愛滋病照護 性別觀點 柯乃熒 國立成功大學醫學院護理系副教授暨國立成功大學附設醫院護理部督導長 21: HIV

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1 22 愛滋病照護 性別觀點 柯乃熒 國立成功大學醫學院護理系副教授暨國立成功大學附設醫院護理部督導長 摘要 : 生理 社會及文化中不平等的性別權力關係, 增加女性及青少女感染愛滋病毒的風險 抗愛滋 病毒藥物治療能有效抑制愛滋病毒複製, 延長愛 滋感染者之預期壽命 愛滋病毒感染已成為慢性 病, 倘若協助女性感染者規則回診及接受治療, 抗病毒藥物治療的效果及因愛滋病死亡的比率並 無顯著性別差異, 加上人工生殖技術的成熟, 讓 愛滋感染配偶對於生兒育女的需求成為實際可達 的願望 促進性別平等及重視人權是愛滋防治的 基石, 護理人員應採取一切適當措施以消除在愛 滋病照護及防治策略對婦女的歧視, 保證她們在 男女平等的基礎上取得各種預防及保健服務 關鍵詞 : 性別平等 婦女 愛滋病毒感染 健康照顧 World Health Organization, WHO WHO, human immunodeficiency virus, HIV ,570 HIV 52% 76% HIV The Joint United Nations Programme on HIV/AIDS/World Heaht Organiztion, 2010 United Nations Population Fund & United The United Nations Children s Fund [UNFPA & UNICEP], HIV 1989 HIV : HIV 7: , % 70% convention on the elimination of all form of discrimination against women, CEDAW, HIV HIV Powers, Poole, Pettifor, & Cohen, 2008 Boily et al., 2009; Nicolosi et al., Boily et al., 2009 HIV HIV HIV *

2 23 11:1 HIV % 2010 HIV HIV Sugar Daddies HIV Hope, highly active antiretroviral therapy, HAART 10.2% 3.7% Yang et al., 2008 HIV Fang et al., HIV CD4 cluster of differentiation 4, CD4 HAART HIV CD4 HAART CD4 Ko et al., 2011 HIV azidothymidine, AZT 2% McIntyre, 2006 HIV HIV HIV sperm washing artificial insemination by husband, AIH in vitro fertilisation, IVF intra cytoplasmic sperm injection, ICSI HIV HIV Fiore et al., HIV HIV HIV 42.9% HIV Wu et al., 2011

3 24 Ko & Muecke, 2005 Ko & Muecke, HIV HIV 2005 HIV HIV HIV HIV 2009 UNAIDS, 2010 UNAIDS UNAIDS, UNAIDS 2005 The Joint United Nations Programme on HIV/AIDS, UNAIDS 2010 zero new HIV infections zero discrimination zero AIDS-related deaths 2015 united nation millennium development goals, MDG [Wu, M. Y., Ho, H. N., & Yang, Y. S. (2001). Obstetrics and gynecology: Assisted reproductive technology in HIVinfected couples. Formosan Journal of Medicine, 5(6), ] 2009 HIV

