Study On Voluntary Counseling, Referral, And Testing On HIV/AIDS In Family Planning And Medical Departments In Shanghai

BACKGRROUND:In order to strengthen AIDS prevention and control in China, HIV/AIDS Voluntary Counseling and Testing (VCT) and HIV/AIDS Voluntary Counseling Referral (VCR) need to be introduced, which mainly provides services of integrated sexulity and reproductive health (SRH), specially on RTI/STDs/HIV/AIDS related counseling, testing and correctly and timely referral. VCT&VCR can not only discover and treat subjects' RTI/STDs/HIV/AIDS, provide psychological support to them, but also encourages clients to understaqnd her/his possible risk factors, reduce high-risk behaviors and encourage partners'notification and counseling and treatment if necessary. Experience of many countries proved that VCT&VCR is the entry point of conducting intervention, treatment and care for HIV/AIDS. Till now, VCT&VCR mainly used among those who had some symptoms related to HIV infection and searched for help from VCT clinic setted by medical departments, which resulted in ignoring general people especially the one who had poor knowledge of STD/HIV/AIDS and had risk behaviors but without any symptoms of RTI/STD/HIV/AIDS. And the situation of SRH related counseling is relative poor. The Chinese government urged that departments should work together to fight agaist HIV/AIDS. In China, family planning network have many advantages to prevent HIV, such as that the family planning work have been expanded to each community, and focus on reproductive people including migrant or citizens. On the other hand, national training projects of integrated counseling capacity of sexual and reproductive health and qualification authentication have been conducted in the department of family planning these years, which benefit for the VCR service. Therefore, cross-sectional study on the service of VCT&VCR in Family Planning and Medical Departments is needed, which will provide basic data for improving the service of VCT&VCR.OBJECTIVES:A cross-sectional study was carried out to study the VCT&VCR related knowledge, experiences among reproductive people in Shanghai and the knowledge of, attitude toward and service provided on VCT&VCR among service providers in Family Planning and Medical Departments. Meanwhile, to explore a strategy to conduct VCT&VCR by Family Planning and Medical Departments in Shanghai better.METHODS:This is a cross-sectional study, qualitative and quantitive methods were employed. Reproductive people and service providers from family planning and medical department were selected from 3 communities of Shanghai, including Luwang, Xuhui and Minhang districts. About 1500 reproductive persons from 3 communities were recruited by multi-stage sampling to participant in the study and implemented the face-to-face interview with a structured questionnaire by trained interviewers. The main contents of the structured questionnaire include STD/HIV/AIDS, VCT&VCR related knowledge, high risk behaviors, VCT&VCR history, needs of RTI/STD/AIDS prevention and VCT&VCR service. At the same time,331 service providers from family planning and medical departments in the three communities were collected by cluster sampling to participant in face-to-face interview to learn their knowledge of AIDS and VCT&VCR, as well as their capacity and willing to provide VCT&VCR services. Focus Group Discussions were carried out by related researches among 60 service providers during the field work period to learn the feasibility, method, possible mechanism and possible problems of combining to conduct VCT&VCR and possible strategies to solve these issues. Quantitative data was inputted into the dataset established by using the Epidata 3.1 software and analyzed by using SAS 9.1 software. The major statistic methods are Pearsonχ2 test, CMHχ2 test, Kruskal-Wallis test, principal component analysis and unconditional logistic regression model and so on. FGDs were recorded by tape and shorthand, then these materials were classified, labeled and analyzed according to different themes, means and standard deviations were calculated after the ranking.RERULTS:There are 1500 reproductive people were surveyed in this study.Results from our investigations with 1500 subjects showed that the mean score of comprehensive knowledge related to HIV/AIDS/STDs of the reproductive persons was only 53.19 of the median(P25=36.17,P75=70.21), the rate of whose score was lower than 60 was 62.40%. Unconditional logistic regression analysis showed that education, career, registered residence and sexual life status were the main factors which influenced the scores of HIV/AIDS/STDs knowledge (P<0.05). There was discrimination against HIV/AIDS infectors or patients among service providers and the clients. About 70 percent (69.40%) participant opposed the marriage with HIV/AIDS infectors or patients, and 70.67% denied to work together with them. unconditional logistic regression analysis showed that education, ever had sexual life combined with the knowledge of AIDS would affect their attitude to AIDS.HIV related risk behavior was prevalent among the participants. In the study, the number of people who had ever had sex life was 967. And 5.38% of them reported having had ever sex with SWs. About 24.51% of the participants reported having at least two sex partners. Meanwhile,16.03% reported having ever had behavior of penilingus, and just 33.55% used condom. About 22% of subjects had the related symptoms on STIs/AIDS, among which 46% had gone to see a doctor in public hospital. The results of unconditional multivariate logistic regression model showed that subjects' age, score of knowledge were related to their behaviors of hospitalizing at statistically