Imibuzo Ephakanyisiwe Ngemuva kokuthi 'Izifo Ezijwayelekile' Zibikiwe
I-HIV pre-exposure prophylaxis (i-PrEP) iyithuluzi elinamandla lokuvimbela lapho umthamo wansuku zonke weTruvada unganciphisa ingozi yomuntu yokuthola i-HIV ngamaphesenti angu-92. Lokhu kubonakala kuyiqiniso nakakhulu kubantu abathandana nabesilisa (MSM) , ngezifundo zamuva eziphakamisa ukuthi i-PrEP ingaba yindlela ephumelelayo kumadoda angama-gay noma abesilisa nabesifazane abashadile abathatha amaphilisi ambalwa ngeviki.
Njengoba ukwamukelwa komphakathi kwe-PrEP kuyaqhubeka nokukhula, ngakho-ke, kunenkinga yokuthi isu lingase liholele ekusakazeni kabanzi kwamakhondomu njengendlela yokuqala (noma okungenani yendabuko) yokuvimbela i-HIV.
Ingabe leyo yinkinga ngempela? Noma ingabe ukusebenza kwe-PrEP okwanele ukuvumela ucansi olungenalo ikhondomu ngaphansi kwezimo ezithile, izimo ezithile?
Ukuqonda i-PrEP, Amakhondomu nokuziphatha kocansi
Ucwaningo olwengeziwe lokuphenya i-PrEP kanye nokusetshenziswa kwekhondomu kuye kwaqhutshwa emiphakathini ye-MSM, iqembu eliqhubeka liphethe umthwalo omkhulu we-HIV e-US Iningi lalaba lithole ukuthi lobulili obungenalo ikhondomu-noma ikakhulukazi ukusondelana kocansi olungenalo ikhanda - isisusa esiyinhloko sokuthi kungani imibhangqwana nabantu ngabanye bakhetha i-PrEP njengendlela yabo yokuvikela eyinhloko.
Ukwengeza okuqhubekayo yizibalo ezibonisa ukuthi okungenani ingxenye yesithathu ye-MSM ukutheleleka kwenzeka ngaphakathi kobudlelwane obuzinikele. Ngisho nasemibhangqwaneni lapho bobabili abalingani bengenalo i-HIV, izinga eliphezulu lezocansi ezingenalo ikhondomu ngaphakathi nangaphandle kobudlelwane (umbono we-90 namaphesenti angama-34 ngokulandelana) kubheka amazinga aphakeme kakhulu okutheleleka.
Kodwa ngisho nangaphandle kwezinkinga zokusondelana nokuzivikela, ezinye izici zinikeza ngokuyinhloko isinqumo somuntu sokufaka amakhondomu esikhundleni sePrEP (ngokuphambene nokuwasebenzisa ngokulandelana). Lokhu kungabandakanya ukunciphisa ukukhathazeka okuhlobene negciwane lesandulela ngculazi, ukulawulwa okubonakalayo kwezempilo komuntu, noma isifiso esilula sokuba nezingane.
Ngamunye angakwazi ukwazisa umbono womuntu ngokuthi yini noma "ayinayo ingozi eyamukelekayo."
Kodwa ingabe i-PrEP idinga ukugqugquzela ubulili obungenalo ikhondomu, ikakhulukazi emibhangqweni exubile lapho umlingani oyedwa enegciwane lesandulela ngculaza kanti enye ingenayo i-HIV?
Ucwaningo oluningi lubonisa ukuthi alukho. Eqinisweni, kungakhathaliseki ukuthi ngaphakathi kokwakha ubuhlobo noma ngaphandle, ukuziphatha ngokobulili (kufaka phakathi ukuthatha ingozi ngokobulili) akubonwanga ukuthi kuguquke kakhulu kubantu abakhetha ukusebenzisa i-PrEP.