4 [Ko, N. Y., Lai, Y. Y., Liu, H. Y., Lee, H. C., & Ko, W. C. (2009). Reproductive counseling for patients with HIV/ AIDS. Journal of AIDS Care, 67, ] Updated HIV/AIDS statistics in Taiwan gov.tw/ch/showtopictext.asp?topicid=416 [Center for Disease Control R.O.C. (2010, December 31). Updated HIV/AIDS statistics in Taiwan. Retrieved January 15, 2011, from ASP?TopicID=416] 2010 [Hsu, C. F. (2010). Sexually transmitted infection and HIV/AIDS prevention among young sex workers. Unpublished master s thesis, National Taiwan University, Taipei City, Taiwan, ROC.] [Lu, H. F., & Lee, S. H. (2008). An exploratory study of sharing injecting equipment and HIV infection among female heroin users. Taiwan Journal of Public Health, 27(2), ] 2009 HIV [Lai, Y. Y., Ko, N. Y., Liu, H. Y., Lee, H. C., & Ko, W. C. (2009). Gender-based differences in clinical presentations of patients with HIV/AIDS. Journal of AIDS Care, 67, ] Boily, M. C., Baggaley, R. F., Wang, L., Masse, B., White, R. G., Hayes, R. J., et al. (2009). Heterosexual risk of HIV-1 infection per sexual act: Systematic review and metaanalysis of observational studies. The Lancet Infectious Diseases, 9(2), Convention on the Elimination of All Form of Discrimination against Women. (2008). Committee on the Elimination of All Form of Discrimination against Women. Retrivevd January 16, 2011, from daw/cedaw/ Fang, C. T., Chang, Y. Y., Hsu, H. M., Twu, S. J., Chen, K. T., Chen, M. Y., et al. (2007). Cost-effectiveness of highly active antiretroviral therapy for HIV infection in Taiwan. Journal of the Formosan Medical Association, 106(8), Fiore, J. R., Lorusso, F., Vacca, M., Ladisa, N., Greco, P., & De Palo, R. (2005). The efficiency of sperm washing in removing human immunodeficiency virus type 1 varies according to the seminal viral load. Fertil Steril, 84(1), Hope, R. (2007). Gender equality and sugar daddies [Gender Equality Series]. Retrieved January 15, 2011, from Ko, N. Y., Lai, Y. Y., Liu, H. Y., Ko, W. C., Chang, C. M., Lee, N. Y., et al. (2011). Gender differences in HIV manifestations at presentation to care and continuity of care among HIVinfected persons in Taiwan. AIDS Care, 23(10), Ko, N. Y., & Muecke, M. (2005). Reproductive decision-making among HIV-positive couples in Taiwan. Journal of Nursing Scholarship, 37(1), Ko, N. Y., & Muecke, M. A. (2006). Prevailing discourses among AIDS care professionals about childbearing by couples with HIV in Taiwan. AIDS Care, 18(1), McIntyre, J. (2006). Strategies to prevent mother-to-child transmission of HIV. Current Opinion in Infectious Diseases, 19(1), Nicolosi, A., Correa Leite, M. L., Musicco, M., Arici, C., Gavazzeni, G., & Lazzarin, A. (1994). The efficiency of maleto-female and female-to-male sexual transmission of the human immunodeficiency virus: A study of 730 stable couples. Italian study group on HIV heterosexual transmission. Epidemiology, 5(6), Powers, K. A., Poole, C., Pettifor, A. E., & Cohen, M. S. (2008). Rethinking the heterosexual infectivity of HIV-1: A systematic review and meta-analysis. The Lancet Infectious Diseases, 8(9), The Joint United Nations Programme on HIV/AIDS. (2010). Getting to zero: Strategy. Geneva, Switzerland: Author. The Joint United Nations Programme on HIV/AIDS /World Health Organzaiotn. (2010). UNAIDS report on the global AIDS epidemic Geneva, Switzerland: Authors. United Nations Population Fund & The United Nations Children s Fund. (2011). Prevention the spread of HIV. In UNFPA (Ed.), Women s & children s rights: Making the connection (pp ). New York: Author.

5 26 World Health Organization. (2009). 10 facts about women s health. Retrieved January 15, 2011 from Wu, M. Y., Chang, L. J., Chen, M. J., Chao, K. H., Yang, Y. S., & Ho, H. N. (2011). Outcomes of assisted reproductive techniques for HIV-1-discordant couples using thawed washed sperm in Taiwan: Comparison with control and testicular sperm extraction/microscopic epididymal sperm aspiration groups. Journal of the Formosan Medical Association, 110(8), Yang, C. H., Huang, Y. F., Hsiao, C. F., Yeh, Y. L., Liou, H. R., Hung, C. C., et al. (2008). Trends of mortality and causes of death among HIV-infected patients in Taiwan, HIV Medicine, 9(7), Care for Women With HIV: Gender Perspectives Nai-Ying Ko RN, PhD, Associate Professor, Department of Nursing, College of Medicine, National Cheng Kung University & Supervisor, Department of Nursing, National Cheng Kung University Hospital. Abstract: When women face social and cultural inequality they inevitably bear increased HIV infection risks. The success of antiretroviral therapies in suppressing HIV s viral load and prolonging patient lives has made HIV a treatable chronic disease. Given the same follow-up treatments, research shows no significant differences between men and women in terms of either clinical, immunological or virological parameters at baseline or mortality after one year of antiretroviral therapy. Also, advances in assisted reproductive technologies now makes having HIV-free children possible for HIV couples. Gender equality and human right are essential to effective HIV prevention. Nurses must take all appropriate measures to eliminate discrimination against women in HIV prevention, treatment and care programs in order to ensure equal gender access to critical healthcare services. Key Words: gender equality, women and girls, HIV infection, health care. Accepted for publication: September 27, 2011 *Address correspondence to: Nai-Ying Ko, No. 1, Ta-Hsueh Rd., Tainan City 70101, Taiwan, ROC. Tel: +886 (6) ext. 5838; nyko@mail.ncku.edu.tw