者和艾滋病病人属于社会弱势群体，比一般人群更需要得到社会保障制度的支持和来自社区和家庭的关爱。而这些制度采取的都是普惠制，并非只针对某一群体。因此，艾滋病感染者和艾滋病病人能以很低的个体成本利用这些普惠的政策和制度，用这些制度解决就业、养老、医疗、康复、入学等问题。
2005年，世界卫生组织已经将艾滋病正式列为残疾的一种。报告认为，我国应尽快将艾滋病病毒感染者和艾滋病病人按照慢性病患者纳入残疾、损伤与康复的关注范畴。少数民族地区艾滋病防治任重道远
报告研究者2007年和2008年多次在四川凉山彝族自治州、云南德宏傣族景颇族州进行深入的实地调研，这两地也正是两省乃至全国受毒品和艾滋病危害的重灾区。以云南德宏州为例，2004年年底全州有吸毒人员25285名，占全州总人口的2.41%，占当年全省吸毒人员的37.1%，占当年全国吸毒人员的3.2%;累计检测出艾滋病病毒感染者8124例。经过3年禁毒防艾人民战争的努力，吸毒人员年均新滋生率连续控制在1%以下，现有吸毒人员从2004年的25285名减少到2007年的15314名,3年减少近万人。
但报告也提醒，凉山、德宏等毒品危害严重地区多紧临境外毒源地，受毒品和艾滋病的危害时间长、程度深，吸毒人员基数大(如凉山、德宏两州现有吸毒人员都在1.5万人以上，累计检测出的艾滋病病毒感染者均超过8000例)，再加上海洛因成瘾者戒断易、巩固难(吸毒人员戒毒后复吸率可高达70%~90%)，禁毒防艾工作经费严重不足、使用效率总体不高等因素影响，禁毒防艾斗争形势不容乐观。报告特别强调，其中最不容乐观的是，民族地区青少年已成为当地受毒品和艾滋病危害最严重的群体，在现有吸毒人员中有超过一半是20岁以下的青少年，这其中又有大约一半是艾滋病病毒感染者。报告认为，他们是制约禁毒防艾工作引向深入的重大瓶颈。
杨团表示，“艾滋病流行严重的少数民族地区，由于早婚、再婚和跨国婚姻现象普遍，经由婚内性传播蔓延艾滋病的社会结构风险尚未引起足够的重视。”
|
China Youth Net http://www.youth.cn 2010-10-11 10:20:00
AIDS needs from the very state system into unconventional special normalization, normalization, integration into the existing social system. This is the Chinese Academy of Social Policy Research Center recently completed a research report "China's AIDS-related policy analysis," the main points raised. Elaborate on how the spread of AIDS
The report is thorough researcher of Yunnan, Sichuan, Henan and Beijing formed after the investigation, in which the drug spread of Yunnan and Sichuan in particular the spread of drugs on behalf of minority areas, the spread of blood on behalf of Henan, and Beijing is being growing number of representatives of MSM to spread. The growing population of AIDS, "specialization"
The main author of the report, Social Policy Research Centre researcher Yang Tuan, deputy director of China Youth Daily recently in an interview that the AIDS model has brought the current number of issues, the most prominent AIDS and affected people is increasing "specialization" This became the sustainable development of China's AIDS prevention a major bottleneck.
Report explained that the so-called "specialization" refers to diseases and for AIDS affected people, from top to bottom to establish a special governing body, appoint a special medical unit, equipped with specialized medical personnel, the introduction of specialized care assistance policies from preventive interventions, medical treatment to help rescue, self-contained. For example, researchers found that in Henan AIDS village generally has two health centers focus on, one specifically for HIV-infected people and AIDS patients, the first major service in the ordinary villagers conventional diseases. Both functions can be described as clear, distinct objects. The report analyzes that the affected people of AIDS and increasing "specialization", out of the existing social system, in addition, the harm at least three:
First, the deviation from the existing control system, resource allocation efficiency. Undue prominence to the special nature of AIDS, but that causes AIDS, chronic diseases property more diluted, more prevention work to strengthen the political attributes. And, also lead to less investment in local government f, entirely dependent on international cooperation projects and the central transfer payments, resource allocation and control needs of seriously out of line. As a result, AIDS prevention and control of human, material and financial resources become increasingly limited by large consumption of limited resources and low efficiency in the multi-sectoral coordination of special work.
