【摘要】：目的目前，我國艾滋病發(fā)病率總體呈上升趨勢，其中性傳播為其主要傳播途徑。我國西部地區(qū)由于吸毒和性交易等艾滋病易感因素的流行，部分地區(qū)面臨艾滋病傳播擴散的嚴重威脅。而由此帶來的社會、經(jīng)濟、心理問題日趨嚴重。目前，大量研究證明包皮環(huán)切能有效的降低男性在異性性行為中HIV感染的風險，包皮環(huán)切術作為一種簡單易行、低成本、高收益的HIV預防的手段，對于控制艾滋病傳播有著重要意義。然而現(xiàn)實生活中，包皮環(huán)切術開展情況并不理想，特別是在一些艾滋病感染的高危人群中，人們對于包皮環(huán)切術的知曉率和接受率更低。本研究為世界各國以推廣包皮環(huán)切手術降低男性經(jīng)異性性行為感染艾滋病的風險為目的，而開展的人們對包皮環(huán)切手術接受意愿和態(tài)度及其影響因素的定性研究的系統(tǒng)綜述，討論在不同社會環(huán)境和文化背景下影響人們對手術接受意愿和態(tài)度的主要因素，為今后推廣包皮環(huán)切術制定相關政策提供重要循證依據(jù)。 方法共檢索了中國生物醫(yī)學文獻數(shù)據(jù)庫，維普期刊資源整合服務平臺，CNKI中國知網(wǎng)，萬方數(shù)據(jù)庫知識服務平臺，Pubmed, OVIDEBMR,BMJ Clinical Evidence, Web of knowledge8個數(shù)據(jù)庫，并用google進行全面搜索。檢索日期從數(shù)據(jù)庫建立起至2013年7月。根據(jù)預先設定的納入排除標準和質(zhì)量評價表，，對文獻進行篩查和質(zhì)量評價。根據(jù)扎根理論對納入研究的文獻進行資料提取與合并。 結果共納入24篇研究，包括：非洲13篇、美洲4篇、亞洲5篇、大洋洲2篇。影響人們手術預防艾滋病的主要因素有：1.促進因素：有利于手術的風俗或宗教傳統(tǒng)、生殖器健康或明確的手術指針、對于手術預防艾滋病和性傳播疾病的了解、來自家庭和伴侶的支持、提高性滿意度；2.阻礙因素：不利于手術的風俗或宗教傳統(tǒng)、對手術缺乏信心和認識、懷疑手術安全性、手術及附加成本、風險性行為、個人因素；3.影響父母決策的因素：基本與影響個人的因素相同。部分父母認為應該將手術的決定權留給孩子。此外對于最佳的手術時間，人們尚無統(tǒng)一觀點。 結論1.目前，全球推廣包皮環(huán)切手術仍以普及相關知識為主，而我們的工作重心在于針對不同目標人群開發(fā)有針對性教育材料和推廣模式，提高工作效率。 2.政府的支持對于MC推廣工作的開展必不可少，特別在經(jīng)濟落后地區(qū)適當?shù)慕?jīng)濟補償能有效地提高手術的接受率，但具體的補償額度和補償方式還需要開展相關研究才能確定。 3.必要的心理輔導不僅可以緩解手術對象的羞恥感和心理負擔，還能增強其術后的同伴教育力量。 4.防止非醫(yī)學目的盲目接受包皮環(huán)切術，同時還要預防術后高危性行為。 5.我國推廣包皮環(huán)切術預防艾滋病的實際工作中，應立足于國情，把握住重點。力求利用有限的醫(yī)療資源達到最大的回報效果。
[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.
【學位授予單位】：重慶醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R512.91

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