医疗

  WAPN+ facilitated a treatment literacy and advocacy training forum in Bangkok, Thailand, at the end of September 2010. The training was attended by 22 participants from 13 countries in the Asia Pacific region.

  Treatment literacy can be defined as understanding HIV/AIDS and all aspects of antiretroviral therapy (ART), including types of ARV drugs, how they work, ARV side effects, treatment adherence, HIV drug resistance and other issues. Treatment literacy is essential to ensuring that people living with HIV are well informed and in a position to participate more actively in treatment, including communicating treatment needs to health care providers.  It is also important to have the knowledge and capacity to hold governments accountable and to ensure they improve the quality and accessibility of health services and the quality of ARV treatment.

The attached report provides a full account of the 3 day forum.

Organization: APN+

Weblink: http://www.apnplus.org/main/Index.php?module=news&news=64


    2010年9月WAPN+在泰国曼谷开展了治疗教育和倡导的培训。来自亚太地区13个国家的22人参加和培训。

    治疗教育包含HIV/AIDS和抗逆转录病毒治疗(ART)的方方面面,例如ARV药物的类型、药效、副作用、治疗坚持度、HIV抗药性,等等。治疗教育能够保证艾滋病毒携带者的知情权,并帮助他/她们积极地参与治疗,例如与医护人员针对治疗需求进行沟通。同时,艾滋病患也需要监督政府,推动其提高卫生服务以及ARV治疗的质量与可达性。


详细信息请参考为期三天的培训报告:Report WAPN TL Training 30 Sep-2 Oct 2010_New.pdf

机构: APN+ - 亚太艾滋病感染者网络



30TH ANNIVERSAR​Y OF THE FIRST REPORTED CASES OF AIDS


STATEMENT OF ANTHONY S. FAUCI, M.D., AND JACK WHITESCARVER, PH.D.,
NATIONAL INSTITUTES OF HEALTH, ON THE 30TH ANNIVERSARY OF THE FIRST REPORTED CASES OF AIDS

On June 5, 1981, an article concerning five previously healthy, young gay men in Los Angeles diagnosed with Pneumocystis carinii pneumonia, an infection that usually appears only in individuals with substantial immune system damage, appeared in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention.
Soon more cases like these appeared, at first mainly in gay men, but then also in injection drug users, hemophiliacs and other recipients of blood and blood products, heterosexual men and women, and babies who acquired the infection from their mothers during birth or breastfeeding. We and our colleagues quickly began to confront the reality of a deadly new disease that would change the world. The disease ultimately would be referred to as AIDS.

Thirty years later, we are gratified by the progress that has been made in understanding, treating and preventing HIV/AIDS. We could not have imagined these advances during the early days of AIDS, when all we could do was provide palliative care to waves of dying patients. Whereas survival was once measured in weeks or months from the time of diagnosis, today, the critical discovery of antiretroviral drugs and their use in combination regimens has resulted in greatly improved life expectancy -- decades, rather than months -- for many HIV-infected people who have access to these medicines and adhere to treatment.

We take pride in the contributions of NIH-supported scientists who have been central to the investigation of the HIV disease process, the development of new therapies for HIV/AIDS and the design and validation of methods of HIV prevention. NIH scientists played a key role in demonstrating that HIV causes AIDS and in developing a diagnostic test for the virus. The ability to test the blood supply for HIV has nearly eliminated the risk of HIV transmission through blood transfusion.

NIH has supported basic and clinical research that provided pivotal data for many of the more than 30 drugs that have been approved by the Food and Drug Administration to treat HIV infection, as well as for strategies to address its associated opportunistic infections, malignancies and clinical complications. Clinical trials funded by NIH also have helped determine the most effective combinations of these drugs to slow or halt the progression of HIV disease. Additionally, NIH-supported studies were instrumental in designing effective strategies to virtually eliminate mother-to-child HIV transmission in developed nations and to dramatically reduce HIV transmission from an infected mother to her newborn or nursing child in the developing world. Many of these clinical trials were designed with the involvement and advice of HIV-affected communities, establishing a model for the conduct of clinical trials for other diseases.

NIH-supported, large-scale clinical trials have resulted in other notable achievements in HIV prevention. These studies sought answers to questions of critical importance to the global public health community. They proved that medically supervised adult male circumcision <http://www.niaid.nih.gov/news/newsreleases/2006/Pages/AMC12_06.aspx> more than halves the risk of female-to-male sexual HIV transmission; that needle and syringe exchange programs can reduce HIV transmission without increasing injection drug use; that a vaccine <http://www.niaid.nih.gov/news/newsreleases/2009/pages/thaivaxstudy.aspx> can achieve modest protection against HIV infection; and that taking an antiretroviral drug daily <http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx> can reduce the risk of HIV acquisition in men who have sex with men.