significance of 0.05.VCT&VCR related knowledge levels of reproductive were low, and the average score was only 50(P25=30,P75=60), the rate lower than 60 was 62.60%. The results of unconditional logistic regression analysis found that the subjects' level of education, career and their knowledge of AIDS would be the main influential factors. The rate of people who had searched for the service of VCT and VCR were 5.53% and 6.00%. The main possible factors influencing the use of VCT service was subjects'age, career, ever subject had a sex or commercial sex. The main possible factors influencing the use of VCR service were gender, education, registered residence, ever subject had a sex or commercial sex. The reproductive people suggested that the VCT service should to be carried out mainly by providers from medical department or CDC, and VCR service should be carried out by service providers from medical department, CDC and family planning system.The 331 providers under study had high-level but partial knowledge of HIV/AIDS control and prevention; most of the providers either from FP or medical department knew the normal transmission very well, but the knowledge of Non-transmission is not as well as the transmission. The median score of comprehensive knowledge related to HIV/AIDS of the service providers was 80(P25=72,P75=88); the rate of whose score lower than 60 was 3.93%. Unconditional logistic regression analysis showed that, compared with service providers from medical department, who were from family planning had lower score of comprehensive knowledge related to HIV/AIDS after adjusting the other possible influencing factors.There existed discrimination against HIV/AIDS infectors or patients. About 26.06% of the service providers from family planning and 24.48% from medical department opposed the marriage with HIV/AIDS infectors or patients(P>0.05); 27.13% of the service providers from family planning and 24.48% from medical department consisted in having the right to refuse provide the service of operation for people who infected with HIV (+)/AIDS(P>0.05); and 45.74% of the service providers from family planning and 65.03% from medical department thought they can refuse surgery and checking IUD for people who infected with HIV (+)/AIDS (P<0.05).In the study, providers from family planning knew more about knowledge of VCT&VCR service can delivery information and direct behavior for people who need help, and can help them reduce the high risk behaviors'and'VCT&VCR service including psychosocial counseling and assistance services'(P<0.05). On the other hand, providers from medical department knew more about'how to test HIV in a proper way'(P<0.05). The integrated median scores of VCT&VCR knowledge is 85(P25=80,P75=90). Unconditional logistic regression analysis showed that scores of VCT&VCR knowledge is statistically associated with the providers' level of education and the scores of HIV/AIDS knowledge.Till now, service related to VCT&VCR which provided were focus on public education, then on counseling, the rate of testing service was only 21.66%. The proportions on service of voluntary counseling provided by FP service were higher than that by medical services, the proportions on service of referral provided by FP service were also higher than that by medical services. About 58.91% of the service providers approved of the service mode that combined family planning with medical department to conduct VCT&VCR. Unconditional logistic regression analysis showed that working duration, score of HIV/AIDS, score of VCT&VCR and whether they had ever received training were associated with their attitude if approved of the service mode. Compared with service providers working less than 5 years, who are more than 15 years were opting to oppose the combined mode; Compared with service providers whose score of HIV/AIDS lower than 72, who are higher or equal to 72 and less than 88 were opting to approve the combined mode; Compared with service providers whose score of VCT&VCR lower than 80, who are higher or equal to 90 were opting to approve the combined mode; Compared with service providers who had ever not received related training, who had received related training were opting to approve the combined mode.The results indicated that the main factors influencing the expansion of VCT&VCR service were accessibility of service, ability of providers and supportive environments in terms of service and policies. Suggestions collected from the group discuss indicated that "perfect network of family planning" base on management level and "accessibility of primary service to VCT&VCR" based on technology level were advantages for combined mode. And "lacking of knowledge, skill and cognition" were major obstacles. VCT&VCR mode combined the two departments need policy support, legal safeguard, increasing funding and training. VCT&VCR mode should be included in the evaluation system. Improving the remuneration and keeping stable team are also necessary. CONCLUSION:People at reproductive age had limited knowledge of AIDS and VCT&VCR, their high HIV risk behavior was prevalent, and the current situation of STD/HIV/AIDS related hospitalizing is worrying, and knowledge and experiences related to VCT or VCR need to be increased, they have high requirement for further services. The service providers from family planning and medical department had relative high-level but partial knowledge of HIV/AIDS/VCT&VCR, and some discrimination against people with HIV(+)/AIDS still existed. The capacities of providing the service of VCT&VCR need to be improved and more training for the service providers needed. To improve the serce of VCT&VCR, the two departments of family planning and medical department should work together.