【摘要】：背景 雖然,近年來我國艾滋病預防控制工作取得了一些進展,但由于目前艾滋病傳播蔓延的危險因素仍廣泛存在,給艾滋病預防控制工作帶來了很大的困難。其中一個很重要的危險因素就是城鄉(xiāng)流動人口的不斷增加,艾滋病患者中流動人口的高比例,流動人口的高流動性,為艾滋病的傳播提供了機會。 在城市流動人口中,建筑工地民工是一個重要的、有自身特點的組成部分。該人群人口基數(shù)大、流動性強,男性占絕大多數(shù),大部分處于青壯年,長期生活在單一性別人群中,處于城市生活邊緣,加之遠離家庭,法制觀念淡薄,性病艾滋病的知識缺乏,已經(jīng)成為我國艾滋病感染流行的主要危險因素之一。而目前在城市郊區(qū)有針對性的在建筑工人中開展艾滋病防治相關研究較少。因此,研究建筑工人艾滋病性病的預防、關懷和支持,可以了解該人群的行為學特征和感染現(xiàn)狀,采取有效的綜合干預模式,提高建筑工人的艾滋病防病知識和安全套的使用率,減少艾滋病的高危行為,對預防艾滋病傳播起到很重要的作用。 研究目標 1、了解南匯地區(qū)建筑工人有關HIV和STI的知識、態(tài)度及危險行為的現(xiàn)狀； 2、評估H1V和STI的流行情況和影響因素; 3、在現(xiàn)有資料和基線調(diào)查數(shù)據(jù)基礎上,改進并執(zhí)行預防干預計劃； 4、評估干預計劃的效果。 研究內(nèi)容與方法 該研究分為兩部分。 第一部分是HIV和STI知識、態(tài)度、衛(wèi)生服務、危險行為以及影響因素的調(diào)查。該部分分三次進行,即第0個月為基線調(diào)查,第3和第6個月分別進行一次隨訪調(diào)查�；�調(diào)查時所有參與者將完成基線問卷調(diào)查,并提供血尿標本。血樣將用于檢測HTV、皰疹病毒II型和梅毒。尿樣將用于檢測衣原體和淋病。第3個月時進行第一次隨訪調(diào)查；第6個月時進行第二次隨訪調(diào)查。 第二部分是執(zhí)行和評估行為干預計劃。在基線調(diào)查結(jié)束時開展行為干預計劃,分三種不同類型,低干預組發(fā)放宣傳小冊子；中干預組同時張貼宣傳海報、展板及播放宣教DVD；高干預組除此以外還開展面對面訪談。在第3和第6個月隨訪時評估其短期和遠期干預效果。三個干預計劃的干預點將在6個工地中隨機抽取。 研究結(jié)果 1、基線調(diào)查結(jié)果 (1)建筑工地是浦東南匯地區(qū)流動人口高度聚集的場所,在此次調(diào)查的657名建筑工人中,以中青年為主,大多數(shù)年齡處于性活躍期,平均年齡38.9±10.1歲；性別構(gòu)成以男性為主占90.4%；文化程度普遍處于較低的水平,初中文化占56.2%；已婚者居多,在婚比例達84.2%；該人群暫住地大都在工地現(xiàn)場的簡易工棚,娛樂活動單調(diào)。 (2)建筑工人普遍對艾滋病的防治知識具有一定程度的了解,對艾滋病傳播途徑問題的回答正確率較高,如“共用注射器能傳播艾滋病嗎(66.2%)”“不使用安全套性交是否能傳播艾滋病(72.1%)”、“性伴越多是否感染艾滋病的風險越大(73.1%)”、“艾滋病可以通過妊娠傳播嗎(60.6%)”等問題的掌握較好；而在非傳播途徑方面的問題回答正確率較低,如“一起吃飯能傳播艾滋病么(40.6%)”、“共用廁所馬桶能否傳播艾滋病(36.5%)”、“咳嗽能否傳播艾滋病(30.9%)”、“接吻能否傳播艾滋病(26.0%)”,“蚊子叮咬能否傳播艾滋病”(14.3%)。 (3)建筑工人對待艾滋病及艾滋病病人仍存在一定的歧視現(xiàn)象。有72,90%的人認為“艾滋病人是令人害怕的”；有18.72%的工人表示“艾滋病人根本不值得同情”。而對于婚前性行為、婚外性行為的態(tài)度正逐步趨向開放。分別有13.5%、11.8%的人對于已婚男子、已婚女子發(fā)生婚外行為表示認同；有12.2%的人同意可以發(fā)生商業(yè)性行為；有7.2%的建筑工人對于男男性行為表示認同。 (4)建筑工人在性行為時使用安全套的比例處于較低水平,普遍存在艾滋病預防知識與安全套使用之間不相關的現(xiàn)象。在已婚的建筑工人中,與配偶發(fā)生性行為時,有50.6%的人從來不用安全套,僅有7.4%的人是每次都用,主要原因是近70%的建筑工人覺得沒有必要,也有16.8%的人是因為沒感覺而不使用安全套。在未婚的建筑工人中,從來不用安全套的占了41.3%,每次使用僅占了14.4%；主要原因是不舒服占57.7%、無所謂占23.1%。 (5)本次調(diào)查未發(fā)現(xiàn)HIV感染者,查出梅毒陽性2例,患病率為0.3%；皰疹病毒感染1例；淋球菌感染2例；衣原體感染者13例,患病率為2.0%； 2、干預效果評價 基線調(diào)查人數(shù)為657人,其中低干預組224人、中干預組209人、高干預組224人；第一次隨訪475人,隨訪率為72.3%,其中低干預組154人、中干預組152人、高干預組169人；第二次隨訪330人,隨訪率為50.2%,其中低干預組102人、中干預組91人、高干預組137人。 (1)低干預組基線調(diào)查、第一隨訪調(diào)查、第二次隨訪調(diào)查艾滋病知識得分分別為6.46±3.94分、11.6±2.25分、12.55±1.36分；第一次隨訪與第二隨訪分別與基線比較,以及第一次隨訪與第二次隨訪比較,14個問題得分均差別顯著,有統(tǒng)計學意義(p0.01)。第一次隨訪與基線比較艾滋病有關態(tài)度,有2個觀點的正向回答變化明顯,有統(tǒng)計學意義(p0.01)；而在性觀念上,第一次、第二次隨訪分別于基線比較,以及第一次與第二次隨訪比較,均無顯著差異(P0.01),無統(tǒng)計學意義�！耙鸦榧澳┗檎咝孕袨闀r從來不用安全套”的比例在第一次、第二次隨訪分別與基線比較,差異顯著,均有統(tǒng)計學意義(P0.01)。 (2)中干預組基線調(diào)查、第一隨訪調(diào)查、第二次隨訪調(diào)查艾滋病知識得分分別為6.31±4.26分、12.37±1.48分、12.23±2分；第一次隨訪與第二隨訪分別與基線比較,14個問題得分均差別顯著,有統(tǒng)計學意義(p0.01)。第一次隨訪與基線比較艾滋病有關態(tài)度,有1個觀點的正向回答變化明顯；第二次隨訪與基線比較,有2個觀點的正向回答變化明顯,有統(tǒng)計學意義(p0.01)；而在性觀念上,第一次、第二次隨訪分別于基線比較,以及第一次與第二次隨訪比較,均無顯著差異(P0.01),無統(tǒng)計學意義�！拔椿檎咝孕袨闀r每次使用安全套”的比例在第一次、第二次隨訪分別與基線比較,差異顯著,均有統(tǒng)計學意義(P0.01)。 (3)高干預組基線調(diào)查、第一隨訪調(diào)查、第二次隨訪調(diào)查艾滋病知識得分分別為7.05±4.35分、12.65±1.43分、12.4±1.76分；第一次隨訪與第二隨訪分別與基線比較,14個問題得分均差別顯著,有統(tǒng)計學意義(p0.01)。第一次隨訪與基線比較艾滋病有關態(tài)度,有2個觀點的正向回答變化明顯；第二次隨訪與基線比較,4個觀點的正向回答均有顯著變化,有統(tǒng)計學意義(p0.01)；而在性觀念上,第一次隨訪與基線比較,有3個觀念的正向回答發(fā)生變化,第二次隨訪與基線比較,有4個觀念的正向回答變化顯著,有統(tǒng)計學意義(p0.01)“已婚者性行為時從來不用安全套及偶爾使用安全套”的比例,在第一次、第二次隨訪分別與基線比較,均差異顯著,有統(tǒng)計學意義(P0.01)；“未婚者性行為時從來不用安全套及每次使用安全套”的比例,在第一次、第二次隨訪分別與基線比較,均差異顯著,有統(tǒng)計學意義(P0.01)。 (4)三種干預方法效果比較 三種干預方法在提高艾滋病知識得分方面發(fā)揮了巨大作用。基線調(diào)查時,組建筑工人之間的艾滋病知識得分比較無統(tǒng)計學意義(P0.01),且三組得分均較低；經(jīng)過干預,第一次隨訪調(diào)查顯示中干預組與高干預組分別與低干預組比較,知識得分均提高顯著(p0.01),但高干預組與中干預組之間差別比較無統(tǒng)計學意義(P0.01)；第二次隨訪調(diào)查顯示,三組間的知識得分比較無顯著差別(P0.01),但三組知識得分依然較高。 三種干預方法在改變艾滋病相關態(tài)度方面也起到了積極作用�；�調(diào)查時,三組建筑工人對于l艾滋病相關態(tài)度及性觀念的比較均無統(tǒng)計學意義(P0.01)；經(jīng)過干預,第一次隨訪調(diào)查顯示,中干預組及高干預組與低干預組比較,均有1個態(tài)度觀點有正向變化,有統(tǒng)計學意義(p0.01)；第二次隨訪調(diào)查結(jié)果顯示,高干預組較低干預組有3個性觀念問題有正向改變,顯著差異(p0.01)。 三種干預方法在改變干預對象艾滋病相關行為方面發(fā)揮了一定的作用,但是作用效果不如對知識的改變明顯。對于已婚者與配偶使用安全套情況而言,通過干預后,第一次隨訪調(diào)查顯示并未出現(xiàn)一定的差異；第二次隨訪調(diào)查顯示,“每次使用”的情況在高干預組與低干預組間產(chǎn)生了顯著差異(p0.01)。而對于未婚者與性伴使用安全套情況,經(jīng)過干預,第一次隨訪調(diào)查顯示“從來不用”的比例中干預組與低干預組間有顯著差異(p0.01),“偶爾使用”的比例高干預組與低干預組間呈現(xiàn)顯著差異(p0.01),而第二次隨訪時則無顯著性差異。 結(jié)論 1、三種干預方法對于艾滋病相關知識知曉率均有非常顯著地提高；對待艾滋病感染者和艾滋病病人態(tài)度在正向方面有了較大幅度的改善。 2、雖然通過干預,與艾滋病相關的知識知曉率提高了,對待艾滋病感染者和艾滋病病人的態(tài)度也發(fā)生了變化,但是與艾滋病有關的危險行為改變不明顯�！耙鸦檎呒拔椿檎甙l(fā)生性行為時經(jīng)常使用安全套”的比例在干預前后均沒有顯著性變化(p0.01),尤其是低干預組及中干預組均無明顯變化；但高干預組在干預前后安全套使用方面仍表現(xiàn)出一些積極的變化,已婚者與未婚者在性行為時“從來不用安全套”的比例均呈現(xiàn)顯著差異(p0.01),有一定幅度的降低,而“每次都用”的比例也呈上升趨勢,比較有統(tǒng)計學意義(p0.01)。 