Abenzi benqubomgomo bacela ukuphela kwalesi sifo ngo-2030
I- United Nations Joint Program on HIV / AIDS (UNAIDS) yamemezela izinhloso ezintsha, ezihloswe ekuqedeni ubhubhane lwe-AIDS emhlabeni wonke ngonyaka ka-2014. Lesi sinyathelo, esaziwa ngokuthi isisombululo sika 90-90-90, sichaza izindlela zokufeza ezintathu zokuqala imigomo ngonyaka ka-2020:
- Ukuthola amaphesenti angama-90 abantu abaphila negciwane lesandulela ngculaza ngokusebenzisa ukuhlolwa okwandisiwe.
- Ukubeka abantu abangamaphesenti angama-90 abantu abahlonziwe ngokutheleleka nge- antiretroviral .
- Ukuqinisekisa ukuthi amaphesenti angama-90 alabo abakwelashwa bayakwazi ukufeza imithwalo engenakulinganiswa yegciwane lesandulela ngculaza ekhombisa impumelelo yokwelapha.
Kuyaziwa ukuthi ngokufeza lelizinga lokucindezelwa kwegciwane, abantu abanesandulela ngculazi basencane kakhulu ukudlulisela igciwane kwabanye. Ngokwenza kanjalo emhlabeni jikelele, izikhulu ze-UNAIDS zikholelwa ngokuqinile ukuthi lesi sifo singakwazi ukuphela ngempumelelo ngo-2030.
Kodwa ingabe kulula ngempela konke lokho?
Ngisho nabalandeli abaqine kakhulu beqhinga bavuma ukuthi izinhloso ezinjalo azikaze zitholwe emlandweni wempilo yomphakathi. Ngomoya ofanayo, nokho, iningi lizovuma ukuthi ngaphandle kokwanda okunamandla kwezinhlelo ze-HIV ezikhona zakwazwelonke, leli thuba lithuba lokufakazela ukuthi leyo nkinga yomhlaba wonke ingahle ilahleke.
Kwakuyiqiniso lokugcina ukuthi kwaholela ekuqinisekiseni isu lo 90-90-90 isu eMhlanganweni WeZizwe Eziphakeme EzinguNgqungquthela Wokuqeda Ingculaza, owabanjelwa eNew York City ngoJuni 2016.
Sikuphi Namuhla
Ngokusho kombiko we-UNAIDS ka-2016, kuyilapho kuye kwaba nokuzuzisa okumangalisayo okwenziwe eminyakeni eholela ekuvunyweni kuka-2016, ukuqhubeka akuzange kube yinto efanayo.
Ohlangothini oluhlangene, kubalwa abantu abayizigidi ezingu-17 abaye bathola ukwelashwa nge-HIV ngo-2015, cishe kabili inombolo ephathwayo ngo-2011.
Sekuphelele, cishe amaphesenti angama-57 alabo abaphila negciwane lesandulela ngculazi bayazi isimo sabo, umkhuba osibeka kahle endleleni yethu yokufinyelela ekuhlosweni kokuhlolwa kwamaphesenti angu-90 ngo-2020.
Ohlangothini oluphansi, abangaphansi kwesigamu salabo abahlolwe abane-HIV (amaphesenti angu-46) okwamanje bathola ukwelashwa, kuyilapho amaphesenti angu-38 kuphela ekwazi ukufeza imithwalo engavamile engavamile (ikakhulukazi ngenxa yezikhalazo zokwelashwa nokunakekelwa okungahambisani). Ngaphandle kokuzibophezela kanye nokuntuleka kokuzibophezela kwabanikela ekuvimbeleni ukwandiswa kwezinhlelo zomhlaba wonke, ikhono lokuthuthukisa kulezi zibalo lingase lihlehliswe ngokuphawulekayo.
