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拯救彝寨下一代--阻断艾滋病母婴传播的凉山之战
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| 2011年04月29日 21:00:51 来源： 新华网 |
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新华网成都４月２９日电（记者白旭 余里）按当地习俗，８岁的彝族男孩阿根日土（化名）１０年后才满１８岁，那时他就可以结婚了。“到时候我会亲手给他盖新房，”他的父亲、３４岁的阿根有黑说。这个消瘦黧黑的男人平时沉默寡言，但儿子婚事这个话题显然让他兴奋起来。
但是，阿根日土和阿根有黑都是艾滋病感染者，其中父亲已在发病期。没人知道，这父子俩对１０年后那个“大日子”的憧憬能否成为现实。
地处四川省西南部的凉山彝族自治州总人口４７３万。州府所在地西昌是中国的航天基地之一，２００７年曾发射过嫦娥一号卫星。然而，凉山还以艾滋病流行闻名。至去年底，凉山累计报告艾滋病感染者２１５６５例。
阿根有黑的家在四川凉山彝族自治州布拖县木尔乡一条小溪边。院子里，在弥漫牲畜粪便的气味中，阿根日土和５岁的弟弟正分吃一个凉馒头，而阿根有黑又怀孕５个月的妻子坐在凳子上缝衣服。
“我是２００８年筛查时发现感染艾滋病的，”阿根有黑说。他的故事和很多当地彝族青年一样：外出打工，吸食毒品，然后染上艾滋病。他的妻子和大儿子也都成了感染者。还好，他的二儿子是健康的。“再有一个孩子的话，应该也没事”。
四川省疾控中心副主任杨文说，吸毒是艾滋病在凉山的主要传播途径。
根据中国的人口政策，凉山的彝族群众一家可生三个孩子，很多人都会用完三个指标，即使他们知道自己已感染艾滋病。
“他们对这种病的严重性还不够了解，”杨文说。
以阿根有黑为例，他说知道这种病很厉害，“但我觉得自己身体还挺好的。”他对大儿子的身体也有信心，去年还花３万块钱给儿子定了亲。他家年收入只有两三千元。
另外，彝族人很看重子嗣，“没有孩子会被看不起，”布拖县妇幼保健院院长胡迎秋说。
保健院曾试图说服艾滋病阳性孕妇放弃生孩子。这些准妈妈们不但拒绝了，后来还躲着大夫，生怕孩子被打掉。
因此，当地艾滋病母婴传播率一路攀升。２００８年，凉山州艾滋病母婴传播率为０．２％，２００９年升至０．５％，２０１０年则为１％。
卫生部疾控局副局长郝阳认为，母婴传播是艾滋病三种传播途径中最残酷的。“孩子刚来到这个世界上，就已成为感染者，”他说。这种现象目前在中国的新疆、云南和四川仍然很常见。
“艾滋病母婴传播可从怀孕期、生产时和哺乳期三个阶段进行阻断，”中国疾控中心妇幼保健中心副主任王临虹说。
首先，村医生要说服阳性孕妇从怀孕１４周开始服用抗病毒药物来降低血液中的病毒载量。其次，孕妇最好选择住院分娩以避免生产过程中的感染。最后，新生儿要选择人工喂养，因为母乳喂养也有可能传播艾滋病毒。
“一般情况下，母婴传播几率是３３％到３５％，而这三种方式把几率降到了目前的８％，”王临虹说，“如果控制得当，这个几率还可能降到２％。”
很多民间组织加入到凉山降低母婴传播感染率的努力中，全国工商联下属红丝带基金即是其中之一。
由中国数十家民营企业资助的这个基金会，２０１０年以来为凉山的阳性孕产妇提供了近万筒免费奶粉。
母婴阻断的另一个困难是当地妇女不愿住院分娩。
“按照习俗，她们在临产前一个多月就不见生人了，不然她们认为生出来的孩子会身体不好，”胡迎秋说。
在布拖，住院分娩率不到２０％，情况较好的昭觉住院分娩率也不过３０％。
当地政府承诺给到医院生孩子的孕产妇几百元的补助，而红丝带基金今年也将给孕产妇发放８００个待产包，其中包括婴儿衣服、奶瓶、纸尿裤、枕头等物品。
在当地政府与各种社会组织的努力下，很多阳性孕产妇生下了健康的宝宝，比如昭觉县四开乡３２岁的阿堵阿牛。她的两个孩子全是健康的，她的丈夫也是艾滋病感染者。
但是，并非所有母亲都有阿堵阿牛那么幸运。由于医生和卫生院短缺，很多妇女无从了解母婴阻断的重要性及操作方式。
当地糟糕的路况也是个问题。很多村子到中心卫生院没有公路，因此要走上好几个小时。“不少产妇快生了才上车往卫生院赶，还没有到，孩子就生下来了，”胡迎秋说。
即使孩子顺利产下，接下来的喂养问题还是让人头疼。
“虽然阳性孕产妇可以得到免费奶粉，但４个月后孩子该添加辅食了怎么办？他们买不起鸡蛋，而孩子光奶粉吃不饱，”胡迎秋说。
事实上，即使阿堵阿牛这样的幸运母亲也有苦恼。
她家阴暗的土坯房里，只有一张床和两个破旧的木头碗柜。她的丈夫披着蓝色察尔瓦，拄着拐杖靠墙站立——他的腿是在外出打工时摔断的。
被问及将怎么养活几个孩子时，阿堵阿牛沉默了。“现在会有亲戚邻居帮忙。将来……（如果父母去世），他们也就长大了，可以照顾自己了……”她低声说。
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艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2010年12月即将出版的《中国特色医疗金鉴》登载的刘君主任及其机构 |
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Save the next generation of Yi Village - blocking the spread of HIV mother to child war Liangshan
April 29 2011 21:00:51 Source: Xinhua
CHENGDU April 29 (Xinhua Bai Xu Yu Lane) according to local customs, 8-year-old boy, the Yi Argentina at soil (a pseudonym) 10 years after the age of 18, when he can get married. "At that time I will personally give him a new house," his father, a black 34-year-old Agen said. The thin swarthy men usually quiet, but apparently the son of the marriage the subject excites him up.
