Mối liên hệ giữa bạo lực tình dục và HIV AIDS qua một số nghiên cứu gần đây

MOI LI€N H€ GlCrn BRO LITC TINH DUC Vn • • • • HiV/fllDS QUn MOT SO NGHI6N CUU GIIN DAV ThS D VAN QUAN'"' C C nghien cun tren the gidi va mdt sd gbien cun d Viet Nam da khdng dinh: bao lyc chdng lai phu nft dang klid phd bien va xdy d nhieu nai, mgi tdng lap xd hgi Tai Viet Nam, bdo cdo cua Uy ban Ddn sd, Gia dinh vd Tre em ndm 2006, cd tdi 90%) nan nhdn cua tinh trang bao luc gia dinh la phu nft vd tre em Trong dd, phu nft thudng cung liic la nan nhdn cua nhieu loai bao luc, nhdt la bao luc tinb due (BLTD) dang cd chieu hudng gia tang nhanh Ket qud dieu tra tai tinb, phd, cd tdi 30%) sd phu nft dugc hdi da tung bi chdng ep budc quan be tinh due, va cd tu 10%-50% phu nft tung bi BLTD ddi (Uy ban Cdc vdn de xa bgi cua Qudc bdi, 2006) Tren thuc te ty le cd the cao ban vi nhieu ngirdi cudc van cdn e ngai khdng mudn phai bay chuyen rieng tu cua minh BLTD dugc coi la mgt bien tugng phuc tap the hien d nhieu chieu canh khdc nhau, chiu tdc ddng cua rdt nhieu yeu td vd de lai nhieu hdu qud ve mat tdm ly, sue khde vd xa bdi cho phu nft, dac biet bdi cdnh dich HlV/AlDS dang cd dien bien phuc tap tai Viet Nam BLTD dugc dinh nghTa Id: bat ky hdnh ddng hay cd gang ndo nhdm thye hien hanh '*' Vien Xa hpi hpc, Hpc vien Chinh trj - Hanh chinh quoc gia Ho Chi Minh 60 ddng tinb due cua mdt ben md khdng dugc phia ben ddng tinb, nhung ldi binh phdm hoac dua cgt lien quan den tinb due, hodc nhung hdnh ddng de cudng doat tinh due thdng qua cudng buc, de dga gdy tdn hai, hoac bao luc bdi bdt ky ngudi ndo, bdt ky hodn cdnh ndo ke ca d gia dinh va nai 1dm viec (UNIFEM, theo dinh nghTa tu Bdo cdo the gidi ve bao luc vd sue khde) Ddy dugc coi la mdt nhtrng hinh thuc cua bao bdnh, BLTD dang tao dieu kien cho dai dich HIV/AIDS lay lan nhanh ban Gdn ddy cdc nghien ciiu tai nhieu nudc tren the gidi vd cd d Viet Nam da chi mdi lien he chat che gifta bao lire va nguy ca nhiem HIV/AIDS Ngudi phu nft ludn phdi ddi mat vdi nguy ca nhiem HIV/AIDS cao bdi vi hg la nan nhdn cua BLTD ban tinh, ban ddi, khach lang chai gay Ddng thdi, phu nu bi nhiem HIV/AIDS cQng phai ddi mat vdi nguy ca bi bao luc nhieu hon nhtrng phu nu khdng bi nhiem HIV/AIDS Tai Viet Nam, phu nft nhiem HIV/AIDS ngdy cdng ed xu hudng gia tang Ude tinh cua Bd Y tl vl sd ngudi nhilm HIV/AIDS cho din nam 2005 cho thay, sd hon 300 nghin ngudi nhiem HIV/AIDS toan qudc, phu nu chiem gdn 1/3 Theo mgt cdng bo mdi day cua Uy ban Cdc vdn de xa hdi cua Quoc hgi, hien Viet Nam cd tren 70%) cdc ca lay nhiem HIV/AIDS xudt phdt tu quan he tinh due vd LY LUAN CHiNH TRI 12-2010 1/3 sd ngudi nhiem HIV hien dang Id phu nft Su cdp thiet phdi dl cap din mdi lien be gifta BLTD vd HIV/AIDS Id dai dich dang cd xu budng nft- boa Ngdy cang cd nhilu phu nu nhiem HIV/AIDS bi bao luc vd chiu su ky tbi va phan biet ddi xu tu gia dinh, cdng ddng va xa bdi Cac nghien ciiu cho thdy, BLTD lam tang nguy ca lay nhiem HIV cua phu nft qua viec cudng ep tinh due, khdng su dung bao cao su, sir dung chdt kich thich quan be tinb due, bi ddnh dap qud trinh quan he tinh due Trong khudn khd bai vilt tdc gia chi phan tich, he thdng hod mdt sd cdng trinh nghien ciiu gdn ddy