Getting the Facts

性傳播疾病的預防：行為的改變 STD Prevention: Behavior Change

安全性行為-推行安全性行為所面臨的問題

政治上的問題-獲取真相問題
政府如果首先沒有確實流行病學的狀況，就啟動預防運動則會犯嚴重的錯誤。畢竟，只要大多數感染仍然是由於有限的人口中的特殊行為所引起的，試圖掩蓋國家的AIDS流行的資訊是沒有什麼意義的。所以，開展預防運動的第一步應該是設法弄清楚誰受到了感染，在哪里感染的，如何感染的，以及被誰感染。一旦弄清楚了誰在真正地冒險、為什麼會去冒險，只有弄清楚了這些特殊的資訊，才能夠清晰地確定特定的感染群體，藉以增大早期阻止疾病流行的機會。鑒於此，提供匿名檢測和與已經確診的感染者面談很有必要。此外，與感染者面談必須由獨立的研究人員來展開，而且所得到的問卷答案一定只能用於統計的目的，而一定不要成為他們個人病例的一部分。
另一方面，如果檢測和面談由同一個醫生來執行，這個醫生然後將結果記錄在一個可以容易識別的病例裏，那麼，許多有高危行為的男男女女會不願意來做檢測了。這樣的被調查者此時只會撒謊，尤其他們是通過同性性接觸、靜脈毒品注射或其他不名譽行為受到感染後，他們更會回避回答問題。這樣一來，有關HIV傳播的統計資料容易被誤導，繼而，想要通過目標人群的行為干預來控制疾病流行的早期機會便會喪失。

可能的早期情形和針對性的舉措
假如某個國家通過匿名檢測和面談顯示其自身國民或外國士兵為HIV傳染的主要來源；那麼，特別針對這些人群的預防宣傳將是有效的。假若發現雙性性接觸是HIV感染的重要因素，向這些人群發放適當的宣傳材料會有效。另一方面，假若在迪士科舞廳“聚會藥丸”用量增大，導致無保護性接觸，則需要針對性地分發宣傳材料。最後，對那些已經知道自己感染的人員需要始終向他們分發“安全性行為指南”。上面的材料由德國（左起前3份）和法國（右）所製作。此處出示的樣本只是舉例，並不表示這兩個國家在早期或現時只有這些性傳播疾病的流行模式。

Examples of possible early scenarios and targeted responses
If anonymous tests and interviews in a certain country should reveal that their own or foreign soldiers are a major source of HIV infection, it would be useful to target them specifically. If it should be found that bisexual contacts are an important factor in HIV transmission, it would be useful to distribute appropriate materials. If, on the other hand, an increased use of “party drugs” in discos contributes to unprotected sexual contacts, specific guidelines are needed addressing this issue. Finally, it is always necessary to deliver the message of “safer sex” to those who already know that they are infected. The materials above were developed in Germany (the first three from the left) and France (on the right). They are shown here only for the purpose of illustration. They are not indicative of the early or current transmission patterns in these two countries.

Safer Sex - Problems of Safer Sex Promotion

Political Problems - Getting the facts
Governments make a serious mistake if they launch prevention campaigns without first ascertaining the actual epidemiological situation. After all, it makes little sense to blanket the nation with AIDS messages as long as most infections are still due to specific behaviors in a limited part of the population. The first order of business should therefore be to find out who gets infected where, how, and by whom. Once it is known who exactly is at risk and why, very specific messages can be directed at clearly defined groups, thus increasing the chance of stopping the epidemic in its early stages. For this, it is necessary to offer free anonymous testing and to interview all those found to be infected. Again, these interviews must be conducted anonymously by independent researchers, and the answers must be used only for statistical purposes. They must not become part of any person’s medical record.
If, on the other hand, both the tests and the interviews are conducted by the same doctor who then records the results in an easily identifiable file, many women and men at risk will avoid getting tested. Those who do end up in the doctor’s office will simply lie, especially if they became infected through homosexual contact, intravenous drug use, or other stigmatized behaviors. As a result, the statistics about HIV transmission become misleading, and an early opportunity to control the epidemic through targeted intervention is lost.

[Course 4] [Description] [How to use it] [Introduction] [Curable STDs] [Incurable STDs] [STD Prevention] [Abstinence] [Safer Sex] [Additional Reading] [Examination]