Ngenkathi iphansi, izifundo zibonisa ukuthi ingozi ayikwazi ukuqedwa ngokuphelele
Ucwaningo lwezokwelapha luye lwabonisa ukuthi ukwelashwa ngezidambisigciwane (ART) kunganciphisa kakhulu ingozi yokutheleleka ngegciwane lesandulela ngculazi endaweni exutshwe (serodiscordant) imibhangqwana-lapho umlingani oyedwa enesandulela ngculazi kanti enye ingenayo i-HIV.
Amasu afaka ukunciphisa ukutheleleka komlingani ogciwane lesandulela ngculazi ngokuqinisekisa umthamo wegciwane elingenakulinganiswa (ngokuvamile obizwa ngokuthi ukwelashwa njengokuvimbela, noma i-TasP ), kanye nokusebenzisa nsuku zonke iphilisi le-antiretroviral ukunciphisa ukutholakala kwe-HIV kumlingani ongathintekile (eyaziwa ngokuthi pre-exposure prophylaxis, noma i-PrEP ).
Okunye okucatshangwayo okubalulekile kukhona amathuluzi okuvimbela ama-ART, njengamakhondomu nokusoka kwabantu ngokuzithandela (okuyaziwa ukunciphisa ingozi ye-HIV kumadoda angenalo igciwane). Ngesikhathi ucwaningo lwangaphambi kwesikhathi lubonise ukuthi izinzuzo ze-ART zingaba ngcono emibhangqwaneni yokuxuba-nge-TasP ukunciphisa ingozi ye-HIV ngamaphesenti angama-96 kanye ne-PrEP ekunciphiseni ingozi ngamaphesenti angama-75-abanye baye babuza ukuthi lezi zibalo zizohlala zingene ukulungiselelwa kwezwe langempela.
I-Sexual Condomless and HIV Risk
Ngenkomfa ka-2014 nge-Retroviruses kanye nezifo ezithathelwanayo (CROI) eBoston, abacwaningi ocwaningweni oluqhubekayo lwe-PARTNER babonise ukuthi, phakathi kwamabhangqwana angu-767 axhumene-nhlobo asebenzisa i-TasP yodwa, akukho ukutheleleka okukodwa okwenzekile naphezu kwezinyathelo ezingaphezu kuka-44,000 zocansi ezingenalo ikhondomu. Lolu cwaningo lwafaka imibhangqwana emibili yocansi kanye nabesilisa abathandana nabesilisa abathandana nabesifazane abashisa ukuthi bangama-37 kuya ku-43 izenzo zesondo ezingenalo ikhondomu ngonyaka.
Kodwa-ke, ngisho nokuvunyelwa kwabacwaningi, izibalo ziyinkimbinkimbi. Ngokusekelwe eziningana zezici eziguquguqukayo-kuhlanganise nezinhlobo zesenzo socansi nokuthi ngabe ukukhishwa kwe-ejaculation kwenzeka noma cha-isikhathi sokuzethemba (esetshenziselwa ukulinganisa ukuqinisekiswa kwezilinganiso) simile ngamaphesenti angu-96.
Lokhu kuhumusha ingozi engamaphesenti angu-4 okutheleleka-hhayi amaphesenti angu-0 abanye abangase bacabange. Kulabo abahlanganyela ocansini lesandulela ngculazi, ingozi yokucatshangelwa yenyuka yaba ngamaphesenti ayishumi. Ucwaningo olulandelayo luye lwafakaza ngokungathí sina ukuthi amathuluzi okuvimbela kahle anganciphisa kanjani ingozi yokutheleleka esikhathini eside.
Izinguquko Emkhakheni Ophakathi KwamaHeterosexual and Gay Couples
Esicwaningweni esenziwa yi- US Centers for Disease Control and Prevention (CDC) , ososayensi bahlaziya idatha yamanje mayelana nokusebenza kwe-TasP, PrEP, namakhondomu kumabhangqwana abesilisa nabesifazane abesilisa nabesifazane abesilisa nabesifazane. Inhloso yalolu cwaningo kwakungeke libikezele ingozi yokudluliselwa kwangempela esimweni "sezwe langempela", kodwa ukukhombisa ukuthi ingozi iqoqwa kanjani ngokuhamba kwesikhathi-okungukuthi, emva kwesikhathi esisodwa nonyaka-10.