de cap den van de mdi quan he gifta BLTD vd HIV/AIDS Tren ca sd dd, dua mgt sd ket ludn, khuyen nghi lien quan den phdng chdng HIV/AIDS vd phdng chdng bao lyc tinh due tai Viet Nam Mot so nghien ciru tren the gioi Dai dich HIV/AIDS dang gia tang vd dac biet ty le phu nft nhiem HIV mdt cao bon Dieu tra tai nhieu nudc tren the gidi da chi mdi lien he gifta BLTD ddi vdi phu nft va HIV/AIDS vdi nhtrng bang chiing cbo thdy, phu nft bi BLTD dl ddi mat vdi nguy ca nhiem HIV Nguyen la vi hg khdng dugc su dung bao caosu, khdng dugc khudc tu quan he tinh due, bi hiep dam tap the, bi danh dap, bi dung cdc dung cu kich due va chat kich thich gdy tdn thuong den ca quan sinh due Trong do, nhieu ngudi nhung ke bao luc lai cd mdi quan be tinh due vdi nhieu ngudi, vdi nhftng nhdm cd nguy ca lay nhiem HIV cao Cdc nghien ciiu cua Donovan; Smith; Kalichman vd Simbayi, da chi rang, chinh viec BLTD ddi vdi phu nft, nhdt la nft mai L t LUAN CHlNH TR! 12-2010 dam da khiln nhung ngudi ddn dng cd nguy ca Idy nhilm HIV khdng chi tu phu nu ma cdn tu chinh nhftng ngudi ddn dng khdc, bdi vi dm dao cua phu nft luu gift tinh dich cua tdt cd nhtrng ngudi dan dng trudc Phu nft cd nguy ca lay nhiem HIV rat cao su eg xat manh va chdy mdu thudng xuyen, dieu cung lam tang them nguy ca lay nhiem cho dan dng Trong dd nghien ciin cua USAID tai Campuehia khang dinh, dai dich HIV d Campuehia cd mdi lien be chat che vdi nghe mua ban dam mang tinh BLTD cao, nhftng ngudi ban ddm cd nguy ca Idy nhiem cao vd tiep tuc lay nhiem cho ngudi khdc Mdt sd nghien ciiu cdn phan tich tinb trang su dung chdt kich thich cua nhftng ngudi gdy bao luc cQng gdp phan lam gia tang nguy ca vd hau qud BLTD, nhdt Id van de lay nhiem HIV d phu nft bdn dam Chang ban, nghien ciin cua USAID tai Campuehia da khang dinh van de su dung chdt kich thich (thuoc kich due, ma tuy, bia rugu ) vdi tinh trang bi BLTD dang khd phd bien Nghien ciiu cho biet, sd dT cdc chat kich thich cd mdi lien be chat che vdi tinh trang BLTD (quy md, muc cQng nhu tinh chat nguy hiem) d gdi mai dam bdi vi chung dang ngdy cang trd nen phd bien, ludn cd sdn, gia re Dac biet Id tinb cdng dung ciia chat kich thich viec trg giup ngudi dan dng thuc hien hanh vi bao luc ddi vdi gdi mai dam, nhu: 1dm cho cdc hdnh dgng cua hg trd nen bao ban, vd nhdt Id Idm cho ngudi ddn dng tu tin hon Chinh dieu ddn den tinh trang lay Ian HIV/AIDS cdng ddng Cac nghien ciiu di den khuyen nghi: Lien hgp qudc, cac van phdng ve phdng chdng AIDS cua chinh phu va mdt sd td chuc phi chinh phu tham gia vdo viec ddy 61 lui HIV cdn tdng cudng cdc phuang phap ngan ngua HIV/AIDS gidi mai dam, giiip gai mai dam tri dugc su an toan nhieu hoan canh khdc nhau, tham chi ca d noi viec ban ddm la bat hgp phdp va chinh phu can can thiep Mot so nghien ciru 6" Viet Nam Tai Viet Nam, nghien ciiu cua VQ Ngge Bdo; Rosenthal vd Trdn Thi Kim Oanh; ISDS, CSAGA va Action Aid; D§ Van Qudn cQng cd xu hudng chi rang: BLTD ddi vdi phu nft gia dinh cQng nhu ddi vdi nhdm nft mai dam Id mdt nguyen nhdn true tiep Idm gia tang nguy ca lay nhiem HIV/AIDS Ddng thai, ndi lo sg ve bao luc cQng cdn trd phu nft tiep can cac thdng tin ve HIV/AIDS dan den khdng dugc dieu tri va tu vdn Mac du mdi quan