男同性戀愛滋感染者就醫就業障礙與因應方式之初探

An Exploratory Study of Barriers to Medical Treatment and Employment and Coping Strategies among HIV-positive Gay Men

林正鄆(Cheng-Yun Lin)

指導教授 ： 張鳳琴

國立臺灣師範大學/教育學院/社會工作學研究所/碩士(2011年)

摘要

本研究主要目的為瞭解愛滋感染者對疾病烙印的主觀認知與感受，以及在就醫就業所遇到的障礙經驗和因應方式，研究對象以7位男同性戀愛滋感染者為主，並邀請衛生醫療與社會福利領域各一位專家進行訪談，期能從雙方的觀點去探討感染者在就醫就業方面的問題，並提出福利政策改善之建議；由於障礙本身就是一種排除現象，故援引社會排除理論來探討感染者的障礙情形，並與目前的法規進行對照。採用質性研究的深度訪談法進行資料蒐集，研究進行時間為2010年9月21日至12月24日，邊訪談邊作資料分析，最後於2011年1月10日完成。

本研究結果如下：
一、感染愛滋病毒產生的壓力和創傷比一般疾病嚴重，且受訪者多持負面評價、容易因情緒低潮而產生憂鬱症狀，甚至可能會衍生自殺的念頭。
二、疾病隱私是受訪者最關注的部份，生活中傾向不讓他人知道感染身份；惟家人朋友若知悉且能夠接納，對受訪者而言是一大支持力量。
三、對愛滋病缺乏認知瞭解易對感染者產生偏見和歧視，不僅一般社會大眾如此，專業體系相關人員也不見得能夠完全接納感染者。
四、醫藥費用是受訪者目前最關切的問題，情感和親密關係則是次要需求。
五、在就醫的正向經驗方面，受訪者表示感染科醫護人員最為親切友善、感染科醫師會協助轉介至對待感染者友善的各科醫師看診；負面經驗則包含態度、言語、行為和行政措施等四個部份。
六、在就業障礙方面，受訪者表示會擔心找工作時需要作愛滋檢驗，故傾向選擇留在原工作崗位，避免換工作而致感染身份曝光；另有受訪者曾因工作職場要求作愛滋檢驗而被迫離職，顯示感染者的就業權益仍未受到積極保障。
七、在面對就醫就業的障礙困境時，不同的受訪者會採取不同的因應方式，包括積極的問題焦點因應和消極的情緒焦點因應，亦可能同時採取兩種策略作為因應，惟疾病隱私是重要的關鍵因素，若在因應過程中可能會造成感染身份曝光，受訪者就會選擇消極的因應方式。

在研究建議部份，應加強社會大眾與專業人員的教育宣導，以增進對愛滋病的認知瞭解，進而能夠接納愛滋感染者，同時落實就醫就業方面的保護措施，當感染者受到就醫就業障礙時，主管機關應嚴懲不當的醫護人員和雇主，維護感染者個人的基本權益；另針對初感染者應關注其感染後的諮商輔導與社會適應，感染者若能建立感染者同儕支持關係，有助於疾病調適和歸屬感。最後，專家則建議可朝學名藥與國際議價作努力，可避免醫藥費用造成政府龐大的財政負擔。

關鍵字

愛滋病 ； 偏見 ； 歧視 ； 社會排除 ； 障礙 ； 因應

並列摘要

The main purpose of this research was to explore the stigma-related experiences, barriers to medical treatment and employment, and coping strategies experienced by HIV-positive people. Social exclusion theory was applied and an antisocial exclusion policy was proposed. A qualitative research method was conducted using in-depth interviews. The interviewees included 7 HIV-positive gay men and 2 AIDS healthcare and social welfare experts between the 21st of September and the 24th of December, 2010.

The results were as follows:
1. The HIV-positive participants experienced severe stress and trauma because of HIV disease. The HIV-positive participants themselves had a negative evaluation of AIDS. Most participants had experienced depression and thoughts of suicide.
2. The privacy of HIV status among HIV-positive participants was of great concern. The participants tend to conceal their illness. However, once their family members and friends had learned of their HIV status and accepted the truth, this resulted in great support for the participants.
3. The HIV-positive participants reported experiencing AIDS stigma, prejudice and discrimination not only from the general population but also from health professionals.
4. The HIV-positive participants were most concerned about medical treatment and expense, followed by the need of intimacy in a personal relationship.
5. The participants reported positive experiences of medical treatment from medical professionals in the Infectious Division, since some physicians transferred them to other doctors who treat HIV-positive persons in a friendly manner. In contrast, participants also reported medical treatment characterized by health professionals with negative attitudes, epithets, reactionary behavior, and problems with administrative services.
6. The main barrier to employment for the participants was disclosure of their positive HIV status when job-hunting. To avoid the HIV status being exposed, the participants tended to stay at the same job. Some participants reported being forced to quit due to their HIV-test results. These results showed that the employment rights for HIV-positive people are not completely enforced.
7. Most HIV-positive participants used multiple coping strategies including problem-focus and emotional-focus coping strategies against barriers and difficulties. However, HIV status confidentiality remained the main concern for the participants in the decision of whether to take action to fight for their rights.

A strengthening of HIV/AIDS education for the general population and for healthcare professionals is recommended to enhance understanding and acceptance of HIV-positive people. In addition, the laws and policies enacted to protect the rights to medical treatment and employment for HIV-positive persons must be enforced. Moreover, counseling services are needed to assist newly HIV-positive persons living with HIV, while the development of HIV support networks are also needed to enhance adaptation and bestow a sense of belonging. Finally, the experts proposed increasing efforts toward the development of generic drugs for AIDS and efforts toward international bargaining to avoid huge financial burdens of medical treatment for HIV-positive people and governments.

並列關鍵字

HIV/AIDS ； prejudice ； discrimination ； social exclusion ； barrier ； coping

參考文獻

徐森杰（2007），社會服務資源的個案管理模式。愛之關懷季刊，第60期，頁18-24。

黎士鳴譯（2005），心理學概要。臺北：麗文文化。

黃世鑫、林志鴻、林昭吟（2003），新貧問題與社會福利政策—科學vs.價值與菁英vs.普羅。國家政策季刊，第2卷，第4期，頁83-124。

露德協會（2009），副作用手冊。臺北：社團法人台灣露德協會。

露德協會（2009），滋露通訊，第114期。臺北：社團法人台灣露德協會。