Quirk M E, Godkin M A, Schwenzfeier E
University of Massachusetts Medical School, Worcester 01655.
Am J Prev Med. 1993 Jan-Feb;9(1):21-6.
Two hundred and fourteen young women received acquired immunodeficiency syndrome (AIDS) prevention interventions at an inner-city family health center serving minority patients predominantly. The community in which the health center is located has a high incidence of intravenous (IV) drug abuse. Either a peer or a health care provider delivered the intervention. In the peer-delivered intervention, a trained peer educator reviewed with patients an AIDS "Rap" videotape and several AIDS brochures, which imparted information about human immunodeficiency virus (HIV), its transmission, and prevention. In the provider-delivered intervention, family practice residents, attending physicians, and nurse practitioners used a patient-centered counseling approach to convey the same information. Questionnaires administered immediately before and after the intervention and at one month follow-up evaluated changes in knowledge, attitudes, and behavior. Analyses of data from both combined intervention groups revealed significant improvements in several areas of knowledge, including the effectiveness of using a condom and cleaning IV drug implements with bleach to prevent transmission of HIV. Many improvements were retained at the one-month follow-up. In addition, subjects in both groups who were sexually active stated immediately after the intervention that asking a sexual partner about past sexual experience would now be less difficult, and at one-month follow-up they reported a significant decrease in the frequency of vaginal sex. Our findings suggest that counseling by physicians can achieve more changes in knowledge of sexual risks, whereas peer education can achieve greater changes in knowledge about IV drug use. Results show that both approaches to AIDS prevention used in this study can significantly affect knowledge, attitudes, and sexual behavior.
214名年轻女性在一家主要为少数族裔患者服务的市中心家庭健康中心接受了艾滋病预防干预。该健康中心所在的社区静脉注射吸毒发生率很高。干预措施由同伴或医疗服务提供者实施。在同伴实施的干预中，一名经过培训的同伴教育者与患者一起观看了一盘艾滋病“说唱”录像带和几本艾滋病宣传册，这些资料传授了有关人类免疫缺陷病毒（HIV）、其传播方式及预防方法的信息。在医疗服务提供者实施的干预中，家庭医学住院医师、主治医生和执业护士采用以患者为中心的咨询方法传达同样的信息。在干预前后及随访一个月时进行问卷调查，以评估知识、态度和行为的变化。对两个干预组合并后的数据进行分析发现，在几个知识领域有显著改善，包括使用避孕套的有效性以及用漂白剂清洁静脉注射吸毒器具以预防HIV传播。许多改善在随访一个月时仍得以保持。此外，两组中有性活动的受试者在干预后立即表示，现在询问性伴侣过去的性经历会不那么困难，并且在随访一个月时，他们报告阴道性行为的频率显著降低。我们的研究结果表明，医生提供的咨询在性风险知识方面能带来更多变化，而同伴教育在静脉注射吸毒知识方面能带来更大变化。结果显示，本研究中使用的两种艾滋病预防方法都能显著影响知识、态度和性行为。
