Imibuzo Ephakanyisiwe Emva 'Izifo' Ezichaziweyo
I-HIV ephambi kwe-prophylaxis (PrEP) isisityebi esinamandla sokuthintela i-dose yemihla ngemihla yeTruvada inokunciphisa umngcipheko womntu wokufumana i-HIV ngama-92 ekhulwini. Oku kubonakala kunyanisekileyo kubantu abalala ngesondo kunye nabesilisa (MSM) , ngezifundo zakutshanje ezibonisa ukuba i-PrEP inokuba yindlela esebenzayo kumadoda angama-gay okanye amadoda angamaqabane athatha iipilisi ezimbalwa ngeveki.
Njengoko ukwamukelwa koluntu kwe-PrEP kuyaqhubeka kukhula, ngokunjalo, ukuxhalabisa ukuba isicwangciso sinokubangela ukushiya iikhondom ngokubanzi njengendlela yokuqala (okanye ubuncinane) yokhuselo lwe-HIV.
Ingaba loo nto ingxaki? Okanye ngaba iPEPP isebenze ngokwaneleyo ukuvumela ukulala ngesondo ngokungenalo ikhondom phantsi kweemeko ezithile?
Ukuqonda i-PrEP, iCondom kunye nokuziphatha koTyala
Uninzi lwezifundo zophando lwe-PrEP kunye nokusetyenziswa kwekhondom zenzeke kwiindawo ze-MSM, iqela lalo liqhubeka lithwala umthwalo omkhulu we-HIV eMelika. Uninzi lwaba bafumene ukuba le zesondo ezingenalo ikhondom-okanye ngokuthe ngqo ukutshatyalaliswa kobulili obungenalo ikhondom- Isizathu esibalulekileyo sokuba kutheni abantu kunye nabanye abantu bakhethe i-PrEP njengendlela yabo yokukhusela.
Ukunyusa ukunyusa oku ngakumbi kubonisa ukuba ubuncinane kwisithathu sesifo se-MSM senzeke phakathi kobudlelwane obuzimeleyo. Kwezibini ezithandanayo apho amaqabane omabini angenayo i-HIV, amazinga aphezulu asemakhondweni angamakhondomu angaphakathi kunye nangaphandle kobudlelwane (ingqiqo engama-90 kunye neepesenti ezingama-34, ngokulandelanayo) kubangelwa amazinga aphezulu aphezulu.
Kodwa nangaphandle kwemibandela yobudlelwane obusondeleyo kunye nokuzikhusela, ezinye izinto zigalela kakhulu kwisigqibo somntu sokutshintsha iikhondom kunye ne-PrEP (ngokuchasene nokuwasebenzisa kwinqanaba). Ezi ziquka ukunciphisa uxhalaba oluhlobene ne-HIV, ukulawulwa okubonakalayo kwimpilo yesondo, okanye umnqweno olula wokuba nabantwana.
Ngamnye unokwazisa umntu malunga nento okanye "ingozi eyamkelekileyo."
Kodwa ngaba i-PrEP ikhuthaza ukulala ngesondo, ikakhulukazi kwiibini ezixubene nomtshato apho elinye iqabane linentsholongwane kaGawulayo kwaye enye ingenayo i-HIV?
Uninzi uphando lubonisa ukuba alusebenzi. Enyanisweni, nokuba ngaba ngaphakathi kokwakhiwa kobudlelwane okanye ngaphandle, ukuziphatha ngokwesini (kuquka ukuthatha ingozi yesondo) akubonwanga ukuba utshintshe kakhulu kubantu abakhethiweyo ukusebenzisa iPrEP.
Kunoko, i-PrEP ibonakala ibonisa ukunyusa ukunyuswa kweengozi kulabo bazibona bebungozi obuphezulu. Oku kwakuyinyani ngokukhethekileyo kwizibini ezixubileyo , abanokuthi basebenzise izixhobo ezininzi (kubandakanywa neikhondom kunye nonyango lwe-HIV njengokhuseleko ) ukukhusela ukudlulisela i-HIV kumlingane ongatshatanga.
