【作者】 何江江；

【导师】 徐凌忠； 武汝廉； 石光； 郝睿智；

【作者基本信息】 山东大学 ， 社会医学与卫生事业管理， 2009， 硕士

【摘要】 研究背景:艾滋病流行已成为全球危机,也是当前我国突出的社会问题之一,其蔓延趋势已呈现从农村向城市,从高危人群向一般人群快速传播的新趋势,作为桥梁人群的进城务工人员将处在艾滋病感染的高风险中。《中国艾滋病防治联合评估报告(2007)》指出,对农民工群体的宣传教育工作仍明显不足,一些宣传教育活动针对性不强、目标人群不明确,缺乏宣传教育效果。在此背景下,本研究以中国工作场所艾滋病教育项目为依托,以行为改变交流为理论基础,进行形成性评估,为制定更好的农民工艾滋病教育策略提供依据。目的:了解工作场所内进城务工人员(农民工)的真实情况,有效地制定艾滋病行为改变交流的信息、主题和沟通渠道,为开展工作场所艾滋病教育项目提供依据,促进工作场所针对农民工的艾滋病预防工作。方法:采取定量和定性相结合的研究方法。定量研究中,通过多阶段分层整群随机抽样获取调查对象,采用电脑和纸质两种形式的企业员工调查表收集数据,应用SPSS 13.0建立数据库,并进行一般性统计描述,χ~2检验,Spearman等级相关分析和Logistic回归分析等;定性研究中,通过目的性抽样选择访谈对象,使用关键人物访谈,个人深度访谈和焦点组讨论等方法收集定性资料,并利用Excel软件进行开放式编码,根据逻辑相似性,归入所属的各种不同主题中,再利用主题分析法和分析性比较等方法归纳整理。结果:问卷调查了云南、广东和安徽3省的13家企业中的管理人员和普通员工,共2771人,其中1013名城镇职工(对比人群),1758名农民工。定性访谈了5个试点行业的农民工、企业管理人员或卫生部门人员,共计131名。定量分析结果:1)艾滋病知识水平:受访农民工中,不能完全知晓艾滋病的三条传播途径占42.15%;能完全识别艾滋病的非传播途径仅有6.48%;完全掌握艾滋病预防知识仅有12.29%;其中,31.34%的不知道艾滋病可以通过性途径传播,70.48%认为打喷嚏、咳嗽能传播艾滋病,62.68%认为共用餐具能传播艾滋病。且艾滋病知识水平的各指标均低于对比人群。年龄,受教育程度,工作年限和收入水平对艾滋病知识水平呈正相关关系。性别,受教育程度,人口的流动性等将是提高农民工艾滋病知识水平的重点考虑因素。采矿业,建筑业和服装制造业的艾滋病知识水平较低。2)对待艾滋病的态度:持完全不接纳态度的受访农民工占13.71%。其中,不愿意接受感染者提供的服务的占76.17%,不愿意和他们共住的占73.55%,近60%的人不愿意和他们一起工作,其歧视程度均高于对比人群。艾滋病相关歧视程度与受教育程度呈负相关关系。此外,性别和工作类别也是重要影响因素。采矿业和建筑业的歧视程度较高。3)高危行为:3个月内,有过性行为的农民工中发生高危行为的比例为23.19%,半数没有使用安全套,明显高于对比人群。其中,男性高于女性,受教育程度较低者和劳动力市场的待就业工人的高危行为比例较高。定性分析结果—行业特征不同,农民工的基本情况有所差异,其共性结果为:·提及出门打工与改善生活条件,提高经济保障和获得好的工作机会有关:没有意识到规划未来;对收入的稳定性、家人幸福、健康、安全等表达了相似的担心;·相对于企业的正式职工,农民工很难享有全面的医疗保险。·获取信息的渠道主要是电视,报纸和计算机网络。社会网络主要是“老乡”(同伴)。企业的沟通渠道有自身的宣传培训计划与设施,职业安全会,工会和各种文体活动等。·农民工对性病艾滋病知识的缺乏,且艾滋病相关羞辱和歧视的深层根源可能与人们对性和吸毒行为的负面评价相关。·工作场所周边存在一些娱乐场所,其中有农民工发生商业性交易的现象;青年男女农民工均对婚前性行为持容忍态度;男性农民工使用安全套的主要障碍是,认为使用安全套,感觉没有购买到真正的服务;以及朋友/同事的影响和安全套可及性。·企业层面上尚没有制定艾滋病相关政策,提供相关艾滋病信息和服务也较少,对性病艾滋病治疗检测方面的信息存在空白。·企业管理层对艾滋病教育表示支持态度;社区层次上,存在潜在的伙伴机构;艾滋病相关的国际准则,国家和省级政策能为工作场所艾滋病政策制定提供支持。结论与建议:农民工艾滋病相关知识缺乏,对艾滋病感染者的羞辱和歧视非常普遍,且高危行为发生较多。不同性别,年龄,受教育程度,工作类别,民族,婚姻状况和收入水平等特征的农民工,其艾滋病风险程度不一。综合考虑目标群体的价值观,理想,社会网络和生活行为习惯等,以及所在地艾滋病疫情与政策,行业特征,工作场所/社区的活动及周边环境,和卫生服务的可获得性,识别出农民工中最高风险的目标群体,确定行为改变交流干预的机会和资源,制定农民工艾滋病行为改变交流策略。更多还原