Most recently, an NIH-funded clinical trial <http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx> demonstrated that an HIV-infected individual can dramatically reduce the risk of transmitting the virus to an uninfected heterosexual partner by starting treatment when his or her immune system is relatively healthy. NIH also helped train the scientists and establish the infrastructure for an important clinical trial funded by the U.S. Agency for International Development showing that a vaginal gel containing an anti-HIV drug can help protect women from HIV infection. These multiple achievements are important because it is clear that controlling -- and ultimately ending -- the HIV/AIDS pandemic will require a combination of scientifically proven HIV prevention tools.

As gratified as we are by these accomplishments, we are sobered by some grim realities and remaining challenges. Despite the global public health community's best efforts to prevent new infections, 2.6 million people around the world became newly infected with HIV in 2009 alone. In developing nations, only about one-third of the 15 million people who need anti-HIV drugs have access to them. In addition, a growing proportion of patients receiving long-term antiretroviral therapy are experiencing treatment failure, drug toxicities, side effects and drug resistance. In this regard, recent studies have noted an increased incidence of malignancies, cardiovascular and metabolic complications and premature aging associated with long-term HIV disease or antiretroviral therapy.

NIH research will continue to address these issues as well as the causes of HIV-related health disparities, their role in disease transmission and acquisition, and their impact on treatment access and effectiveness. These include disparities among racial and ethnic populations in the United States; disparities between developed and resource-constrained nations, and disparities based on gender, age, or sexual identity. NIH research also will continue to play a critical role in providing the scientific foundation to achieve the goals of the President's National HIV/AIDS Strategy. Among the important scientific challenges that remain are the development of a safe and effective vaccine that can take its place among the combination of prevention tools as well as the possibility of curing at least a proportion of HIV-infected individuals.

The HIV/AIDS pandemic will remain one of the most serious public health crises of our time until better, more effective and affordable prevention and treatment regimens are developed and universally available. As the single largest public funder of HIV/AIDS research in the world, NIH is committed to advancing a comprehensive program of basic, clinical, translational and behavioral and social science research toward controlling and ultimately ending this modern plague. In memory of the patients, friends, loved ones and colleagues we have lost over these three decades, we wholeheartedly embrace this responsibility and opportunity knowing that history will judge us as much for what we accomplish during the coming years as for what we have achieved thus far.

Dr. Anthony S. Fauci is the director of the National Institute of Allergy and Infectious diseases. Dr. Jack Whitescarver is the NIH associate director for AIDS research and the director of the NIH Office of AIDS Research.

NIAID conducts and supports research -- at NIH, throughout the United States, and worldwide -- to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at <http://www.niaid.nih.gov/ >.

The Office of AIDS Research, a part of the Office of the NIH Director, coordinates the scientific, budgetary, legislative, and policy elements of the NIH AIDS research program.   OAR sets scientific priorities, enhances collaboration, and ensures that research dollars are invested in the highest priority areas of scientific opportunity that will lead to new tools in the global fight against AIDS.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
美国国家卫生研究院(NIH)医学博士Anthony S. Fauci、博士Jack Whitescarver为艾滋三十周年发表讲话。

    1981年6月5日,三名来自洛杉矶的年轻男同性恋者被诊断出患有卡氏肺囊虫肺炎,这种疾病通常只有在病患免疫体遭受破坏时才会感染,该病例报告发布于美国疾病控制与防治中心期刊《发病率与死亡率周报》上。

    三十年过去了,我们对在认识、预防与治疗艾滋病方面所取得的进步非常欣喜。NIH所支持的科学家们在艾滋病毒调查、新型治疗方法的研发、以及设计和实验艾滋病预防方法等方面所取得的进步令我们深感骄傲。

    NIH支持的艾滋病预防大型临床实验取得了显著的成果。这些研究解答了很多全球卫生系统共同面临的问题,证明了在严格的医学监控下,对成年男性进行包皮环切手术能够降低一半以上由女性传染的艾滋病毒的风险(http://www.niaid.nih.gov/news/newsreleases/2006/Pages/AMC12_06.aspx );针头和注射器交换项目可以在不增加注射吸毒的基础上降低艾滋病毒的传播; 注射疫苗能在一定程度上防治艾滋感染(http://www.niaid.nih.gov/news/newsreleases/2009/pages/thaivaxstudy.aspx );每日服用抗逆转录药物能够降低男男性行为者感染艾滋的风(http://www.niaid.nih.gov/news/newsreleases/2010/Pages/iPrEx.aspx )。