Esikhundleni salokho, i-PrEP yabonakala ukuqinisa ukuziphatha kokunciphisa ingozi kwalabo abazibona bezingozi kakhulu. Lokhu kwakuyiqiniso ikakhulukazi emibhangqweni yokuxuba , okukhona amathuba okusebenzisa amathuluzi amaningi (kuhlanganise namakondomu nokuphathwa kwegciwane lesandulela ngculaza njengokuvimbela ) ukuvimbela ukudlulisela i-HIV kumlingani ongathintekile.
I-PrEP ayizange idalwe ngokulinganayo
Kodwa-ke, ubudala, kubonakala sengathi yiyona nto eyenza i-PrEP ne-sex-condomless babe ne-association ngqo. Ucwaningo olwenziwa ngo-2016 olusuka ku-Adolescent Medicines Trial Network (ATN) lokungenelela kwe-HIV / AIDS lubike ukuthi amaphesenti angama-90 e-MSM aneminyaka engu-18 no-22 kuya ku-22 ubudala ahlanganyela ekuziphatheni ngokocansi ngokungenalo ikhono ngenkathi e-PrEP, nokuthi lesi sigameko sanda kakhulu ukuhambisana nomuntu okwelashwa . (Ukwethembeka kwakufanelekele ukugxila okuphezulu kweTruvada egazini lomuntu.)
Okutholakele kwakubalulekile uma bephakamisa ukuthi i-PrEP ingagcini nje ukunciphisa ingozi yomuntu ebonakalayo yokutheleleka kepha yanda ingozi yocansi, okungenani kubantu abancane. Ngokuphathelene nalokhu, izinga lokunamathela kwezidakamizwa labonakala liyehla ngokushesha kuleli qembu-kusukela emazingeni aphezulu angama-56 ngeviki le-4 kuya kuma-36% kuphela ngeviki 48-ngesikhathi lapho izinga eliphezulu lezifo ezithathelwana ngocansi (amaphesenti angu-22) ahlala engashintshi .
Kungakhathaliseki ukuthi izimo zokuziphatha eziyingozi zingashintsha ngokuhambisana nokunciphisa izinga lokunamathela lihlala lingacacile. Okucacile ukuthi amazinga aphezulu we-syphilis, i-gonorrhea, ne-chlamydia yanezela nje amathuba okugciwane lesandulela ngculaza futhi angase alahle izinzuzo ze-PrEP, ikakhulukazi kubantu abasha abavame ukunamathela ngokwezinga eliphezulu .
Ubulili bunendima ebalulekile ekunqumeni ukusebenza kwe-PrEP, futhi, ngalokhu, kusalokhu kuhlobene negebe ekuqondeni kwethu i-PrEP yabesifazane.
I-PrEP bekuyisikhathi eside ibhekwa njengendlela yokuzivikela kwabesifazane ababeswele amandla ngokocansi. Kodwa-ke, ngokungafani kakhulu nezilingo ze-MSM, ucwaningo lwangaphambili lwaluveze ukuthi izinga lokuhluleka lalingaphezulu kakhulu kwabesifazane ku-PrEP nokuthi ukuhluleka okunjalo kwakubhekwe ngokuyinhloko ekulandiseni okungavumelani.
Kodwa ukunamathela kwezidakamizwa empeleni kwaba kubi kakhulu kwabesifazane kunamadoda? Noma bekukhona yini ezinye izici ezanikele ekuhlulekeni?
Ucwaningo olwenziwa ngo-2014 oluvela eNyuvesi yaseNorth Carolina (UNC) lunikeze ukuqonda, okuphakamisa ukuthi i-PrEP ingahle iphumelele kangako kwabesifazane ngenxa yezingcingo eziphansi zesidakamizwa ezikhungweni zomzimba ezisengozini nezibelethweni zangasese.