Ngisho nase-US, izibalo zezwe ziwela ngaphansi kwezingqikithi ezibekwa yi-UN , nama-Centers for the Disease Control and Prevention reporting, okuyizigidi ezingu-1.2 zabantu baseMelika abaphila negciwane lesandulela ngculaza, amaphesenti angu-86 atholakale ukuthi, amaphesenti angu-36 asekwelapha, futhi amaphesenti angu-30 kuphela agodliwe.
(Lezo zibalo zaphikisana ngo-2016 nguMnyango WezeMpilo Nengqondo YaseNew York, okusho ukuthi kwabangu-819,200 baseMelika abaphila negciwane lesandulela ngculazi, amaphesenti angu-86 atholakale ukuthi, amaphesenti angu-68 ayethola ukwelashwa, kanti amaphesenti angu-55 ayengacindezelwa.)
Kusukela kumbono womhlaba wonke, umbiko we-UNAIDS uqokomise izindawo zombili ezikhanyayo nezindawo zokukhathazeka ekufezeni imigomo engu 90-90-90:
- Ngokuphelele, i-Europe YaseMpumalanga, iYurophu YaseYurophu neNyakatho Melika iyahamba kahle kakhulu, kanti amaphesenti angu-86 abantu abane-HIV abonakale kahle, amaphesenti angu-56 ekwelapheni, kanti amaphesenti angu-47 azuze umthamo wegciwane elingenakulinganiswa.
- E-Afrika eseningizimu ye-Sahara, isifunda esiphezulu kwamaphesenti angama-67 azo zonke izifo ezithathelwanayo emhlabeni wonke, intuthuko iye yahlaba umxhwele emazweni amaningi amazwe ahlukumezekile, neBotswana, Rwanda, Malawi, Swaziland, Kenya, neLesotho kahle endleleni eya ekufinyeleleni izinhloso zokusheshisa.
- Ngokufanayo, i-Asia, iThailand neCambodia inhle kakhulu ngaphambi kwezinhloso zazo ezingu-2020, kuyilapho i-China ibike kakade ukuthi kunamaphesenti angama-91 okunciphisa ukwanda kwamagciwane phakathi kwabantu abathintekayo.
- Ngokuphathelene nokulethwa kwezidakamizwa, iLatin America neCaribbean kuthiwa kunezibalo eziphezulu kakhulu (amaphesenti angu-55), neBrazil ebika ngaphezu kwamaphesenti angama-80 esandulela ngculaza kuye kwabonakala futhi amaphesenti angaphezu kuka-85 aphethwe yi-viral.
- Ngokuphambene nalokho, kwezinye izingxenye zaseLatin America-naseMpumalanga Yurophu, eNtshonalanga Afrika, e-Eastern Africa nase-Central Africa-amazinga aphezulu okuhlolwa kwe-HIV awazange akhiphe amazinga aphakeme kakhulu yokwelapha noma ukucindezelwa kwegciwane. Ukufinyeleleka ekunakekeleni nasekunikezeni izinketho zezinketho kuyaqhubeka nokuphazamisa intuthuko kulezi zifunda.
- Ukubhebhetheka nakakhulu kuyi-Eastern Europe, eRussia, nase-Asia Ephakathi, lapho ukujova ukusetshenziswa kwezidakamizwa kuqhubeka nokushayela izinga lokutheleleka . Isibambiso sokunakekelwa ngaphakathi kwalezi zifunda (kufaka phakathi ukuhlukumezeka kwabantu nokuhlukunyezwa ) kuye kwaholela ekunyuseni okukhulu emkhakheni wokutheleleka wonyaka.
Izindleko zokushaya amaphrojekthi angu 90-90-90
Ngokusho kwezikhulu ze-UNAIDS, ukuze kufinyelelwe imigomo engama-90-90-90, ukuxhaswa kwamazwe ngamazwe kuzodingeka ukwandise ku-$ 19.3 billion ngonyaka ka-2017. Ngemuva kwalokhu kuphakanyisiwe, izindleko zonyaka zizokwehla zizungeze u-R18 billion ngonyaka ka-2020, ngenxa enkulu ukuguqulwa okuhloswe kumanani okutheleleka.