    最近,NIH支持的临床研究(http://www.niaid.nih.gov/news/newsreleases/2011/Pages/HPTN052.aspx )表明,艾滋病毒感染者如果在自身免疫系统相对较健康的情况下开始治疗,其感染健康的异性性伴侣的可能性将大大降低。另外,NIH也协助美国国际开发署对其资助的临床研究人员进行培训,并提供研究所需的基础设施,该研究结果表明含有抗艾滋药物的阴道凝胶能够防治妇女感染艾滋。
 
    这些研究成果对我们的抗艾工作至关重要,它们证明了如果要控制、以及最终结束艾滋感染需要采用大量科学研究证实的艾滋预防方法。

    虽然我们对目前所取得的研究成果感到欣喜,但是我们也清醒地认识到残酷的现实,我们仍面临巨大的挑战。尽管全球卫生系统都尽全力预防新增感染,2009年全球仍有2600万新增感染者。在发展中国家,1500万感染者中只有三分之一的患者能够获得艾滋治疗药物。另外,越来越多长期接受抗逆转录病毒治疗的患者正面临治疗失败、药物中毒、副作用以及抗药性等问题。因此,在长期艾滋疾病与抗逆转录病毒治疗的过程中,研究显示出越来越多关于恶性肿瘤、心血管与新陈代谢并发症、早衰等问题的案例。

    NIH研究将继续针对这些问题开展科研工作,同时也将对与艾滋病毒有关的健康隐患开展研究。在更好、更有效、更廉价的预防和治疗方案发明以及在全球范围内的推广之前,艾滋流行仍将是全球公共卫生系统面临的最严酷的危机之一。NIH将一如既往地致力于临床以及社会科学研究,为控制以及最终消灭这一现代瘟疫而努力。

    Anthony S. Fauci博士是NIH过敏症与传染病学部主管。Jack Whitescarver博士NIH艾滋研究部副主任以及NIH艾滋研究办主任。

    作为美国卫生与人力资源服务部的组成部门,美国国家卫生研究院(NIH)是美国医疗研究机构,旗下包括27个研究所与研究中心。NIH是美国主要的联邦研究机构,支持并开展大量基础的、临床的以及转化型研究,同时也致力于研究普通和罕见疾病的成因、治疗以及治愈方法。

更多信息请登录NIH官方网站www.nih.gov


    从HIV/AIDS被发现以及成为全球健康隐患至今已有整整三十年了。

    自第一例艾滋病案例于1981年6月5日被诊断至今,已有三千万人死于这种疾病。全球领导人于上周一集聚一堂,共同对艾滋问题进行回顾与展望。虽然最新的联合国报告指出全球抗击艾滋的努力有效地降低了新增感染率,尤其是在亚太地区效果显著,但本地区仍然非常脆弱。

主持人:Sen Lam
演讲者:联合国艾滋规划署,亚太区代理司长JaneWilson



Wilson:艾滋病毒携带者的数量保持稳定,相比较2001年,新增感染者的数量确实下降了20%。因此我认为这对我们来说是一个非常重要的讯息。通过为高危群体提供高质的治疗服务,艾滋病的流行程度锐减,这个巨大的改变是我们共同的努力的结果。

    柬埔寨是全世界八个能够实现全国80%人口获得ART(抗逆转录病毒治疗)普及治疗的国家之一,这是一个非常大的成就。

    泰国对母婴之间的病毒传播的预防覆盖率也达80%。印度所取得的成就更为巨大,特别是在南印度地区。总体来说,2001年至2009年间,全球新增感染率下降25%,而在印度这一数值超过50%。如果考虑到印度的人口比例,这就是一个非常重大的发现。我认为需要强调的是,所有的这些成就都是通过一点一滴积累起来的。你也许听说过在那些地区开展的很多大型项目,医疗服务的提供、与当地政府和社区之间所建立的强大的合作关系都对项目的成功起了关键的作用。

LAM: 那么你能不能简单地给我们介绍一下太平洋地区的情况?