tdm cdng trinh nghien cuu cua hai tac gia: Doreen Rosenthal va Tran Thi Kim Oanh la: di tim cac yeu td dnh hudng den hdnh vi tinh due khdng an toan cua nft mai ddm vdi khdeh hang vd ban tinh, nhien nghien ciiu ciing da dua nhung bang chiing ve tinh trang nft mai dam dang bi khach hang, ban tinh BLTD bg khdng cd quyen quyet dinh su dung bao cao su, hg bi budc phai thoa man theo cac yeu cau cua khach hang va ban tinb Ddy chinh la Iy dan den su gia tang nhiem HIV d nhdm nft mai dam ciing nhu cdng ddng Vao nam 2007, mgt nghien ciiu tai Viet Nam cd tieu de BLTD vd nguy co nhiem HIV/AIDS da dugc Vien Nghien ciiu phat trien xa hgi (ISDS), Trung tam Tu vdn va thdng tin tu lieu ve bao luc gidi (CSAGA) va Action Aid tien hanh nham dua nhftng bang chung xac thuc ve mdi quan he gifta BLTD va can benh HIV/AIDS Nghien ciiu da dugc tien hanh d huyen Vi 62 Xuyen, Ha Giang; huyen Udng Bi, Qudng Ninh va quan Gd Vdp, Thanh phd Hd Chi Minh Nghien ciiu da cbi mdi lien he giua BLTD (trong gia dinh va cd the la ca ben ngoai gia dinh) vdi nguy ca lay nhiem HIV, BLTD gdn liln vdi tinh due khdng an todn Theo dd, BLTD dugc coi la mdt nhting binh thuc cua bao hdnh, nd tao dieu kien cho dai dich HIV/AIDS lay lan nhanh bon Nghien ciin cho biet, mdi quan ngai Idn nhdt cbo cdc nan nhan bi BLTD Id nguy ca lay nhiem HIV tu chdng hodc ban tinb, vi bg khdng dugc su dung cac bien phdp an todn nhu bao cao su va hg khdng dugc khudc tu quan he tinh due Phan Idn nhiing ngudi gay BLTD la nhftng ngudi cd quan he tinh due cung liic vdi nhieu ngudi, ddc biet la hg thudng cd quan he vdi nhdm cd nguy ca lay nhiem HIV cao Id gdi mai dam Sau lay nhiem tu cac ddi tugng nay, ngudi chdng hoan toan cd the truyen benh sang vg minh Nghien ciiu cQng chi rang nhting nhan thuc sai lam, su thieu hieu biet cua phu nu da dan den bau qua cua BLTD la: khung hoang tinh than keo dai, bi ton thuang the chat, sg hai quan he tinh due, cd thai ngoai y mudn, nao hiit thai va lay nhiem cac benh phu khoa, dac biet la HIV Ben canh dd, nghien ciiu cdn cho biet, mdt yeu td lam tang nguy ca lay nhiem HIV/AIDS la nhiing ngudi phu nu nan nhan cua BLTD - thudng khdng cd khd nang cdng khai tinh trang HIV duang tinh Dieu cang tao dieu kien de nan dich HIV/AIDS bung phat Nghien cuu da dua kit ludn: phdng chdng BLTD la gdp phdn phdng chdng nan dich HIV/AIDS Nghien ciiu cua Trung tam CSAGA, cho biit tu nam 1997 - 2005, cd khoang 2.500 cudc ggi din dudng day tu vdn cua trung tam cd lien quan tdi BLTD Trong so nhftng ngudi ggi dien cd tdi hem 30%) LY LUAN CHiNH TRI 12-2010 tnrdng hgp ngudi gay BLTD la chong hay ban tinh Phdn Idn nhung trudng hgp xdy BLTD, quan he vg chdng, hg khdng su dung bao cao su Nhilu ngudi vg du biet rdng chdng khdng chung thuy vdi minh, nhung lai khdng thi thuylt phuc chdng su dung bao cao su Phan tich cua CSAGA cho thay nhtrng phu nft bi cudng ep tinh due tu chdng hay ban tinh deu cd mdt ndi lo chung la su an toan cua ban than ve siic khde: tinh trang viem nhiem ca quan sinh due thudng xuyen va nguy ca mac cac benh Idy truyen qua dudng tinh due Tuy nhien, it ngudi nghT rang hg dang dung trudc nguy ca Idy nhilm HIV Nghien ciiu ciia Do Van Quan cQng da dua nhftng bang chung cho thay mdi lien he