I-pros and cons of the iphilisi yokuvimbela i-HIV
Kungase kumangaze bambalwa ukuthi izinga lokutheleleka kwegciwane lesandulela ngculaza phakathi kwabantu abadala abangaphezu kweminyaka engama-50 luphawuleka futhi lukhula. Namuhla amaphesenti angama-21 azo zonke izifo ezintsha ze-HIV ziphakathi kwabantu abadala, okuyikota yesine kulaba bantu abadala abaneminyaka engama-60 nangaphezulu.
Ngenkathi omunye engase acabange ukuthi ukuthandwa kwezidakamizwa zokuphuza erectile njenge-Viagra noma i-Cialis kudala amazinga aphezulu okudlulisela, iqiniso eliwukuthi thina, njengomphakathi, sithatha sengathi abantu abangaphezu kweminyaka engama-60 no-70 abanayo impilo , ngisho nempilo emihle yezocansi.
Futhi lokho akusobala ukuthi akuyiqiniso.
Ngenxa yalokho, odokotela ngokuvamile abahluleki ukuxoxa ngocansi oluvikelekile neziguli zabo ezindala noma ngisho nokuzibuza ngemikhuba yabo yobulili. Umhlinzeki ongajabuliyo kanye nokungaqondi kahle ngengozi ye-HIV kwabanye abadala asebekhulile bephelela ekushiyekeni okungakaze kube khona.
Eminyakeni yamuva, ukutholakala kwe- HIV ngaphambi-exposure prophylaxis (i-PrEP) kuye kwabeka abantu engozini izindlela zokuzivikela kangcono ekutheleleni. Kuvunyelwe yi-US Food Administration and Drug Administration ngonyaka ka-2012, isu lepilisi le-once-day liye laboniswa ukunciphisa ingozi ye-HIV ngamaphesenti angaba ngu-96 kubantu abathile abasengozini enkulu.
Ngokusekelwe kulokhu, isiqondiso samanje esivela ku-US Public Health Services (USPHS) sincoma ukuthi noma yikuphi umuntu "engozini enkulu yokutheleleka" kunikezwe i-PrEP njengengxenye yeqhinga elikhulu lokuvimbela i-HIV. Futhi lokho kuhlanganisa nabantu asebekhulile, kungakhathaliseki ukuthi bangqingili, babesilisa nabesifazane, noma bangqingili.
Kodwa naphezu kwemizamo kahulumeni yokwandisa ukutholakala kwe-PrEP, abantu abadala asebekhulile bahlala bengabaqiniseki ukuthi kulungile yini kubo, bavame ukubalula imithi yezindleko noma umthwalo wokunamathela kwezidakamizwa nsuku zonke njengemingcele ebalulekile. Abanye, okwamanje, bakholelwa ngokwabo ngokwanele ngokuvikelwa ngamakhondomu noma ngemisebenzi yezocansi okubhekwa njengengozi encane.
Kwabanye okwamanje, i-PrEP iyindlela abakholelwa ukuthi idinga ukulinganiswa ngokulinganayo nangesinye isinye, ukulinganisa izinzuzo ezingase zibe nemiphumela engaba khona.
Ummeli we-HIV Imibuzo PrEP Ukusetshenziswa kwabasebekhulile
Esihlokweni somagazini kaMeyi 2016 we- Advocate , uStuart Sokol, indoda eneminyaka engu-71 ubudala, ongenayo igciwane lesandulela-ngculazi oye waba ngumqondisi we-National AIDS Hotline kanye neLos Angeles County Commission kwi-HIV Health Services, wanikeza umbono wakhe mayelana nokuthi abadala nabakwa-PrEP babefanele yini ukuxuba njengoba ezinye izikhulu zezempilo zisikisela.
"Naphezu komkhuba wamanje wokuthola ukuthi usanda kutholakala ukwelashwa," kusho uSokol, "siyazi ukuthi kuthatha iminyaka kusukela ekuvezweni kokuqala kwegciwane lesandulela ngculaza kuze kube yilapho izimpawu zokuqala zenza baziwayo. Lokhu kungaba isikhathi eside kusukela eminyakeni eyisishiyagalolunye kuya kweyishumi nambili, noma ngisho 15. "
"Lezo zinsuku zingangenza ngibe nama-80s," kusho uSokol, wathi, "Kusobala ukuthi uma ngineminyaka engama-20, ama-30s, ama-40, ama-50 noma ama-60, ngingazama ukuthola ithuba, kodwa ngineminyaka engu-70 uqinisekile. "
U-Sokol waphinde wababuza ukuthi ngabe abantu beqembu lakhe, okungenzeka ukuthi babe nokukhathazeka ngokwezokwelapha okudinga ukuhlola njalo nokuhlolwa kwebhu, babezimisele ukuhambisa ukuhlolwa kwegazi okwengeziwe ukuze baqaphe kokubili isimo sabo segciwane lesandulela ngculazi nemiphumela emibi yemithi.
