Merten Sonja, Ntalasha Harriet, Musheke Maurice
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Socinstr. 57, 4002, Basel, Switzerland.
University of Basel, Petersplatz 1, 4003, Basel, Switzerland.
PLoS One. 2016 Jun 9;11(6):e0155510. doi: 10.1371/journal.pone.0155510. eCollection 2016.
This article investigates reasons why children who were considered at risk of HIV were not taken for HIV testing by their caregivers. Qualitative and quantitative data collected in Zambia from 2010-11 revealed that twelve percent of caregivers who stated that they had been suspecting an HIV infection in a child in their custody had not had the child tested. Fears of negative reactions from the family were the most often stated reason for not testing a child. Experience of pre-existing conflicts between the couple or within the family (aOR 1.35, 95% CI 1.00-1.82) and observed stigmatisation of seropositive children in one's own neighbourhood (aOR 1.69, 95% CI1.20-2.39) showed significant associations for not testing a child perceived at risk of HIV. Although services for HIV testing and treatment of children have been made available through national policies and programmes, some women and children were denied access leading to delayed diagnosis and treatment-not on the side of the health system, but on the household level. Social norms, such as assigning the male household head the power to decide over the use of healthcare services by his wife and children, jeopardize women's bargaining power to claim their rights to healthcare, especially in a conflict-affected relationship. Social norms and customary and statutory regulations that disadvantage women and their children must be addressed at every level-including the community and household-in order to effectively decrease barriers to HIV related care.
本文调查了被认为有感染艾滋病毒风险的儿童未被其照料者带去进行艾滋病毒检测的原因。2010年至2011年在赞比亚收集的定性和定量数据显示，在表示怀疑自己照料的儿童感染了艾滋病毒的照料者中，有12%的人没有带孩子去检测。担心家庭出现负面反应是最常被提及的不给孩子检测的原因。夫妻之间或家庭内部先前存在冲突的经历（调整后比值比1.35，95%置信区间1.00 - 1.82）以及观察到自己所在社区对血清反应呈阳性儿童的污名化现象（调整后比值比1.69，95%置信区间1.20 - 2.39）表明，这些因素与不给被认为有感染艾滋病毒风险的儿童检测存在显著关联。尽管通过国家政策和项目已提供了儿童艾滋病毒检测和治疗服务，但一些妇女和儿童无法获得这些服务，导致诊断和治疗延迟——这并非卫生系统的问题，而是家庭层面的问题。社会规范，比如赋予家庭男性户主决定其妻子和子女使用医疗服务的权力，损害了妇女争取医疗保健权利的谈判能力，尤其是在受冲突影响的关系中。必须在包括社区和家庭在内的各个层面解决对妇女及其子女不利的社会规范、习俗和法律法规问题，以便有效减少与艾滋病毒相关护理的障碍。