WILSON: 太平洋地区的数据又有所不同。从2001年至2009年,艾滋病毒携带者的数量从2万8千人升至5万7千人。和亚洲相比较,这些数值并不高,但是对于本地区来说,这确实是一个不小的数字。对于某些社会来说,影响是巨大的。这个地区非常多样化。如果你从整体来看,巴布新几内亚是本地区艾滋流行度最高的国家,感染率达0.9%,但该数值目前日趋平稳,这是共同努力的成果。该区域艾滋感染主要通过性行为传播,特别是在巴布新几内亚。但同时我们也看到注射吸毒也是主要感染途径之一,尽管数值相对较小,但在某些社区和国家却造成很大的影响。

LAM:考虑到亚洲各国发展的不同程度,以及其它社会经济因素,我们是否可以做出这样的假设:即使我们取得很多成果,但该地区仍将非常脆弱?

WILSON: 这真是个非常好的问题,因为当我们谈论覆盖率这个问题时, 尽管整个区域治疗率达31%,东南亚地区更是达到43%,但是更为重要的是如何维持现有的治疗率,如何保持我们目前所取得的成果。总体来说,性工作者、注射吸毒者、男男性行为者以及跨性别者是最容易感染艾滋病毒的群体,我们必须保证艾滋预防和治疗项目的持续性。例如,目前很多国家正在商讨自由贸易协议,这将严重威胁到病患获得药品的途径,这些协议将对整个区域产生可怕的影响。

LAM:你并未提及社会和文化因素,亚洲很多国家都设有严格的反毒品和反同性恋法律,对于性工作的立场也非常严苛。这些因素是否对艾滋病毒感染者来说构成巨大的挑战呢?

WILSON:毫无疑问,这些因素产生的影响非常巨大。我认为各国政府正逐渐意识到这些问题。很多国家,例如中国、越南、印尼,已经开始对政策进行修改,美沙酮项目和针头交换项目正在各地大量展开。我觉得总体来说,公共卫生官员已认识到性工作是一项职业,从人类出现的那一天就一直伴随着我们。但还是有很多案例,在该地区一些国家仍然保留殖民时期遗留下来的法律。我们必须废除这些过时的法律和政策,以便让大家在区域能够自由地活动,使那些携带艾滋病毒的人能够不受歧视,自由地接受预防、治疗、关爱和支持服务。

LAM: 我知道在这些国家很多项目经费都来自外国援助,而非该国自己的财政。这将也是未来发展的趋势吗?

WILSON:这确实令人担忧,特别是在某些国家,例如越南正逐渐成为中等收入国家,该国一直都非常依赖海外捐赠,但将来也许无法获得相同的捐赠。如果病人开始进行抗逆转录病毒治疗,那该治疗必须保持一生,一旦停止病人的健康将受到危害。如果病人产生抗药性,但又必须服药,那么他们只能选择那些昂贵的二线药物。因此维持目前的抗逆转录病毒治疗的管制非常重要,保证每个病患都能持续治疗,这也是预防艾滋非常重要的方法。


Asia Report 翻译

原文链接: http://www.radioaustralia.net.au/connectasia/stories/201106/s3236705.htm




It's thirty years since HIV AIDS was identified and recognised as a global health threat.


Thirty million people have died since the first AIDS case was reported on 5th June 1981. World leaders gather in New York on Monday, to look at the way forward, even though the latest United Nations report says the response to the global HIV-AIDS epidemic has resulted in a significant fall in new infections.

Asia and the Pacific registered some of the best results in stopping new HIV infections, but the region remains extremely vulnerable.


Presenter: Sen Lam
Speaker: Jane Wilson, acting director, UN AIDS, Asia and the Pacific

WILSON: The number of people living with HIV remains stable and new infections are actually twenty percent lower than they were in 2001. So I think that's a very important message to get across. They've turned their epidemics around, and they're providing quality services to their most at risk populations, so really making a very big difference. Cambodia's one of only eight countries worldwide, to have reached eighty percent universal access to anti-retroviral therapies, so that's a real success story.

Thailand also has a coverage of eighty percent for prevention of parent to child transmission services. India's really making quite significant strides, particularly South India. Compared to 2001 to 2009, overall, the average is that rates of infection have fallen by twenty-five percent globally, but India's rate of new infections has fallen by over fifty percent. And when you consider the population scale in India, that's a very, very significant finding. And I think what we say is, alot of this has been achieved by scaling up. You perhaps have heard of some of the very large programmes that are operating there. Many more points of service delivery, very strong partnership with the community and the government. This is the way these things have been achieved.


LAM: And Jane, can you give us a quick snapshot of what's happening in the Pacific?

