Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns.
Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns.
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DOI：
10.1371/journal.pmed.0030261
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发表时间：
2006-07
期刊：
影响因子：
15.8
通讯作者：
Iacopino V
中科院分区：
文献类型：
--
作者：
Weiser SD;Heisler M;Leiter K;Percy-de Korte F;Tlou S;DeMonner S;Phaladze N;Bangsberg DR;Iacopino V
博茨瓦纳政府最近实施了一项常规或“选择退出”艾滋病毒检测的政策，以应对艾滋病毒感染的高流行率（估计为37%的成年人）。我们对来自博茨瓦纳5个地区的1268名成年人进行了一项基于人群的横断面研究，以评估这项政策实施11个月后，他们对常规检测的知识和态度、HIV检测的相关性以及检测的障碍和促进因素。大多数参与者（81%）报告极其或非常支持常规检测。大多数人认为，这项政策将减少检测障碍（89%）、与艾滋病毒有关的污名（60%）和对妇女的暴力（55%），并将增加获得抗逆转录病毒治疗的机会（93%）。同时，43%的参与者认为常规检测会导致人们因害怕检测而避免去看医生，14%的人认为这项政策可能会增加与检测相关的性别暴力。自我报告的艾滋病毒检测流行率为48%。检测的调整相关因素包括女性（AOR = 1.5, 95% CI = 1.1-1.9）、高等教育（AOR = 2.0, 95% CI = 1.5 - 2.7）、更频繁的医疗保健访问（AOR = 1.9, 95% CI = 1.3-2.7）、感知到获得艾滋病毒检测（AOR = 1.6, 95% CI = 1.1-2.5）和不一致的安全套使用（AOR = 1.6, 95% CI = 1.2-2.1）。对艾滋病毒感染者和艾滋病患者持污名化态度的个体很少接受艾滋病毒/艾滋病检测（AOR = 0.7, 95% CI = 0.5-0.9）或听说过常规检测（AOR = 0.59, 95% CI = 0.45-0.76）。虽然自愿和常规检测总体上呈阳性，但68%的人认为他们无法拒绝艾滋病毒检测。进行检测的主要障碍包括害怕了解自己的感染状况（49%）、没有意识到艾滋病毒的风险（43%）以及害怕因艾滋病毒检测呈阳性而不得不改变性行为（33%）。常规检测似乎得到了广泛支持，并可能减少在博茨瓦纳进行检测的障碍。随着其他地方采用常规检测，应采取措施确保真正的知情同意和人权保障，包括保护妇女免受与艾滋病毒有关的歧视和保护妇女免受与检测有关的伴侣暴力。2005年，有500万人新感染人类免疫缺陷病毒（艾滋病毒），它引起的疾病——获得性免疫缺陷综合症（艾滋病）——造成300万人死亡。尽管抗艾滋病毒药物（抗逆转录病毒药物）的供应有所增加，但艾滋病疫情继续蔓延，特别是在撒哈拉以南非洲。为了阻止它，需要做更多的工作来防止艾滋病毒的传播。关于安全性行为的教育可以起到帮助作用——艾滋病毒最常见的传播途径是与受感染的伴侣发生无保护的性行为——但增加艾滋病毒检测是至关重要的。不幸的是，撒哈拉以南非洲地区接受自愿咨询和检测的人数低得令人担忧。害怕被污名化——社会上的耻辱——和歧视，对阳性结果本身的恐惧，以及对获得抗逆转录病毒药物的担忧，都使人们不愿接受检测。在博茨瓦纳，三分之一的成年人感染了艾滋病毒。自2002年以来，抗逆转录病毒药物一直是免费提供的，但博茨瓦纳国家治疗方案在头两年的注册速度很慢，部分原因是没有充分接受自愿艾滋病毒检测。因此，在2004年初，政府推行了一项常规艾滋病毒检测政策，所有病人在去看医生时都要接受艾滋病毒检测，除非他们选择不去。艾滋病规划署和世界卫生组织于2004年6月正式建议采用这种艾滋病毒检测方法，其主要目的是增加对艾滋病毒检测和治疗的接受程度，并像对待任何其他常规医疗程序一样对待艾滋病毒检测，从而减少与艾滋病毒有关的耻辱。然而，有人担心这项政策可能会适得其反——例如，人们可能不会去看医生，因为他们害怕接受检查，认为他们无法拒绝检查。在这项研究中，研究人员调查了博茨瓦纳常规检测的知识和态度，以更好地了解常规检测政策的后果。在这项政策实施11个月后，研究人员采访了博茨瓦纳各地的成年人，了解他们对常规艾滋病毒检测的知识和态度。只有一半的参与者在接受采访前听说过常规测试，但几乎所有人都赞成常规测试。超过一半的人认为这将减少与艾滋病毒有关的耻辱和对艾滋病毒阳性妇女的暴力行为。然而，几乎一半的人认为常规检查可能会阻止人们因为害怕检查而去看医生，少数人认为这项政策会增加对妇女的暴力行为。近一半的受访者进行了艾滋病毒检测，例如，研究人员发现，女性比男性更有可能接受检测，而对艾滋病毒感染者和艾滋病患者持污名化态度的人不太可能接受检测。由于害怕了解自己的艾滋病毒状况，缺乏对风险的认识，以及害怕在阳性情况下不得不改变性行为，这些都阻止了人们接受检测。最后，虽然测试的经历通常是积极的，但大约三分之二接受过测试的受访者认为很难拒绝测试。这些结果表明，博茨瓦纳普遍支持进行常规艾滋病毒检测，这一发现得到了最近接受治疗人数增加的支持。这组研究人员写道，在博茨瓦纳和其他地方，常规检测为预防和治疗艾滋病毒/艾滋病带来了重大希望。特别是，增加接受艾滋病毒检测的人数可能会减少与艾滋病毒有关的耻辱，这将进一步增加检测，并有望减缓艾滋病毒的传播。但这项研究的结果也强调了一些值得关注的领域。无论何时实施艾滋病毒检测政策，都必须通过以下方式保护人权：确保患者掌握对接受检测作出知情和自由决定所需的一切必要信息；保护妇女免受与艾滋病毒状况有关的暴力；确保完全保密。研究人员总结说，需要仔细监测博茨瓦纳的项目和类似的项目，以确保这些人权得到充分满足。请通过以下网址访问这些网站：http://dx.doi.org/10.1371/journal.pmed.0030261•美国国家过敏和传染病研究所关于艾滋病毒感染和艾滋病的情况介绍•美国卫生和人类服务部关于艾滋病的信息•美国疾病控制和预防中心关于艾滋病毒/艾滋病的信息•联合国艾滋病规划署和世界卫生组织2004年关于艾滋病毒检测的政策声明•AVERT，一个英国慈善机构，对博茨瓦纳5个地区的1268名成年人进行的一项以人口为基础的横断面研究表明，常规艾滋病毒检测似乎得到了广泛支持，并可能减少艾滋病毒检测的障碍。
The Botswana government recently implemented a policy of routine or “opt-out” HIV testing in response to the high prevalence of HIV infection, estimated at 37% of adults. We conducted a cross-sectional, population-based study of 1,268 adults from five districts in Botswana to assess knowledge of and attitudes toward routine testing, correlates of HIV testing, and barriers and facilitators to testing, 11 months after the introduction of this policy. Most participants (81%) reported being extremely or very much in favor of routine testing. The majority believed that this policy would decrease barriers