包皮环切手术预防艾滋病接受意愿影响因素的系统综述

发布时间：2018-11-14 09:02

【摘要】：目的目前，我国艾滋病发病率总体呈上升趋势，其中性传播为其主要传播途径。我国西部地区由于吸毒和性交易等艾滋病易感因素的流行，部分地区面临艾滋病传播扩散的严重威胁。而由此带来的社会、经济、心理问题日趋严重。目前，大量研究证明包皮环切能有效的降低男性在异性性行为中HIV感染的风险，包皮环切术作为一种简单易行、低成本、高收益的HIV预防的手段，对于控制艾滋病传播有着重要意义。然而现实生活中，包皮环切术开展情况并不理想，特别是在一些艾滋病感染的高危人群中，人们对于包皮环切术的知晓率和接受率更低。本研究为世界各国以推广包皮环切手术降低男性经异性性行为感染艾滋病的风险为目的，而开展的人们对包皮环切手术接受意愿和态度及其影响因素的定性研究的系统综述，讨论在不同社会环境和文化背景下影响人们对手术接受意愿和态度的主要因素，为今后推广包皮环切术制定相关政策提供重要循证依据。方法共检索了中国生物医学文献数据库，维普期刊资源整合服务平台，CNKI中国知网，万方数据库知识服务平台，Pubmed, OVIDEBMR,BMJ Clinical Evidence, Web of knowledge8个数据库，并用google进行全面搜索。检索日期从数据库建立起至2013年7月。根据预先设定的纳入排除标准和质量评价表，，对文献进行筛查和质量评价。根据扎根理论对纳入研究的文献进行资料提取与合并。结果共纳入24篇研究，包括：非洲13篇、美洲4篇、亚洲5篇、大洋洲2篇。影响人们手术预防艾滋病的主要因素有：1.促进因素：有利于手术的风俗或宗教传统、生殖器健康或明确的手术指针、对于手术预防艾滋病和性传播疾病的了解、来自家庭和伴侣的支持、提高性满意度；2.阻碍因素：不利于手术的风俗或宗教传统、对手术缺乏信心和认识、怀疑手术安全性、手术及附加成本、风险性行为、个人因素；3.影响父母决策的因素：基本与影响个人的因素相同。部分父母认为应该将手术的决定权留给孩子。此外对于最佳的手术时间，人们尚无统一观点。结论1.目前，全球推广包皮环切手术仍以普及相关知识为主，而我们的工作重心在于针对不同目标人群开发有针对性教育材料和推广模式，提高工作效率。 2.政府的支持对于MC推广工作的开展必不可少，特别在经济落后地区适当的经济补偿能有效地提高手术的接受率，但具体的补偿额度和补偿方式还需要开展相关研究才能确定。 3.必要的心理辅导不仅可以缓解手术对象的羞耻感和心理负担，还能增强其术后的同伴教育力量。 4.防止非医学目的盲目接受包皮环切术，同时还要预防术后高危性行为。 5.我国推广包皮环切术预防艾滋病的实际工作中，应立足于国情，把握住重点。力求利用有限的医疗资源达到最大的回报效果。
[Abstract]:Objective at present, the incidence of AIDS in China is on the rise, and its neutral transmission is the main way of transmission. Due to the prevalence of drug abuse and sex trade, some areas in western China are facing the serious threat of spread of AIDS. The resulting social, economic, psychological problems are becoming more and more serious. At present, a large number of studies have proved that circumcision can effectively reduce the risk of male HIV infection in heterosexual sex. Circumcision is a simple, low-cost and high-benefit HIV prevention method. It is of great significance to control the spread of AIDS. However, in real life, circumcision is not satisfactory, especially in some high risk groups of AIDS infection, people know less about circumcision and acceptance rate. The purpose of this study is to promote circumcision to reduce the risk of male transheterosexual AIDS infection in the world. A systematic review of qualitative studies on people's willingness and attitude towards circumcision and its influencing factors has been carried out. This paper discusses the main factors that affect people's willingness and attitude towards surgery under different social and cultural backgrounds, and provides an important evidence-based basis for popularizing circumcision and making relevant policies in the future. Methods Chinese biomedical literature database, Weipu periodical resources integration service platform, CNKI China knowledge network, Wanfang database knowledge service platform and Pubmed, OVIDEBMR,BMJ Clinical Evidence, Web of knowledge8 database were searched and searched by google. The retrieval date was from the establishment of the database to July 2013. The literature was screened and evaluated according to pre-set exclusion criteria and quality evaluation tables. According to the rooted theory, the literature included in the study was extracted and merged. Results A total of 24 studies were included, including 13 in Africa, 4 in America, 5 in Asia and 2 in Oceania. The main factors affecting the prevention of AIDS are: 1. Contributing factors: surgical customs or religious traditions, genital health or clear surgical guidelines, knowledge of surgery to prevent HIV / AIDS and sexually transmitted diseases, support from families and partners, and increased sexual satisfaction; 2. Obstacles: customs or religious traditions not conducive to surgery, lack of confidence and understanding of surgery, doubt of surgical safety, surgical and additional costs, risky behavior, personal factors; 3. Factors that affect parents' decisions: basically the same factors that affect individuals. Some parents think the operation should be left to their children. In addition, there is no unified view on the optimal operating time. Conclusion 1. At present, the global promotion of circumcision is still focused on popularizing relevant knowledge, and our focus is to develop targeted educational materials and promotion models for different target populations to improve work efficiency. 2. Government support is essential for the promotion of MC, especially in economically backward areas, the appropriate economic compensation can effectively improve the acceptance rate of surgery, but the specific amount of compensation and compensation methods still need to carry out relevant research to determine. 3. The necessary psychological counseling can not only relieve the shame and psychological burden of the patients, but also enhance their peer education. 4. Prevention of non-medical purposes of blind circumcision, but also to prevent high-risk sexual behavior after surgery. 5. Our country popularizes prepuce circumcision to prevent the actual work of AIDS, should be based on the national conditions, grasp the key points. Strive to use the limited medical resources to achieve maximum return effect.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R512.91

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