WILSON: The Pacific, we're talking about very different numbers, as you'd know. I mean, we have between 2001 and 2009, from 28-thousand people living HIV, to 57-thousand. So if you compare with Asia, these are not large numbers, but for the Pacific, these are very significant numbers. And it can have a very major impact on their specific societies. It's a very diverse region. if you look over all, Papua New Guinea has the region's largest epidemic, with the prevalence rate of point-nine per cent but that is gradually starting to level off, so there is some progress being made in the Pacific. It is largely being driven by sexual transmission, particularly in Papua New Guinea and over all, but we are seeing injecting drug use, which is described as a small but significant factor, as becoming apparent in some communities, in some countries in the region.


LAM: And Jane, given the socio-economic factors and the uneven levels of development in Asia, may we assume then, that if gains have indeed been made, that the region is still extremely fragile?

WILSON: That's a really, really good question, because while we can talk about coverage rates, for example of treatment of thirty-one percent overall, and in Southeast Asia of forty-three percent, maintaining these treatment rates, maintaining the progress that we've reached is extremely important. Over all, the communities that are the most vulnerable to HIV, that is sex workers, people who inject drugs, men who have sex with men and transgender people, we really need to make sure that programmes aimed at prevention and treatment are maintained, and that challenges for treatment are dealt with. For example, some of the current free trade agreements being negotiated at present, really have tangible threats to accessible drugs, which would have an appalling effect on the region.


LAM: You touched a little on social and cultural factors, that many Asian countries have strict anti-drug and anti-gay laws, and also a tough stance against sex work. do these factors pose a huge challenge to HIV sufferers?

WILSON: They're absolutely massive. And I think governments are gradually becoming much more aware of these factors, and you've got significant changes of policy in countries like China, like Vietnam, like Indonesia, where methadone programmes, and needle exchange programmes are being rolled out. I think public health officials are overall, aware that sex work is a profession that's been around as long as man has been on the earth. But there're still in many cases, outdated laws. In many cases, handed down from colonial pasts, in some cases not, but these kinds of laws and policies really need to be overtaken so that people can move around the region freely, those people living with HIV and also access treatment, care and support and prevention, without experiencing discrimination.

LAM: And Jane, I understand that many of these countries don't spend their own money; that much of the funds for treatment and other programmes come in the form of foreign aid. Is that likely to be an issue in the future?

WILSON: It's extremely worrying, particularly in some countries - we take Vietnam, which is becoming a middle income country and they're very reliant on international donors and then, can't access donor funding in the same way. People when they go on anti retroviral therapy need to maintain it for the whole of life, and if they stopped taking drugs, of course their health suffers, they become resistant, and if they have to start taking drugs, they have to go to more expensive second-line drugs, so it's extremely important that drug regimes, anti retroviral regimes are maintained and that people can continue treatment, because that's also a very good way of preventing HIV infection.


Weblink: http://www.radioaustralia.net.au/connectasia/stories/201106/s3236705.htm

流行病学专家 Elizabeth Pisani2008年撰写的《妓女的智慧》(The Wisdom of Whores)一书引起了巨大反响,书中披露了其多年来在艾滋领域工作的经验,内容涵盖了从筹款的政治艺术到在曼谷与按摩院性工作者的交流等。IRIN/PLUS NEWS对她进行采访。

(Q=问题/A=回答)

Q:为什么我们对预防艾滋所作出的努力没有成功的阻止该病毒的流行?

A:失败的原因有很多。其中一个是我们直到艾滋开始大面积感染和传播之时才开始进行预防工作,到那时一切都变得非常困难。如果流行度越高,我们对有效的预防的需求就越大,这样才能保持感染面积不会继续增大。

就全球范围来说,在艾滋预防方面我们错失很多良机。其中一个是针对注射吸毒人员的针头交换项目。实施相关政策、并对法律作出适当调整的国家最终有效地降低了该群体的艾滋感染率。不幸的是,包括美国和俄罗斯在内的很多国家并没有选择这么做。另外一个机会是为有偿性工作者提供安全套、润滑油以及性病检查。尽管证据显示在色情行业中要实现安全套高使用率并非难事,但这项工作并没有很好地开展,特别是在非洲撒哈拉以南地区。

对于不同的艾滋预防方法我们相当的精挑细选。如果要获得成功那么必须得从四个方面来完善艾滋预防方法:行为方面、技术方面、政治方面以及财政方面,如果缺失其中任何一面,那么整个方法都行不通。举例来说,从技术上来说,如果一个人禁欲那么他/她将完全不会感染上艾滋病毒,但是从行为方面考虑,相关研究指出完全禁欲是不太可能发生的,因此如果向公众宣传后半辈子只要夹紧腿做人就能预防艾滋是行不通的。

Q: 在对抗艾滋的过程中我们忽略了什么?为什么?

