聯合國愛滋病規劃署的調查與所謂的HIV/AIDS第四個90目標的方向一致

資料來源：刺胳針醫學期刊；www.thelancet.com Vol 393 June 1, 2019；財團法人台灣紅絲帶基金會編譯

該調查回應了社區在思考防治愛滋病毒/愛滋病的公共衛生介入措施時注意心理健康的趨勢。保羅韋伯斯特報導。

在聯合國愛滋病規劃署三管齊下的90-90-90全球愛滋病控制的目標 – 即90％愛滋病的診斷、90％的治療，和90％的病毒抑制 –中加入所謂的第四個90心理健康的倡議者，讚揚聯合國愛滋病規劃署在一項新的且重要的國際女同性戀、男同性戀、雙性戀、跨性別和雙性人（LGBTI）的調查中探索心理健康。

呼籲增加「90％的心理健康」作為愛滋關懷的第四個90目標，最初係源自於一群來自巴塞隆那全球衛生研究所衛生系統研究小組負責人Jeffrey Lazarus所領導的研究人員。「我們建議在測試和治療目標中增加第四個90：確保那病毒載量已受抑制的人中有90％能具有與健康有關之生活品質」，Lazarus和其他共同作者們在2016年的一篇論文中建議「考慮到那些已經實現了病毒抑制的人們，但是仍然必須與其他嚴重的非傳染性疾病、抑鬱症、焦慮、經濟壓力，和經歷那些愛滋病毒相關的問題或擔憂受到歧視等挑戰採取激烈的競爭之需求」。Lazarus說聯合國愛滋病規劃署決定在其新調查中去探究這些確切的問題正與他訴求第四個90「 調整配合良好 」。「接下來，我期待在聯合國的其他調查中看到類似的方法正在進入並實施」，Lazarus說。

聯合國愛滋病規劃署新的82道問題之線上調查，是與法國Aix-Marseille大學、美國明尼蘇達大學以及總部位於英國曼徹斯特的LGBT基金會的研究人員共同合作開發的，聯合國愛滋病規劃署衝擊影響的資深顧問Erik Lamontagne說。

為了探究受訪者的心理健康，此項調查研究之變項涵括了所謂的出櫃、家庭支持、性滿足、身體健康、快樂、自尊，和恐同症的內化等等，Lamontagne解釋道。「我們是第一個密切關注所有這些因素，並試圖將幸福、或健康，與導致健康問題如HIV的感染之冒險行為予以關聯並探討的。我們正與呼籲第四個90目標所建議之相同的方向中去尋找，但並不僅侷限於那些已經感染到愛滋病毒的人」。

「為了探究受訪者的心理健康，此項調查研究之變項涵括了所謂的出櫃、家庭支持、性滿足、身體健康、快樂、自尊，和恐同症的內化等等」

調查的早期反應一直很強烈，在網上發布後之頭幾週便有37,00名受訪者完成了問卷，其中佔11％的人是愛滋病毒感染者，Lamontagne說道。「我們是試圖去了解有關更多情況之信息，包括伊朗、土耳其、緬甸、越南和在非洲的許多地區，對LGBTI等人來說這些正是我們對他們所在的社區了解很少的地方」，他補充道。到目前為止，這項調查已發表了18種語言，目前亦有四個以上的翻譯正在進行中，包括馬來語和簡體中文。

LGBT基金會的首席執行長Sean Howell表示，他的團隊正在提供管道給其網絡中全球達2,500萬之社交媒體成員。「更深刻地去瞭解LGBTI人們如何在全世界中生活，因此我將這項調查看作是一項至關重要的努力」，Howell解釋道。「更多地了解他們的生活品質和心理健康對協助改善他們的整體健康來說至關重要」。

「在近幾十年的研究中探索健康的努力正深植於所謂積極正向的心理學因素上」，多倫多大學工作與健康研究所資深的科學家Peter Smith解釋道。Smith指出埃默里大學心理學家Cory Keyes於2005年在探索廣泛全面性的心理健康之原則的一項開創性研究中，所提出13點旺盛的範躊中突顯的因素，如快樂、社區歸屬感和具有目的感覺等。 「我們從長期的研究中知道那些更幸福的人往往會活得更久」，Smith說道，「而且幸福和安全的行為兩者之間可能存在著關係」。

芝加哥伊利諾理工學院的心理學教授Steve Dubois，曾探討了女同性戀和男同性戀者其伴侶關係和身心健康、健康行為和醫療保健使用上之關聯，他表示聯合國愛滋病規劃署的調查「絕對與倡導加入第四個90之倡議者所提出的方向一致」。

「聚焦於健康更廣義來講有助於找出健康行為和健康上更多實證之關聯，對於LGBTQ和其他個人，我們可以定位健康行為在更大的健康背景下」，Dubois補充道。「評估這些概念也同時幫助研究人員測試並找到健康幸福與各個變項之間的關聯」。

