联合艾滋病预防工作和生殖健康工作.ppt

,PromotingSaferandHealthierSexasanElementofLinkingHIVandSRH联合艾滋病预防工作和生殖健康工作：推广健康和安全的性行为,ChaiyosKunanusontHIV/AIDSandSTIAdviser,UNFPA/CSTBangkok,UNFPAInternationalWorkshoponHIVPreventionTargetingSexWorkinChina,23April2007,Beijing,PRChina,WhyPromoting?为什么要促进这项工作,Toincreasenumber(proportion)ofpopulationwhopracticesaferbehaviourstoreachcriticalmasstochangesocietalnorm增加采取安全性行为的人数（或人口比例）-这些人数达到一个足以改变社会规则的决定性规模-改变社会规则,Whatisneeded?需要什么,Increasedcoverage逐渐增加覆盖面,Currentprogrammecoverage目前项目覆盖面,Source:UNAIDS2005,Ascaled-upresponsetoAIDSinAsiaandthePacific,Content内容,Reviewofsexworkandinterventions回顾脆弱人群如性工作者的干预Aframeworkforprioritylinkages:LinkingHIVandAIDSwithSRH在预防艾滋病工作中加入性生殖健康的内容Comprehensiveright-basedapproachforHIV/STIpreventioninsexwork:在性工作者中开展以权力为基础的艾滋病/性病预防综合模式Reducingvulnerability降低风险MeetingthespecialSRHneeds满足特殊需要Buildingsupportiveenvironment建立支持环境,Importantissues要点,Sexworkhappensinawiderangeofsettingsinurbanareaswhileitmightnotbewellidentifiedinruralareas.性工作（暗娼）广泛存在于城市，也可能不为人知地存在于农村地区Mostsexworkersarehighlymobile.大多数性工作者属于高度流动群体TraffickedsexworkersinbrothelsarelikelytogetHIVinthefirstsixmonths.性工作者在性工作场所的最初6个月最容易感染HIVSexworkersusuallyhaveregularpartnersandcondomuseisverylow.性工作者通常有固定的服务对象（熟客），且安全套使用率很低Concertedinterventionsareneeded.需要采取协同的干预,The100%CUP百分之百安全套,Elements:Enforcementandcoverage.要点：执行与覆盖Highlyeffectiveforbrothel-basedEE.对固定性工作场所的性工作者很有效Replicable,scalingupdifficult具有可推广性，但有一定难度,Source:WHO,100%CUPinentertainmentestablishments,%21yoThaimenreportedvisitedSWand%condomuse,inthelast12mo.,LinkedwithSTIservicesystem,supportedbyNationalAIDSProgramme与性病服务结合，由国家艾滋病项目支持,Sonagachi印度的例子,RelianceRespectRecognition依赖-尊重-认可PeereducatorsandfriendlySTIservices同伴教育与性病亲情服务ResultedinEmpowermentofSW性工作者权利赋予的结果Replicable,scalingupdifficult具有可推广性，但有一定难度,LinkedwithlocalSTIclinics,supportedbyINGO,donorsandthegovernment与当地性病门诊结合，由国际非政府机构、捐赠人、政府部门支持,Whathavewelearned?学到了什么,SuccessfulHIVpreventionprogrammesamongsexworkerswerelinkedwithSTIservicesi.e.“respondtoneeds”.成功的性工作者HIV预防项目包含了性病服务Inordertocreateimpacts,goodcoverageofinterventionsisneeded.保证干预的覆盖面才能产生好的项目效果Forsustainability,collaborationamongstaffofgovernmentandcommunityorganizationsmustbeinplace.保证和政府、其他组织的良好沟通，才能使得项目可持续发展,Recommendation建议,Combinedcommunityledinterventions由社区牵头的干预Promoteleadershipamongsexworkers促进性工作者中的领导力Teambuildingandcapacitybuilding团队和能力建设Economicsupports经济支持Ensureadequateeducationandnutrition开展适当的教育，保证合理的营养Involvesexworkers,gatekeepers,communityleadersandlocalauthoritiesindesigninginterventions邀请项目各方共同参与干预设计Includesafersexinterventionsforclients应当包含对“客人”的安全性行为干预Ensuremedicalservicesforall保证医疗服务Coverage保证覆盖面,Content内容,Reviewofsexworkandinterventions回顾性工作与干预Aframeworkforprioritylinkages:LinkingHIVandAIDSwithSRH在预防艾滋病工作中加入生殖健康的内容Comprehensiveright-basedapproachforHIV/STIpreventioninsexwork:在性工作者中的预防艾滋病/性病综合模式Reducingvulnerability降低风险MeetingthespecialSRHneeds满足需要Buildingsupportiveenvironment建立支持环境,The“Framework”框架,Keylinkages关键结合点,FrameworkforLinkages结合点的框架,Fourkeyareas四个关键的方面,Advocacy倡导,Services服务,Advocacy倡导,Developpolicythatsupportsdualprotection倡导更健全的保护政策Policyoncomprehensivesafersexservices倡导安全性服务政策,BroadenSRHservicestoreachkeypopulationsincludingthroughoutreach通过包含外展的一系列方式拓宽生殖健康服务的渠道Promotecondomusefordualprotection促进安全套的使用ProvideafullrangeofSRHservices,includingpreventionforandwithPLWHA对受艾滋病影响的人群提供全程生殖健康服务Empowerwomenandgirlstonegotiatesafersex加强女性的性主动权，以采取更安全的性行为IncludeservicesthataddressGBV,offeringemergencycontraceptionandHIVPEP提供包含关注性别暴力、紧急避孕和预防艾滋病职业暴露的一系列服务,Services服务,Promotesaferandhealthiersex促进安全和健康的性工作,Creatingasupportiveenvironment创造支持环境,Comprehensivecondomprogramming综合安全套项目,Condomuserate安全套使用率,Low,Contemplation思考,HIV/AIDSawarenessSelfrisk,selfefficacy对的认识,Socialsupportandcommunityacceptance来自社会的支持,Availability,Affordability,GenderequalityEmpowermentTraining性别平等培训,Myths,Misperceptions误解,Transportationdifficulties,Culturalbarriers障碍,Motivation激励,Capacity能力,Opportunity机遇,Pre-contemplation思考前,High,Preparation行动准备,Action-Maintenance行动保留,UsersPerspectiveonCondomUse,Behaviouralchangeandmaintenance行为改变与维持,Itisessentialthatinterventionsareatbothindividualandcommunity/societylevels从社会和个人两方面入手的干预才能获得成功,Comprehensivecondomprogramming综合的安全套项目,Tomakeimpacts产生影响,Needtoscaleupeffectiveinterventions需要扩大有效干预Coveringmorepeople,geographyandmandates.覆盖更多人、地理范围和要求Morepartners更多的伙伴Workharder!工作更努力,Content内容,Reviewofsexworkandinterventions回顾性工作与干预Aframeworkforprioritylinkages:LinkingHIVandAIDSwithSRH在预防艾滋病工作中加入生殖健康的内容Comprehensiveright-basedapproachforHIV/STIpreventioninsexwork:在性工作者中的预防艾滋病/性病综合模式Reducingvulnerability降低风险MeetingthespecialSRHneeds满足需要Buildingsupportiveenvironment建立支持环境,Principlesandapproaches原则与方式,UNAIDS7principlesofeffectiveHIVprevention联合国艾滋病规划署关于有效预防艾滋病工作的个原则Humanrightsandgenderequality尊重人权和性别平等Differentiatedandlocallyadapted适应差异化和本地化Evidence-informed尊重事实和证据Comprehensive综合服务Longtermandsustainedeffort长期和可持续的工作Coverage,scaleandintensity保证覆盖面，规模和深度Communityparticipation社区参与Participationofsexworkerorganisations,networksandcommunities保证性工作者组织，网络和社区的参与,3Pillars三个支柱,ReducingvulnerabilitiesandaddressingstructuralissuesrelatedtoHIVandsexwork降低风险，解决HIV和性工作中的结构性问题ScalingupHIV,SRHandotherhealthandsocialservices,andaddressingbarrierstoaccessinthesexworkcontext扩大HIV、生殖健康和其他社会卫生服务，解决性工作者获得这些服务的障碍Buildingsupportiveenvironmentstoexpandchoicesandopportunitiesforsexworkersandtheircommunity建立支持环境，使性工作者和性工作者社区有更多的选择机会,Paradigmshift事例HIVPreventioninSexWork性工作中的HIV预防,Sexworkers性工作者,Events,Vulnerability脆弱性,GenderinequalityLackofeducation性别歧视缺乏教育,Mobility流动性,Poverty贫困,Clients客人,IncomeSurplus多余的收入,Quitsexwork离开性工作Socialsupport社会支持MedicalRx医疗,?,Before以前,During现在,After以后,Pillar1.ReducingvulnerabilitiesandaddressingstructuralissuesrelatedtoHIVandsexwork支柱一：降低风险，解决HIV和性工作中的结构性问题,Poverty,genderinequality,migrationandmobility,displacement,gender-basedviolence,genderidentification,lackofeducation,andinjectingdrugusearekeydriversandheightenvulnerabilitytoHIV.贫困，性别不平等，迁移与流动，基于性别的暴力，性别认同，缺乏教育，静脉吸毒是导致感染HIV的高危因素,Pillar2.ScalingupHIV,SRHandotherhealthandsocialservicesandaddressingbarrierstoaccessinthesexworkcontext支柱二：扩大HIV、生殖健康和其他社会卫生服务，解决性工作者获得这些服务的障碍,SexworkerHIVvulnerabilityisheightenedthrough:性工作者之所以更加容易感染艾滋病是因为：pooraccesstohealth,legal,socialandotherservices不易获得健康、法律、社会和其他服务violenceandharassment,stigmaanddiscrimination暴力、骚扰、侮辱与歧视inadequateaccesstocondomsandotherHIVpreventionmeasures获得安全套和其他预防艾滋病的支持不够inadequatetreatmentandpreventionofsexuallytransmittedinfections.获得预防性病和治疗性病的支持不足SexworkerslivingwithHIVoftenlacktreatment,careandsupport受艾滋病影响的性工作者难以获得治疗、关爱与支持,Pillar3.Buildingsupportiveenvironmentstoexpandchoicesandopportunitiesforsexworkersandtheircommunities支柱三：建立支持环境，使性工作者和性工作者社区有更多的选择机会,Skillsenhancementsandeconomicincentivesprovideopportunitiesforalternativeemploym