Abaqulunqi bomgaqo-nkqubo bacela ukuphela kwesi sifo ngo-2030
INkqubo yeZizwe eziManyeneyo kwi-HIV / AIDS (i-UNAIDS) yabhengeze iinjongo ezinesibindi, ezijoliswe ekupheliseni ubhubhane lwe-AIDS emhlabeni jikelele ngo-2014. Le nyathelo, eyaziwa njengeqhinga 90-90-90, ichaza iindlela zokufezekisa ezintathu zokuqala iinjongo ngonyaka ka-2020:
- Ukufumanisa iipesenti ezingama-90 zabantu abaphila ne-HIV ngokuvavanya.
- Ukubeka abantu abangama-90 ekhulwini abantu abachongwe ngokufanelekileyo kwi- antiretroviral therapy .
- Ukuqinisekisa ukuba iipesenti ezingama-90 zala machiza ziyakwazi ukuphumeza imithwalo engabonakaliyo yentsholongwane ebonakalisa impumelelo yonyango.
Kuyaziwa ukuba ngokufezekisa eli nqanaba lokunciphisa i-virus, abantu abanentsholongwane kaGawulayo abanako ukusulela abanye intsholongwane. Ngokwenza njalo kwihlabathi lonke, izikhulu ze-UNAIDS zikholelwa ngokunyanisekileyo ukuba ubhubhane lunokupheliswa ngokukhawuleza ngowe-2030.
Kodwa ngaba kunzima nje ngokuba konke?
Kwaye nabaxhasayo abanamandla kakhulu baqaphela ukuba iinjongo ezinjalo azizange zenzeke kwimbali yoluntu lwempilo. Ngako-ke, ngumoya ofanayo, baninzi baya kuvuma ukuba ngaphandle kokunyuka okukhulu kweenkqubo ze-HIV ezikhoyo zelizwe, iwindi yithuba lokwenza ukuba ingxaki yehlabathi ingabikho kodwa ilahlekile.
Kwakuyiqiniso lokugqibela ekugqibeleni kwakhokelela ekuvunyelweni kwesiCwangciso se-90-90-90 kwisiHlomelo esiPhakamileyo seZizwe eziManyeneyo malunga nokupheliswa nguGawulayo, esiqhutyelwe kwiSixeko saseNew York ngoJuni 2016.
Kuphi namhlanje
Ngokwe-2016 ingxelo ye-UNAIDS, ngelixa kuye kwaba nempumelelo ezuziweyo kwimihla ekhokelela ekuvunyelweni kuka-2016, inkqubela ayizange ibe yinto efanayo.
Kwinqanaba elongezelelweyo, kuqikelelwa ukuba abantu abayizigidi ezili-17 baxelwe ukuba bafumana unyango lwe-HIV ngo-2015, phantse kabini inombolo ephathwe ngo-2011.
Ewonke, phantse ama-57 ekhulwini abo baphila ne-HIV bayazi isimo sabo, isimo esisibeka kakuhle endleleni yethu yokufikelela kuvavanyo lweepesenti ezingama-90 ezijoliswe ngo-2020.
Kwinqanaba elincinane, ngaphantsi kwesigamu salabo bafumene abane-HIV (iipesenti ezingama-46) okwangoku bafumana unyango, ngelixa iipesenti ezingama-38 kuphela zikwazi ukufezekisa imithwalo engabonakaliyo yentsholongwane (ngenxa yeengcambu zonyango kunye nokunakekelwa okungahambelaniyo). Ngaphandle kokungafunwa kwemali kunye nokungabikho kokuzibophezela kwabaniki-zimali ezibekwe ukukhusela ukwandiswa kweeprogram zehlabathi, ukukwazi ukuphucula kula manani kunokwenzeka ukuba kuqhutywe ngokukhawuleza.
Nokuba e-US, amanani kazwelonke awela phantsi ngaphantsi kweenqobo ezibekwe yi-UN , kunye namaziko eNgxelo yokuLawula nokuKhuselwa kweziTyhulwa, ukuba i-1.2 yezigidi zabantu baseMerika abaphila ne-HIV, i-86 pesenti ifunyenwe, iipesenti ezingama-36 zonyango, kunye neepesenti ezingama-30 kuphela ezixinzelelweyo.
(Lezo zibalo zaye zachaswa ngo-2016 yiSebe lezeMpilo leMpilo neNgcono ye-New York City, echaza ukuba kuma-819,200 aseMerika aphila ne-HIV, i-86 pesenti ifunyenwe, i-68 ekhulwini yayifumana unyango, kwaye i-55 ekhulwini yayisicatshulwa.
