Y HOC VIET NAM T H A N G 9 - SO 1/2011
HIEU QUA VE Sir QUAN TAM, CHAM SOC. HO TROT
CUA GIA DINH VA CONG DONG DOI V6l NGUlOri
N H I I MHIV SAU 2 NAM THUD HIEN MO HiNH CAU LAC BO PHONG CHONG HIV/AIDS TAI THANH PHO LANG SON
Lu'dng Xuan H i e n * , Do V^n D u n g * *
TOM T A T
Sau 2 nam thiTc hien mo hinh "CSu lac bo phdng, chong HIV/AIDS''M thanh phd Lang Sdn da cho thay:
Ty le gia dlnh biet va chap nhan ngu'di nhiem, ty le ngu'di nhiem dUdc gia dinh ch3m soc khi dm dau deu t3ng hdn trUdc can thiep, chi so hieu qua dat 21,3% - 37,1%. Ty le ngUdi nhiem bi cong dong k/ thj, xa lanh giam; nhan dUdc sU chSm soc ciia cong dong t3ng, chi so hieu qua dat 89,2% va 84,9%.
Ngoai nganh y te, ngu'di nhiem con nhan dUdc sir cham soc cua cac to chu'c phi chinh phu, cac doan the xa hoi, nhom ban giup ban...cac ty le nay deu ting hdn trUct can thiep, chi so hieu qua dat tiT 34,7% - 37,5%.
SUMMARY
THE EFFECT OF ATTENTION, CARE, SUPPORT OF FAMILY AND COMMUNITY FOR PEOPLE INFECTED
WITH HIV AFTER TWO YEARS OF THE MODEL
"ANTI-HIV/AIDS CLUB" IN LANG SON CITY After two years of the model "anti-HIV//UDS club" in Lang Son city, the study shows that:
The rate of families who know and accept people infected with HIV and the rate of HIV-infected people who be cared for by their family when they sick all increase than before the intervention, the index effect reached from 21.3% to 37.1%. The rate of people infected who be differentiated by community reduce; the rate of people infected who get a community care increase, the index effect reached from 89.2% to 84.9%.
In addition to the health sector, people infected with HIV get a medical care from the non- governmental organizations, social associations and support group... All these rates are increased than before the intervention, the index effect reached from 34.7% to 37.5%.
I.
DAT V A N DEHIV/AIDS dang la mot trong cac van de du'dc quan tam hang dau tren the gidi va tai Viet Nam CO anh hu'dng manh me va lien quan chat che tdi phat trien kinh te, van hoa va xa hoi. Trong nhiJng nam qua, tai Viet Nam cong tac phdng, chong HIV/AIDS da thu du'dc nhihig ket qua dang kich le. Tuy nhien, ban than ngu'di nhiem chu'a b'ch ciTc tham gia cac hoat dpng phdng, chong
HIV/AIDS, sir ky thj phan biet ddi xiT lien quan den HIV/AIDS cdn kha nang ne d mot sd ndi...
do dd ket qua phdng chong HIV/AIDS cdn nhUng han che nhat dinh.
Lang Sdn la mot tinh mien nui bien gidi phia bac la mot trong nhiTng tinh bj tac dong nhieu nhat bdi dai djch HIV/AIDS do nhOlig dac diem ve kinh te - x§ hdi. Den 30/12/2009, ty le hien nhiem HIV cua tinh Lang Sdn la 188/ 100.000 dan. 100 huyen/thanh phd va 54,9% sd xa, phu'dng, thj tran cd ngu'di nhiem HIV/AIDS. Chung toi tien hanh nghien cu'u nay nham muc tieu: Danh gia hieu qua ve sif quan tam, cham soc, ho trd cua gia dinh va cong dong doi vdi ngu'di nhiem HIV sau 2 nam thi/c hien mo hinh "Cau lac bo phdng chong HIV/AIDS" tai thanh phd Lang Sdn.
IL D 6 I TUONG VA PHUONG PHAP NGHIEN COU 2.1. Doi tu'dng^ dja diem va thdi gian nghien cu'u:
Ddi tu'dng nghien cu'u: La ngu'di nhiem HIV/AIDS du'dc cac labo do Bo Y te cap phep khang djnh ket qua xet nghiem va doi tu'dng biet tinh trang nhiem cua minh. Doi tu'dng hien dang sinh song tai cong ddng, cd danh sach quan ly;
du'dc thong bao va dong y tham gia nghien cu'u.
