易地扶贫搬迁背景下凉山彝族艾滋病传播风险的健康社会决定因素及其作用机制研究

Poverty is an important factor for causing AIDS epidemic, and the poverty situation is serious in the Yi areas of Liangshan prefecture, Sichuan Province. Acquired immune deficiency syndrome (AIDS) has become the most serious problem accompanied by poverty in the Yi areas of Liangshan prefecture. Since 2016, the policy of anti-poverty by relocating in other places aims to change the poverty situation of the local residents of the Yi areas, and also changes their social determinants of health (SDH), such as living environment, education and social security. The relationship between social determinants of health and risk of HIV transmission has become a research hotspot abroad, but very few studies investigate their relationship in China. Based on the theory of SDH and in the situation of anti-poverty by relocating in other places, we will select the Yi residents of Liangshan prefecture who are covered by the anti-poverty Policy as the subjects. We will build the evaluation index system of SDH for risk of HIV transmission by quantitative and qualitative research methods. We will evaluate the SDH, HIV infection, new HIV infection and HIV related high risk behavior by questionnaire investigation and laboratory test. The structural Equation Modeling will be used to establish the network model between SDH and risk of HIV transmission, and find the main SDH for the risk of HIV transmission and its mechanism. We will propose the related policy suggestions for reduce the risk of HIV transmission, and provide scientific evidences for establishing the AIDS prevention and control measures and strategies in this areas.

贫困是导致艾滋病流行的一个重要原因，四川省凉山州彝族聚居区贫困问题突出，艾滋病是当地与贫困共存的最严重的健康问题。2016年起实施的易地扶贫搬迁政策旨在改变当地居民的贫困现状，同时也改变了居民的居住环境、教育、社会保障等健康社会决定因素。国外关于健康社会决定因素与艾滋病传播风险的相关研究已成为热点，而国内相关研究甚少。因此，本研究基于健康社会决定因素理论，在易地扶贫搬迁政策背景下，以政策覆盖的凉山州彝族居民为研究对象，采用定量和质性研究方法建立艾滋病传播风险的健康社会决定因素评价指标体系，结合实验室检测方法评价不同人群的健康社会决定因素、HIV感染及新发感染和高危行为特征；运用结构方程模型构建该人群艾滋病传播风险的健康社会决定因素网络关系模型，并探讨主要的健康社会决定因素及其作用机制；在此基础上，提出旨在降低艾滋病传播风险的政策建议，为制定当地艾滋病的重点防控措施提供科学依据。

艾滋病不同于其他疾病，有着其重要的社会性，凉山州地区的贫困状况和独特的民俗文化使得艾滋病流行相关影响因素错综复杂。本研究在易地扶贫搬迁政策背景下，以政策覆盖的凉山州彝族居民为研究对象，探讨了健康社会决定因素在艾滋病传播中影响及作用机制等若干关键问题，并为艾滋病防控提出政策建议。研究结合凉山州2009-2015年监测数据分析和两轮德尔菲专家咨询结果，运用层次分析法构建了凉山州彝族艾滋病传播风险的健康社会决定因素评价指标体系并获取了指标权重，包含8个一级指标，29个二级指标，89个三级指标。在健康社会决定因素评价指标体系和质性研究基础上设计调查问卷，以易地扶贫搬迁计划覆盖的彝族居民作为研究对象，最终纳入1927例研究对象开展现场调查，采用免疫印迹试验发现Human Immunodeficiency Virus（HIV）阳性患者191例（9.9%）。采用多元统计分析及结构方程模型构建了艾滋病传播风险的健康社会决定因素网络关系模型，结果显示偶遇性行为（路径系数：0.255）和注射吸毒行为（路径系数：0.321）是影响艾滋病感染风险的直接因素；外出务工行为通过偶遇性行为和注射吸毒行为影响艾滋病感染风险；社会规范、艾滋病相关知识知晓及风险意识、个人社会经济地位、社会支持等多个社会决定因素也是影响艾滋病感染风险的间接因素；并结合质性研究揭示了健康社会决定因素影响艾滋病感染风险的原因。该研究显示了健康社会因素决定因素对当地艾滋病感染的重要影响，并从个体行为因素、日常环境因素和社会结构型因素方面进行了充分研究，并开发了系列艾滋病防控相关干预工具，从健康社会决定因素视角为凉山州艾滋病防控策略制定提供了重要的政策建议，为艾滋病防治提供了新的研究思路。