Ukususela kwimbono yehlabathi, ingxelo ye-UNAIDS ibonakalise iindawo ezintle kunye neendawo zokukhathazeka ekufinyeleleni iinjongo ezingama 90-90-90:
- Yonke, i-Europe Yentlabathi, iYurophu yaseNtshona, kunye neNyakatho Melika zihamba kakuhle, kunye ne-86 pesenti yabantu abane-HIV bachongwa ngokuqinisekileyo, ama-56 ekhulwini kwonyango, kunye nama-47 ekhulwini abafumana umthwalo wentsholongwane engabonakaliyo.
- E-Afrika engaphantsi kwe-Sahara, ummandla obandakanya ama-67 ekhulwini kuwo onke ama-infections emhlabeni jikelele, inkqubela phambili iye yahlaba umdla kumazwe amaninzi kunzima, kunye neBotswana, iRwanda, i-Malawi, iSwazini, iKenya kunye neLesotho ngokufanelekileyo ekuphumeleleni iithagethi zokukhawuleza.
- Ngokufanayo, i-Asia, iThailand, neCambodia zihamba phambili kwiinjongo zabo ezingama-2020, ngelixa i-China sele ivakalise i-91 incentage yezinga lokunciphisa i-viral phakathi kwabantu bayo baphathwa.
- Ngokubhekiselele ekuhanjisweni kokonyango, i-Latin America kunye neCaribbean zichazwe ukuba zineenkcukacha eziphezulu kakhulu (iipesenti ezingama-55), kunye neBrazil ingxelo engaphezu kwama-80 ekhulwini lwabantu abanentsholongwane kaGawulayo sele ichongiwe kwaye ngaphezulu kwama-85 ekhulwini bayakhutshwa.
- Ngokwahlukileyo, kwezinye iindawo zaseLatin America kunye neMpuma Yurophu, iNtshona Afrika, iMpuma Afrika, kunye ne-Central Africa-izinga eliphezulu lokuvavanya i-HIV aluzange lenze ukuba kukho amazinga aphezulu okonyango okanye ukunyuswa kwegciwane. Ukufikeleleka ekunakekeleni kunye nokunikezwa kweekhethi zokunikezela kuyaqhubeka nokuphazamisa inkqubela kule mimandla.
- Ukugqithisa ngakumbi nakwiiMpuma Yurophu, iRashiya, kunye ne-Asia ephakathi, apho ukusetyenziswa kwezidakamizwa kusetyenziswa ukuqhuba amazinga okusuleleka . Isithintelo sokunyamekela kule mimandla (kubandakanywa ukuzithemba kwabantu kunye nokuphulwa komthetho ) kuye kwabangela ukwandiswa okuphawulekayo kumlinganiselo wentsholongwane yonyaka.
Iindleko zokubetha iinjongo ze-90-90-90
Ngokwamagosa ase-UNAIDS, ukwenzela ukuba kufumaneke iithagethi ezingama-90-90-90, inkxaso-mali yamazwe ngamazwe iya kunyuka ukuya kuma-19.3bhiliyoni angama-R3 000 ngonyaka. Emva kwesi sixa esicetywayo, iindleko zonyaka ziya kunqanda ukuya kwi-18 billion yezigidigidi ngo-2020, ngenxa ukuguqulwa kwamanqanaba kwintsholongwane.
Ukuba iinjongo zeprogram ziya kufinyelelwa, iinjongo zinokuba zikhulu, njengoko kuboniswe ngophando lwe-2016 kwi-Harvard University Centre yoPhando lwe-AIDS. Ngokwolu cwaningo, ukuphunyezwa kwesi sicwangciso eMzantsi Afrika- ilizwe elinomthwalo omkhulu we-HIV-lingaphambukisa amaninzi angama-73 000 kunye nokufa kwabantu abayizigidi ezili-2 ngaphezu kweminyaka emihlanu, kunye nezifo ezi-2 zezigulane kunye nezigidi ezi-2 ezifa ezidlulileyo kwiminyaka eyi-10.
Nangona iindleko zokuphunyezwa zazingqongqo kwi-$ 15.9 yezigidigidi zaseMzantsi Afrika kuphela, ixabiso lokuphumelela kwesicwangciso (ngokwemibhedlele embalwa, ukufa kunye neenkedama zentombi) zithathwa njengezizathu ezifanelekileyo zokuhlawula imali.
Nangona iinjongo zezimali ezifana nalezi zinokubonakala zinengqiqo, zinikwe iingeniso zangexesha elide kwiinkqubo zezempilo zelizwe, inyaniso elula kukuba igalelo lehlabathi liye laqhubeka lihla ngonyaka. Ukususela ngo-2014 ukuya ku-2015 yedwa, iminikelo yezizwe zawela ngaphezu kweebhiliyoni zama-dollar, ukusuka kwi-$ 8.62 billion ukuya kwi-bill 7.53 yebhiliyoni.
