Iqiniso elihlukile kusuka ku-Fallacy
Ukusetshenziswa kokusoka kwabesifazane ngokuzithandela (VMMC) ukunciphisa ingozi yokudlulisela i-HIV emadodeni angqingili kuyinto ephikisana kakhulu. Ngenkathi kukhona ubufakazi obuqinile bokuthi amadoda asokile abesengozini encane yokutheleleka ngegciwane lesandulela ngculaza ngokusebenzisa ukulala ngokobulili kunamadoda angewona abasokile, umkhuba ngokuvamile uvame ukugxekwa kanzima kulabo abangafuni ukusoka noma ukubuza ukufaneleka kocwaningo lokuqala.
Uchungechunge lwezilingo ezilawulwe ngokungahleliwe olwenziwe e-Afrika kusukela ngo-2005 kuya ku-2007 lubonise ukuthi i-VMMC inganciphisa ingozi yokudluliselwa kwamaginini kuya kwepenile noma yikuphi kusuka ku-51% ukuya ku-60%.
Ngokusekelwe ekuqinisekiseni lokhu kuhlolwa, i-World Health Organization (WHO) kanye ne- Joint United Nations Programme nge-HIV / AIDS (UNAIDS) yakhipha izincomo ngo-2007 ethi:
"Ukusoka kwamadoda kufanele kubonakale njengendlela eyengeziwe, ebalulekile yokuvimbela igciwane lesandulela-ngculazi esitholakale ngculaza kubantu ... (kodwa) akufanele nanini lithathe izindlela zokuzivikela nge-HIV."
Ngo-2011, kwenziwa i-VMMC engaphezu kwezigidi ezingu-1.3, ikakhulukazi eMpumalanga naseNingizimu Afrika lapho izinga lokukhula kwabantu abadala lingaba liphezulu ngo-26%. UMongameli Obama uphinde wazinikela ekusekeleni ukusoka kwezigidi ezingu-4.7 ngasekupheleni kuka-2013.
Ukusoka njengokuvimbela: Umgwaqo oyedwa?
Ehlangothini le-flip le nkinga, ucwaningi oluningi olufanayo lubonisa ukuthi ukusoka kwabesilisa akunikezi inzuzo efanayo yokuzivikela kumlingani wesifazane ongathintekile ebuhlotsheni be-serodiscordant .
Kunezimbangela eziningana zezimbangela zalokhu okungahambi kahle-kubandakanya ukuhlukunyezwa kwezinto eziphilayo ezivela kubesifazane futhi, kwezinye izimo, ukuqala kwesandulela ngculaza ngaphambi kokuba isilonda sokusoka siphulukiswe ngokuphelele.
Ayikho ubufakazi bokuthi ukusoka kuyonciphisa ingozi yokutheleleka emadodeni abesilisa nabesilisa (MSM) , lapho umzila oyinhloko wokutheleleka ubulili obufanayo .
Kungakhathaliseki ukuthi ukusoka kunganikeza inzuzo yokuvikelwa emadodeni abamba ubulili obudala nomlingani wesifazane ahlala engavumelani.
Ukuphikisana okuqhubekayo ukuthi ukusoka akubonakali kuthinta amazinga okudlulisela i-HIV emazweni athuthukile njengoba enza emazweni ajwayelekile, aphezulu kakhulu njengama-sub-Saharan Africa.
Ngenxa yobukhulu bobufakazi, i-WHO / i-UNAIDS yakha indlela yokuhlela ngokusho:
"Umthelela omkhulu kakhulu wempilo yomphakathi uzoba ezindaweni lapho i-HIV ikhona khona (ukukhulelwa kwegciwane lesandulela ngculaza kubantu abaningi lidlula u-15%), isakazeka kakhulu ngenxa yokudluliswa kobulili obuhlukile, futhi lapho kunabantu abakhulu (isib. Abangaphezu kuka-80%) abasokile . "
Ngo-2011, i-UNAIDS ibike ukuthi izinga lokukhula kwabantu abadala e-Afrika engaphansi kweSahara laliphakathi kuka-10% (eMalawi) kanye no-26% (eSwaziland). Ngokuqhathaniswa, izinga lokukhula kwabantu abadala labantu base-US lizungeze u-0.6%.