to testing (89%), HIV-related stigma (60%), and violence toward women (55%), and would increase access to antiretroviral treatment (93%). At the same time, 43% of participants believed that routine testing would lead people to avoid going to the doctor for fear of testing, and 14% believed that this policy could increase gender-based violence related to testing. The prevalence of self-reported HIV testing was 48%. Adjusted correlates of testing included female gender (AOR = 1.5, 95% CI = 1.1–1.9), higher education (AOR = 2.0, 95% CI = 1.5–2.7), more frequent healthcare visits (AOR = 1.9, 95% CI = 1.3–2.7), perceived access to HIV testing (AOR = 1.6, 95% CI = 1.1–2.5), and inconsistent condom use (AOR = 1.6, 95% CI = 1.2–2.1). Individuals with stigmatizing attitudes toward people living with HIV and AIDS were less likely to have been tested for HIV/AIDS (AOR = 0.7, 95% CI = 0.5–0.9) or to have heard of routine testing (AOR = 0.59, 95% CI = 0.45–0.76). While experiences with voluntary and routine testing overall were positive, 68% felt that they could not refuse the HIV test. Key barriers to testing included fear of learning one's status (49%), lack of perceived HIV risk (43%), and fear of having to change sexual practices with a positive HIV test (33%). Routine testing appears to be widely supported and may reduce barriers to testing in Botswana. As routine testing is adopted elsewhere, measures should be implemented to assure true informed consent and human rights safeguards, including protection from HIV-related discrimination and protection of women against partner violence related to testing. In 2005, there were 5 million new infections with the human immunodeficiency virus (HIV), and the disease it causes—acquired immunodeficiency syndrome (AIDS)—killed three million people. Despite the increased availability of drugs that can fight HIV (antiretrovirals), the AIDS epidemic continues to grow, particularly in sub-Saharan Africa. To halt it, more needs to be done to prevent the spread of HIV. Education about safe sex can help—HIV is most commonly spread through unprotected sex with an infected partner—but increasing HIV testing is of paramount importance. Unfortunately, the uptake of voluntary counseling and testing in sub-Saharan Africa is worryingly low. Fear of being stigmatized—socially disgraced—and discriminated against, fears about the positive result itself, and worries about access to antiretroviral drugs are all putting people off being tested. In Botswana, one in three adults is infected with HIV. Since 2002, antiretroviral drugs have been freely available but enrollment in the Botswana National Treatment Program during its first two years was slow, in part due to inadequate uptake of voluntary HIV testing. Consequently, in early 2004, the government introduced a policy of routine HIV testing in which all patients are tested for HIV when they visit their doctor unless they opt out. A major aim of this approach to HIV testing, which was formally recommended in June 2004 by UNAIDS and the World Health Organization, is to increase uptake of HIV testing and treatment, and to reduce HIV-related stigma by treating the HIV test like any other routine medical procedure. However, there are fears that the policy could back-fire—people might not visit their doctors, for example, because they are afraid of being tested and think that they will not be able to refuse