Ukunciphisa Ingozi Emibhangqwaneni Yomuntu Oya ocansini nobulili obufanayo
Ingozi ye-HIV ngokusebenzisa ubulili obungakavikelekile kubonakala sengathi iphakeme kakhulu, izikhathi ezingaphezu kwezikhathi ezingu-18 kunezocansi. Izizathu zengozi eyanda kakhulu ziyaziwa futhi zihlanganisa izinto ezifana nalezi:
- I-fragility yama-tissue e-rectal, okwenza igciwane libe nokufinyelela okuqondile egazini ngezinyembezi ezincane noma abrasions.
- Ukukhathazeka kwama-tissue ama-rectal kanye nokuphakama kwawo okungaqondakali ekuthelelekeni ngisho nalapho kungakahleleki.
- Ukugxila okuphezulu kwegciwane lesandulela-ngculaza ku-semen kanye no-fluid pre-cum ("pre-cum"), okungaba kabili ingozi yokutheleleka nge-log-eyodwa (okungukuthi, idijithi eyodwa) ukunyuka komthamo womuntu.
Ngaphezu kwalokho, ukuvinjelwa kwegazi emathisini angama-rectal okonakaliswe kungandisa ingozi yomlingani ("phezulu") obangelwayo, okwenza igciwane libe yindlela yokudlulisela nge-urethra nezicubu ezibeka ikhanda lepenisi (ikakhulukazi ngaphansi kwejwabu).
Ukuhlola ingozi ye-HIV "Per-Act" ne "Per Partner"
Ekubuyekezeni kwabo ngezifundo eziyi-16 eziphakeme kakhulu, abacwaningi be-Imperial College kanye neLondon School of Hygiene and Tropical Medicine baphetha ngokuthi isenzo sobungozi besandulela ngculazi ngesandulela ngculazi sasingaba ngu-1.4% ukulalela (" phansi ") umlingani.
Ngenkathi izinga lezinhlekelele lingabonakali lihluka ngokuzibandakanya ngokocansi, kungakhathaliseki ukuthi abantu abesilisa ocansini noma abesilisa ocansini namadoda (MSM) , ubungozi babonakala banda kakhulu uma umlingani obengenayo engasokile (amaphesenti angu-0.62 angasokile nongu-0.11 wamaphesenti asokile) .
Ngokuqhathanisa, ingozi yomlingani ngamunye- lapho umuntu onesandulela ngculaza ebudlelwaneni obukhethekile nomlingani ongenawo igciwane lesandulela ngculazi-upende isithombe esicacile nakakhulu sabalingani abamukelayo nabangenayo.
Izifundo eziyishumi zabuyekezwa zaqhutshwa kuphela phakathi kwe-MSM futhi azihlangananga ubude bobudlelwano noma imvamisa yezocansi ezingekho ngaphansi kocansi.
Ukuhlaziywa kwedatha kwakwazi ukuphakamisa ukuthi:
- abalingani abahlanganyela kokubili ngokobulili obudala bokungenayo kanye nokufaka ngaphandle kwekhondomu babenengozi yokufingqa ngamaphesenti angu-39.9.
- umlingani ongenayo i-HIV owabandakanyeka kuphela ngokobulili obudala obungenayo ngaphandle kwekhondomu enesifo sokufingqa ngamaphesenti angu-21.7, kanti umlingani obamukelekayo we-HIV wayenengozi yokufinyelela cishe ngamaphesenti angu-40.4.
(Nakuba imiphumela yokuhlaziya i-meta iphoqelela, kubalulekile ukuqaphela ukuthi amamodeli ahlukene wezifundo ezibuyekezwayo ashiya indawo ethile yokuhumusha.)
Izindlela Zokunciphisa Ingozi Yegciwane lesandulela ngculaza kusuka e-Sex Anal
Njenganoma iyiphi enye indlela yokudlulisela i-HIV , ukuvimbela kudinga inhlanganisela yamasu okuphumelela ngokwengeziwe:
- Nciphise ukutheleleka komlingani we-HIV.
- Nciphise ukutholakala komlingani ongenazo i-HIV.
- Vimbela igciwane lesandulela ngculaza ukuthi lihlangane namaseli namascuba asengozini.
