【China AIDS:7224】 社区快检在中国，听听来自社区组织的声音

http://asiacatalyst.org/blog/2012/03/commentary-community-rapid-hiv-tests-in-china-the-voice-from-community-based-organizations.html

[COMMENTARY] Rapid HIV Tests in China: The Voice From Community-based Organizations| 社区快检在中国，听听来自社区组织的声音

March 29, 2012 12:23 PM | 

By Hou Ye

The debate around real-name HIV testing--sparked by proposals in Guangxi and Hunan provinces early this year--has pushed the issue of confidentiality once again to center stage. To decrease loss to follow-up among people who test positive for HIV (i.e. people not returning for their results), testing agencies should rigorously protect patients' confidentiality. Without an expectation of confidentiality, people may be reluctant to return for test results and be HIV-identified. This issue is no longer just relevant to hospitals, as a growing number of community-based organizations have begun providing HIV screening to their members and clients. Many of these organizations work with key affected populations (KAPs), such as gay and male sex workers, provide HIV screening to their communities. It is important for these agencies to share their experiences.

随着前段时间广西、湖南等地拟立法推行艾滋病检测实名制引起社会各界激烈的讨论，感染者的隐私权成为关注焦 点。值得注意的是，为降低艾滋病检测的阳性流失率，检测机构应该对个人信息严密的保护以及负责人的后续跟进#。因此近几年来，在中国各个地区出现了越来越 多的社区小组，他们大多来自于重点或易感人群--男同、男性性工作者等，为社区成员提供HIV抗体快速初筛检测。

The director of a Kunming-based NGO that started rapid HIV testing in June 2010 told Asia Catalyst: "In this city, you have always been required to register your real name and ID number if you want to take a HIV test but we provide anonymous HIV screening in our organization. It's very convenient, and it takes only 20 to 30 minutes to get the results." And their services don't stop there. "[O]ur peer consultants provide consultation before and after the test. If it's positive, we accompany the patient to the municipal Center for Disease Control (CDC) for confirmation, in order to help them calm their nerves." According to their own count, 70 percent of those who went for screening are male sex workers and gay university students. With this kind of support, the follow-up loss rate among people who tested positive dropped from 50 to around 10 percent.

" 这里的医疗机构提供的检测从来都是实名制的，而我们小组提供了匿名的初筛检测，20-30分钟之内就能获得检测结果，非常便捷。而且在检测之前后，我们的 同伴咨询员还会为检测人提供详细的咨询以及初筛阳性之后的确诊陪同。所以他们不会太过恐惧。"一家位于中国云南省的民间组织的负责人向亚洲促进会介绍。该 组织自2010年6月开始为社区提供快检服务，据介绍，大多数到该组织接收检测的人为男性性工作者和高校男同性恋学生，占总人数的70%左右。通过这一方 式，感染者流失率从原来的50%降低到10%左右。

In 2006, Yunnan became the first province to make the switch from anonymous to real-name testing. Citing confidentiality concerns, fewer people overall chose to be tested after the switch. Worse, because of an increase in mandatory targets, medical institutes and NGOs spent money paying people to get tested and not on more interventions such as safe-sex consultations and psychological counseling. Ultimately the CDCs in Yunnan returned to anonymous testing. This wasn't soon enough--many KAPs are no longer willing to get tested because of trust and confidentiality problems.

作为艾滋病高流行地区，云南省在2006年以前一直实行艾滋病毒匿名初筛检测。2006年开始要求从初筛开始进行实名制，成为了全国首先推行初筛实名制的地区。出于对隐私保密的担忧，这一政策的出台直接导致检测量下降。 更为糟糕的是，因为对检测数量有硬性指标，为完成任务，医疗机构和一些民间组织采取资金奖励的措施督促重点或易感人群到当地医疗机构检测，忽略了安全知识 与预防措施咨询、心理辅导等更为人性化的干预措施，这种不恰当的动员导致当地社群对检测产生了强烈反感情绪，使得检测工作适得其反#。尽管之后云南各个市 级疾控中心恢复了初筛匿名的检测，但对检测机构的不信任感以及担心隐私泄露，很多高危人群并不愿意主动进行检测。然而，云南并不是一个特例，过去的几年中 在中国各个地区，医疗机构与社区的矛盾屡见不鲜。