Ngaphandle kwe-US, ohlala eyona nxaxheba enkulu kunazo zonke kwi-global initiative, igalelo phantsi kolawulo luka-Obama lucacile ukusuka ngo-2011. Uninzi lwama-pundits lubonisa ukuba umendo uza kuqhubeka, kunye nabaninzi kwiNgqungquthela bebiza ukuba "uzimisele kwakhona" imali ngaphandle kokunyuka kwindleko yokusetyenziswa kwe-AIDS.
Ngokudabukisayo, ukwenzela ukuba kufinyelele iinjongo ezi-90-90-90, umrhumo wase-United States uza kufuna ukwandiswa okungenani i-biliyoni ezigidi ezingama-2 kwi-cycle yangoku.
Njengokuba okwangoku, ama-US avumile ukulinganisa idola enye kuzo zonke igalelo ngamanye amazwe, kodwa kuphela ukufakwa kolukhuni lwe-$ 4.3 billion (okanye enye yesithathu yenjongo ye- Global Fund ye- $ 13 billion). Oku kuguqulela ekunciphiseni kwiplantshi ukusuka kwii-R5 billion ezidlulileyo, kunye neepesenti ezingama-7 kuphela ezikhuphuka ukusuka kwi-$ 4 yezigidigidi ze-$.
Ngokwahlukileyo, amazwe amaninzi aneenkxwaleko zoqoqosho oluzinzulu azinzile izibophelelo zawo, kunye neKhomishani yaseYurophu, eCanada, naseItaly ngalinye lifaka isibambiso ngamaphesenti angama-20, ngelixa iJamani liye landa ngeepesenti ezingama-33. Ngaphandle neKenya, i-GDP nganye ye-1/50 ye-US, yenza izigidi ezingama-5 kwiiprogram ze-HIV ngaphandle kwemida yesizwe.
Kodwa nangapha ngaphaya kombandela weedola kunye neentente, impembelelo yesicwangciso se-90-90-90 iya kufaka ingxaki kwiinkqubo ezininzi zezempilo zelizwe ezingenazo iindlela zokufumana inkxaso-mali okanye iziseko okanye iinkqubo zokubonelela ngeenkonzo zokubonelela ngokufanelekileyo. Iimveliso zokugcina imithi sele zenzeke rhoqo kwiindawo ezininzi zaseAfrika, ngelixa ukungaphumeleli kokugcina izigulane ekunyamekeleni kuguqula nayiphi na inzuzo eyenziwa ngokubeka abantu kwiyeza kuqala.
Ngaphandle kwemali eyongezelelweyo yokujongana nale miqobo kunye nezinye izithintelo zemihlaba, izikhulu ze-UNAIDS zilumkisa ukuba iindleko zokungaphumeleli zingaba ziphezulu-kubangelwa ukusulelwa kwezigidi ezi-17.6 ezifayo kwizifo ezingama-2020 kunye nezigidi ezili-10.8.
Ngaba Sinokuyiphatha Indlela Yethu Ngaphandle Kwebhubhane?
Nangona inkqubela phambili ephawulekayo ekukhuseleni ubhubhane lwe-HIV, abaphandi kwiLondon School of Hygiene kunye neTransic Medicine bakhombisa ukuba iithagethi ezingama-90-90-90 zinethuba elithile lokuphelisa ingxaki ngo-2030. Ubungqina bokuba ukwandisa unyango kunokunciphisa amazinga okusulela unyango ngokunciphisa oko kuthiwa "umthamo wentsholongwane yoluntu" -iqhinga elaziwa ngokugqithiseleyo njengeNyango njengeCoption (okanye i-TasP ).
Ngokutsho kophando, zikhona izikhalazo ezinzulu kwisicwangciso. Ukususela kwimbali yomlando, ukuhla kwehle kakhulu kwiintsholongwane ze-HIV kwenzeka phakathi kuka-1997 no-2005, iminyaka eyabhalwa yimicimbi emithathu enkulu:
- Ukuqaliswa kwezilwanyana zokudibanisa ezinamandla kakhulu, ezaziwa ngexesha njenge- HAART (okanye unyango olusetyenzisiweyo lwe-antiretroviral) .
- Ukufika kwama-antiretrovirals, okwenza iziyobisi zifikeleleke kumazwe asakhulayo.
- Ukuqaliswa kwezidakamizwa ezisebenzayo ezingaphezulu kwe-HIV, ezifana ne- tenofovir , kunye ne-simple-pilice single-treaty treatments.
Nangona kunjalo, ukususela ngeli xesha, kubekho ukunciphisa okuthobekileyo kwinqanaba lokusuleleka kwihlabathi. Enyanisweni, kumazwe angama-195 afakwe kwisifundo, ukunyuka kwamawaka angama- 102 okusukela ngonyaka ka-2005 ukuya ku-2015. Phakathi kwabo, uMzantsi Afrika wabika ukwanda kwama-infected infections angaphezu kwe-100 000 ukususela ngo-2014 kuya ku-2015, ukongeza kwizifo ezingama-1.8 ezikhuselekileyo e-Afrika kunye nezigidi ezi-2.6 ingxelo ngonyaka jikelele ngonyaka.