- Dja diem nghien cu'u: Tai thanh pho Lang Sdn, tinh Lang Sdn.
Thdi gian nghien o^i/.-TCr thang 1/2009 -1?/2010.
2.2. Phu'dng phap nghien c&u:
Thiet ke nghien cu'u: Can thiep cong dong cd so sanh tru'dc sau.
- Phu'dng phap nghien culj; Can thiep cong dong bang mo hinh "Cau lac bo phdng, chong HIV/AIDS".
+ Cac hoat dpng chinh cua mo hinh: Tap huan cho Ban Chi dao. Ban Chu nhiem va thanh vien chu chot; cung cap tai lieu; xay duhg va trien khai cac hoat dpng 3 b/ (tir tin, b/ giac va tiT lap)...
+ Chi tieu danh gia hieu qua mo hinh:
. Ty le gia dinh biet va chap nhan, cham s6c ngu'di nhiem HIV;
.Ty le ngu'di nhiem du'dc cong dong cham sdc, nhuTig cd quan, doan the tham gia cham sdc...
*TrWdng Dai hoc Y Thai Binh; **TrWdng Cao Ding YteNinh Binh Phan bi$n khoa hoc: GS.TS. Dao VSn Dung
Y HOC VI$T NAM T H A N G 9 - s 6 1/2011 III. KET QuA NGHIEN ClTU
Bang 1. Sir quan tam, chSm s6c ho trd cua gia dinh va cong dong ddi vdi ngu'di nhiem tru'dc va sau can thiep.
Npi dung
Tru'dc can thi^p
( H i )
SL o/o
Sau can thi^p ClU)
SL %
CSHQ
(%) - Gia dinh biet doi tu'dng nhiem
HIV (ni = 303; n^ = 303) 226 74,6 303 100 <0,001 34,0 DUdc gia dinh chap nhSn (nl
= 226; n2 = 303) 117 51,8 215 71,0 <0,001 37,1
Khi 6m dau dUdc gia dinh
chSm soc (ni = 303; ni = 303) 208 68,6 252 83,2 <0,001 2i,3 Bi cpng dong ky thi, xa l^nh
(n, = 303; n, = 303) ' 26 8,6 1,7 <0,001 80,2
DUdc sir ch3m soc cua cpng
dong (ni = 277; n; = 298) 108 39,0 215 72,1 <0,001 84,9 Sir quan tam, cham sdc ho trd cua g a dinh va cpng dong ddi vdi ngu'di nhiem tru'dc va sau can thiep cung cd nhu'ng thay ddi tich ci/c, cu the: Ty le ddi tu'dng du'dc gia dinh biet tinh trang nhiem ciia minh sau can thiep t3ng hdn tru'dc can thiep (100% so vdi 74,6%), vdi p<0,001, CSHQ dat 34,0%. Ty le ngu'di nhiem du'dc gia dinh chap nhan sau can thiep tSng hdn tru'dc can thiep (71,0% so vdi 51,8%), vdi p<0,001, CSHQ dat 37,1%. Ty le ngu'di nhiem khi dm dau du'dc gia dinh ch§m sdc sau can^thiep tang hdn tru'dc can thiep (83,2% so vdi 68,6%), vdi p<0,001, CSHQ dat 21,3%. Ty le ngu'di nhiem bj cpng dong ky thj xa lanh sau can thiep giam hdn tru'dc can thiep (1,7% so vdi 8,6%), vdi p<0,001, CSHQ dat 80,2%. Ty le ngu'di nhiem du'dc sir cham sdc cua cpng dong sau can thiep tang hdn tru'dc can thiep (72,1% so vdi 39,0%), vdi p<0,00i, CSHQ dat 84,9%.
Bang 2. Nhij'ng cd quan, doan the tham gia cham sdc ngu'di nhiem tru'dc va sau can Cd quan, to chuTc
Can bp y te xa/ phu'dng
Tru'dc can thiep (n = 108) ' SL
72
o/o 66,7
Sau can thiep (n = 215) SL
187
o/o
87,0 <0,001
thiep.