3、發(fā)放宣傳小冊子、張貼宣傳海報、擺放宣傳展板、播放宣教DVD、面對面訪談等各種干預措施均適用于提高建筑工人的艾滋病性病相關知識知曉率,以及使他們對待艾滋病感染者和艾滋病病人的態(tài)度向正向轉(zhuǎn)變。 4、通過此次調(diào)查,驗證了知識的提高并不意味著行為的改變,只有持久的行為干預才能產(chǎn)生廣泛的影響。此次低、中、高三種不同的干預方法,究竟那一種更適合在本地區(qū)建筑工人中開展艾滋病宣傳教育和行為干預工作,尚待進一步研究；同時,尚需探討其他更合理更有效的行為干預模式,以在建筑工人及其他各類人群中開展艾滋病干預教育工作,并取得良好的實效,達到全人群遏制與控制艾滋病性病的傳播與蔓延。
[Abstract]:background
Although some progress has been made in the work of AIDS prevention and control in China in recent years, the risk factors for the spread of AIDS still exist, which have brought great difficulties to the prevention and control of AIDS. One of the most important risk factors is the increasing population of urban and rural migrants and the floating population of AIDS patients. The high proportion of floating population provides the opportunity for the spread of AIDS.
In the urban floating population, the migrant workers in the construction site are an important part of their own characteristics. The population has a large population base, a strong mobility, the majority of men, most of them in the young, a long life in a single group of others, the edge of life in the city, the weak concept of the legal system, and the knowledge of STD and AIDS. Lack of knowledge has become one of the main risk factors for the epidemic of AIDS infection in China. At present, there are few related studies on AIDS prevention and control in construction workers in the suburbs of the city. Therefore, the study of the prevention, care and support of AIDS venereal diseases in construction workers can be used to understand the behavioral characteristics and infection status of the population. Taking effective comprehensive intervention model, improving the knowledge of AIDS prevention and disease prevention of construction workers and the use rate of condoms, reducing the high risk behavior of AIDS, plays an important role in preventing the spread of AIDS.
Research goals
1, understand the knowledge, attitude and risk behaviors of HIV and STI in construction workers in Nanhui.
2, to assess the prevalence and influencing factors of H1V and STI;
