醫療專業人員對愛滋病人烙印之倫理變遷

Ethical Changes of Stigma toward AIDS Patients among Medical Professionals

10.6386/CGN.202009_31(3).0003

辜漢章(Han-Chang Ku)；黃美智(Mei-Chih Huang)；柯乃熒(Nai-Ying Ko)

醫療專業人員 ； 愛滋病 ； 烙印 ； 倫理 ； Medical professionals ； HIV/AIDS ； ethics

長庚護理

31卷3期（2020 / 09 / 01）

329 - 337

繁體中文

愛滋病人隨著高效能反轉錄病毒療法普遍使用，存活期及預後改善朝向慢性病發展，病人社會及心理問題仍有極大改善空間。國內早期研究顯示醫師及護理師因愛滋病教育訓練及血體液感染防治設備不足，因靜脈藥癮、同性戀等負向觀感對愛滋病人產生烙印，若強制醫療專業人員安排照顧則會選擇離職，罔顧身為醫療專業人員之專業倫理。本篇文章介紹醫療專業人員對愛滋病人烙印之變遷，隨著社會風氣改變及婚姻平權及醫療代理人之探討、愛滋病在職教育普及、學校教育提供照護倫理課程、實務及情境模擬演練、臨床專業問題探討及以病人為中心之情境討論，醫療專業人員對愛滋病人整體負向觀感改變，對於傳染途徑的風險掌握與知覺更加理性，期許能達成聯合國2030年對於愛滋病人零歧視的願景。

With the widespread use of highly active antiretroviral therapy as treatment, survival and prognosis of HIV-infection have improved significantly. It has been a chronic disease since then. HIV carries a negative perception such as intravenous drug addiction and homosexual. Efforts are needed to improve patients' social and psychological problems. Early research showed that physicians and nurses used to carry a negative attitude toward patients with HIV infection due to inadequate prevention strategies and lack of education training. Mandatory required medical staff caring for HIV patients usually leads to high turnover of personnel. This article described the changes of stigma, along with the changes in social climate, homosexual marriage rights, popularity of in-service AIDS education, ethics courses in nursing education, and patient-centered practices in clinics. We hope that medical professionals would change the negative attitude toward AIDS patients, becoming more reasonable and understanding the risk of infection, achieving the goal of zero discrimination advocated by the Joint United Nations Vision Programme on HIV/AIDS patients for ending the AIDS epidemic in 2030.