CSHQ (o/o)
30,4 Can bp trung tam y te
Thanh pho/huyen
41 38,0 110 51,2 <0,05 34,7
Can bo benh vien tinh 34 31,5 94 43,7 <0,05 38,7
Cac to chu'c phi chinh phu 37 34,4 101 47.0 <0.05 36.6
Cac doan the xa hoi 38 35,2 102 47,4 <0,05 34,7
Nhom ban giup ban 65 60,2 178 82,8 <0.001 37,5
Ngu'di khac 18 16,7 45 20,9 >0,05 25,1
Ty le cac cd quan, doan the tham gia cham sdc ngu'di nhiem sau can thiep deu cao hdn tru'dc can thiep, sir khac biet cd y nghTa thong ke vdi p<0,05 va p<0,001, CSHQ dat tir 30,4% den 38,7%.
IV. B A N LUAN
Odi vdi ngu'di nhiem HIV/AIDS, sir yeu thu'dng giup 6d cua nhOng ngu'di than ddng vai trd quan trpng trong viec ho trd tam ly, tuan thu dieu trj cung nhu' tSng kha n3ng hoa nhap cpng dong. Mpt dac diem cua ngu'di nhiem la can sir ho trd va cham sdc lau dai, nen khong ai khac ngoai nhu'ng ngu'di trong gia dinh c6 the lam du'dc viec nay. Cung chinh vi vay trong cac chu'dng trinh can thiep di/a vao cpng dong thi cac giai phap can thiep tac dpng v4o ngu'di nha
ddng vai trd quan trpng. Nhihig ngu'di trong gia dinh thu'dng c6 thai dp thu'dng yeu, an ui va giup dd ngu'di nha khi bj nhiem HIV/AIDS. Ket qua nghien cufu cho thay, ty le gia dinh biet ve tinh trang nhiem HIV/AIDS cua ddi tu'dng, ty le ngu'di nhiem du'dc gia dinh chap nhan, cham sdc khi dm dau t3ng hdn so vdi tru'dc can thiep. Oieu nay se giup ich cho ngu'di nhiem rat nhieu trong viec hoa nhap va cam giac khong bj c6 lap. Day la hieu qua cua cac giai phap truyen thong - Giao due suTc khoe cua cac cau lac bp ddi vdi gia dinh
8
Y HOC VIET NAM T H A N G 9 - s 6 1/2011 ngu'di nhilm. Cung nhu" nhieu nu'dc tren the gidi,
viec cham sdc cho ngu'di nhiem di/a vao gia dinh la chu yeu nen cac ket qua nay la rat c6 y nghTa.
Ky thi va phan biet ddi xiT lien quan den HIV/AIDS la van de thu'dng gap d cpng dong, dieu nay da du'dc the hien rat nhieu qua cac cau chuyen thi/c te cung nhu' du'dc chu'ng minh trong rat nhieu nghien cu'u. Tuyen truyen nang cao kien thuTc phdng benh chan doan sdm cho ngu'di dan tai cpng dong gan nhu" la mpt giai phap chinh cua tat ca cac chu'dng trinh muc tieu quoc gia hien dang du'dc trien khai. Vdi noi dung phdng chong HIV/AIDS thi viec tuyen truyen cho cpng dong de khong ky thj va phan biet ddi xiT vdi ngUdi nhiem HIV/AIDS lai ddng vai trd quan trpng. Ngu'di nhiem HIV cd the song mpt cupc song binh thu'dng rat nhieu nam nen ddi hoi ban than hp can cd y thuTc va biet each dieu trj, ch3m sdc cung vdi sir chia se, ho trd cua nhij'ng ngu'di than trong gia dinh va cpng dong. Chinh vi vay ma rat nhieu cac van ban chinh sach cung nhu' Luat Phdng chong HIV/AIDS tai Viet Nam da du'dc xay di/ng gdp phan ho trd ngu'di nhiem va tranh sir ky thi, phan biet ddi xiT lien quan den HIV/AIDS^ Ket qua nghien cu'u cho thay ty le ngu'di nhiem bj cpng dong xa lanh, ky thj sau can thiep giam so vdi tru'dc can thiep (1,7% so vdi 8,6%), vdi^P<0,001, CSHQ dat 80,2%. Theo chung tdi de tranh sir ky thj, phan biet ddi xOr vdi
ngu'di nhiem HIV/AIDS can cd nhij'ng giai phap truyen thong sau rpng den cac tang Idp nhan dan. Thay ddi nhan thuTc va thai dp cua ngu'di dan trong cpng ddng se khdng chi giup cho ngu'di nhiem song hoa nhap ma cdn giup cho con cai va nhu'ng ngu'di than cua hp du'dc ddi xiT binh dang, khdng bj phan biet ddi xiT, ngu'di nhiem cd cd hoi de cd nhQlig cdng viec on djnh trong xa hoi.