3, improve and implement preventive intervention plans on the basis of available data and baseline survey data.
4, evaluate the effectiveness of the intervention program.
Research content and method
The study is divided into two parts.
The first part was the survey of HIV and STI knowledge, attitudes, health services, dangerous behavior and influencing factors. This part was divided into three times, that is, zeroth months as a baseline survey, third and sixth months respectively. All participants in the baseline survey will complete the baseline questionnaire survey and provide hematuria specimens. Blood samples will be used to detect HTV, The herpes virus type II and syphilis. Urine samples will be used to detect Chlamydia and gonorrhea. The first follow-up survey is conducted at third months, and second follow-up surveys are conducted at sixth months.
The second part was the implementation and evaluation of the behavior intervention program. At the end of the baseline survey, the behavior intervention program was carried out in three different types, and the low intervention group issued the brochure; the intervention group also posted the posters, the exhibition board and the broadcast of the DVD, and the high dry pre group also carried out face-to-face interviews. During the third and sixth months follow-up, the intervention group was followed up. The short-term and long-term intervention effects were evaluated. The intervention points of the three intervention plans were randomly selected from 6 construction sites.
Research results
1, baseline survey results
(1) the construction site is a place where the floating population is highly aggregated in Nanhui area of Pudong. Among the 657 construction workers in this survey, the majority of the workers are middle-aged and young, most of them are sexually active, the average age is 38.9 + 10.1 years old; the sex constitution is dominated by male 90.4%; the cultural level is generally at a low level, the junior middle school culture is 56.2%; married. Most of the people were married, and the proportion of them was 84.2%. Most of the people lived in the simple workshops at the construction site, and the entertainment activities were monotonous.
