Managing uncertainty around HIV/AIDS in an urban setting: Private medical providers and their patients in Pune, India
Managing uncertainty around HIV/AIDS in an urban setting: Private medical providers and their patients in Pune, India
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DOI：
10.1016/j.socscimed.2005.02.008
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发表时间：
2005-10-01
影响因子：
5.4
通讯作者：
Rangan, S
中科院分区：
文献类型：
--
作者：
Kielmann, K;Deshmukh, D;Rangan, S
不断变化的流行病学模式以及新的快速诊断技术和疗法的出现，给从事艾滋病毒工作的提供者带来了相当大的不确定性。在印度，对艾滋病毒护理的需求越来越多地由私人医生（PP）来满足，但人们对他们如何应对管理艾滋病毒患者的挑战知之甚少。为了探讨私营医疗部门的艾滋病毒管理做法，在印度浦那进行了一项调查，215个PP，然后进行深入访谈，重点是在一个子集的27个PP之间的做法的社会背景。本文主要利用访谈数据，说明了一些不确定性，在竞争激烈的医疗市场中，供应商的报告行动的基础。PP将艾滋病毒视为一种“新的”和具有挑战性的疾病，他们缺乏足够的知识和技能。再加上人们认为抗逆转录病毒治疗费用高、复杂，对艾滋病毒患者的社会、经济和心理能力的成见导致了高度个人化的管理做法。虽然这些没有达到临床“最佳实践”指南，但它们反映了对印度城市艾滋病毒护理更广泛的不确定性的适应性反应。通过强调PPs管理HIV患者的背景问题，本文建议需要明确承认临床环境之外的不确定性的社会，道德和经济基础。(c)2005爱思唯尔有限公司保留所有权利。
Changing epidemiological patterns and the advent of new rapid diagnostic technologies and therapies have created considerable uncertainty for providers working in HIV. In India, the demand for HIV care is increasingly being met by private practitioners (PPs), yet little is known about how they deal with the challenges of managing HIV patients. To explore HIV management practices in the private medical sector, a survey was conducted with 215 PPs in Pune, India, followed by in-depth interviews focusing on the social context of practice among a sub-set of 27 PPs. Drawing primarily on interview data, this paper illustrates a number of uncertainties that underlie the reported actions of providers in a competitive medical market. PPs perceive HIV as a 'new' and challenging disease for which they lack adequate knowledge and skills. Combined with the perceived high cost and complexity of antiretroviral treatment, preconceptions about HIV patients' social, financial and mental capacity lead to highly individualistic management practices. While these fall short of clinical 'best practice' guidelines, they reflect adaptive responses to the wider uncertainties surrounding HIV care in urban India. By highlighting contextual issues in PPs' management of HIV patients, the paper suggests the need to explicitly acknowledge the social, moral and economic bases of uncertainty beyond the clinical setting. (c) 2005 Elsevier Ltd. All rights reserved.