However, Argentina, and Argentina on the black soil is AIDS, which the father has been in the onset period. No one knows that this father and son for 10 years after the "big day" for the vision can become reality.
Located in the southwestern Sichuan Province, Liangshan Yi Autonomous Prefecture of the total population of 4.73 million. Xichang is the state capital where one of China's space base in 2007, was fired Chang'e satellite. However, the AIDS epidemic is also known in Liangshan. To the end, Liangshan cumulative 21,565 cases of AIDS reported.
Argentina home black Liangshan Yi Autonomous Prefecture in Sichuan Butuo County Moore Township, a small stream. Yard, the smell of animal waste in the diffuse in Argentina on earth and 5 year old brother is a cool sub-eat bread, and Argentina are black and 5 months pregnant wife sitting on the bench, sewing.
"I found the 2008 screening of HIV infection," Agen said black. His story and, like many local youth Yi: migrant workers, drug abuse, and then infected with AIDS. His wife and son have also become infected. Fortunately, his second son is healthy. "And then have a child, it should also be fine."
Yang, deputy director of Sichuan Provincial Center for Disease Control, said drug use is the main HIV transmission routes in Liangshan.
According to China's population policy, the Yi people in Liangshan, a child can have three, many people will run out of three indicators, even if they know they are infected with AIDS.
"They are the seriousness of this disease is not enough to understand," Yang said.
Black case with Argentina, he said, know that this disease is very severe, "but I feel pretty good physically." He has great confidence in his son's body last year, also spent 30,000 dollars to his son set the pro- . His family income of just two or three thousand dollars.
In addition, the Yi people are valued heirs, "no child will be looked down upon," President Hu Yingqiu Butuo County MCH said.
Care homes have to give up trying to convince children of HIV-positive pregnant women. These mothers who not only refused, and later still dodging the doctors for fear of the child to be destroyed.
Therefore, the local rate of mother to child transmission of AIDS all the way up. In 2008, the Liangshan Prefecture of MTCT of HIV was 0.2% in 2009 to 0.5% in 2010 compared to 1%.
Ministry of Health, Hao Yang, deputy director of Disease Control Bureau that the three types of mother to child transmission of AIDS transmission is the most cruel. "The children just came to this world, had become infected," he said. This phenomenon is present in China, Xinjiang, Yunnan and Sichuan is still very common.
"AIDS from mother to child transmission during pregnancy, birth and breast-feeding block in three phases," deputy director of China Center for Disease Control Maternal and Child Health Pro Hong Wang said.
First, the village doctors to convince positive pregnant women 14 weeks of pregnancy to start taking antiviral drugs to reduce the viral load in the blood. Second, the best choice for pregnant women to avoid the production of hospital deliveries in the process of infection. Finally, newborn to choose artificial feeding, because breastfeeding also can transmit the AIDS virus.
"Under normal circumstances, mother to child transmission probability is 33% to 35%, which dropped three ways to present risk of 8%" Wang Linhong said, "If properly controlled, this may also be reduced to 2% chance."
Many civil society organizations to reduce mother to child transmission rate of infection in Liangshan efforts, the National Federation of the Red Ribbon Foundation is under one of them.
Dozens of private enterprises by the Chinese funded the foundation since 2010, the Liangshan positive pregnant women free milk provides nearly ten thousand barrel.
PMTCT Another difficulty is that local women do not want to hospital delivery.
"According to custom, they are not seen prior to delivery to a stranger more than a month, or else they think kids will be born in poor health," Hu Yingqiu said.
In Butuo, hospital delivery rate of less than 20%, the situation is better Zhaojue hospital delivery rate was only 30%.
The local government promised to give a baby to the hospital a few hundred dollars of subsidies maternal, and Red Ribbon Foundation grant this year of 800 pregnant women will be produced package, including baby clothes, baby bottles, diapers, pillows and other items.
The local government and the efforts of various social organizations, many positive pregnant women gave birth to a healthy baby, such as four open Zhaojue County 32-year-old Arab village bull block. Her two children are all healthy, her husband is also HIV infected.
However, not all mothers have the A block bull so lucky. As the shortage of doctors and hospitals, many women unable to understand the importance of PMTCT and the mode of operation.
Local poor road conditions is also a problem. Many hospitals no roads to the center village, so go for hours. "A lot of mothers born before the car quickly to hospitals in time, not that the child born," Hu Yingqiu said.
Even if the child birth to the next feeding problem or a headache.
"Although positive pregnant women can get free milk, but 4 months after the child how to do the complementary feeding? They can not afford eggs and milk light enough to eat children," Hu Yingqiu said.
In fact, even blocking the bull so lucky A mother has distress.
Adobe house her house dark, and only one bed and two old wooden cupboards. Cha Erwa her husband, dressed in blue, standing on crutches against the wall - his leg was broken when the migrant workers.
When asked to how many children to feed, the Arab block bull silent. "Now there will be relatives and neighbors to help. In the future ... ... (if the parents died), they will grow up, you can take care of himself ... ..." she whispered.
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