1. 丁志音, C. Y.,李芳盈, F. Y,方啟泰, C. T.(2013)。醫師對愛滋病照護經驗、知識及態度的變遷：1994 及2012 年調查之比較。台灣衛誌，32(5)，435-448。
   連結：
2. 丁志音, C. Y,涂醒哲,Twu, S. J.(2004)。傳染病照護的選擇性歧視─醫師及牙醫師的愛滋病專業倫理觀與照護意願。台灣衛誌，23(1)，45-57+58。
   連結：
3. 余嘉惠, C. H.,邱奕頎, Y. C.,鄭夙雰, S. F.,柯乃熒, N. Y.(2018)。愛滋感染者的污名與靈性照顧。護理雜誌，65(3)，11-16。
   連結：
4. 陳志軒, C. H.,王盈婷, Y. T.,徐畢卿, B. C.(2017)。專業人員的反思─疾病烙印的自我覺察。護理雜誌，64(3)，12-18。
   連結：
5. Aberg, J. A.(2006).The changing face of HIV care: Common things really are common.Ann Intern Med,145(6),463-465.
6. Chan, K. Y.,Reidpath, D. D.(2007).Stigmatization of patients with AIDS: Understanding the interrelationships between Thai nurses' attitudes toward HIV/AIDS, drug use, and commercial sex.AIDS Patient Care STDS,21(10),763-775.
7. Churcher, S.(2013).Stigma related to HIV and AIDS as a barrier to accessing health care in Thailand: a review of recent literature.WHO South East-Asia Journal of Public Health,2(1),12-22.
8. Goffman, E.(1963).Stigma: notes on management of spoiled Identity.New York:Simon & Schuster Inc.
9. Jin, H.,Earnshaw, V. A.,Wickersham, J. A.,Kamarulzaman, A.,Desai, M. M.,John, J.,Altice, F. L.(2014).An assessment of health care students' attitudes toward patients with or at high risk for HIV: implications for education and cultural competency.AIDS Care,26(10),1223-1228.
10. Li, L.,Guan, J.,Liang, L. J.,Lin, C.,Wu, Z.(2013).Popular Opinion Leader intervention for HIV stigma reduction in health care settings.AIDS Education and Prevention,25(4),327-335.
11. Li, L.,Wu, Z.,Zhao, Y.,Lin, C.,Detels, R.,Wu, S.(2007).Using case vignettes to measure HIV related stigma among health professionals in China.International Journal of Epidemiology,36(1),178-184.
12. Lin, C.,Li, L.,Wu, Z.,Wu, S.,Jia, M.(2008).Occupational exposure to HIV among health care providers: A qualitative study in Yunnan, China.Int Assoc Physicians AIDS Care (Chic),7(1),35-41.
13. Link, B. G.,Yang, L. H.,Phelan, J. C.,Collins, P. Y.(2004).Measuring mental illness stigma.Schizophr Bull,30(3),511-541.
14. Merriam-Webster Dictionary. (2018). Stigma. received from https://www.merriam-webster.com/dictionary/stigma
15. Payne, R.,Muenchhoff, M.,Mann, J.,Roberts, H. E.,Matthews, P.,Adland, E.,Goulder, P. J.(2014).Impact of HLA-driven HIV adaptation on virulence in populations of high HIV seroprevalence.Proceedings National Academic of Sciences of the USA,111(50),E5393-5400.
16. Rodger, A. J.,Cambiano, V.,Bruun, T.,Vernazza, P.,Collins, S.,van Lunzen, J.,Lundgren, J.(2016).Sexual activity without condoms and risk of HIV transmission in Serodifferent couples when the HIV-positive partner is using. suppressive antiretroviral therapy.JAMA,316(2),171-181.
17. The Joint United Nations Programme on HIV/AIDS. (2017). Number of people living with HIV. Retrieved from http://aidsinfo.unaids.org/
18. Varas-Diaz, N.,Neilands, T. B.,Cintron-Bou, F.,Marzan-Rodriguez, M.,Santos-Figueroa, A.,Santiago-Negron, S.,Rodriguez-Madera, S.(2013).Testing the efficacy of an HIV stigma reduction intervention with medical students in Puerto Rico: The SPACES project.Journal of International AIDS Society,16(3 Suppl 2),18670.
19. World Health Organization. (2018). Viral suppression for HIV treatment success and prevention of sexual transmission of HIV. retrieved from https://www.who.int/hiv/mediacentre/news/viral-supression-hiv-transmission/en/
20. Yang, C. H.,Huang, Y. F.,Hsiao, C. F.,Yeh, Y. L.,Liou, H. R.,Hung, C. C.,Yang, S. Y.(2008).Trends of mortality and causes of death among HIV-infected patients in Taiwan, 19842005.HIV Medicine,9(7),535-543.
21. 王淑娟, S. J.,賴霈妤, P. Y.,劉曉穎, S. Y.,柯文謙, W. C.,柯乃熒, N. Y.(2012)。協助同性伴侶參與末期愛滋病患不施行心肺復甦術之自主決定。護理雜誌，59(5)，97-102。
22. 杜漢祥, D. H.,陳郁慧, Y. H,湯宏仁, H. J.(2018)。談 U = U 及愛滋感染管制。感染控制雜誌，28(1)，41-43。
23. 武香君, H. C.,柯乃熒, N. Y.,施鐘卿, C. C.,馮明珠, M. C.(2014)。護理人員對照顧愛滋病知識、態度行為趨向、自覺感染風險與照顧意向之探討。護理雜誌，61(5)，43-53。
24. 柯乃熒, N. Y.,潘純媚, S. M.,馮明珠, M. C.,張瑞玲, R.,馬先芝, H. J.,劉長安, C. A.(2002)。以焦點團體探討南部護理人員照顧愛滋病患者的經驗。護理雜誌，49(3)，37-44。
25. 陳志軒, C. H.,徐畢卿, B. C.,李靜姝, C. C.,黃建豪, C. H.(2012)。健康研究中的烙印議題。台灣醫學，16(1)，84-92。

1. (2023)。挑戰與改變：愛滋污名對實務工作者服務經驗的衝擊。社會政策與社會工作學刊，27(2)，1-46。