A:社会性别是整个抗艾过程中最大的误解之一。我们一直把妇女看做无辜的,而男人总是万恶之源,但事实上一个巴掌拍不响,如果没有双方的参与,异性之间的性行为是无法传播的。实际上妇女也可能是传染源。在非洲撒哈拉以南的地区,刚刚结婚的年轻女性更有可能是被感染一方,新婚的男人通常是病毒的传播者,但新增感染者中仍有大约三分之一的案例是妻子传染丈夫。

妇女被当成无辜的受害者这一观念对很多项目设计产生误导,例如针对妇女的赋权项目以及小额贷款项目。这两种项目都非常有用,但对于解决艾滋问题效果并不大。我们更应该花大力气做的是倡导安全套的使用以及提高性健康服务,特别是在色情业,这些工作都应该更早开展。我们对商业性的色情行业仍没有投入应有的关注。

对于艾滋病传染问题,我们总是采取两等分的态度来看待--一般化或集中化,但是即使一般化该问题,新增艾滋感染案例中,比起一般大众来说,性工作者的感染占了更高的比例。

Q:在你的《妓女的智慧》一书中,你提到在亚洲,艾滋预防应该关注高危群体,例如性工作者和注射吸毒人员。在东非和非洲南部,艾滋病毒更是一个全民问题。那么到底什么才是最好的艾滋预防方法?

A:老实说,我并不知道在非洲撒哈拉以南地区要采用何种方法预防艾滋感染,我也并不认为有其他人发现了更好的方法。我预测感染率不但不会降低,反而有上升的可能性。
从另一个方面来说,在对其它健康和发展问题不造成影响的情况下,如果有可能在CD4细胞值更高的时候提供和扩大治疗,那么艾滋病毒最终将不会是什么大事。"AIDS Mafia"的成员,例如我自己,不会随便说"艾滋病毒并不是什么大问题"这样的话,因为我们是经历过艾滋感染爆发高峰期的一代人,病人的死亡可不是一件小事。但是现在如果每个人都有途径接受治疗并能够承担治疗费用,并且每个感染者的病情都能得到很好的控制,那么艾滋病将不再是一个大问题。


Asia Report 翻译

原文链接:

http://www.plusnews.org/report.aspx?reportID=92915

  Hanoi authorities on Tuesday allocated VND5 billion (US$243,000) for a program to crack down on prostitution.

  Half of the funding will support a rehab center to treat sex workers, including those addicted to drugs, and HIV-infected children.

  Money will also be spent on propaganda such as leaflets, newspapers and documents aiming to raise awareness of sex workers.

  Hanoi police department will also be supported to strengthen crackdown on secret brothels and prostitutes in public places.

  On May 12, the government unveiled on its website a five-year plan to reduce prostitution by an initial 40 percent by 2015.

  With a budget of VND629 billion ($30.5 million), the program looks to free communes and towns from prostitution and minimize harms on society.

  Rehab and healthcare centers, job training for former sex workers and public awareness are among the measures the government said will be taken to battle prostitution.


Weblink: http://www.thanhniennews.com/2010/Pages/20110601115436.aspx


  In 2010, the Population Services International (PSI) program, Sun Quality Health (SQH), and its sister network of village health workers, Sun Primary Health, performed more than 2.1 million client consultations in Myanmar. John Hetherington, who has managed the network since 2007, talked to CHMI (Center for Health Market Innovations) about how--in the second-poorest country in the Asia-Pacific region--SQH has assembled one of the broadest service packages of any social franchise network operating today in an attempt to provide high quality, well regulated priority health services to local people.


CHMI: You offer a wide range of services under the Sun Quality Health brand. How do you select the services the brand will include?
John Hetherington: With a backbone of 1200 doctors in more than 200 townships, we can be entrepreneurial. We first ask, is there a need not being met? And is there an opportunity for a network of providers to offer that service? In Myanmar, the largest health concerns - malaria, family planning, pneumonia, diarrheal disease, TB - are either too expensive to treat, or doctors don't provide the right quality service. As in many places, we started with reproductive health and family planning, where there is a natural fit for social franchising.

Why is it that so many social franchising programs start by offering family planning?

JH: I think family planning is unlike other services because everyone from 15-49 is potentially a client - meaning, they are theoretically all fertile -- and this makes it different than addressing diseases which require many more inputs to be efficient, targeting, testing, etc., particularly in Asia, where many of the big diseases tend to be concentrated epidemics. With FP, you have the potential to offer (almost) anyone you interact with something that can be of service to them. You have the potential for large scale impact without the precise geographical targeting that you would need to treat an epidemic.