(2) construction workers generally understand the prevention and control of AIDS to a certain extent, the answer to the problem of AIDS transmission is more correct, such as "sharing syringes can transmit AIDS (66.2%)" "does not use condom sexual intercourse can transmit AIDS (72.1%)", "the greater the risk of AIDS infection, the greater the risk of AIDS (73). ".1%)", "AIDS can be transmitted through the transmission of pregnancy (60.6%)" and other problems, and the right rate is lower in non transmission ways, such as "to eat to spread AIDS (40.6%)", "the toilet toilet can spread AIDS (36.5%)", "coughing can spread AIDS (30.9%)", "kissing can" No transmission of AIDS (26%), "mosquito bite can spread AIDS" (14.3%).
(3) there are still certain discrimination phenomena in construction workers treating AIDS and AIDS patients. There are 72,90% people who think "AIDS patients are frightening"; 18.72% of the workers say "aids people are not worthy of sympathy". And for premarital sex, the state of sexual behavior outside marriage is gradually opening to the open. There are 13.5%, 11.8% respectively. For married men, married women were identified with married women; 12.2% agreed to have commercial behavior; 7.2% of the construction workers agreed with male male behavior.
(4) the proportion of condoms used by construction workers in sexual behavior is at a lower level, and there is an unrelated phenomenon between AIDS prevention knowledge and condom use. In married construction workers, 50.6% of them have never used condoms when they have sex with their spouses, only 7.4% of them are used every time, the main reason is nearly 70%. Construction workers do not feel necessary, and 16.8% of them do not feel and use condoms. The unmarried builders never use a condom 41.3%, and each use only accounts for 14.4%. The main reason is the discomfort is 57.7%, and it doesn't matter 23.1%..
(5) 2 cases of syphilis positive were found without HIV infection in this survey, the prevalence rate was 0.3%, 1 cases of herpes virus infection, 2 cases of gonococcal infection and 13 cases of Chlamydia infection, the prevalence rate was 2%.
2, evaluation of intervention effect
The number of baseline surveys was 657, of which 224 in the low intervention group, 209 in the middle intervention group and 224 in the high dry group; the first follow-up was 475, and the follow-up rate was 72.3%, of which 154 in the low intervention group, 152 in the middle intervention group and 169 in the high dry group; second followed up 330, and the follow-up rate was 50.2%, among which the low intervention group was 102, the intervening group 91, the high dry pregroup.
(1) the baseline survey of the low intervention group, the first follow-up survey, the second follow-up survey of AIDS knowledge scores were 6.46 + 3.94, 11.6 + 2.25, 12.55 + 1.36. The first follow-up and second follow-up were compared with the baseline, and the first follow-up and second follow-up compared, the scores of the 14 problems were significantly different (P0.01) The first follow up and baseline comparison of AIDS related attitudes, the positive responses of 2 views were significant and statistically significant (P0.01); the first time, the first second follow-up, and the first and second follow-up, had no significant difference (P0.01), no statistical significance. "Married and the last marriage sex." For the first time, there was no statistically significant difference between the second follow-up visits, compared with baseline (P0.01).
(2) the baseline survey in the middle intervention group, the first follow-up survey, the second follow-up survey of AIDS knowledge scores were 6.31 + 4.26, 12.37 + 1.48, 12.23 + 2. The first follow-up and second follow-up compared with the baseline, 14 problems were significantly different (P0.01). The first follow-up and baseline comparison of AIDS related The positive response of 1 views was obvious. Compared with the baseline, there were 2 positive responses in the second follow-up and the statistical significance (P0.01), while in the sexual concept, the first time, the second follow-up, and the first and second follow-up, had no significant difference (P0.01), no statistical difference. The proportion of "unmarried people's use of condoms every time" was the first, the second follow-up compared with the baseline, the difference was significant (P0.01).