Futhi ngenkathi i-Medicaid kanye nezinqubomgomo eziningi zomshuwalense wezempilo zizohlanganisa i-PrEP kumakhemikhali abo okudakamizwa, ukukhokhelwa ngokubambisana kanye nokudonswa kwemali kungase kube yinto engavumelekile kwabanye.
U-Sokol uphinde wabhekisela ukungabi nolwazi phakathi kwabahlengikazi njengenkinga ebhekene nabaningi abadinga ulwazi mayelana nezinzuzo ze-PrEP kanye nokushiyeka.
"Akukhona udokotela wami wokunakekelwa oyinhloko noma u-urologist wami ozaziyo mayelana nemicabango yabo (mayelana ne-PrEP)," kusho uSokol. "Baye baxwayisa ngokumelene nemiphumela emibi noma baphakamisa umtholampilo we-HIV."
Ucwaningo luvame ukusekela isimangalo sikaSokol. Ngo-2015, amaCenter for the Disease Control and Prevention (CDC) abike ukuthi amaphesenti angama-34 abahlinzeki bezempilo abayinhloko e-US ayengakaze azwe nge-PrEP.
Kulabo abenza kanjalo, abaningi babhekisela iziguli kubahlengikazi bezobuchwepheshe naphezu kwemizamo ye-CDC ne-USPHS ukuqinisekisa odokotela ukuthi ukunakekelwa kwe-PrEP kungahle-futhi kufanele kuhanjiswe ngaphakathi kwesikhashana sokunakekelwa okuyinhloko.
Ngisho naphakathi kwemikhuba ethile ye-HIV, kusekhona okungahambisani nokusebenzisa i-PrEP ezigulini, kanti amaphesenti angu-17 kuphela abike ukuthi abeke umuthi.
(Ngokuvamile, ukuthengwa kwabathengi e-US kuhlala kuthobekile, ngokunye okucwaninga okuphakamisa ukuthi phakathi kuka-22,000 no-25,000 baseMelika kungenzeka njengamanje ku-PrEP.)
Iziphakamiso ekusekelwe kwe-PrEP kwabasebekhulile
Naphezu kokubalwa kwezibalo, ukusetshenziswa kwe-PrEP kwakunezikhathi ezine eziphakeme phakathi kwabantu abaphakathi kweminyaka engama-40 kuneminyaka engama-20 ubudala, okubonisa ukuthi ukuguga (kanye nemali engenayo, izimo zengqondo, nokuqwashisa okukhulu kwempilo yokuvimbela ngokuvamile) Izithiyo ezimbalwa zokwelashwa.
Abasekeli be-PrEP baqhubeka beveza isimo sengqondo sobulili nemikhuba engenza abantu abadala abadala bangengozini enkulu yokutheleleka. Phakathi kokukhathazeka:
- Ucwaningo lubonisa ukuthi abaningi abadala abaneminyaka engaphezu kwengu-50 abangaphezu kweminyaka engama-50 bahlanganyela engozini enkulu yokufaka i- x , kungakhathaliseki ukuthi bayalula noma bayisisu.
- Ukusetshenziswa kwekhondomu kufinyelela ekunciphiseni njengoba umuntu ekhula, kusuka kumaphesenti angu-24 kubantu abaneminyaka engama-50 kuya ku-59 kuya kwezingamaphesenti angu-17 kubantu abaneminyaka engama-60 kuya ku-69.
- Amaphesenti angamaphesenti angu-62 namaphesenti angu-78 abesifazane abakaze baxoxisane nodokotela wabo ngezocansi kusukela ekushintsheni ama-50.
- Ucwaningo oluthile lubonise ukuthi abesilisa abadala asevame ukusebenzisa amakhondomu ngenxa yokuhluleka ukugcina ukulungiswa.
- Ukwengeza, abesifazane abaningi asebekhulile abanesandulela ngculazi bakholelwa ukuthi bona kanye nomlingani wabo ongenawo igciwane lesandulela ngculazi badinga ikhondomu ngoba bayama-post-menopausal.
