Magura S, Grossman J I, Lipton D S, Amann K R, Koger J, Gehan K
Narcotic and Drug Research, Inc., New York, NY 10013.
Public Health Rep. 1989 May-Jun;104(3):231-40.
The authors examined the factors associated with methadone patients' decisions about participating in a clinic-based AIDS prevention protocol. Despite the offer of incentives, only 27 percent attended AIDS education and only 12 percent obtained voluntary HIV antibody (ab) testing. However, AIDS education was attended by proportionately more of those who were at highest risk for AIDS because of current intravenous drug use. The availability of HIV-ab testing neither encouraged nor discouraged participation in AIDS education. Patients who were relatively more likely to choose HIV-ab testing were older, had been or were married, had plans to have children, believed the test to be useful, and believed that their counselors support their decision to be tested. Those who declined to be tested were reluctant to confront the emotional aspects of their risk status, were concerned about possible breaches of confidentiality, and doubted the value of testing. The implications of the findings for implementing AIDS prevention measures in methadone programs are discussed. Programs need either to require attendance at AIDS education or give patients an incentive to attend. HIV-ab testing should be available but should remain voluntary. A stronger medical rationale for testing is developing and may increase future participation. Methadone programs must continue to engage patients actively in AIDS risk reduction efforts.
作者研究了与美沙酮治疗患者参与基于诊所的艾滋病预防方案决策相关的因素。尽管提供了激励措施，但只有27%的人参加了艾滋病教育，只有12%的人进行了自愿HIV抗体检测。然而，由于当前静脉吸毒而处于艾滋病最高风险的人群中，参加艾滋病教育的比例相对更高。HIV抗体检测的可获得性既没有鼓励也没有阻碍人们参与艾滋病教育。相对更有可能选择HIV抗体检测的患者年龄较大，已婚或曾已婚，有生育计划，认为检测有用，并且相信他们的咨询顾问支持他们进行检测的决定。那些拒绝检测的人不愿意面对其风险状况的情感方面，担心可能出现的保密性泄露问题，并怀疑检测的价值。文中讨论了这些研究结果对在美沙酮治疗项目中实施艾滋病预防措施的启示。项目要么要求患者参加艾滋病教育，要么给予患者参加的激励。应提供HIV抗体检测，但应保持自愿。检测的医学依据正在增强，可能会增加未来的参与度。美沙酮治疗项目必须继续积极促使患者参与降低艾滋病风险的工作。
