Usulelo lwamadoda amabini kwipilisi yokukhusela ekukhuseleni inkxalabo
Kwaye kwabikwa ngokubanzi ngoFebhuwari 25, 2016 ukuba indoda ethatha inkunkuma ye-HIV, iTruvada , inesifo sengculaza nangona ihambelana ngokupheleleyo ne-regimen ye-day-day. Iindaba zaphakamisa iingxakini ezinzulu phakathi kwezinye malunga nendlela esebenzayo isicwangciso-esaziwa ngokuba yi-HIV ngaphambi kokutshatyalaliswa kweprophylaxis (i- PrEP ) -yinyani ukuqinisekisa ukuba abantu abangenayo i-HIV bahlala bengakhuselekanga.
Kwingxelo yabo, uphando nge-Maple Leaf Medical Clinic (i-MLMC) eCanada yaqinisekisa ukuba umntu oneminyaka engama-43 ubudala ongama-gay wayevavanywe kakuhle kwi-HIV ngexesha le-PrEP, kwaye ukuhlaziywa kwamaxwebhu eefomathi kunye nezilingo zonyango zonyango ( esetyenziselwa ukulinganisa ukuxilongwa kweziyobisi egazini) ubungqina obuhlawulwe kwizinga eliphezulu lokuthobela.
Uvavanyo oluqhubekayo lokuzaliswa kwemfuza ekugqibeleni lwabonisa ukuba le ndoda yayifumene "inqabile" yokuguquka kwintsholongwane kaGawulayo , eyayinganyangekiyo kwiijenja zombini ezibandakanya iTruvada.
Ngoko umbuzo uhleli: ngaba le ngxaki "njengengqabile" njengokuba abanye beendaba baye babika? Okanye ingaba isiganeko, ngokwenene, sichaza i-chink ebonakalayo kwiinqwelo zezixhobo zokukhusela i-HIV?
I-Real-World Efficiency ye-PrEP
Ininzi imibutho ye-HIV namhlanje iya kukucebisa ukuba i-PrEP, xa ithatyathwe ngokufanelekileyo ngendlela yeTruvada tablet, inganciphisa umngcipheko womntu wokufumana i-HIV ngamaphesenti angama-90 okanye ngaphezulu.
Baya kunika isilumkiso kubasebenzisi, ngokukodwa abo basemngciphekweni omkhulu , ukuba isilwanyana akufanele sisetyenziswe ngaphandle kodwa njengenxalenye yenkqubo yokukhusela i-HIV (kubandakanywa neikhondom, ukunciphisa inani lamalingani ezocansi, njl.
Kodwa isigidimi sisoloko sichaza uluntu ngendlela ehluke kakhulu, kunye neendaba zentlalo kunye neentengiso zeendaba ngokuphindaphindiweyo-ukucoca okanye ukubeka ubungqina obunjalo.
Namhlanje akuqhelekanga ukuva ukuba i-PrEP "i-99 ekhulwini ephumelelayo" ekukhuseleni i-HIV, okanye ukujonga uphando olwenziwe ukuze luchaze ukuba i-PrEP "eyi-100 yeepesenti ephumelelayo" phakathi kwabantu abasengozini yokugonywa ngamadoda angasebenzisi iikhondom .
Nangona kuyiyo inyaniso ukuba ezinye izifundo phakathi kwabantu abasetyhini abasengozini yokuxhatshazwa kwabasetyhini baye babika ukuba akukho tshintsho phakathi kwabo babambelele ngokupheleleyo kunyango, ezi ziphumo aziguquleli kwiimeko zehlabathi zangempela, apho abaninzi abadibanisa banokunciphisa kakhulu ukusebenza kwe-PrEP kumgangatho ngamnye.
Zininzi zalezi zidibaniso ezibeka isiganeko saseCanada ngokukhanya ngakumbi.
