Verkuyl D A
Lancet. 1995 Jul 29;346(8970):293-6. doi: 10.1016/s0140-6736(95)92171-0.
What is it like to practise obstetrics and gynaecology in a country with a high prevalence of HIV infection? My experience relates especially to Zimbabwe, but the same factors apply equally well to Zambia, Zaire, Uganda, Kenya, Tanzania, Malawi, and Mozambique. Within a population of 11 million in Zimbabwe, at least 1 million are HIV positive according to the official figures. AIDS often means "home-based care"; the nearest clinic or hospital, which has very little to offer, may be 3 hours away by wheelbarrow. Many patients who die with chronic diarrhoea lack a piped water supply nearby, an indoor toilet, or even a waterproof sheet. Every year in Zimbabwe there are 120,000 confinements of HIV-positive women compared with 7000 HIV-positive pregnancies in the USA. Transmission of the virus in Africa is mainly heterosexual and vertical, although blood transfusion still plays a part. Intravenous drug use is not a problem but alcohol is, by way of promoting risky behaviour. A secondary epidemic of tuberculosis (TB) (also among HIV-negative persons) adds to the difficulties in sub-Saharan Africa.
在一个艾滋病毒感染率很高的国家从事妇产科工作是怎样的一番情景呢？我的经历主要是关于津巴布韦的，但同样的因素在赞比亚、扎伊尔、乌干达、肯尼亚、坦桑尼亚、马拉维和莫桑比克也同样适用。根据官方数据，在津巴布韦1100万人口中，至少有100万人是艾滋病毒呈阳性。艾滋病往往意味着“居家护理”；最近的诊所或医院可能要坐手推车三个小时才能到达，而且能提供的医疗服务非常有限。许多死于慢性腹泻的患者附近没有自来水供应、室内厕所，甚至连防水布都没有。在津巴布韦，每年有12万名艾滋病毒呈阳性的妇女分娩，而在美国，艾滋病毒呈阳性的孕妇只有7000例。在非洲，病毒的传播主要是通过异性性行为和母婴传播，不过输血仍然起到一定作用。静脉注射吸毒不是问题，但酒精却是问题，因为它会助长危险行为。结核病的二次流行（在艾滋病毒阴性人群中也存在）给撒哈拉以南非洲地区带来了更多困难。
