Killewo J, Sandström A, Dahlgren L, Wall S
Department of Epidemiology and Biostatistics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzama.
Soc Sci Med. 1997 Jul;45(2):319-29. doi: 10.1016/s0277-9536(96)00347-4.
In order to deepen the understanding of risk factors associated with HIV infection in the Kagera region of Tanzania and to investigate the potentials of communicating with the people in planning for interventions, two studies were performed in the districts of Bukoba Urban, Bukoba Rural and Muleba in 1989. The HIV prevalence of these areas ranged between 4.5% and 24.2% according to the prevalence study performed earlier in 1987. The studies involved the community in ward meetings on the one hand, and previously studied individuals on the other hand. The studies aimed both at conveying to the people the results of a previously performed study and at collecting new data using a combination of quantitative and qualitative methods in order to better understand the associated risk factors, perceived or real, and what suggestions the community could offer for reducing HIV transmission in the region. From the initial study, awareness about AIDS was found to be universal. Change of sexual partners and infection with syphilis were found to be the major risk factors for HIV-I infection. From the ward meetings people suggested a variety of solutions for interventions which we have categorized as either "hard" or "soft". The "hard" solutions involved suggestions such as isolation, imprisonment, castration and killing of AIDS victims, while the "soft" solutions involved sympathetic handling of the sick and educating the people about the modes of transmission and how best to prevent infection. There was a greater tendency for the low HIV prevalence rural communities to suggest the "hard" solutions than the high HIV prevalence urban ones which tended to suggest the "soft" solutions. However, with the changing dynamics of HIV infection in the region towards higher HIV prevalence in rural areas, it is likely that the "soft" solutions will gain acceptance and become adopted for interventions throughout the region. The information obtained from these studies has provided lessons that can be used for rational counselling as well as for guiding the implementation of IEC activities geared at interventions. It is also suggested that there should be further research into new strategies or their combinations which could be crucial in prevention such as those of community participation, empowerment of women and solidarity in AIDS intervention work.
为加深对坦桑尼亚卡盖拉地区与艾滋病毒感染相关风险因素的理解，并调查在规划干预措施时与民众沟通的潜力，1989年在布科巴市、布科巴农村和穆莱巴地区开展了两项研究。根据1987年早些时候进行的患病率研究，这些地区的艾滋病毒感染率在4.5%至24.2%之间。这些研究一方面让社区参与病房会议，另一方面让之前研究过的个体参与。研究目的既包括向民众传达先前进行的研究结果，也包括使用定量和定性方法相结合来收集新数据，以便更好地理解相关风险因素，无论是感知到的还是实际存在的，以及社区能够就减少该地区艾滋病毒传播提出哪些建议。从最初的研究中发现，对艾滋病的认识很普遍。性伴侣更换和梅毒感染被发现是艾滋病毒-1感染的主要风险因素。在病房会议上，人们针对干预措施提出了各种解决方案，我们将其分为“强硬”或“温和”两类。“强硬”解决方案包括诸如隔离、监禁、阉割和杀害艾滋病患者等建议，而“温和”解决方案包括对患者给予同情对待以及向民众宣传传播方式和如何最好地预防感染。艾滋病毒感染率较低的农村社区比艾滋病毒感染率较高的城市社区更倾向于提出“强硬”解决方案，而城市社区则倾向于提出“温和”解决方案。然而，随着该地区艾滋病毒感染动态的变化，农村地区的艾滋病毒感染率不断上升，“温和”解决方案很可能会被接受并在整个地区用于干预措施。从这些研究中获得的信息提供了可用于合理咨询以及指导旨在进行干预的信息、教育和宣传活动实施的经验教训。还建议应进一步研究新的策略或其组合，这对于预防可能至关重要，例如社区参与、妇女赋权以及艾滋病干预工作中的团结等策略。