In 2009, an NGO along the coast initiated the rapid HIV test in local community of men who have sex with men (MSM) with foreign funding. This form of testing, using blood from fingertips, was well received in the community and quickly became popular, because of the speedy results. Compared to the cold and soulless atmosphere of the hospital, individuals can choose to be tested in a more comfortable environment with privacy, respect, and careful consultation from their peers and NGO. "Rapid HIV tests tie us to the community, which enables us to conduct more comprehensive HIV/AIDS intervention," one staffer commented.

2009年一家位于 中国沿海城市的社区组织通过某国际基金会支持，开始试行指尖（末梢采）血社区快检。这种检测模式很快获得社区的欢迎。首先，快速获得检测结果解决了告知难 的问题，参加检测的人也不用为了等待结果而备受长时间的心理折磨；同时，社区组织可以在社区人员喜欢的环境中开展检测，而且时间的灵活度也很大，因此大大 提高了检测的可及性，扩大了干预的覆盖面；由于社区组织提供服务，因此能够营造一个私密、无歧视的环境，社工和同伴提供的检测前、后以及等待时期的咨询服 务让整个检测不再是"死神的宣判"，高危人群因此能够以更平常的心态主动检测，以更理性的心态面对结果。这家组织的工作人员向我们表示："以社区组织为主 导的快检使得我们的干预力度更深，与社区的联系更紧密。"

Recognition for the role of these tests is coming. Dr. Wu Zunyou, director of the National Center for AIDS/STD Control and Prevention, said in an interview: "[C]ommunity-based organizations are a bridge between the government, medical institutes and KAPs. The HIV screening they provide lessens people's worries and helps to expand the population for testing." Furthermore, our Chinese partner organizations tell us that municipal CDCs in many cities have or plan to collaborate with local NGOs to provide rapid HIV tests in local communities, an official recognition of the services that these local organizations have to offer.

通 过几年的试验，以社会组织为主导的快检模式已经初见成效。中国疾控中心性病艾滋病预防控制中心主任吴尊友博士提出应鼓励社区卫生服务机构提供艾滋病快检服 务，"社区组织是连接政府和疾控机构与高危行为人群的中间纽带，社区机构进行检测不仅会减少筛查者的顾虑，也会扩大检测范围。" 亚洲促进会也了解到，在中国北部、西南以及沿海地区，多个城市的疾控中心已经或逐渐开始为社区组织提供技术或资源，支持他们在当地开展这项服务，为社区开 展快速检测的合法性敲下了定音锤。

The trust and deepening cooperation between medical institutes and NGOs is one important step but challenges remain. One young NGO worker explained: "Because of different capacity levels, it will make a lot of trouble if too many organizations are providing these services without careful planning and systematic capacity building. A lot of technical issues need to be tackled here, such as emergency treatment, identity exposure during the testing, capacity of consulting and informing, etc." But she quickly added, "Improving your professionalism and the service you provide is the only way to win the recognition of the community."

对于疾控等卫生部门和民间组 织来说，社区快检能够加强彼此间的信任，深化合作。但同时，大面积推行社区快检也为民间组织带来了巨大的挑战，"如果盲目地大范围地推广快检，是会出大乱 子的。因为目前很多社区组织的能力参差不齐，如果没有经过专门培训就开展服务会产生很多问题，如突发状况的应急处理、快检过程中的暴露问题，受检人员结果 告知的接受能力评估等等", 一位年轻的NGO工作人员表示了他的担忧#。这也给很多即将开展社区快检的机构敲响警钟，"只有不断提升自身和服务的专业度，才能够最终获得社区的认 可。"他补充道。

 Hou Ye is the China Program Assistant at Asia Catalyst. This post was translated from its original Chinese.

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