gifta BLTD va lay nhilm HIV/AIDS Thdng qua tra ldi cua hon 30 nft ban dam cho thay cd mdi lien he rd rang anh hudng xau cua BLTD den sue khoe, nhat la vdn dl HIV/AIDS cua nft mai dam Cd khoang 1/3 sd nft mai dam dugc phdng van thua nhan minh dang bi nhilm HIV/AIDS Nghien ciiu cho biet, vi nhieu Iy khdc nhau, nhat la mai dam la nhdm xa hdi yeu the, bi xa hdi dinh kien, hg it cd kha nang tfr choi khach hang mac du cd the nhan biet trudc minh rat cd the bi BLTD Trong sd dd, cd gan 1/2 khang dinh hg dugc ddi tac (ban tinh, khach lang choi, xa hgi den ) ep bugc hoac khuyen dung cac chat kich thich (ma tuy, thuoc kich due, rugu bia ) trudc quan he tinb due Su tuc gian, bao, tham chi la xau hd vi khuyet tat ddi sdng tinh due cua nam gidi deu dd len dau nu mai dam, dac biet la ddi vdi nhdm khach tudi nien Day chinh la nguyen nhan dan den viec gia tang hanh vi BLTD va dac biet la lay nhiem HIV d nft mai dam Dieu dat van de la neu mudn giam thilu cac hau qua lien quan den L V LUAN CHlNH TR! 12-2010 HIV va bao ve siic khoe cua ca nhan, cdng ddng thi vdn dl BLTD ndi rieng, bao lyc ndi chung ddi vdi nhdm nu mai dam phai dugc quan tam nghien ciiu, cd giai phap can thiep vdi nhieu each thiic khae va phu hgp Mot so ket luan va khuyen nghi Ttr nhimg phan tich nhu vua neu cd the dua mdt sd ket luan va khuyen nghi nhu sau: BLTD cua nam gidi ddi vdi phu nft gia dinh va ben ngoai dang la mdt bien tugng mang tinh kha phd bien d cac nudc tren the gidi, dd cd Viet Nam BLTD la mdt chu de nhay cam d Viet Nam, thudng bi giau kin, vi the ma nd It dugc ban luan va nghien cuu mgt each thau dao BLTD cd nguyen nhan sau xa la su tdn tai dai ddng cua su bat binh ddng gidi vd nhiing dinh kien ve vai trd va quyen lyc cua nam gidi ddi vdi phu nft BLTD la mdt nguyen nhan true tiep lam cho HIV/AIDS lay truyen nhanh han, cac ben lien quan bi tdn thuang ve bd phan sinh due; khdng dugc thuong thuyet ve tinh due an toan; khdng dugc sii dung bao cao su; bi sir dung chat kich thich trude quan he tinh due De gdp phan phdng chdng nan dich HIV/AIDS, can phai nhan manh quan diem phdng chdng bao luc, dd cd BLTD la gdp phdn phdng chdng nan dich HIV/AIDS Trong chua thi thuc hien dugc muc tieu kiem soat hay ngan chan mdt each triet de van de mai dam, cac chuang trinh, chinh sach phdng chdng mai dam cua Viet Nam can chuyen manh sang hudng giam hai, bao ve quyen ngudi, cai thien tinh trang siic khoe va mang tinb toan dien ban Can xdy dung, Idng ghep tdi lieu tuyen truyen, budng dan ky nang phdng, chdng bao luc gdn liln vdi tai lieu tuyen truyen ve phdng chdng benh Idy truyin qua dudng tinh due va HP//AIDS 63 ... nghien ciiu gdn ddy de cap den van de mdi quan he gifta BLTD vd HIV/ AIDS Tren ca sd dd, dua mgt sd ket ludn, khuyen nghi lien quan den phdng chdng HIV/ AIDS vd phdng chdng bao lyc tinh due tai... kich thich trude quan he tinh due De gdp phan phdng chdng nan dich HIV/ AIDS, can phai nhan manh quan diem phdng chdng bao luc, dd cd BLTD la gdp phdn phdng chdng nan dich HIV/ AIDS Trong chua... gioi Dai dich HIV/ AIDS dang gia tang vd dac biet ty le phu nft nhiem HIV mdt cao bon Dieu tra tai nhieu nudc tren the gidi da chi mdi lien he gifta BLTD ddi vdi phu nft va HIV/ AIDS vdi nhtrng