Getting the Facts

性传播疾病的预防：行为的改变 STD Prevention: Behavior Change

安全性行为-推行安全性行为所面临的问题

政治上的问题-获取真相问题
政府如果首先没有确实流行病学的状况，就启动预防运动则会犯严重的错误。毕竟，只要大多数感染仍然是由于有限的人口中的特殊行为所引起的，试图掩盖国家的AIDS流行的信息是没有什么意义的。所以，开展预防运动的第一步应该是设法弄清楚谁受到了感染，在哪里感染的，如何感染的，以及被谁感染。一旦弄清楚了谁在真正地冒险、为什么会去冒险，只有弄清楚了这些特殊的信息，才能够清晰地确定特定的感染群体，借以增大早期阻止疾病流行的机会。鉴于此，提供匿名检测和与已经确诊的感染者面谈很有必要。此外，与感染者面谈必须由独立的研究人员来展开，而且所得到的问卷答案一定只能用于统计的目的，而一定不要成为他们个人病例的一部分。
另一方面，如果检测和面谈由同一个医生来执行，这个医生然后将结果记录在一个可以容易识别的病例里，那么，许多有高危行为的男男女女会不愿意来做检测了。这样的被调查者此时只会撒谎，尤其他们是通过同性性接触、静脉毒品注射或其他不名誉行为受到感染后，他们更会回避回答问题。这样一来，有关HIV传播的统计数据容易被误导，继而，想要通过目标人群的行为干预来控制疾病流行的早期机会便会丧失。

可能的早期情形和针对性的举措
假如某个国家通过匿名检测和面谈显示其自身国民或外国士兵为HIV传染的主要来源；那么，特别针对这些人群的预防宣传将是有效的。假若发现双性性接触是HIV感染的重要因素，向这些人群发放适当的宣传材料会有效。另一方面，假若在迪士科舞厅“聚会药丸”用量增大，导致无保护性接触，则需要针对性地分发宣传材料。最后，对那些已经知道自己感染的人员需要始终向他们分发“安全性行为指南”。上面的材料由德国（左起前3份）和法国（右）所制作。此处出示的样本只是举例，并不表示这两个国家在早期或现时只有这些性传播疾病的流行模式。

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]