Uma imigomo yezinhlelo kufanele ifinyelelwe, izinzuzo zingase zibe ezinkulu, njengoba kuboniswa isifundo se-2016 esivela eHarvard University Centre ye-AIDS Research. Ngokombiko, ukusetjenziswa kweqhinga eNingizimu Afrika -lizwe elinomthwalo omkhulu we-HIV-kungabangela ukutheleleka okungaba ngu-73 000 kanye nokufa kwabantu abayizigidi ezi-1.2 ngaphezu kweminyaka emihlanu, begodu nokutheleleka kwezigidi ezi-2 kanye nokufa kwabantu abayizigidi ezimbili ngaphezu kweminyaka eyi-10.
Ngenkathi izindleko zokuqaliswa kwezimali zithinteka nge $ 159 billion ezidakayo eNingizimu Afrika kuphela, izindleko zokusebenza kahle kwepulani (ngokubhekwa kwezibhedlela ezimbalwa, ukufa kanye nezintandane zomama) zazibhekwa njengezizathu eziphezulu zokukhokha.
Nakuba izinhloso zezimali ezifana nalezi zingase zibonakale zingenangqondo, zinikezwa izinzuzo zesikhathi eside ezifundweni zezempilo zikazwelonke, iqiniso elilula ukuthi iminikelo yomhlaba iqhubeke nokuncipha ngonyaka ngonyaka. Kusukela ngo-2014 kuya ku-2015 kuphela, iminikelo yomhlaba yawela ngaphezu kwama-dollar ayizigidi eziyizinkulungwane, kusukela ku-$ 8.62 billion ukuya ku-$ 7.53 billon.
Ngisho ne-US, ohlala eyingxenye enkulu kunazo zonke emkhankasweni we-HIV womhlaba wonke, iminikelo ngaphansi kokubusa kuka-Obama iye yahamba ngokungafani kusukela ngo-2011. Iningi lezindleko zibonisa ukuthi lo mkhuba uzoqhubeka, iningi leCongress libiza "ukuhlela kabusha" izimali kunokuba ukwanda kwonke imali esebenzisa i-AIDS.
Ngokudabukisayo, ukuze kufinyelelwe imigomo engama-90-90-90, umnikelo wase-US uzodinga ukwandisa okungenani u-$ 2 billion phakathi nenkathi yamanje.
Njengamanje okwamanje, i-US ivumile ukufanisa idola elilodwa kuwo wonke amaqembu anikezwe ngamanye amazwe, kodwa kuphela ekufakeni kanzima kwe $ 4.3 billion (noma ingxenye yesithathu yomgomo we- Global Fund sika $ 13 billion). Lokhu kuhumusha ekunciphiseni ukushayela kusuka ezinyangeni eziyizigidi eziyizigidi zamaRandi ayizigidi eziyizinkulungwane ezingu-5, kanti kuphela ukukhuphuka kwamaphesenti angu-7 kusuka kumnikelo owedlule we-$ 4 billion we-US.
Ngokuphambene nalokho, amazwe amaningi anezinkinga ezijulile zezomnotho azinzile izibopho zawo, ne-European Commission, Canada, ne-Italy ngamunye efaka isibambiso ngamaphesenti angu-20, kuyilapho iJalimane selikhuphuke ngokwabo ngamaphesenti angu-33. Ngisho neKenya, i-GDP ngayinye eyi-1/50 ye-US, ihambise izigidi ezingu-5 ezigodini zezinhlelo ze-HIV ngaphandle kwemingcele yawo kazwelonke.