I-PrEP ayizange ifakwe ngokulinganayo
Ubudala, nangona kunjalo, kubonakala ngathi yinto enye apho i-PrEP kunye nesondo elingenalo ikhondom sinxulumano oluhambelanayo. Ucwaningo olwenziwa ngo-2016 oluvela kwi-Adolescent Trials Network (ATN) lweNgcaciso ye-HIV / AIDS yabika ukuba i-90% ye-MSM eneminyaka engama-18 ukuya kweye-22 ukuya kwi-sexual anal sex while i-PrEP, kwaye ukuba iziganeko zandise ukwanda komntu othe wonyango . (Ukuxhaswa kwakufaneleke ukuxhomekeka okuphezulu kweTruvada kwigazi lomntu.)
Iziphumo zazibalulekileyo njengoko zicetyiswa ukuba i-PrEP ingagcini nje ukunciphisa umngcipheko wokubona intsholongwane kodwa ukwandiswa kwengozi yokuthatha isondo, ubuncinci kubantu abancinci. Okubaluleke kakhulu, izinga lokunamathela kwezidakamizwa lalibonakala lihla ngokukhawuleza kweli qela-ukusuka kuma-56 ekhulwini kwiVeki ye-4 ukuya kuma-36 eepesenti ngeveki yama-48 ngeli xesha apho izinga eliphezulu lokusuleleka ngesondo (iipesenti ezingama-22) lingatshintshi .
Kungakhathaliseki ukuba iziganeko zobungozi ziya kutshintshwa ngokuhambelanayo nokunciphisa amazinga okunamathela akuhlali kakuhle. Yintoni ecacileyo kukuba amazinga aphezulu e-syphilis, i-gonorrhea, kunye ne-chlamydia yongeza kwimeko yokuba i-HIV kwaye inokuthi ilahle iindleko ze-PrEP, ngokukodwa kubantu abaselula abanamazinga amaninzi okubambelela .
Ubulili bendima indima ebalulekileyo ekuqaliseni ukusebenza kwe-PrEP, kwaye, malunga noku, kukho i-gap malunga nokuqonda kwethu kwe-PrEP kubasetyhini.
I-PrEP yayisetyenziswe ixesha elide njengendlela yokuzikhusela kwabasetyhini ababenciphekile ngesondo. Nangona kunjalo, ngokungafani nakwiimvavanyo ze-MSM, uphando lwangaphambili luye lwabonisa ukuba amazinga okuhluleka aphezulu kakhulu kwabesetyhini kwi-PrEP kwaye ukuba ukungaphumeleli okunjalo kubangelwa ukulandelelana okungahambisani.
Kodwa ngaba ukunyanzelisa iziyobisi kunokuba kubi kakhulu kwabesetyhini kunamadoda? Okanye ngaba kukho ezinye izinto ezabangela ukuba zenzeke?
Ucwaningo olwenziwa ngo-2014 oluvela kwiYunivesithi yaseNorth Carolina (UNC) linike ingqiqo, luchaza ukuba i-PrEP inokuthi ingabasebenzi kangangoko kwabasetyhini ngenxa yemigangatho ephantsi yeziyobisi ezikhuselekeni zentsholongwane yomzimba kunye nesisu.
Abaphandi ba-UNC bafumanisa ukuba ukuchithwa nokusabalaliswa kweTruvada ngaphakathi kwala maseli kwawa phantsi kwee-tisses zangama-anal and rectal; kakhulu, ngokokuba, nangona kungenakathandabuzwa ngokubambelela kwansuku zonke, kuphela i-75% yabasetyhini bakwazi ukuphumeza inqanaba elifanayo lokukhuselwa njenge-MSM. Ngokwahlukileyo, kwacetyiswa ukuba iPrEP inokukwazi ukukhusela kwi-MSM kunye nembalwa njengeepilisi ezintathu ngeveki.