Abacwaningi be-UNC bathola ukuthi ukutholakala nokusatshalaliswa kweTruvada ngaphakathi kwala maseli kwehla kakhulu ngaphansi kwezingcubu zangasese nama-rectal; ngakho-ke, eqinisweni, ukuthi ngisho nokunamathela kwansuku zonke kungaphazanyiswa, abesifazane abangama-75% kuphela abakwazi ukufeza izinga elifanayo lokuvikelwa njenge-MSM. Ngokuphambene nalokho, kwaphakanyiswa ukuthi i-PrEP ingakwazi ukukhokhela ukuvikeleka ku-MSM ngamaphilisi amabili noma amathathu ngesonto.
Ukungalingani kusekela ngokuqinile ukusetshenziswa kwe-PrEP njengendlela yokuncoma, esikhundleni sokunye, ithuluzi lokuvimbela i-HIV kubesifazane.
Ukwehluleka Kwe-PrEP Kwabesilisa Abalala Ngabantu
Ngisho phakathi kwe-MSM, inkinga ye-PrEP ne-sexually condomless ihlala ingxabano futhi ngezinye izikhathi idideka. Futhi ngenkathi i-PrEP ingakaze yamukelwa njengecebo lokuma, iningi liyovuma ukuthi ukusetshenziswa kwalo kukhuthazwa kakhulu ngamazinga aphezulu kakade okuya ocansini okungenawo amakhondomu phakathi kwabantu abesilisa nabesifazane abesilisa nabesifazane.
Ngaphezu kwalokho, ubufakazi obuqhubekayo bokusebenza kwe-PrEP ku-MSM, ngisho nalabo abanamacala okungahambisani nawo , kuye kwehlisa ingozi ebhekwayo ngisho nabantu abasengozini enkulu (okungukuthi, labo ababandakanya ubulili beqembu, ukuhlukunyezwa ngokocansi, noma ukujova izidakamizwa ).
Kodwa lezi zindlela zihambelana kangakanani neengozi yangempela?
Lo mbuzo ubekwe ngokucacile ekukhanyeni ngo-2016 lapho kuvela imibiko yokuthi amadoda amabili angama-gay atheleleke nge-HIV naphezu kokuthatha i-Truvada nsuku zonke. Kuzo zombili izimo, imibiko yemidiya iphakamise ukuthi la madoda ayenesifo "esingavamile" ukumelana ne-HIV kokubili i-tenofovir ne-emtricitabine (ama-agent amabili ezidakamizwa aseTruvada).
Ochwepheshe basinciphisa kakhulu izindaba, bethi kwakungekho imbangela ye-alamu nokuthi izinzuzo ze-PrEP zisabala kakhulu imiphumela. Futhi kulokhu, babeyiqiniso.
Okungavamile ukuthi ukufakazela ukuthi loluhlobo lwe-HIV lungabhekwa njengento engavamile, noma ukuthi ukumelana nezidakamizwa eziningi ezikhonjiswe kumadoda amabili kwakungavamile.
Ngokushesha ngo-2016, ucwaningo lwe-epidemiological oluvela kumaCentral of Disease Control and Prevention lwaqeda ukuphikiswa kwe-tenofovir-isidakamizwa esiyinhloko eTruvada-sase sinamaphesenti angama-20% eNyakatho Melika naseYurophu , futhi ingaba ngamaphesenti angu-50 e-Afrika.
Ngenkathi kunedatha encane kakhulu ekuphikeleni kwe-emtricitabine yomhlaba wonke, izifundo eziningi zesilwane ziye zabonisa ukuthi ukumelana ne-tenofovir kuphela kwanele ukudala ukuphumelela kwezifo ngisho nokunamathela nsuku zonke ku-PrEP.
Ngaphezu kwalokho, ukumelana nezidakamizwa eziningi-noma ngisho nokuphikiswa kwezidakamizwa eziningi- akuyona isimo esingajwayelekile esinikezwa ukusakazeka kwegciwane. Futhi uma sidluliselwa komuntu oyedwa kuya kwesinye, kungenzeka ukuthi ukwanda okwanele, okufaka isandla ekukhusheni izidakamizwa ezidluliselwa kubantu abaningi abasanda kutholakala.