Ngokusekelwe enombeni yezizathu ezingase ziphazamise, amathuba okutheleleka phakathi kwabantu abathandanayo-isimo abasebenzisa i-ART kuphela kulinganiselwa ukuthi abe amaphesenti amabili kubantu abesilisa nabesifazane kanye namaphesenti angu-25 emibhangqwana yama-gay. Okutholakele kwakusekelwe ezinkampanini eziningi zokuhlola, kuhlanganise:
- Ukunciphisa amaphesenti angu-80 engozini yokusebenzisa ikhondomu
- Ukuncishiswa kwamaphesenti angamaphesenti angu-96 lapho abalingani abanegciwane lesandulela ngculaza bekhona kwi-ART / TasP
- Ukuncishiswa kwamaphesenti angu-73 engozini yabalingani abangabathandani abangabathandana nabo ku-PrEP
- Ukuncishiswa kwamaphesenti angu-44 engozini yabalingani abangathandana nabangqingili ku-PrEP
- Ukuncishiswa kwamaphesenti angu-54 engozini yomlingani wesilisa ongasenqatshiwe osokwa
- Ukuncishiswa kwamaphesenti angu-73 engozini yomlingani wesilisa ongasenalutho, ongasokile ofaka ingane ("phezulu") ngesikhathi socansi
- Isilinganiso sezenzo eziyisithupha zokuziphatha ngocansi ngenyanga
Kubalulekile ukuphawula ukuthi ukuhluka kwamanani phakathi kwabantu abathandanayo nabesilisa nabesilisa abathandana nabangqingili akugcini nje kuphela emathubeni amaningi okutheleleka ngesandulela ngculazi , kepha kucwaningo lwamanje olubonisa amazinga aphansi we-PrEP phakathi kwabesifazane abashadile. Abacwaningi bayavuma ukuthi ukutholakala okukhulu kwe-PrEP kanye / noma ukuthuthukiswa okunamandla okunamathela kungadlulisa lezi zilinganiso.
Ukwengeza, izifundo eziningi zakamuva ziphakamisa ukuthi ukusetshenziswa kwe-PrEP okwesikhashana ku-MSM kungase kube nenzuzo efanayo yokuvikela njengokusetshenziswa kwe-PrEP nsuku zonke. Uma imiphumela enjalo ingaqinisekiswa, njengabaningi abalindele, umthelela ekusebenzeni kwe-PrEP kumabhangqwana we-MSM uzokhuliswa kakhulu.
Izimbangela Zengozi Yesikhathi Esifishane Nesikhathi Eside
Abaphenyi baqhubeka babonisa ukuthi imibhangqwana esebenzisa indlela eyodwa yokuvimbela yayinengozi enkulu yokutheleleka, kokubili esikhathini esifushane neside. Phakathi kokuthola kwabo:
- Imibhangqwana yamaGayida eyayithembele kuphela kumakhondomu yayinengozi engamaphesenti angu-13 e-HIV ngonyaka owodwa kanye nengozi engamaphesenti angama-76 engcupheni eminyakeni engaphezu kwengu-10, ngokusekelwe kwedatha yokusetshenziswa okuhambisanayo. Ngokuphambene nalokho, abesilisa abesilisa nabesifazane abathandana nabo baboniswa ukuthi banamaphesenti angu-1 namaphesenti angu-11 engozini, ngokulandelana.
- Imibhangqwana yamaGayida eyayithembele kuphela ku-TasP yayinengozi engamaphesenti angu-3 ngaphezu konyaka owodwa kanye nengozi engamaphesenti angama-25 eminyakeni engaphezu kwengu-10. Ngokuqhathanisa, imibhangqwana engabesilisa nabesifazane yayingenani elingamaphesenti angu-0.2 futhi ingozi yezingu-2, ngokulandelana.