Ukungalingani kusekela ngokugqithiseleyo ukusetyenziswa kwe-PrEP njengesiqhelo, ngaphandle kwesinye isixhobo, ukukhusela i-HIV kwabasetyhini.
Ukuphulwa kwe-PrEP kubantu abalala ngesondo nabantu
Ngaphandle kwe-MSM, umcimbi we-PrEP kunye nesondo elingenalo ikhondom uhlala unengxabano kwaye ngamanye amaxesha uphazamisa. Nangona i-PrEP ingakaze ivunywe njengeqhinga lokuzimelela, ininzi iyavuma ukuba ukusetyenziswa kwayo kukhuthazwa kakhulu ngamazinga aphezulu asemakhondomeni kunye nabasetyhini.
Ukongezelela koko, ubungqina obuninzi bokusebenza kwe-PrEP kwi-MSM, kwaphakathi kwalabo abangenakuhambelaniswa , behlise umngcipheko obenziwayo nakubantu abasengozini enkulu (oko kukuthi, abo bathatha isondo ngokwesini, ukulala ngesondo okanye ukusetyenziswa kweziyobisi ).
Kodwa ke le ngcamango ihambelana njani nengozi?
Umbuzo wabekwa ngokucacileyo ekugqibeleni ngo-2016 xa kuthe kwavela iingxelo ukuba amadoda angama-gay anesifo sengculaza nangona ethatha iTruvada imihla ngemihla. Kwimeko zombini, iingxelo zeendaba ziphakanyisile ukuba amadoda athelelekileyo "inqabileyo" ye-HIV engaxhatshazwayo kokubili kwi-tenofovir kunye ne-emtricitabine (ii-agent zepilisi ezimbini eziseTruvada).
Iingcali zancinci kakhulu iindaba, ziqinisekisa ukuba akukho nto ebangela ukuba i-alarm ibe neenzuzo zePrEP isasaza kakhulu imiphumo. Kwaye kulo mbandela, bachanekile.
Okungaphantsi kokuqinisekileyo ukuba lolu hlobo lokuxhatshazwa yi-HIV lungaqwalaselwa "lunqabile," okanye ukuba ukuchasana kwamachiza amaninzi okuchazwe kumabini omabili kwakungekho into eqhelekileyo.
Ngoku kutshanje ngo-2016, uphando lwe-epidemiological ukusuka kumaziko okuLawula nokuLawulwa kweMilwelwe lugqityile ukuxhatshazwa kwe-tenofovir-isilwanyana esisisiseko kwiTruvada-sele sele sine- 20% eNtshona Melika naseYurophu , kwaye ingaba ngama-50 ekhulwini e-Afrika.
Nangona kukho idatha encinane kwi-emtricitabine yokumelana nokuzimela, ininzi yezifundo zezilwanyana ziye zabonisa ukuba ukumelana ne-tenofovir ngokwaneleyo kubangela ukuba uphumelele kwiintsholongwane kunye nokunamathela kwansuku zonke kwi-PrEP.
Ukongezelela koko, ukunganyangeki kwamachiza-okanye ukuxhatshazwa kweziyobisi ezininzi- akuyona imeko engavamile yokusasazwa kwegciwane. Kwaye xa kudlulayo ukusuka komnye umntu ukuya kwinye, ukunyuka kwenyuka kuphela, kubangele ukunyuka kokuxhatshazwa kwezidakamizwa ezidlulileyo kubonwa kubantu abaninzi abasanda kusulelwa.
Ngoko Yintoni Eyasitsho Kona?
Ukususela kwimibono yempilo yoluntu, umyalezo uhlala ucacile: I-PrEP icetyiswa njengenxalenye yesicwangciso se-HIV esaziwayo, esibandakanya ukusetyenziswa kwamakhondom kunye nokunciphisa ukuziphatha kokubeka ingozi.