Ukulinganisa Ubufakazi
Phakathi kuka-1989 no-2005, izifundo eziningi zokubheka e-Afrika zaphawula ubuhlobo obuphakathi kwephesenti lamadoda asokile abasengozini enkulu kanye nezinga eliphansi le-HIV. Ngenkathi eminye yemiphumela yayicindezela-kuhlanganise nesifundo esikhulu seqembu e-Uganda esabonisa ukuthi izifo zokutheleleka zazingamaphesenti angama-42% kwabesilisa abasokile-kwakukhona izifundo eziningi kakhulu eziphikisana nemiphumela noma ukubuza umbuzo umbhali.
Ngo-2005, ukubuyekezwa okuhlelekile kwezifundo ezingama-35 zokuhlola kwenziwa ukuqinisekiswa kobudlelwane phakathi kwamazinga okusoka okwandisiwe nokunciphisa izinga lokudlulisela abesifazane. Noma kunjalo, ubufakazi babhekwa njengenganele ukuvumela ukusetshenziswa kokusoka njengethuluzi lokuvimbela abantu.
Kusukela ngo-2005 kuya ku-2007, uchungechunge lwezilingo ezilawulwe ngokungahleliwe ezenziwa emazweni amathathu ase-Afrika ekugcineni zanikeza ubufakazi obuningi bokusekela lo mkhuba.
- E- Kenya , amadoda angu-2 784 aphakathi kweminyaka engu-18 no-24 abhalwa isifundo esiholwa yi-University of Illinois. Icala laqedwa ngaphambi kwesikhathi lapho ukusoka kuboniswa ukuba kube nokuphumelela kwama-53% ekuvimbeleni ukudluliselwa kwe-HIV.
- ENingizimu Afrika , amadoda angu-3 273 aphakathi kuka-16 no-24 abhaliswa ekulingweni ekhokhelwa yi-Agence Nationale de Recherche sur la SIDA (ANRS). Icala laqedwa ngemuva kwezinyanga ezingu-17 ngemuva kwemiphumela yesikhashana yabonisa ukutheleleka okumbalwa kwama-60% eqenjini elisokile.
- E- Uganda , amadoda angama-4 996 aphakathi kuka-15 no-49 abhalwa ukuhlolwa okwenziwa yi-John Hopkins Bloomberg School of Health Public. Icala liphinde laqedwa ngaphambi kwesikhathi ngemuva kokubonisa ukusebenza kahle kwama-51%.
Nakuba ukuhlaziywa kwe-meta kuye kwasekelwa ngokuyinhloko ekutholeni ukushayisana kwezifo zase-Afrika, abanye baye babuza ukuthi ngabe izinselele zokuqalisa-kuhlanganise nokunciphisa ukusetshenziswa kwekhondomu nokuziphatha okuvimbela ukuziphatha-akufanele ziqondiswe ngokugcwele.
Izindlela Ezingenzeka Eziphilayo Zokudluliswa Kwehlisa
Ucwaningo oluthile eminyakeni yamuva lucacise ukuthi ibhethrikhi biome ngaphansi kwejwabu kungase kube imbangela yengozi yokudluliselwa kwabasilisa abangasokile. Ukucwaninga kubonisa ukuthi inqwaba yebhaktheriya ingaba ne- Langerhans amangqamuzana ebusweni besikhumba ibe "ngabaculi" ekuzivikelweni kwawo.
Ngokujwayelekile, amangqamuzana e-Langerhans asebenza ngokubamba nokuthutha ama-microbe ahlaselayo kumaseli omzimba omzimba (kuhlanganise namaseli e-CD4 ), lapho ahlonishwa khona nge-neutralization. Kodwa-ke, lapho umthwalo webhaktheriya ukwanda, njengoba kwenzeka ngaphansi kwejwabu, impendulo yokuvuvukala ikhona futhi amangqamuzana e-Langerhans awela ngempela amangqamuzana ngezinambuzane ezimbi kunokuba nje abonise.
Ngokusoka ipeni, amabhaktheriya anaerobic ngaphansi kwejwabu akakwazi ukukhula, ngaleyo ndlela ukunciphisa impendulo yokuvuvukala. Ucwaningo oluqhubekayo lungabangela ekuthuthukiseni ama- microbicidal agents noma amanye amasu angewona okuhlinzekwa ukunciphisa umphumela.
Ukusebenza kohlelo e-Afrika
Ukulinganisa ngezibalo ze-WHO, i-UNAIDS kanye neSouth African Centre for Epidemiological Modeling and Analysis (SACEMA) kusikisela ukuthi, esimweni esiphakeme sokusabalala ngokobulili ngokobulili obuyindlela yokudlulisela phambili, ukutheleleka okusha okusha kuzokhunjulwa kuwo wonke amadoda ayisihlanu abasokwa . Ngokwemfundiso, uma amadoda angama-90% esokwa ngaphakathi kwalaba bantu, kungaba nokuncipha kokuhlanganiswa kwezifo zesifazane ezingaba ngu-35% kuya ku-40% (ngenxa yamazinga aphansi okutheleleka emphakathini).