Ngakho Lokho Kusitshela Kithina?
Kusukela embonweni wezempilo yomphakathi, umlayezo uhlala ucacile: I-PrEP inconywa njengengxenye yesulo le-HIV elinolwazi, olubandakanya ukusetshenziswa kwamakhondomu nokunciphisa ukuziphatha okuyingozi.
Ngaphezu kwalokho, i-PrEP ayihloselwe bonke abantu kodwa kunalokho labo ababhekwa njengengozi enkulu . Uma isetshenziswe, i-PrEP kufanele ihlale isetshenziswa nsuku zonke, ngaphandle kokuphazanyiswa, futhi ngokuhlolwa okujwayelekile ukuqinisekisa isimo sabasebenzisi nokugwema ukuthuthukiswa kwemiphumela emibi.
Uma sekushiwo ukuthi, izinqumo ezinolwazi azijwayele ukuthi zisekelwe ezihlahlandlela zodwa, futhi lokhu akulona iqiniso nakancane uma kuziwa ngamakhondomu. Uma ucabangela ukuthi ungasebenzisa amakhondomu, zama njalo ukugcina into eyodwa engqondweni: ukuvimbela akuyona indlela emgwaqweni owodwa.
Ukuze uzivikele ngokweqile, udinga ukubhekana nokutheleleka kwakho kuphela ekutheleleni kodwa ukuhlukunyezwa komlingani wakho wezocansi. Uma isimo somlingani wakho singaziwa (futhi awukwazi noma ungazimisele ukuxoxa ngalokhu naye), uyobe usebenza kahle ukuthatha zonke izinyathelo zokugwema ukutheleleka, kuhlanganise nokusetshenziswa kwamakhondomu.
Uma, ngakolunye uhlangothi, umlingani wakho ene-HIV, kubalulekile ukuhlola ukuthi useyiphi indlela yokwelapha futhi, okubaluleke nakakhulu, ngabe ngabe umthamo wegciwane elingenakutholakali uzuziwe .
Izikhulu zezempilo zomphakathi eziningi namuhla zisondela ekumemezeleni ukuthi abantu abanegciwane elingenakulinganiswa "bangenangqondo" yokudlulisela i-HIV (kamuva nje uDemetre Daskalakis, umphathi osizayo ehhovisi laseNew York City Bureau of HIV / AIDS Prevention and Control).
Ngakho-ke, kunengqondo ukusikisela ukuthi ukwelashwa kwe-HIV, lapho kusetshenziselwa ukuhlanganiswa ne-PrEP, kunganikeza ukuvikeleka okuphelele ngokulwa ne-HIV ngokungabikho kwekhondomu-kodwa kuphela uma umsebenzi we-viral uchithekile ngokuphelele futhi uma kuqinisekiswa ukuthi i-PrEP ihambisana nsuku zonke.
Lokho akusho ukuthi kukhona amaphesenti angu-0 amathuba okutheleleka. Ukuqeda ukuvimbela ngokocansi kuphela kungenza isiqiniseko sokuthi, ngisho nokuthi lokho kunamaphutha .
> Imithombo:
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> Ghorayshi, A. "Icala Lesibili Lomuntu On Daily PrEP Ukuthola i-HIV." I- BuzzFeedNews. Ishicilelwe ku-Okthoba 19, 2016.
> Taniguchi, T .; Nuritdinova, D .; I-Grubb, i-J .; et al. "Uhlobo lwe-HIV olulwisana nomuthi oluthile oluqhubekayo luhlala luvame futhi luthinta imiphumela ye-virologic naphezu kokwelashwa kwe-anti-antiretroviral ye-genotype." I-AIDS Research Retroviruses Abantu. Mashi 5, 2012; 28 (3): 259-264.
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