【Abstract】 Research Background:The epidemic of AIDS has become a global crisis,and also is a prominent social problem in China.Its spread has been some new trends of rapid dissemination,from rural to urban and from HIV/AIDS high-risk group to the general population.Rural-to-urban migrant workers(called ’nongmingong’ in China),as a bridge group of HIV/AIDS spread,will be at high risk of HIV infection.The "China’s AIDS prevention and control joint assessment report(2007)" pointed out that,for migrant workers,the HIV/AIDS publicity and education activities was still insufficient,and not strong,also the target population is not clear,which caused the lack of effectiveness of publicity and education.Under this background,this study, based on the China Workplace HIV/AIDS Education Programme,and taking the theory of behavior change communication as foundation,carried out formative assessment to provide a basis for developing a better strategy for AIDS education of migrant workers.Objective:To understand the real situation of migrant workers at workplace,to develop effectively information,themes and channels for AIDS-related behavior change communication,to provide a basis for carrying out Workplace HIV/AIDS education project,and to promote AIDS prevention work for migrant workers. Methods:A combination of quantitative and qualitative research.In quantitative research,to obtain the survey respondents through multi-stage stratified cluster random sampling,using two forms of questionnaires(computer and paper-based) to collect data,using SPSS 13.0 to set up database and carry out general descriptive analysis,χ2 test,Correlation analysis and Logistic regression analysis,etc.;In qualitative research,to select interviewee with purposive sampling,using key informant interview,in-depth interview and focus group discussion and other methods to collect qualitative data,after using Excel software to carry out open-end coding,, classified into a variety of different themes according to the logical similarity,and collated and analyzed by the theme analysis and analytical comparison.Results:A total of 2771 managers and ordinary employees accepted the questionnaire survey at 13 enterprises in Yunnan,Guangdong and Anhui province,thereinto,1013 urban workers(comparative group) and 1758 migrant workers.And a total of 131 migrant workers,business management or health personnel accepted qualitative interviews within five pilot sectors.Results of Quantitative Analysis:1) Knowledge level on AIDS:Among the respondents of migrant workers,being not fully aware of three transmission of AIDS(account for 42.15%);to identify fully non-transmission of AIDS(only 6.48%);to know fully knowledge on AIDS prevention(only 12.29%);and 31.34%of migrant workers did not know HIV/AIDS could be transmitted by sex,70.48%thought they might infect HIV by sneezing or coughing,62.68%considered sharing utensils could make the spread of AIDS.All indicators for measuring the knowledge level on AIDS were lower than the comparative group.The knowledge level had a positive correlation with Age, educational level,working year and income level.Gender,educational level and mobility of the population will be the focus of consideration to improve the level of AIDS knowledge.Mining industry,construction and garment manufacturing sector were with lower level of AIDS knowledge.2) Attitude towards AIDS:13.71 percent of the respondents among migrant workers, who did not accept fully AIDS or people living with HIV/AIDS(PLWHA).Among them,76.17 percent was unwilling to accept services provided by PLWHA,and they did not want to live together with PLWHA,which accounted for 73.55%,nearly 60% was unwilling to work with PLWHA,and the extent of discrimination was higher than the comparative group.AIDS-related discrimination had a negative correlation with educational level.In addition,gender and job category were also important factors. Mining and construction industry were with a higher degree of discrimination.3) High-risk behaviors:Among respondents of migrant workers with having sex during the last 3 months,23.19 percent had high-risk behaviors,and half of them did not use condoms,significantly higher than the comparative group.Among them,the male was higher than the female,and workers with the lower level of education or jobless being in the labor market,who was in a higher proportion of high-risk behavior.Results of Qualitative analysis -- The basic situation of migrant workers was varied for the characteristics of different industries,while the common findings are following:·Improving the living conditions,enhancing economic security and getting good job opportunities were often as the reasons of working outside their hometown;being not aware of planning for the future;to express similar concerns about the stability of income,happiness,health and safety,etc.;·Compared to formal workers at workplace,migrant workers were very difficult to enjoy the full range of medical insurance.·Getting information mainly by television,newspapers and computer.The major social network was "hometown fellowship"(companions).The communication channels in enterprises,which were their own training programs and facilities,the occupational security meeting,trade unions and a variety of sports activities.·Being Lack of AIDS/STD knowledge among migrant workers,and underlying causes of AIDS-related stigma and discrimination,which may be related to social negative evaluation on sexual and drug abuse behaviors.·Surrounding the workplace,there were some entertainment places,at where the phenomenon of commercial sex trade happened among migrant workers;both young male and female migrant workers had a tolerant attitude on pre-marital sex behaviors; the main obstacles of condom usage for male migrant workers were,which they felt they did not purchase real services after using condom,and the impact of friends / colleagues and condom accessibility.·At the enterprise level,they did not develop AIDS-related policies,and provided fewer AIDS-related information and services,while being gaps on treatment and testing information related to AIDS/STD.·Enterprise management shows a support attitude to HIV/AIDS education;at the community level,there are some potential organizations with the same goal; HIV/AIDS related code,regulations and policies respectively at international,national and provincial level can give a support for developing workplace HIV/AIDS policy.Conclusions and Suggestions:Among migrant workers,they were lack knowledge on HIV/AIDS,and AIDS-related stigma and discrimination was widespread,and more high-risk behaviors happened.The AIDS risk varied from different social-demographic characteristics,such as gender,age,educational level,job category,ethnicity,marital status and income level.Considering the target group’s values,ideals,social network and living habits,as well as the local AIDS epidemic and policy,industry characteristics,the workplace / community activities and surrounding environment,and the availability of health services,to identify the highest risk target groups of migrant workers,and to determine the opportunities and resources of behavior change communication intervention,at last,to develop a better AIDS behavior change communication strategy for migrant workers.更多还原