Without using the media to market to clients, how does your franchise attract clients?

JH: Advertising for medical services is illegal. Here, as in many countries, there are lots of people who go to their local doctors when they are ill or think they are ill. Many of these doctors have practiced for 20-30 years without continuing medical education. These are the doctors we retrain, so [with their clients] we have a captive audience, in a way.
How do you set prices?

JH: We set prices in a way that they are not a barrier to the poorest person we want to reach in the given target. We make services available at a price people are expecting--50 cents to a dollar for a malaria treatment, versus the five to six dollars it would cost otherwise. If we were not subsidizing these services, doctors would not provide them, or they might give patients the wrong drugs--give an injection, for example.

Speaking of which, how do you ensure quality?
JH: Social franchising is more complex to manage than other channels of social marketing--you need higher levels of training, monitoring and supervision.

On our staff, we have close to 80 doctors that, on average, visit each of the 1200 clinics every six weeks. They observe service delivery and answer the franchisee doctors' questions. We also send mystery clients to assure that the level of service quality remains intact. We use vignettes in training.

These techniques ensure that [franchisees] are not gauging people with prices or giving the wrong treatment. However, we don't own these clinics. We hope the training around good hygiene, infection prevention, client relationships, and counseling improves overall practices, since we don't monitor health areas outside the SQH basket of services.

Is it difficult to get providers to participate?

JH: No - their business increases. Their reputation is better, they have more services to offer, and their customers can get an IUD for 50 cents instead of 50 dollars.
In Myanmar, the public sector is not able to serve the needs of most people; 80-90% of people go to the private sector for health care. This is not unique. The private sector, while used by everyone, is atrocious in most places. With proper management, however, it can be made to do less harm--and even do very good work.
I have had surrealistic conversations with some country officials or [global health policy makers] where someone asks [a policy maker], what is your national protocol for first-line treatment for malaria? Yet, if you look at the data, 99% of people go to a pharmacy and buy drugs off the shelf. Some have to have a philosophical shift to understand this.

Describe your relationship with the Myanmar government.

JH: There is always a give and take between an NGO and the government. We have a longstanding relationship with the government in Myanmar and some of our staff are former civil servants. [Officials] appreciate that we are improving the quality of services by providing continuing medical education where there is none, and reporting on treatments not captured by the national health management information system.
The health minister has also seen the impact of Sun Quality Health. It's not minor--it's providing something like 25% of all family planning services, and we are detecting and treating more than 12% of all TB cases nationally.
We heard you are now offering screening for cervical cancer, which is very unusual even though 80% of cases occur in the developing world.

JH: Our franchising director at the time, Dr. Nyo Nyo Mihn learned a couple of years ago at a medical quality conference funded by one of our donors that you can screen [for abnormal cells] with acetic acid and treat abnormal cells with cryotherapy using Co2 in low resource environment, all without electricity. PSI's innovations fund allows us to be entrepreneurial without massive amounts of money, so we are now beginning training.

Some people in the health ministry are concerned that private sector doctors should be doing something they consider to be a hospital service. But almost no one is doing cervical screenings anywhere, so again, there is a choice of doing nothing, or doing something in partnership with the health facilities that are actually being accessed by people.

We are also piloting a basic package of anti-retroviral therapy with 100 clients, which hasn't yet been done in social marketing.

You also provide TB screening and treatment.

JH: Starting this intervention in 2004 was our biggest gamble. A recent study showed that the TB prevalence in Myanmar is five to six times higher than what was previously estimated. Now, our franchise does more than 12% of all case detection and treatment in the country.

Recently, in a village meeting, a woman spontaneously came up to us in tears. She told us she had been dying from TB and the treatment she got from a government clinic wasn't working for her. A PSI health worker told her to go to a [Sun Quality Health] doctor. She said, 'I'm healthy now and you saved my life'. I was thinking, that's one person, and there are 17,000 people every year getting that service that would otherwise die, and give TB to eight other people.

Yet, you still have people outside the country saying you can't work ethically inside the country, and the regime here can also be xenophobic. We can negotiate between those two things--the government doesn't see [the program] as impinging on their sovereignty and the opposition doesn't see it as giving succor to the regime. This model would be interesting to use in other difficult political situations, perhaps in Zimbabwe.