- Emibhangqwana yama-gay ehlanganisa i-TasP, i-PrEP, nokusoka, amakhondomu asetshenzisiwe njalo, futhi engenzi lutho ngobulili obunamathele kumlingani ongathintekile, ingozi ye-HIV ihlelwe kumaphesenti angu-0.1 ngaphezu konyaka owodwa namaphesenti angu-1 ngaphezulu kweminyaka eyishumi.
- Ngokufanayo, amaconsi abonakala emibhangqwaneni engqingili ehlangene eyayihlanganisa i-TasP, i-PrEP, ukusoka, nokusetshenziswa kokukhondomu okuqhubekayo . Kwabesilisa, ingozi ngaphezu konyaka owodwa yayingu-0.1% namaphesenti angu-10 eminyakeni engaphezu kweyishumi. Ingozi phakathi kwabesifazane yayingaphansi kwamaphesenti angu-0.05 no-0.5%, ngokulandelana.
Le miphumela yaxhaswa, ngokwengxenye, ngokuhlaziywa kuka-2014 yi-Sorbonne Université eParis, okuhlaziye idatha kusuka ezifundweni eziyisithupha ezihlukene ekusetshenzisweni kwe-TasP phakathi kwezimo ezixubile zomshado ezihlukene. Imibhangqwana ehlanganisiwe kulolu cwaningo yenza ubulili obuphakathi kwama-kathathu no-12 ngenyanga, ne-80% yokusebenzisa ikhondomu esebenzayo.
Abaphenyi baphetha ngokuthi idatha etholakalayo ayisekeli ukusikisela ukuthi i-ART inganciphisa ingozi ye-HIV kuze kube yilapho. Kunalokho, ukuhlaziywa kwabo kubonisa ukuthi, ngenkathi ingozi yokutheleleka iphansi kakhulu phakathi neminyaka emibili yokuqala, leyo ngozi ingakhuphuka ibe ngamaphesenti angu-1 emva kwezinyanga ezingu-18. Ucwaningo aluzange luhlole ukusebenza kwesikhathi eside kwe-ART emibhangqwaneni yama-gay serodiscordant.
> Imithombo:
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> Rodger, A: Bruun, T .; I-Cambiano, i-V .; et al. "Ingozi yokudlulisela i-HIV ngezocansi ezingenalo ikhondomu uma i-HIV + engumlingani kwi-ART ecasulayo: isifundo se-PARTNER." I-21th Conference mayelana nama-retrovirus kanye nezifo ezithinta amathuba (CROI); IBoston, eMassachusetts; NgoMashi 3-6, 2014; abstract 153LB.
> Lasry, A; Isihlengo, S .; Wolitski, R .; et al. "Ingozi yokudlulisela ucansi nge-HIV phakathi kwemibhangqwana ye-serodiscordant: ukuhlola imiphumela yokuhlanganisa amasu okuvimbela." AIDS . Juni 14, 2014; 28 (10): 1521-1529.
> Supervie, V .; U-Viard, J; I-Costagliola, D .; et al. "Isandulela ngculaza ngesandulela ngculaza ngesenzo socansi ngasinye ngaphansi kokutheleleka okudambisene ne-antiretroviral: ukubuyekezwa okuhlelekile kanye ne-Bayesian modeling". Izifo Ezithathelwanayo Emitholampilo. Ngo-Ephreli 19, 2014; 223 [i-Epub ngaphambi kokuphrinta].
> Molina, J; Fonsart, C .; Susa, B; et al. "Kufunwa i-PrEP nge-oral TDF-FTC ku-MSM: Imiphumela ye-ANRS I-Ipergay Trial." Ingqungquthela ka-2015 kwi-Retroviruses kanye nezifo ezivame ukubhekana nazo (CROI); NgoJulayi 24, 2015; Seattle, Washington; abstract 23LB