the test. In this study, the researchers investigated knowledge of and attitudes to routine testing in Botswana to understand better the consequences of a routine testing policy. The researchers interviewed adults throughout Botswana about their knowledge of and attitudes to routine HIV testing 11 months after introduction of the policy. Only half of the participants had heard of routine testing before being interviewed but nearly all were in favor of routine testing. More than half thought it would reduce HIV-related stigma and the violence toward women that is associated with an HIV-positive status. However, almost half believed that routine testing might prevent people from going to the doctor because of fear of testing and a few thought the policy would increase violence against women. Nearly half of the interviewees had had an HIV test and the researchers found, for example, that women were more likely to have been tested than men and that people with stigmatizing attitudes toward people living with HIV and AIDS were less likely to be tested. Fear of learning one's HIV status, lack of perceived risk, and fear of having to change sexual practices if positive all stopped people taking the test. Finally, although experiences with testing were generally positive, approximately two-thirds of interviewees who had been tested felt that it would have been difficult to refuse the test. These results show that there is widespread support for routine HIV testing in Botswana, a finding supported by recent increases in treatment uptake. Routine testing, write the researchers, holds significant promise for the prevention and treatment of HIV/AIDS in Botswana and elsewhere. In particular, increasing the number of people tested for HIV may reduce HIV-related stigma, which should further increase testing and hopefully slow the spread of HIV. But the results of this study also highlight some areas of concern. Whenever HIV testing policies are implemented, human rights must be protected by ensuring that patients have all the information necessary to make an informed and free decision about being tested, by providing protection for women against violence related to HIV status, and by ensuring total confidentiality. Careful monitoring of Botswana's program and similar programs will be needed to ensure that these human rights are fully met, conclude the researchers. Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030261 • US National Institute of Allergy and Infectious Diseases factsheet on HIV infection and AIDS • US Department of Health and Human Services information on AIDS • US Centers for Disease Control and Prevention information on HIV/AIDS • UNAIDS and World Health Organization 2004 policy statement on HIV testing • AVERT, a UK-based charity, provides information about HIV and AIDS in Botswana A cross-sectional, population-based study of 1,268 adults from five districts in Botswana showed that routine HIV testing appears to be widely supported and may reduce barriers to HIV testing.
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影响因子：
3.6
作者：
Kalichman, SC;Simbayi, LC
通讯作者：
Simbayi, LC
DOI：
10.1080/0954012030001595140
发表时间：
2003-10-01
影响因子：
1.7
作者：
Day, JH;Miyamura, K;Churchyard, GJ
通讯作者：
Churchyard, GJ
影响因子：
3.7
作者：
Heywood, M J
通讯作者：
Heywood, M J
影响因子：
3.7
作者：
Kenyon, Kristi
通讯作者：
Kenyon, Kristi
影响因子：
120.7
作者：
Kamb, ML;Fishbein, M;Peterman, TA
通讯作者：
Peterman, TA