Secondly, the formation of abnormal "privileged class." Compared to patients with common diseases, due to the special form of publicity, a doctor places a special, special treatment to help the passage of time, AIDS patients and medical personnel and ordinary people will form a different feeling. In particular, consider themselves different from ordinary people living with AIDS patients, political f should give me free drugs, directly into the minimum living allowance, help me to restore production and life. AIDS doctors and other doctors do not feel like I treat AIDS patients, the government must ensure that I am not crash f, have to give me a bonus.
Third, is not conducive to change the boot part of the AIDS risk behaviors revenge on society. The main mode of sexual transmission of AIDS through individual behavior is difficult to control the use of coercion. To reduce the number of intentional sexual transmission of AIDS patients, susceptible to change will be caught in a dangerous situation of AIDS in the culture, values and practices. AIDS "specialization" approach, undermining the entire population's understanding of AIDS and widespread awareness, outside of infected and susceptible population the vast majority of people do not think that the special policy in relation to himself on the resulting AIDS effects of social discrimination and social exclusion and stigmatization of AIDS in early order of magnitude. Because, when ordinary people spontaneously, consciously draw a line of people with AIDS, their marginalization, the AIDS susceptible to fall into abandoned by the public social danger. AIDS can be incorporated into existing medical and insurance system
AIDS report the main idea of normalization is: AIDS into the existing social system, in health care, social security, disabled services, existing public service system for synchronized planning, implementing, achieving normalization operation, the conventional management.
Report argues that AIDS is a chronic infectious disease, therefore, requires not only the health care system against AIDS, but also in need of public health prevention system. AIDS into the health system, not only conducive to the treatment of AIDS patients, but also conducive to the early susceptible prevention, early detection and early treatment.
Secondly, people living with HIV and AIDS patients are vulnerable in the society is more need than the general population and support the social security system from the community and family care. These are taken to the GSP system, not only for certain groups. Thus, HIV-infected persons and AIDS patients can use a low cost of individual policies and systems Pratt & Whitney, with these systems to solve the employment, pension, medical care, rehabilitation, school and other issues.
In 2005, the World Health Organization has officially classified as AIDS as a disability. The report holds that China should, as soon as HIV and AIDS patients with chronic diseases included in accordance with disability, injury and rehabilitation of areas of concern. Minority AIDS long way to go
The researchers reported several times in 2007 and 2008, Liangshan Yi Autonomous Prefecture in Sichuan, Yunnan Dehong State-depth field research, both in the two provinces and the country is also subject to hazards of drugs and AIDS-stricken area. Dehong Prefecture, Yunnan, for example, the end of 2004 the state has 25,285 drug addicts, accounting for 2.41% of the total population states, accounting for 37.1% of drug users in the province, accounting for 3.2% of drug users in the country; total detected 8124 cases of HIV infection. After 3 years of anti-drug AIDS prevention efforts of the people's war, a new breeding ground for drug addicts average annual rate of 1% or less continuous control, the existing drug users in 2004 from 25,285 down to 15,314 in 2007, a decrease of nearly ten thousand people 3.
But the report also warns that Liangshan, Dehong and other multi-drug-infested areas close to the source of foreign drugs by the harm of drugs and AIDS a long time, degree of depth, a large base of drug users (such as the Liangshan, the two states existing drug addicts Dehong more than 1.5 million people in the cumulative detection of HIV infection caught more than 8000 cases), together with heroin addiction withdrawal easy to consolidate the hard (relapse rate after detoxification of drug addicts can be as high as 70% to 90%) , a serious shortage of anti-drug funding for AIDS prevention work, not high overall efficiency in the use of factors, anti-drug fight AIDS prevention situation is not optimistic. The report particularly stressed the most is not optimistic that the nation has become a local youngster by drugs and AIDS of the most affected groups, in the current drug users, more than half of young people under 20 years old, of which there are about half of HIV infection. Report that they are restricting the work of deepening the anti-drug AIDS prevention a major bottleneck.
Yang Tuan, said, "AIDS epidemic in minority areas, due to early marriage, remarriage, and cross-border marriages in general, through the spread of sexually transmitted within marriage the social structure of the risk of AIDS has not yet attracted enough attention."
|
|