Ngaphezulu, i-PrEP ayijoliswe kubo bonke abantu kodwa kunoko abo bacinga ukuba basengozini enkulu . Xa zisetyenziswe, i-PrEP imele ilandwe rhoqo imihla ngemihla, ngaphandle kokuphazanyiswa, kunye nokuvavanywa rhoqo ukuqinisekisa imeko yabasebenzisi kunye nokuphepha ukuphuhliswa kwemiphumo emibi.
Xa kuthethwa oko, izigqibo ezinolwazi azisoloko zisekelwe kwizikhokelo ezizimeleyo, kwaye oku akuyona into enyanisekileyo xa kufike iikhondom. Xa ucinga ukuba usebenzisa iikhondom, soloko uzama ukugcina into enye engqondweni: ukuthintela akuyona enye indlela yesitalato.
Ukuze uzikhusele ngokuzeleyo, kufuneka udibanise kuphela ukusuleleka kwakho kwintsholongwane kodwa ukhathazeka kweqabane lakho lezesondo. Ukuba isimo sakho somlingani singaziwa (kwaye awukwazi okanye ungafuni ukuxoxa ngale nto naye), uya kulungele ukuthabatha zonke izicwangciso zokukhusela ukusuleleka, kuquka ukusetyenziswa kweikhondom.
Ukuba, ngenye indlela, iqabane lakho linentsholongwane ka-HIV, kubalulekile ukuvavanya ukuba useyonyango kwaye, ngokubaluleke ngakumbi, nokuba umthwalo ongenakubonakalayo wegciwane lesandulela ngculaza ufezekile.
Amagosa amaninzi empilo karhulumente namhlanje aya kusondela ekuvakaliseni ukuba abantu abanentsholongwane engabonakaliyo "bangenakubeka ingozi" ekudluliseni i-HIV (ngokutsha kakhulu iDemetre Daskalakis, umkhomishina owancedisayo kwiBhunga leNew York City kwi-HIV / AIDS Prevention and Control).
Ngoko ke, kunengqiqo ukubonisa ukuba unyango lwe-HIV, xa lisetyenziselwa ukudibanisa ne-PrEP, lunokukukhusela ngokukhuselekileyo kwi-HIV ngokungabikho kweikhondom-kodwa kuphela xa umsebenzi we-viral uchithwa ngokupheleleyo kwaye ukuba ukunyanzelwa kwansuku zonke kwi-PrEP kuqinisekiswa.
Into engathethiyo kukuba kukho i-0 ekhulwini ithuba lokusuleleka. Ukugqiba kuphela ukuyeka ulwabelana ngesondo kunokuqinisekisa ukuba, kwaye nokuba oko kunokwehluleka .
> Imithombo:
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> Cottrell, M .; Yang, K .; INkosana, H .; okqhubekayo. "Ukuqulunqa izicwangciso zokulandelwa kweTruvada PrEP ngokuphumelelayo kunye nomzekelo we-PK-PD ovelisa ama-metabolites asebenzayo kunye ne-nucleotides endogene (EN)." Inkomfa yophando lwe-HIV. 28-31 Oktobha, 2014; EKapa, eMzantsi Afrika; yomlomo ongabonakaliyo 22.06 LB.
> I-Ghorayshi, A.. "Icandelo lesibini lomntu we-Daily PrEP Ukufumana i-HIV." I- BuzzFeedNews. Ishicilelwe ngo-Oktobha 19, 2016.
> Taniguchi, T .; Nuritdinova, D .; Grubb, J; okqhubekayo. "Uhlobo lwe-HIV oluxhatshazwayo lwe-HIV lugqithiseleyo luhlala ludlulele kwaye luchaphazela iziphumo ze-virologic nxamnye neyeza-antiretroviral ekhokelwa yi-genotype." Uphando lwe-AIDS lwe-Retroviruses zabantu. Matshi 5, 2012; 28 (3): 259-264.
> I-Parik, i-U. kunye neeMellors, J. "Ngaba kufuneka siyike ukuchaswa kwi-tenofovir / emtricitabine ipreexposure prophylaxis?" Iingcamango zangoku kwi-HIV / AIDS. NgoJanuwari 11, 2016; 11 (1): 49-55