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【社会人文】文化宗教对HIV流行趋势的影响
Date: October 20, 2006
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Population Trends, Practices And Beliefs Could Have Adverse Effect On HIV Rates
A review of research on the prevalence of HIV in the Middle East and North Africa has found that whilst cultural and religious practices may be behind a low prevalence of HIV in the region, they could potentially contribute to increasing the spread of HIV.
Research from the World Health Organisation, published in this week's British Medical Journal, argues it is possible that some practices which are common among Muslim populations may contribute to decreasing the risk of HIV transmission. One is low alcohol consumption, which reduces 'risky' behaviours and another is potentially male circumcision which was shown in a recent clinical trial to have a protective effect but application of these results to other epidemiological, cultural and social settings still needs to be confirmed.
At the same time other population trends, beliefs and practices in the region may have an adverse effect. Most countries in the region have young populations with a rapidly increasing age at marriage, but young people may be ill-equipped to protect themselves against sexually transmitted infections. Traditional Muslim approaches have tended to be very conservative, and it is difficult to break the silence around issues of sexual behaviour -- especially those which deviate from religious norms.
A detailed analysis of religious publications and doctrinal pronouncements revealed that strong moralising views were common -- HIV was seen as divine retribution and religion was presented as a protection. This can mean that those with HIV/AIDS are stigmatised.
The construction of gender also plays a part - strong prohibitions against extramarital sex, which are applied more strictly to women, are associated with lower HIV prevalence. While there are fewer women than men with HIV in the region, this sex ratio appears to be shifting, suggesting the disease is spreading and highlighting women's special vulnerability as they are married to older men who are more likely to have been exposed to HIV infection. The cultural view that women are innocent reinforces the lack of information about sexual risk and makes it difficult for women to protect themselves.
The author notes that 'a theology of compassion and approaches advocating harm reduction seem to be emerging in several Muslim countries, and greater acceptance of HIV positive people is justified with reference to religion. Things are also improving on a practical level - in recent years better information systems to track HIV have been put in place in the region and around half of the countries have formulated national plans to tackle HIV.'
The author concludes that whilst knowledge is still inadequate and stigma and greater discrimination prevail in many settings, over the past couple of years 'there has been greater visibility and more public discussion of HIV/AIDS in the region. Throughout the region governments and non-governmental organisations have initiated promising projects to break the silence around HIV, spread information, promote prevention and provide care and treatment. The challenge now is how to capitalise on the strengths represented by cultural tradition while fostering effective responses to the epidemic.' 人口构成及数量趋势，生活习惯及宗教信仰可能对HIV发病率具有负面作用
一篇关于中东和南非HIV流行研究的综述发现在这些区域HIV低发的背后存在文化和宗教习惯的因素，同时，这些文化及宗教习俗也潜在有促进HIV的传播的可能性。
世界卫生组织已发表在本周英国医学期刊的研究认为穆斯林教徒常有的某些习俗可能有利于降低HIV传播的危险姓：一是酒精饮用量少，减少了危险行为，另一个可能是男性包皮环切术，最近的临床试验显示这种手术可能具有保护作用。但这些结果对其他的流行病学，文化及社会环境的适用性仍有待确认。
同时，这一区域的其他人口构成趋势，信仰及习惯可能具有负面作用。此地区多数国家有许多年轻人结婚时仍处于快速发育期，而年轻人可能对性传播传染病疏于防范。传统的穆斯林方式往往非常保守，而且很难改变对性行为观念避而不谈的现状，尤其是那些可能偏离宗教规范的观念。
对宗教出版物及学派宣言的详细分析揭示普遍存在强烈的教化观念：HIV是神的惩罚，宗教信仰以保护者的姿态出现。这意味着那些HIV艾滋病患者被打上了耻辱烙印。
性别构成对HIV的流行也有部分作用。严格禁止婚外性交，尤其对妇女这种禁令更加严厉，这与HIV的低发率相关。而在携带HIV的女性数量比男性少的地区，这种性别比率似乎变化不定，提示疾病正在传播，并且当妇女嫁给可能感染HIV的年长男性时突出了妇女的特殊易感性。而认为女性无责任的文化观念使得女性缺乏性危险性的知识，难以保护自己。
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作者:admin@医学,生命科学 2010-12-01 17:11
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