Izinto ezichaphazela ukuphumelela kwe-PrEP
Kuphando lwabo, abaphandi be-MLMC bacebise ukuba indoda yaseKhanada isuleleke ngumlingane we-HIV ogqirhayo lwakhe lwe-antiretroviral. Emva kokuvavanyelwa kwemizimba, intsholongwane yabonakwethu iboniswe ukuba ayixhatshazi kwi-tenofovir kunye ne-emtricitabine (icandelo leziyobisi zaseTruvada), ngokukhawuleza ukukhupha inzuzo yokukhusela i-PrEP.
Nangona ezinye iipundits ziye zatsho ukuba lolu hlobo lokumelana nokusetyenziswa kweziyobisi ezinqabileyo-ludlulele-ngaphantsi kwepesenti enye-uphando oluthile lubonisa umfanekiso ohlukileyo. Ngokomzekelo, siyazi ukuba ukunyamezwa kwe-tenofovir okwangoku kuqhutyelwa kuyo nayiphi na iipesenti ezingama-20 (eYurophu) ukuya kuma-57 ekhulwini (e-Afrika) phakathi kwezigulane ezithotyelwayo, ngokwemibiko ye-2016 evela kwi-TenoRes Study Group.
Kwiimeko ezinjengeli, nangona iqela le-emtricitabine lihlala likwazi ukusebenza, ukukwazi ukukhusela intsholongwane kuhlala, ngokusemgangathweni, kuncinci. Le mibuzo yedwa nje ukuba iimeko zokusuleleka kwimeko yaseCanada zazingekho "ezinqabileyo," ngeli gxi ninisa imingeni ejongene noluntu apho amazinga okukhuselwa kwe-tenofovir aphezulu.
Okwangoku, amanye ama-confounders angakwazi ukuphazamisa ukusebenza kwe-PrEP. Oyintloko phakathi kwabo:
- Ukungaphumeleli ukufezekisa nokugcina amanqanaba afanelekileyo eTruvada kwigazi. Nangona i- dosing engahambelani ngokuqhelekileyo ibangelwa yile meko, kwaziwa kwakhona ukuba izigulane eziqala i-PrEP zifuna ukuba zonyango malunga neentsuku ezingama-20 ukuya kwe-30 ngaphambi kokuba izidakamizwa ziqwalaselwe ngempumelelo. Xa amazinga okuchithwa kwezidakamizwa aphunyeziweyo, amaxabiso angaphantsi kwamanye amaxesha angabikho kombandela-ubuncinci kumadoda angama-gay.
- Ukungalingani ekusebenzeni kwe-PrEP ngamadoda angama-gay kunye nabasetyhini abasetyhini. Kukho ubungqina bokuba u- PrEP angeke asebenze ngokufanelekileyo kubasetyhini kwaye nokuba kunye nokuthotyelwa okupheleleyo, okungaphazamisekiyo, inzuzo yokukhusela ingawa phantsi ngaphantsi kweepesenti ezingama-90 ezibonakala kumadoda angama-gay.
Ngobonke babo, ezi zinto zibonisa izinto ezimbini: ukuba ukusebenza kwe-PrEP kwezinye iindawo kuya kuba ngaphantsi kunabanye, kwaye ukuba imfuno yekhondom kunye namanye amanyathelo okukhusela ahlala efanelekileyo njengakuqala.
I-PrEP kunye nabalingani bezoXhabano zoLuntu
Xa kuthethwa oko, ukuphumelela kwe-PrEP ayibonakali iyancitshiswa yimiba emininzi yengozi echaphazelekayo. Nangona ukusetyenziswa kwekhondom engahambelani kunye namaqabane amaninzi eentlobano zesini, ngokomzekelo, bayaziwa ukuba bandise i-HIV, abanako ukunciphisa ukuphumelela kwe-PrEP kubantu abasengozini.
Enyanisweni, phakathi kwamadoda angama-gay abonakala bephakathi kwinqanaba eliphezulu lomngcipheko, ukusetyenziswa kwe-PrEP kusekunxulumene nokuqikelelwa kwe- 86% ekhuselekileyo inzuzo kubantu abangabasebenzisi i-PrEP. Inzuzo ibonakala nje ukwandisa kulabo abasebenzisa iikhondom rhoqo, abasebenzisa iikhondom rhoqo, kwaye ngubani owanciphisa inani labo labelana ngesondo (ngakumbi iimeko ezingaziwa okanye isimo sengonyango).