Ukusetshenziswa kwe- antiretroviral therapy (i-ART) kumlingani ogciwane lesandulela ngculaza kuyaziwa ngokunciphisa kakhulu ingozi yokudluliselwa lapho umsebenzi wegciwane ephikisiwe ngokugcwele futhi njalo njalo ezingeni elingabonakali. Isu, esaziwa ngokuthi i- Treatment as Prevention (TasP) , siboniswe ukunciphisa ingozi ye-HIV ngamaphesenti angama-96 ngaphakathi kokwakhiwa kobudlelwane obuhle (isimo se-serodiscordant).
Okwamanje, ukusetshenziswa kwe- pre-exposure prophylaxis (i-PrEP) -ngakho umlingani ongathintekile unqunywe umthamo wansuku zonke we-HIV umuthi we- Truvada- owaziwa ukunciphisa ubungozi phakathi kwamaphesenti angu-44 no-75%.
Ukusetshenziswa okunamandla nokufanele kwamakhondomu kubonakala kubalulekile ekuvimbeleni ukutheleleka nge-HIV, ne-US Centers for Disease Control and Prevention ukubika ukuthi ukusetshenziswa kwamakhondomu okuqhubekayo kungavimbela ukuthunyelwa komuntu okuyisishiyagalombili kwabayishumi. (Lo mbiko wabuye waphetha ngokuthi kuphela i-MSM eyodwa-yesithupha ibike ukusetshenziswa kwekhondomu okuqhubekayo.)
Idatha ikakhulukazi isekela ukusetshenziswa okuhlangene kwe-TasP, PrEP, namakhondomu njengendlela ephumelela kakhulu yokunciphisa ingozi ye-HIV, kokubili abalingani bobulili obuhlukile kanye nabakwa-MSM bahlanganyela ebulili obuyindlala.
Ngokuphambene nalokho, ubulili obungaphansi kancondomanje abukakunconywa, noma ngabe kokubili i-TasP ne-PrEP isetshenzisiwe, njengoba kungenzeka ukuthi kungenzeka ukuthi ingozi yesikhathi eside emibhangqwana ethile yezinga elixubile.
Ukuvezwa Kwengozi kanye Nezocansi Zobulili
Uma ukholelwa ukuthi kungenzeka ukuthi utholakale ne-HIV, noma ngekhondomu ye-condomless anal, kukhona imithi enganciphisa kakhulu ingozi yokutheleleka okuthiwa i-post-exposure prophylaxis (i-PEP).
I-PEP inezinsuku ezingama-28 zemithi elwa nezidambisigciwane, okufanele zithathwe ngokuphelele futhi zingaphazanyiswa. Ukuze unciphise ingozi yokutheleleka, i-PEP kumele iqaliswe ngokushesha ngangokunokwenzeka - kungakapheli amahora angu-36 okuvezwa .
Imithombo:
I-Baggaley, i-R .; I-White, R .; kanye noBoily, C. "Ingozi yokudlulisela i-HIV ngokusebenzisa izindlela zangasese e: ukubuyekezwa okuhlelekile, ukuhlaziywa kwe-meta kanye nemiphumela yokuvimbela i-HIV." I-International Journal ye-Epidemiology . Agasti 2010; 39 (4): 1048-1063.
Cohen, M .; I-Chen, i-Y .; UMcCauley, uM .; et al. "Ukuvimbela ukutheleleka nge-HIV-1 nge-antiretroviral yokuqala yokwelapha." I-New England Journal of Medicine. Agasti 11, 2011; 365 (6): 493-505.
Grant, R .; Lama, J .; U-Anderson, uP .; et al. "I-Preexposure Chemoprophylaxis Yokuvimbela I-HIV Emadodeni Alala Ngamadoda." I-New England Journal of Medicine. Disemba 30, 2010; 363 (27): 2587-2599.
I-Baeten, i-J .; Donnell, D .; Ndase, P .; et al. "I-Antiretroviral Prophylaxis Yokuvimbela I-HIV Emadodeni Nabesifazane Abesilisa Nabesifazane." I-New England Journal of Medicine. Ngo-Agasti 2, 2012; 367 (5): 399-410.
I-Supervie, i-V .; U-Viard, J; I-Costagliola, D .; et al. "Ingozi yesandulela ngculaza ngesandulela ngculazi ngesenzo socansi ngaphansi kokuhlanganiswa okulwa nama-antiretroviral y: ukubuyekezwa okuhlelekile nokuhlelwa kwe-Bayesian." Izifo Ezithathelwanayo Emitholampilo. Ngo-Ephreli 19, 2014; i-pii: ciu223 [i-Epub ngaphambi kokuphrinta].