Cung nhu' tat ca cac quoc gia khac tren the gidi, ngu'di nhilm HIV/AIDS se du'dc quan ly va cham sdc chu yeu tai cpng ddng trong thdi gian dai. Viec cham sdc va ho trd nay can cd mpt nguon nhan li/c nhat djnh. Do do, viec ho trd va chia se cua cpng ddng ddng vai trd quan trpng, khdng gidng nhu' mpt sd benh man tinh khac, HIV/AIDS la mpt benh mang tinh chat xa hpl, cac du'dng lay truyen lien quan den nhij'ng van de mang tinh nhay cam nhu' nghien chich ma tuy, mal dam... Vdi nen van hoa mang dam net phu'dng ddng nhu' Viet Nam thi viec van dpng du'dc nhUng ngu'di dan trong cpng dong tham gia cham sdc va ho trd khdng phai ddn gian. Ben canh sir giup 6d Ian nhau cua nhij'ng ngu'di
nhiem, vai trd cua cpng dong va gia dinh trong cham sdc ho trd ngu'di nhilm HIV/AIDS da du'dc cai thien. Sau 2 nam can thiep ty le ngu'di nhiem du'dc cpng dong cham sdc tang hdn tru'dc can thiep (72,1% so vdi 39,0%), vdi p<0,001, CSHQ dat 84,9%. Nhu'ng cd quan, doan the da tham gia cham sdc ngu'di nhiem la: cd quan y te cac cap, cac to chu'c phi chinh phu, cac doan the xa hoi va nhom ban giup ban vdi ty le sau can thiep cao hdn tru'dc can thiep, CSHQ dat tiir 30,4% den 38,7%, vdi p<0,001 va p<0,05. Bao cao cua UNAIDS, d Uganda vdi mo hinh cham soc tai nha da giam du'dc sir ky thi; 79% benh nhan da du'dc cham sdc tai gia dinh va 76% benh nhan AIDS khdng bj cpng dong ruong bd, xa lanh. Chinh cham sdc tai cpng dong da gan ket du'dc ca hoat dpng diT phdng va cham sdc ngu'di nhiem HIV/AIDS.
V. KET LUAN
Ty le gia dinh biet va chap nhan ngu'di nhiem, ty le ngu'di nhilm du'dc gia dinh cham sdc khi dm dau deu tang hdn tru'dc can thiep, chi sd hieu qua dat 21,3% 37,1%. Ty le ngu'di nhilm bj cpng dong ky thj, xa lanh giam; nhan du'dc sir cham sdc cua cpng dong tang, chi sd hieu qua dat 89,2% va 84^9%.
Ngoai nganh y te, ngu'di nhilm cdn nhan du'dc sir cham sdc cua cac to chu'c phi chinh phu, cac doan the xa hoi, nhom ban giup ban...cac ty le nay deu tang hdn tru'dc can thiep, chi sd hieu qua dat tiT 34,7% 37,5%.
T A I LIEU THAM K H A O
1. Ban Bi thu" Trung u'Ong Dang (2005), Oil thi 54-Cr/m ngay 31/11/2005 cua Ban Bi thW vi tSng cu'dng lanh dao cong tac phong, chong HIV/AIDS trong tinh hinh mdi, Ha Noi.
2. Ban Khoa giao Trung u'Ong (2006), HWdng dan so 15-HD/BKGTW-BCSD, ngay 14/12/2006 ve Hu'dng dan thut hien Chi thj 54-Cr/TW cua Ban Bi thu' ve "TSng cu'dng lanh dao cong tac phong chong HIV/AIDS tmng tinh hinh mdi".
3. Bo Y te (2006), Luat phong, chong nhiem vi rut gay ra hoi chutig suy giam mien dich mSc phai d ngwdi (HIV/AIDS), Ha Noi.
4. B9 Y te (2006), ChWdng trinh hanh dong chSm soc, ho trd va dieu tri HIV/AIDS tai Viet Nam giai doan 2006 - 2010, Hoi nghj quoc gia ve Quan ly, cham soc va dieu trj HIV/AIDS.
5. Ngoc Mai (2009), "Phong chong AIDS bang 3 tu", Tap chi AIDS va cong dong, sd 11 (131) 2009, Cue phong, chong HIV/AIDS - Bo Y te.