Ukugwema i-HIV kubaluleke nakakhulu kubantu abadala asebekhulile abanikezwa ukuthi izimo eziphezulu zezokwelapha ezikhona uma kuqhathaniswa nabantu abancane. Ngaphezu kwalokho, abadala abasanda kuthola igciwane ngokuvamile banamanani aphansi e- CD4 ngesikhathi sokuxilongwa, kanye nokunciphisa i-CD4-ehambisana nokukhula ngokushesha kwezifo .
Ukwelapha i-HIV kungabuye kube nzima kubantu asebekhulile njengoba kungenzeka ukuthi bangaphathwa ngezinye izimo ezinjengomfutho wegazi ophezulu, isifo senhliziyo, izifo zamaphaphu nesifo sikashukela. Lokhu kuholela engozini ephezulu yokusebenzisana kwezidakamizwa , kanye nezinkinga ezihlobene nokuhlelwa kwezidakamizwa nokunamathela kwezidakamizwa.
Ngokubambisana, zonke lezi zinkinga zisekela ukusetshenziswa kwe-PrEP, uma nje kugwema izinkinga zokutheleleka nokwelapha kubantu abadala asebekhulile.
Ukukhetha Okulungile
Kungakhathaliseki ukuthi i-PrEP iyifanele yini wena nodokotela wakho kunesidingo sokwenza isinqumo ngomuntu ngamunye, ngokudalulwa ngokugcwele kokubili kokusebenza nokuqeda ukusetshenziswa kokusekelwe ezimweni zakho kanye nengozi. Lokho okuyikho ngempela akuyona ikhambi elilodwa-elilinganayo-sonke isixazululo.
Kumele futhi kukhunjulwe ukuthi i-PrEP ayifuni ukuthi ibe yithuluzi elimele. Amakhondomu, ukunciphisa abalingani bobulili benombolo, kanye nokusetshenziswa kwe- antiretroviral therapy kumlingani we-HIV kufanele bonke bahlolwe njengengxenye yeqhinga lokuvikela elihlangene.
"Ngithanda umqondo wokuthi kunezixazululo ezingasebenza," kusho uSokol. "Ngingamaphesenti angu-100. Kodwa ngidinga ukucabangela ukuthi (PrEP) kufanele yini kimi."
Ekugcineni, kuyisinqumo somuntu siqu-esenziwe ngolwazi olugcwele, olungenabulungiswa-oluzocacisa ukuthi i-PrEP iyona enhle yini kuwe. Khuluma nodokotela wakho noma uxhumane nesiteshi se- AIDS sesifunda sakho ukuze uthole ulwazi oluthe xaxa noma ukudluliselwa kuchwepheshe oseduze nawe.
Imithombo:
Grant, R. "Ukusakazwa kwe-PrEP Innovations." Ingqungquthela Yezizwe Ezingu-10 nge-HIV Ukwelashwa Nokuvimbela Ukuvimbela. EParis, eFrance; Okthoba 2015; slide isethulo.
Isevisi yezempilo yomphakathi yase-US (PHS). "I-Preexposure Prophylaxis Yokuvimbela Ukwelashwa Kwegciwane lesandulela ngculazi e-United States - 2014: Umhlahlandlela Wokusebenza Ngokwemitholampilo." Washington, DC; eshicilelwe uMeyi 14, 2014;
I-Castel, A .; Ukushesha, D .; I-Tang, i-W .; et al. "Ukuqonda ukuhlinzeka nge-HIV Care Provider mayelana nesisusa sokubhala PrEP." I-Journal of Immune Deficiency Deficiency Syndrome. 2015; 70 (5): 520-528.
I-Pillowsky, i-D. ne-Wu, L. "Izingozi zokuziphatha ngokocansi kanye nezingozi ze-HIV phakathi kwabaseMelika abaneminyaka engama-50 nangaphezulu: ukubuyekezwa." Ukuphulukiswa kwezidakamizwa. 2015; 6: 51-60.
I-Guaraldi, G; Zona S, Abafowethu, T .; Stentarelili C, et al. "Ukuguga negciwane lesandulela ngculaza ngokubhekelana nesifo sengculazi ngesikhathi sokuguga: abantu abahlukahlukene abanezinhlaka ezihlukene zokuzibandakanya." PLoS One. April 2015; 10: e0118531.