Xa kuthethwa oko, i-PrEP ayinakucingelwa nje ngokuba "magic bullet" ngokuthe ngandlela-thile ilahla inzuzo yezinye iindlela zokukhusela, ezifana neikhondom. NgoFebruwari 2017, umntu wesithathu wavavanywa ngexesha elihle kwi-PrEP. Nangona kunjalo, abaphandi bakholelwa ukuba ukuhanjiswa kwezinto kwenzeka enkulu kwinxalenye enkulu "yenani eliphakamileyo" labalingani bezesondo.
Indoda eneminyaka engama-50 ubudala yaseDutch yayithatha inxaxheba kwisifundo se-PrEP yaseYurophu kwaye yabika amaqabane angaphezu kwama-90 kunye neentlobo ezingaphezulu kwe-100 zesini esingafanelanga ukuziphatha ngesondo ngexesha leviki ezili-12. Ngoxa wayesePrEP, le ndoda yayifumaneka kabili ukuba i-gonorrhea ye-rectal kwaye ibe kanye ne-chlamydia emacaleni.
Nangona ubukhulu becala belo khoko bekhokele ekubeni bakholelwe ukuba le yenzeke isiganeko esisodwa, abanye abaqinisekanga. Xa bevavanya intsholongwane yaloo mntu, bafumanisa ukuba akukho ntshintsho ye-HIV engatshintshiyo nayiphi na uhlobo kwaye le ntsho longwane yakhe ithathwa njengento ebizwa ngokuthi "uhlobo olusendle."
Oko kuthetha ukuthini, ukuba unikezwe irekhodi lakhe lokumamathela, iziyobisi kufuneka zibonelele ngokukhusela ngaphandle kokuba ezinye iimeko zenzeke usulelo. Ukuba kunjalo, le miba engaziwayo ingafaka abanye engozini. Kuze abaphandi bazi ngakumbi, iindlela zokuziphatha zesondo ezikhuselekileyo mazifanele zilandelwe ukuba kuphela ukubonelela ulondolozo olongezelelweyo.
Imithombo:
> Hoornenborg, E. no de Bree, J. "Ukunyanga okuthe ngqo nge-Wild-Type HIV-1 Virus kwi-PrEP Umsebenzisi ngezinga eliphezulu zeTDF." INgqungquthela yeeRevrovirus kunye nezifo ezithintekayo; Seattle, Washington; NgoFebruwari 13-16, 2017; 953.
> Molina, J .; Capitenti, C; Ngendawo, B .; okqhubekayo. "On-Demand Preexposure Prophylaxis kwiMadoda kwiNgcipheko ephezulu ye-HIV-1 Infection." I-New England Journal of Medicine. Disemba 1, 2015; papashwe kwi-intanethi ngaphambi kokuprinta; INGXELO: 10.1056 / NEJMoa1506373.
> I-POZ Magazine. "I-PrEP ihluleka kumntu we-Gay Unamathela kwiTruvada yemihla ngemihla, Unyanzela i-HIV-resistant drug". NgoFebruwari 25, 2016.
> Iqela leSifundo seTenoRes. "I-epidemiology yehlabathi jikelele yokuchasana neziyobisi emva kokungaphumeleli kwe-WHO iphakanyise iirimimeni zokuqala zentsholongwane kaGawulayo-1: isifundo seqela eliphindaphindiweyo." Izifo ezithathelwanayo zeLancet. NgoJanuwari 28, 2016; papashwe kwi-Intanethi; INGXELO: 10.1016 / S1473-3099 (15) 00536-8.
> IKomiti yeCandelo eliLawulayo le-UK PROUD. "UKUHLAWULWA kwexesha eliqhelekileyo ukuhlalutya kwe-prophylaxis (PrEP) kukukhusela kakhulu kwi-HIV kubantu besilisa kunye namanye amadoda alala nabantu base-UK." ELondon, eNgilani; ukukhutshwa kweenkcukacha ezikhutshwa ngo-Oktobha 16, 2014.