Ukuhlaziywa kwezindleko-ukubonisa ukuthi, ngokuvimbela lezi zifo, umthwalo wemikhakha yezinhlelo zokunakekelwa kwezempilo inganciphisa kakhulu. Ucwaningo olulodwa lwesifundazwe saseGauteng eNingizimu Afrika-lapho izinga lokutheleleka lingaphezu kwama-15%-kuboniswe ukuthi izindleko zokusoka kwamadoda angu-1 000 (cishe ama-$ 50,000) zingakhipha imali engaphezu kuka-3.5 million emithonjeni ye-antiretroviral kuphela, ngaphandle kokukhuluma ngokuqondile izindleko zezokwelapha kanye / noma zokuvakasha.
Noma kunjalo, abanye baye baphikisa ukuthi izibalo zithemba ngokweqile, kanti isifundo esisodwa (esiphikisana kakhulu) sisho ukuthi ukuqaliswa kwezinhlelo zamahhala ezikhishwa ngamahhala kungaphezu kwama-95 okubiza kakhulu kunokusoka ekuvimbeleni ukutheleleka nge-HIV.
Ngo-2013, i-WHO yavuma ukusetshenziswa kwe-Prepex, isiyaluyalu sokuqala sokusokwa kwabantu besilisa. I-ring elastic flexible ifuna ukungasebenzi kwamanzi futhi ifakwe ngqo kwejwabu, ngaleyo ndlela inqume ukunikezwa kwegazi. Cishe ngesonto, izicubu zezinhlanzi ezifile zingasuswa ngaphandle kwesilonda esivulekile noma iziqu. Lolu buchwepheshe obusha luthemba ukwandisa inani le-VMMC ngo-27 million ngo-2020.
Ingabe ukusoka njengokuvimbela kunamandla e-US?
Kusukela kumbono womphakathi wezempilo, kubalulekile ukuthi uqaphele ukuthi akukho mhlaba wonke owake wakhuthaza ukusoka kwabantu besilisa njengendlela yokuvimbela i-HIV. Ngokusobala, kukhona ukungafani okuyinhloko emadenjini e-Afrika okuthuthukisiwe, ikakhulukazi njengoba ukutheleleka okusha kuka-60% e-US kuphakathi kwe-MSM.
Ukwengeza, umthelela omubi kubantu besifazane-osuvele usengozini ngenxa yezinto eziphilayo kanye nezenhlalo-kubonakala sengathi ukhululekile kunoma yikuphi ukuzuzisa okungenzeka ukuqaliswa okukhulu, ngisho nasemiphakathini engozini lapho izinga lokukhula kwesandulela ngculazi liphakeme. Abanye baze bakholelwe ukuthi imilayezo ehlosiwe ephathelene nokusoka ingaba nomthelela omubi kakhulu emiphakathini lapho ukuhlukumezeka kusebenza kakade futhi ukusetshenziswa kwekhondomu kuyawela ngaphansi kwe-50%.
Noma kunjalo, ucwaningo oluningi lubonise ukuthi ukusoka kokubeletha kunganciphisa ingozi yesilisa yase-US yokuphila ngegciwane lesandulela-ngculaza ngokuthola u-20%. Ngo-2012, i-American Academy of Pediatrics yakhipha isitatimende senqubomgomo esisha esikhombisa ukuthi "izinzuzo zezempilo zokusoka kwabesilisa abasanda kuzalwa zidlula izingozi nokuthi izinzuzo zenqubo zivumela ukufinyelela kule nqubo imindeni eyikhethayo." Phakathi kwezinzuzo ezibalwe kuzo kwakuvimbela ukutheleleka kwamagciwane , umdlavuza we-penile , nokudluliselwa kwezifo ezithile ezithathelwana ngocansi , kubandakanya i- HIV .
Odokotela abaningi kanye neziphathimandla zempilo bathatha isimo esingenabulungiswa ngokuqondene nokusoka kwabantu besilisa abadala, ngokucindezela ukuthi kunciphisa kunokuba kuqede ingozi yokudluliselwa kwegciwane lesandulela ngculazi nge-vaginal-penile. Okwamanje azikho izincomo e-US zokusebenzisa ukusoka kwabesilisa ngokuzithandela ukunciphisa ingozi yokudlulisela kubantu.
Imithombo:
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