(3) high dry pre group baseline survey, the first follow-up survey, second follow-up investigation of AIDS knowledge scores were 7.05 + 4.35, 12.65 + 1.43, 12.4 + 1.76. The first follow-up and second follow-up compared with the baseline, 14 scores were significantly different, there were statistical significance (P0.01). The first follow-up and baseline comparison of AIDS related The positive responses of 2 views were obvious; the positive responses of the 4 views were significantly changed in the second follow-up and the baseline, and the positive responses were statistically significant (P0.01); while in the sexual concept, the first follow-up was compared with the baseline, and the positive responses of the 3 concepts were changed, and the second follow up and baseline compared to the baseline, there were 4 positive ideas. The response was significant (P0.01). The ratio of "married people's sexual behavior never with condoms and the occasional use of condoms" was significantly different in the first, second follow-up and baseline, with statistical significance (P0.01); "unmarried men never use condoms and use condoms every time". For the first time, there was a significant difference between the second follow-up and baseline (P0.01).
(4) the comparison of the effect of the three methods of intervention
The three intervention methods played a great role in improving the knowledge score of AIDS. In the baseline survey, the score of AIDS knowledge among the groups of construction workers was not statistically significant (P0.01), and the scores of the three groups were low. The intervention, the first follow-up survey showed that the intervention group and the high dry group were compared with the low intervention group, respectively. The scores were significantly increased (P0.01), but there was no significant difference between the high dry pre group and the middle intervention group (P0.01). The second follow-up survey showed that there was no significant difference in the knowledge score between the three groups (P0.01), but the three groups of knowledge scores were still higher.
The three intervention methods also played a positive role in changing the attitude of AIDS related. In the baseline survey, there was no significant difference between the three groups of construction workers on L AIDS related attitudes and sexual attitudes (P0.01). After the intervention, the first follow-up survey showed that the middle intervention group and the high dry group were compared with the low intervention group, and there were 1 attitudes. There were positive changes in views and statistically significant (P0.01); the results of the second follow-up survey showed that there were 3 positive changes in personality problems in the lower intervention group and the significant difference (P0.01).
The three interventions have played a role in changing the AIDS related behavior of the subjects, but the effect is not as obvious as that of the knowledge. For the married and spouses, the first follow-up survey showed no difference in the first follow-up survey, and the second follow-up survey showed that " There were significant differences between the high dry pregroup and the low intervention group (P0.01). For the unmarried and sexual partners, the first follow up survey showed that there was a significant difference between the intervention group and the low intervention group (P0.01), and the proportion of "occasional use" was higher than that of the low intervention group. There was a significant difference between the intervention groups (P0.01), but there was no significant difference between the second groups.
conclusion
1, the three kinds of intervention methods have greatly improved the awareness rate of AIDS related knowledge, and the attitude towards AIDS infected and AIDS patients has been greatly improved in the positive direction.
2, although the awareness rate of AIDS related knowledge increased through intervention, the attitude towards AIDS infected and AIDS patients had also changed, but the change in the risk behavior related to AIDS was not obvious. "The proportion of married and unmarried people who often use condoms when they have sex" is not significant before and after intervention. There was no obvious change in sex change (P0.01), especially in the low intervention group and the middle intervention group, but there were some positive changes in the use of condom before and after the intervention, and the proportion of married and unmarried people who had never used a condom in sexual behavior showed significant difference (P0.01), and "every time", "every time" The proportion of "used" also showed an upward trend, which was statistically significant (P0.01).
3, publicizing brochures, poster posters, placing publicity boards, playing DVD, face-to-face interviews and other interventions are applicable to improving the awareness rate of AIDS related knowledge related to construction workers.
【學位授予單位】：復旦大學
【學位級別】：碩士
【學位授予年份】：2011
【分類號】：R181.3

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