Møller Valerie, Erstad Ida, Cramm Jane M, Nieboer Anna P, Finkenflügel Harry, Radloff Sarah, Ndoro Tinashe, Kwizera Stella A
a Rhodes University, Institute of Social and Economic Research , PO Box 94 , Grahamstown , 6140 , South Africa.
Afr J AIDS Res. 2011 Apr;10(1):25-36. doi: 10.2989/16085906.2011.575545.
A cornerstone of tuberculosis (TB) control is early diagnosis and treatment. The first hurdle that prospective TB patients must overcome is to present at a public health clinic for treatment. The Global Plan to Stop TB addresses the new challenges of the intersecting epidemics of TB and HIV, and it aims to cut the transmission chain by achieving early and effective treatment of all people with TB infection. This goal may be more difficult to achieve in practice. Findings from a representative community survey conducted in an area of high HIV prevalence in the Eastern Cape Province of South Africa suggest that patients must conquer fear of knowing their HIV status in order to present for TB diagnosis and treatment. A total of 1 020 adults residing in a low-income suburb of Grahamstown, Makana Municipality, participated in a questionnaire survey that probed attitudes and opinions about TB and HIV/AIDS-related issues. The respondents were presented with eight factors previously cited in the literature as causing delays in presenting for TB treatment at a public health clinic. The single largest proportion of respondents attributed delay to a fear of discovering that one is HIV-positive. While the vast majority of the respondents agreed that knowing one's HIV status is a civic responsibility ('the right thing to do'), half indicated that the lack of privacy during voluntary counselling and testing for HIV at a public health clinic acts as a disincentive. The evidence suggests that a fear of knowing one's HIV status is a deep-seated anxiety that is often not openly acknowledged, and that it is intertwined with the stigma related to the 'new' TB associated with HIV and AIDS. It is crucial to allay this deep-seated fear in the general public so that South Africa's integrated HIV and TB services, designed to accelerate control of the twin epidemics, are successful.
结核病防控的基石是早期诊断和治疗。未来的结核病患者必须克服的第一道难关是前往公共卫生诊所接受治疗。《全球遏制结核病计划》应对结核病与艾滋病毒交叉流行带来的新挑战，旨在通过对所有结核病感染者进行早期有效治疗来切断传播链。这一目标在实际中可能更难实现。在南非东开普省艾滋病毒高流行地区进行的一项具有代表性的社区调查结果表明，患者必须克服对知晓自身艾滋病毒感染状况的恐惧，才能前来进行结核病诊断和治疗。共有1020名居住在马卡纳市格雷厄姆斯敦低收入郊区的成年人参与了一项问卷调查，该调查探究了对结核病以及与艾滋病毒/艾滋病相关问题的态度和看法。受访者被问及文献中先前提到的导致在公共卫生诊所延迟接受结核病治疗的八个因素。最大比例的受访者将延迟归因于害怕发现自己感染了艾滋病毒。虽然绝大多数受访者都认为知晓自身艾滋病毒感染状况是一项公民责任（“正确的做法”），但有一半受访者表示，在公共卫生诊所进行艾滋病毒自愿咨询和检测时缺乏隐私是一种阻碍因素。有证据表明，对知晓自身艾滋病毒感染状况的恐惧是一种根深蒂固的焦虑，常常不被公开承认，并且它与与艾滋病毒和艾滋病相关的“新型”结核病的污名化交织在一起。消除公众心中这种根深蒂固的恐惧至关重要，这样南非旨在加速控制这两种流行病的艾滋病毒与结核病综合服务才能取得成功。