Dubois和Lamontagne都注意到，雖然現存的調查中比如歐洲的MSM互聯網調查，美國疾病控制和預防中心的行為風險因子監測系統，以及美國國家衛生研究院酒精和相關情況的流行病學調查研究，都提供了於某些國家或地區其LGBTI族群生活品質某些方面上有用的的見解，但他們提供的數據是較無目的散射的。

UNAIDS survey aligns with so-called fourth 90 for HIV/AIDS

The survey echoes a trend in the community to take notice of mental wellness when thinking of public health interventions to fight HIV/AIDS. Paul Webster reports.

 Advocates for a so-called fourth 90 to add mental wellbeing to UNAIDS’s three-pronged 90–90–90 targets for global HIV control—ie, 90% diagnosis of HIV, 90% treatment, and 90% viral suppression—are praising UNAIDS for probing mental wellbeing within a major new international lesbian, gay, bisexual, trans, and intersex (LGBTI) survey.

 The call to add 90% mental wellness as a fourth 90 target in HIV care first came from a group of researchers led by Jeffrey Lazarus, head of the health systems research group at The Barcelona Institute for Global Health.

“We propose adding a fourth 90 to the testing and treatment target: ensure that 90% of people with viral load suppression have good health-related quality of life”, Lazarus and coauthors suggested in a 2016 paper, “to take into account the needs of those who have achieved viral suppression but still must contend with other intense challenges such as serious noncommunicable diseases, depression, anxiety, financial stress, and experiences of or apprehension about HIV-related discrimination.” Lazarus says the decision by UNAIDS to probe these exact issues in its new survey “aligns well” with his fourth 90 call. “Next, I’d like to see a similar approach implemented into other UN surveys”, Lazarus says.

The new UNAIDS 82-question online survey was developed in collaboration with researchers at Aix-Marseille University, the University of Minnesota, and the Manchester, UK-based LGBT Foundation, says Erik Lamontagne, senior impact adviser at UNAIDS.

To probe respondents’ mental wellness, the survey canvasses variables including so-called outness, family support, sexual satisfaction, physical health, happiness, self-esteem, and the internalisation of homophobia, Lamontagne explains. “We are the first to look closely at all of these factors, and to try to correlate happiness, or wellness, to risk-taking behaviours that drive health problems such as HIV infection. We are looking in the same directions suggested in the calls for a fourth 90, but not just for those people living with HIV.”

“…the survey canvasses variables including so-called outness, family support, sexual satisfaction, physical health, happiness, self-esteem, and the internalisation of homophobia…”

Early response to the survey has been strong, says Lamontagne, with 37,000 respondents completing the questionnaire in the first weeks after it was published online, 11% of whom are living with HIV. “We are trying to learn more about conditions for LGBTI people in places where we really know little about their communities, including Iran, Turkey, Myanmar, Vietnam, and many places in Africa”, he adds. So far, the survey has been published in 18 languages, with four more translations currently in progress, including Malay and simplified Chinese.

Sean Howell, CEO of the LGBT Foundation, says his group is providing access to its network of 25 million social media members worldwide. “I see this survey as a crucial effort to much more deeply understand how LGBTI people live worldwide”, Howell explains. “Learning more about their quality of life and mental wellness is critically important to helping to improve their overall health.”

The push to probe wellness is rooted in decades of research into so-called positive psychology factors, explains Peter Smith, senior scientist at the Institute for Work & Health at the University of Toronto. Smith points to a pioneering 2005 study exploring axioms of comprehensive mental health by Emory University  psychologist Cory Keyes, which proposed a 13-point categorisation of flourishing that highlighted factors such as happiness, community belonging, and a sense of purpose. “We know from longitudinal studies that people who are happier tend to live longer”, says Smith, “and there’s likely a relationship between happiness and safe behaviour.”

Steve Dubois, a psychology professor at the Illinois Institute of Technology in Chicago who has probed linkages between lesbian and gay partnership relationships and physical and mental health, health behaviours, and healthcare use, says the UNAIDS survey “absolutely is consistent with the direction proposed by the fourth 90 advocates”.

The wellbeing focus facilitates finding empirical associations between health behaviours and health more broadly, so we can situate health behaviours in the greater context of health, for LGBTQ+ individuals”, Dubois adds. “Assessing these constructs simultaneously helps researchers test and find links between wellbeing and related variables.”

Dubois and Lamontagne both note that although existing surveys such as the European MSM Internet Survey, the US Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System, and the National Institutes of Health National Epidemiologic Survey on Alcohol and Related Conditions offer some useful national and regional insights into some aspects of LGBTI quality of life, the data they provide is scattershot.

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