Organization: the Population Services International (PSI)

Learn more about Social Franchising

Weblink: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care


CHMI

    国际人口服务组织(the Population Services International),Sun Quality Health (SQH)组织与其姐妹组织--Sun Primary Health乡村健康工作者网络于2010年在缅甸全国提供超过210万次健康咨询服务。于2007年接管该项目的John Hetherington接受健康市场创新组织(Center for Health Market Innovations-CHIMI)的采访,介绍SQH如何在缅甸--这个亚太地区最贫穷的国度之一,基于目前可利用的社会特许经营网络,集合最广泛的服务为当地人群提供高质、管理完善的医疗服务。

CHMI:贵机构以Sun Quality Health为商标提供各种各样的服务,你们是如何选择将要提供的服务类别的?

JH:我们遍布在全国超过200个乡镇的1200名医生能够支持我们开始工作。我们首先会询问是否有需求?如果某个资源网络有能力填补该需求空缺,是否能够为其提供机会?在缅甸,痢疾、计划生育、肺炎、腹泻以及肺结核是最大的健康问题,这些疾病要不就是治疗费用过于高昂,要不就是医生无法提供高质量的服务。在很多地区,我们首先开始提供生殖健康以及计划生育服务,这类服务对于社会特许经营来说比较容易实现。

CHMI:为什么很多社会特许经营项目都以计划生育项目开始?

JH:我认为计划生育和其它服务不一样,因为每一个年龄在15-49岁之间的人都是我们的潜在客户,理论上说她们都有怀孕的可能性。因此,计划生育项目与那些对高效的、目标性和实验性的投入要求更多的疾病防治项目有所不同,特别是在亚洲地区,很多这类疾病都是传染性的。计划生育项目几乎能够为你接触到的每个人提供一些适合她们的服务。和流行疾病项目不同,计划生育项目不需要严格地以地理面积来锁定服务目标群体,也能产生很大的影响力。

CHMI:既然你们不利用媒体来宣传,那是如何吸引顾客呢?

JH:对医疗服务做广告是违法的。和很多国家一样,在这里大家通常都找本地的医生看病。很多医生已经行医20-30年了,但在这段时间中却没有持续接受相关医疗教育。我们对这些人进行培训,这样做也同时能留住他们的老顾客。

CHMI:你们如何定价?

JH:对于项目锁定的目标群体中最贫困的人来说,我们所设定的价格不会对他们造成任何障碍。我们所提供的服务的价格都保持在人们的预期范围内:疟疾治疗我们每次收费50美分至一美元,其它地方对该项服务的收费大约是五、六美元。如果我们不补贴这些医疗服务,医生将拒绝诊断病患,或者有可能不对症下药。

CHMI: 说到这里,你们如何保证医疗质量?

JH:社会特许经营比起其它种类的社会营销管理起来都更为复杂,需要更高级别的培训、管理和监督。我们整个医生团队人数将近80人,平均每六个星期对1200个诊所逐个访问。他们观察诊所医生的工作情况,并解答他们所提出的问题。我们也派遣一些"便衣"病患去就诊,以检查医疗质量是否能保持一致。

用这些方法能够确保特许经营方不乱向病患收费,也能保证医疗服务的质量。但是这些合作的诊所并非我们所有。我们希望通过对卫生学、传染预防、客户关系以及咨询服务开展培训来提高医疗特许经营的实践的整体效果。

CHMI: 让医护人员加入这个项目是否困难?

JH:不,事实上他们的工作量增加了,声望也越来越大,所提供的服务也越来越多。现在他们的顾客花50美分就能够买到一个节育器(IUD),而过去需要美元。在缅甸,公共医疗无法满足大部分人的需求,80-90%的人在私营医院接受医疗服务。这种情况并不罕见。然而大多地方的私营医疗机构却非常糟糕,但如果能够对其进行适当的管理,这些机构将能够为公众提供很好的服务。

CHMI:请向我们描述你与缅甸政府的关系?

JH:非政府组织(NGO)与政府之间永远是合作与让步并行。我们与缅甸政府已结成一个长期的关系,这个项目里也有很多工作人员曾经是公务员。我们通过持续地提供医疗教育来改善服务质量,并对治疗的情况进行及时的汇报,这些工作目前在缅甸仍是一片空白,因此政府对我们的工作表示欣赏。

缅甸卫生部部长也看到了Sun Quality Health项目的影响力。我们的计划生育服务占该服务全国总量的25%,我们也对全国12%的肺结核病例开展追踪治疗,这并不是个小数目。


Asia Report 翻译

组织: the Population Services International (PSI)-- 国际人口服务组织

了解社会特许经营(Social Franchising


原文链接: http://healthmarketinnovations.org/blog/2011/may/26/how-engage-private-sector-doctors-deliver-high-quality-and-affordable-priority-care


 

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