Kodwa ngisho nangaphandle kwempikiswano yama-dollar namasenti, umthelela we-90-90-90 isu uzofaka ukungenelela kwezinhlelo eziningi zempilo kazwelonke ezingenayo indlela yokwamukela imali noma ingqalasizinda noma izindlela zokuhlinzekela ukuhlinzeka ngokucophelela ukunakekelwa. Imithi yokukhishwa kwemithi isivele isenzeka njalo ezindaweni eziningi zase-Afrika, kuyilapho ukwehluleka ukugcina iziguli ekunakekeleni kuguqula noma yikuphi ukuzuza okwenziwe ngokubeka abantu empilweni yokuqala.
Ngaphandle kwemali eyengeziwe yokubhekana nalezi zithiyo nezinye izakhiwo, izikhulu ze-UNAIDS zixwayisa izindleko zokuhluleka zingaba ziphezulu-okubangelwa ukutheleleka okusha kwezigidi ezingu-17.6 ngo-2020 kanye nokufa kwezigidi ezingu-10.8.
Singayiphatha Kanjani Indlela Yethu Esiqhingini?
Ngenkathi inqubekela phambili ephawulekayo iye ekunqandeni isifo segciwane lesandulela ngculaza emhlabeni wonke, abaphenyi eLondon School of Hygiene and Tropical Medicine basikisela ukuthi izinhloso ezingu 90-90-90 zinethuba elincane lokuqeda le nkinga ngo-2030. Basho ukuthi amasu asekelwe ubufakazi bokuthi ukwandisa ukwelashwa kungadlulisa amazinga okutheleleka ngokunciphisa okuthiwa "umthamo wendiza emphakathini" -iqhinga elaziwa ngokuvame njengeCravenment as Prevention (noma TasP ).
Ngokusho kocwaningo, kusekhona izikhala ezinzima kuleli qhinga. Kusukela kumbono womlando, ukwehla okukhulu kwezigciwane lesandulela ngculazi kwenzeka phakathi kuka-1997 no-2005, iminyaka eyabhalwa yizehlakalo ezintathu ezinkulu:
- Ukwethulwa kwemithi yokwelapha enamandla kakhulu, eyaziwa ngaleso sikhathi njenge- HAART (noma ukwelashwa okudambisa imishanguzo) .
- Ukufika kwezidambisigciwane ezijwayelekile, okwenza izidakamizwa zithengeleke emazweni asathuthuka.
- Ukwethulwa kwezidakamizwa ze-HIV eziphumelelayo kangcono, njenge- tenofovir , kanye nokulula, iphilisi elilodwa lokuhlanganisa imithi.
Kodwa-ke, kusukela ngaleso sikhathi, kuye kwaba khona ukwehlisa okuncane kuphela izinga lokutheleleka emhlabeni jikelele. Eqinisweni, kumazwe angu-195 afakiwe kulolu cwaningo, ukwanda okwenziwe ngonyaka ka-102 kusukela ngo-2005 kuya ku-2015. Phakathi kwalawo, iNingizimu Afrika ibike ukwanda kwezifo ezintsha ezingaphezu kuka-100 000 kusukela ngo-2014 kuya ku-2015, okwandisa izifo eziyizigidi ezingu-1.8 e-Afrika kanye nezigidi ezingu-2.6 kubikwe emhlabeni wonke ngonyaka.
Phakathi naleso sikhathi, ukusabalala kwegciwane lesandulela ngculaza (okungukuthi, inani labantu abaphila lesi sifo) liye lakhula ngokwesilinganiso samaphesenti angu-0,8 ngonyaka ngonyaka ka-2000, kuya ku-38.8 million ngonyaka ka-2015.
Futhi ngenkathi izinga lokushona liye lahla kusukela ku-1.8 million abantu abafa ngo-2005 kuya ku-1.2 ngo-2015, izifo ezihambisana ne-HIV ziye zanda ngokuphawulekayo emazweni amaningi. Isifo sesifo sofuba (i-TB) siyiqiniso, kubalwa cishe amaphesenti angu-20 okufa phakathi kwabantu abaphila negciwane lesandulela ngculazi (ikakhulu emazweni asathuthuka). Kodwa naphezu kokuthi amazinga okutheleleka nge-HIV aphakama kubantu abane-TB, i-HIV ivame ukushiywa njengesizathu sokufa (noma ngisho nesibangela sokufa) kumanani kazwelonke.
