艾滋病时代性传播感染的控制

1、1会计学艾滋病时代性传播感染的控制艾滋病时代性传播感染的控制Historical Reflections: 反思艾滋病/性传播感染历史AIDS and Sexually Transmitted Infections (STIs) 20072005199719941990s198719851983198219811980 19761939-4519371928 1914-18190919051879187035-40 million people with HIV 3500万4000万HIV感染人群HPV vaccine HPV疫苗Combination ART 联合抗逆转录病毒治疗(ART)A

2、ZT effective in PMTCT AZT有效阻断HIV的母婴传播(PMTCT)HPV recognized as the cause of 90% of all cervical cancers 认识到HPV引起90%的宫颈癌AZT 齐多夫定药物HIV antibody test HIV抗体检测Identification of HIV 鉴定HIV病毒Herpes increasingly prevalent 疱疹流行越来越高AIDS detected AIDS病例发现Pelvic Inflammatory Disease 盆腔炎症性疾病Chlamydia recognized 认识

3、衣原体感染World War II 第二次世界大战Shadow on the Land Penicillin (AJPH article on its application for syphilis 1943) 青霉素(1943年用于治疗梅毒)World War I 第一次世界大战 (治疗梅毒特效药物) Introduction Wassermann test and Salvarsan 1 华氏试验(梅毒补体结合试验)和撒尔佛散1Discovery of Irepona pallidum 梅毒螺旋体的发现 Koch: etiology of infectious diseases Koch

4、： 感染性疾病病因学 Differentiation syphilis/gonorrhea 鉴别梅毒与淋病100 Years15 Years10 YearsGlobal distribution of burden of disease attributable to 20 leading selected risk factors导致全球疾病负担的20个主要危险因素低体重 Under weight不安全性行为 Unsafe sex血压 Blood pressure 吸烟 Tobacco酒精 Alcohol饮水不安全Unsafe water, sanitation and hygiene胆固醇

5、Cholesterol固体燃料室内烟尘Indoor smoke from solid fuels 铁缺乏 Iron deficiency 超体重 Overweight锌缺乏 Zinc deficiency 水果与疏菜摄入不足Low fruit and vegetable intake 维生素A缺乏 Vitamin A deficiency 锻炼不足 Physical inactivity 伤害危险因素 Risk factors for injury 铅暴露 Lead exposure 吸毒 Illicit drugs 不安全医疗注射 Unsafe health care injections

6、缺乏避孕措施Lack of contraception 儿童性侵害 Childhood sexual abuse Developing countries with high mortality 高死亡率的发展中国家 Developing countries with low mortality低死亡率的发展中国家Developed countries 发达国家Attributable DALYs (% of global DALYs)10% 20% 30% 40% 50% 60% 70% 80% 90% 100%Source: WHO, World Health Report, 2002.伤

7、残调整生命年(占全球DALY比例%) 核心人群桥梁人群大众人群Adapted from: Cates Jr & Dallabetta, Lancet 2000Sex Workers性工作者Clients嫖客Regular partners固定性伴Transmission dynamics传播动力学Intermediate outcome中间结果Ultimate impact最终影响Strategies策略Targeted interventions目标干预Enhanced STI prevention & Quality Case Management加强性病预防和高质量的病例管理Increa

8、sed condom use in commercial sexReduced GUD prevalence Reduced HIV incidence(Reduced HIV prevalence)Increased condom use in general population商业性行为时提高安全套使用降低生殖器溃疡性疾病患病率在普通人群中提高安全套使用降低HIV发生率(降低HIV感染率)Clinical services established:建立临床服务Activities活动Objectives目标Goal目的Outcomes结果Increased condom promotio

9、n 提高安全套促进Improved STI detection and case management改进性病检测和病例管理Increased condom use in commercial sex商业性行为时提供安全套使用Reduced prevalence of GUD & other STIs降低生殖器溃疡性疾病和其它性病的患病率Reduced HIV/STI incidence and prevalenceTraining 培训Supplies 供应Supervision监督 M&E 督导评估Condom strategy established:安全套策略Communication

10、s strategyestablished: 交流策略Enabling environment supported: 支持性环境Increased access to condoms 提高安全套可及性Increased coverage and use of clinical services提高临床服务的覆盖面与使用Chancroid elimination and syphilis control消除软下疳和梅毒控制Supply供应100% CUP 100%安全套使用early use of HCS 早期使用HCStargeted focus针对焦点Prevention 预防symptom

11、 recognition症关识别early use of HCS早期使用HCSpolicy reviews政策stigma reduction减少歧视health system capacity卫生系统能力减少HIV性病发病率与患病率UNIVERSAL ACCESS全民普及Strategic Directions策略方向Testing / Counseling检测/咨询 Prevention 预防HealthSystems卫生系统 Treatment / Care治疗/保健 Strategic Information策略信息 VCT自愿咨询检测PITC医务人员主动提供的检测和咨询 infant

12、 / family婴儿/家庭Sexual transmission性传播HCSPLWHA存活的艾滋病人群New Approaches新的方法IDU注射吸毒者PMTCT母婴阻断ART抗逆转病毒治疗TB结核OI机会感染Care保健Leadership领导Financing经费Human Resource人力资源Strategic Planning 战略规划ProcurementSupply采购供应 Laboratory实验室Surveillance监测DrugResistance 耐药OperationalResearch操作性研究 Monitoring &Evaluation督导评估Implem

13、entation of the global strategy for the prevention and control of STIs全球性传播感染预防控制策略的实施The Action Plan for the implementation of the STI strategy to set out: 实施性病策略的行动计划 priorities 优先重点Actions 行动a time frame and 时间框架和performance indicators at the global and regional，country levels. 全球、区域、国家层面的执行指标核心人群桥梁人群大众人群Adapted from: Cates Jr & Dallabetta, Lancet 2000Sex Workers性工作者Clients嫖客Regular partners固定性伴Transmission dynamics传播动力学Intermediate outcome中间结果Ultimate impact最终影响Strategies策略Targeted interventions目标干预Enhanced STI prevention & Quality Case Management加强