Sexually Transmitted Infection Epidemiology and Care in Rural Areas: A Narrative Review.
Sexually Transmitted Infection Epidemiology and Care in Rural Areas: A Narrative Review.
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DOI：
10.1097/olq.0000000000001512
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发表时间：
2021-12-01
影响因子：
3.1
通讯作者：
Pearson WS
中科院分区：
文献类型：
--
作者：
Jenkins WD;Williams LD;Pearson WS
尽管农村地区约占美国人口的19%，但很少有研究探索性传播感染(STI)的风险，以及城市开发的干预措施如何适用于人口更稀少的地区。虽然不同农村地区的性病感染率不同，但这些地区获得筛查的机会越来越少，针对农村的性病干预检测也很有限。这篇叙述性综述利用了卫生的政治生态学模型，并探索了影响STI风险和筛查的四个领域：流行病学；卫生服务；政治和经济；以及社会。通过对PubMed的搜索，可以找到描述农村性传播感染流行病学、筛查、获取和使用以及这些领域内干预效用的文章。流行病学通过多种手段增加风险，例如风险增加的人群的存在以及阿片类药物/药物使用流行有时产生的不成比例的影响。农村卫生服务的数量正在减少，往往不太容易获得，而且可能使那些需要服务的人蒙羞。当地的政治和经济影响包括资金决定、法律/法规的可变执行以及对减少伤害服务的系统预防。社会规范，如耻辱和歧视，可以阻止个人寻求适当的护理，并降低个人的自我效能，以降低个人风险。农村地区的性传播感染范围很大，面临着预防机会和资源的减少。虽然已经制定和试行了许多性传播感染干预措施，但很少有措施在农村地区进行规模化测试或付诸实施。通过在整体模式中考虑降低农村性传播感染风险，可以探索针对农村环境的干预措施。农村地区的性传播感染风险往往增加，但不应期望城市开发的干预措施在农村地区同样有效，需要制定和测试替代办法。
Though rural areas contain approximately 19% of the US population, little research has explored sexually transmitted infection (STI) risk and how urban-developed interventions may be suitable in more population-thin areas. While STI rates vary across rural areas, these areas share diminishing access to screening and limited rural-specific testing of STI interventions. This narrative review utilizes a political ecology model of health, and explores four domains influencing STI risk and screening: epidemiology; health services; political and economic; and social. Articles describing aspects of rural STI epidemiology, screening access and use, and intervention utility within these domains were found by a search of PubMed. Epidemiology contributes to risk via multiple means, such as the presence of increased-risk populations and the at-times disproportionate impact of the opioid /drug use epidemic. Rural health services are diminishing in quantity, often have lesser accessibility, and may be stigmatizing to those needing services. Local political and economic influences include funding decisions, variable enforcement of laws/statutes, and systemic prevention of harm reduction services. Social norms such as stigma and discrimination can prevent individuals from seeking appropriate care, and also lessen individual self-efficacy to reduce personal risk. STI in rural areas is significant in scope, and facing diminished prevention opportunities and resources. While many STI interventions have been developed and piloted, few have been tested to scale or operationalized in rural areas. By considering rural STI risk reduction within a holistic model, purposeful exploration of interventions tailored to rural environments may be explored. Rural areas often experience increased STI risk, but urban-developed interventions should not be expected to be equally effective in rural areas, and alternatives need to be devised and tested.