Abacwaningi baphinde baqaphele ukuthi ukukhula kwamazinga okutheleleka okuhambisana nokuphila okude isikhathi eside (umphumela wendlela yokwelashwa eyandisiwe) kuzodinga ohulumeni ukuba baphathe abantu abanda ukwanda abane-HIV. Futhi ngaphandle kwezinsiza zokugcina ukwedluliswa kwamagciwane ngaphakathi kwalabo bantu-hhayi nje iminyaka embalwa kuphela, kodwa impilo yonke-konke kungenzeka ukuthi izifo zokutheleleka zizovuselela, mhlawumbe ngokuphawulekayo.
Ngenkathi kukhona ubufakazi obunamandla bokuthi i-TasP ingakwazi ukuguqula amazinga e-HIV kubantu abaningi, abacwaningi bathi ngeke sithembele ekwelapheni yedwa ukuqeda lesi sifo. Esikhundleni salokho bacebisa izinguquko ezinkulu ngendlela izinhlelo ezibili zikhokhelwa ngayo futhi zithunyelwa. Lokhu kuhlanganisa ukwanda kwezimali ezifuywayo, okuvumela ukugeleza kwamahhala ngisho nezidakamizwa ezishibhile ze-HIV, nokutshala imali ekuthuthukiseni izinhlelo zikazwelonke zokulethwa kwezempilo.
Kuzophinde kudingeke ukuthi kube nokungenelela okunempumelelo okuvimbela, kufaka phakathi utshalomali ohlelweni lokunciphisa umonakalo lokujova abasebenzisi bezidakamizwa, ukusetshenziswa kweqhinga le-HIV pre-exposure prophylaxis (PrEP) kubantu abafanelekile, kanye nokuqiniswa kwezinhlelo zekhondomu ngesikhathi lapho ukusetshenziswa phakathi osemncane usuke ehamba phambili.
Ngaphandle kwalezi zinguquko ezisisekelo, abacwaningi bathi, isu elingaba ngu 90-90-90 lingaba nethonya elikhulu ekutheni izinga lokufa liphinde lifinyelele ekufinyeleleni ukuguqulwa okuqhubekayo kwezifo ze-HIV.
> Imithombo:
> Carter, M. "Ukuphela kwesifo sengculaza ngo-2030 okuyizinto ezikude: izifo ze-HIV emhlabeni wonke, izibalo zokwelapha kanye nokufa kwabantu kubonisa." I- NAM AIDSMap . Agasti 2016.
> I-GBD 2015 Abahlanganyeli be-HIV. "Ukulinganisa izigameko zomhlaba jikelele, zesifunda, nezesizwe, ukusabalalisa nokufa kwe-HIV, 1980-2015: i-Global Burden of Disease Study 2015." I-Lancet. Agasti 2016; 3 (8): e361-e387.
> UJamieson, D. noKellerman, S. "I-90 90 90 ibhekisela ekuqedeni i-HIV Pandemic ngo-2030: Ingabe ukuthengiswa kungayiphatha?" Journal of the International AIDS Society. 2016; 19 (1): 20917.
> Uhlelo lweZizwe Ezihlangene mayelana neHIV / AIDS (UNAIDS). "Izinzuzo zomhlaba wonke zenzelwe amaphesenti angu 90-90-90." I-Geneva, eSwitzerland; NgoJulayi 18, 2016.
> Wallensky, R .; I-Borre, E .; I-Bekker, L .; et al. "Imiphumela Yomtholampilo Yezomtholampilo Nezomnotho ka-90-90-90 eNingizimu Afrika." Ama- Annal of Medicine Internal. September 6, 2016; 165 (5): 325-333.