台灣醫院性病愛滋匿篩執行現況與心理健康服務之需求性評估

The current status of anonymous voluntary STD/HIV counseling and testing in hospitals in Taiwan and an assessment of the need for integrated mental health services

目標：本研究針對我國自1999年起推動之性病愛滋匿名篩檢（以下簡稱匿篩），調查不同地區和層級規模匿篩醫院，呈現其服務現況與困境，並評估心理健康服務之需求性。方法：針對國內匿篩醫院之主要業務承辦人進行深度訪談。結果：本研究共訪談15家匿篩醫院，發現匿篩多由感染科或家醫科提供服務，各院匿篩服務會提供基本之衛教與情緒支持，但衛教效率不佳、篩檢空間與時間有限、心理健康服務資源缺乏；其中12家認為需要心理健康服務資源介入，以增進篩檢服務效能；亦有開始嘗試跨團隊合作服務者，卻又表示擔憂個案不慎感染時之追蹤與管理。結論：匿篩存在心理健康服務之需求性，除了解篩檢者次文化差異、邀請同儕志工參與、加強匿篩之軟硬體設備，防疫措施應結合心理健康服務資源，以了解民眾篩檢動機與情緒狀態，並在院內推廣跨團隊合作照護，以篩檢者為中心，運用適合疾病預防與健康促進之健康信念模式或社會認知理論，提供適性之衛教內容，讓愛滋匿篩兼具初級預防之功效。

Objectives: Anonymous voluntary STD/HIV counseling and testing (VCT) was first implemented in Taiwan in 1999. The aims of this study were to investigate its current status and the challenges for various levels of hospitals offering VCT in different areas, and to assess the need for integrated mental health services. Methods: In-depth interviews were conducted with VCT counselors in 15 hospitals. Results: VCT was administered primarily via Divisions of Infectious Diseases and Family Medicine with the provision of STD/HIV education and emotional support. Among the major challenges were ineffective health education, limited VCT resources, inadequate private space, and lack of mental health services. Of the 15 interviewees, 12 suggested that VCT integrated with mental health services would optimize program effectiveness. Inter-professional practices have been introduced in some hospitals offering VCT, but some interviewees raised concerns about subsequent follow-up in the context of inter-professional practice if VCT participants seroconverted. Conclusions: There is a need for mental health services along with the provision of VCT. To improve the VCT program, it is important to understand the subculture among VCT participants, to involve peer volunteers and multidisciplinary counselors, and to enhance privacy during VCT. Disease control measures should be combined with mental health services to further our understanding of people's motives for VCT and their psychosocial state. Therefore, it is necessary to develop patient-oriented co-operative VCT programs which offer tailored and theory-driven health education interventions based on such theories as the Health Belief Model and Social Cognitive Theory, thereby making VCT a part of primary prevention efforts.