Okwangoku, ukunyuka kwe- HIV (okt, inani labantu abaphila ngesifo) lenyuke ngomyinge we-0.8 ekhulwini ngonyaka kunyaka-2000, ukuya kuma-38.8 wezigidi ngo-2015.
Nangona ixabiso lokufa liye lahla ukusuka kwii-1.8 yezigidi zokufa ngo-2005 ukuya ku-1.2 ngo-2015, izifo ezinxulumene ne-HIV ziye zanda ngokuphawulekayo kumazwe amaninzi. Isifo sofuba (i-TB) yimeko kwinqanaba, kubalwa malunga neepesenti ezingama-20 zokufa kwabantu abaphila ne-HIV (ikakhulukazi kumazwe asakhulayo). Nangona kunjalo nangona iifom zentsholongwane kaGawulayo ziqhubela phezulu kubantu abane-TB, i-HIV isoloko ikhutshwe njengobangela wokufa (okanye nokuba yintoni ebangela ukufa) kwiimanani zentlanga.
Abaphandi baphinde bathi ukunyuka kwamazinga okusuleleka okubambisene nokuhlala kwexesha elide (umphumo wenkxaso yokwandisa unyango) kuya kufuna ukuba oorhulumente bakwazi ukulawula abantu abahlala benesifo se-HIV. Kwaye ngaphandle kwendlela yokugcina ukunyanzelwa kwe-viral ngaphakathi kwendawo-kwaye kungekhona nje kwiminyaka embalwa, kodwa ngokubomi-konke oko kwenzeka ukuba amazinga okusuleleka aya kuhlawulela, mhlawumbi ngokumangalisayo.
Nangona kukho ubungqina obunyanzelayo bokuthi i-TasP inokutshintsha ii-HIV kwiindawo eziphakamileyo kakhulu, abaphandi bathi asikwazi ukuthembela kwonyango kuphela ukuphelisa ubhubhane. Kunoko bacebisa iinguqu ezinzulu ngendlela iiprogram zizoxhaswa ngayo kwaye zihanjiswe. Ezi ziquka ukunyuka kwenkxaso-mali yasekhaya, ukuvumela ukuhamba okukhululekayo kwezilwanyana ezichanekileyo ze-HIV, kunye nokutshala imali ekuphuculweni kweenkqubo zeenkonzo zelizwe.
Kuza kufuna kwakhona ukungenelela okuthintekayo, kubandakanywa utyalo-mali kwisicwangciso sokunciphisa ukulimaza ukufaka injecting users, ukusetyenziswa kobuchule be-HIV ngaphambi kokuchaswa kweprophylaxis (PrEP) kwiindawo ezifanelekileyo, kunye nokuxhotyiswa kweenkqubo zekhondom ngexesha osemncinci uhamba.
Ngaphandle kwezi nguqu zentlangano, abaphandi bathi, isicwangciso se-90-90-90 siya kuba nefuthe elongezelelweyo kwizinga lokufa nokunciphisa ukuguqulwa okuqhubekayo kwe-HIV.
> Imithombo:
> Carter, M. "Ukuphela koGawulayo ngo-2030 kwiindawo ezikude: iziganeko zeHIV emhlabeni jikelele, ukubalwa kwonyango kunye nokufa kwabantu." UNAM AIDSMap . Agasti 2016.
> I-GBD 2015 Abambiseneleli be-HIV. "Uqikelelo lweziganeko zomhlaba, zommandla, nakwilizwe, ukuxhaphaka, nokufa kwe-HIV, ngo-1980-2015: iSifundo seNgcaciso yeSifo soHlabathi kwi-Global 2015." ILancet. Agasti 2016; 3 (8): e361-e387.
> UJamieson, D. kunye noKellerman, S. "I-90 90 90 i-stategyggy to stop the HIV pandemic by 2030: Ingaba i-chain chain iyayiphatha?" Umbhalo we-International AIDS Society. 2016; 19 (1): 20917.
> Uhlelo lweZizwe eziManyeneyo kwiHIV / AIDS (UNAIDS). "Iimpumelelo zehlabathi zijoliswe kwiinjongo ezingama-90-90-90." I-Geneva, eSwitzerland; Julayi 18, 2016.
> Wallensky, R .; Borre, E .; Bekker, L; okqhubekayo. "Imiphumo ye-Clinical and Economic Effects ye-90-90-90 eMzantsi Afrika." Ama-Annal of Medicine Internal. NgoSeptemba 6, 2016; 165 (5): 325-333.