Mafunso Anadzuka Pambuyo pa Matenda Aakulu Ambiri
HIV Pre-exposure prophylaxis (PrEP) ndi chida champhamvu choteteza zomwe Truvada imachita tsiku ndi tsiku zingachepetse chiopsezo cha munthu kuti atenge kachilombo ka HIV. Izi zikuwoneka kuti ndi zoona makamaka kwa amuna omwe amagonana ndi amuna (MSM) , ndi kafukufuku waposachedwapa omwe akusonyeza kuti PrEP ikhoza kukhala yogwira mtima kwa amuna kapena akazi okhaokha omwe amatenga mapiritsi ochepa pa sabata.
Pamene kuvomereza kwa PrEP kukupitiriza kukuliraku, kotero, khalani ndi nkhawa kuti njirayi ingayambitse kufalikira kwa makondomu monga njira yoyamba (kapena yocheperako) ya kachilombo ka HIV.
Kodi izi ndizovuta kwenikweni? Kapena kodi prEP ndiyomwe ikuthandizira kugonana kosakondwera pazifukwa zinazake?
Kumvetsetsa prEP, makondomu, ndi chiwerewere
Kafukufuku wochuluka wofufuza za PrEP ndi kugwiritsa ntchito kondomu zachitidwa m'mabungwe a MSM, omwe akukhalabe ndi vuto lalikulu la HIV ku US Ambiri mwa iwo apeza kuti kugonana kosakondomu-kapena makamaka kugwirizana kwa chiwerewere - chofunika kwambiri pa chifukwa chomwe maanja ndi anthu amasankha PREP monga njira yawo yoyamba yotetezera.
Kuwonjezeranso zina ndizomwe zikuwonetsa kuti pafupifupi gawo limodzi mwa magawo atatu a matenda a MSM amapezeka mu chiyanjano chodzipereka. Ngakhalenso maanja omwe onse awiri ali ndi kachilombo ka HIV, chiwerengero chachikulu cha kugonana kosakondomu pakati ndi kunja kwa chiyanjano (maganizo 90 ndi 34 peresenti) zimakhala ndi chiwerengero chachikulu cha matenda.
Koma ngakhale kupitirira pa nkhani za chibwenzi ndi kudziletsa, zina zimathandiza kwambiri kuti munthu asankhe kondomu ndi PrEP (mosiyana ndi kuwagwiritsa ntchito). Izi zingaphatikizepo kuchepetsedwa kwa nkhawa yokhudzana ndi kachilombo ka HIV, komwe kumayang'aniridwa ndi thanzi labwino, kapena kukhala ndi chilakolako chokhala ndi ana.
Aliyense amatha kudziwitsa malingaliro a munthu pa zomwe ziri kapena "sizili zovomerezeka."
Koma kodi PrEP imalimbikitsa kugonana kosakondomu, makamaka pazifukwa zosiyana-siyana zomwe mwamuna kapena mkazi ali ndi kachilombo ka HIV ndipo winayo alibe kachilombo ka HIV?
Kafukufuku ambiri amasonyeza kuti izo sizimatero. Ndipotu, kaya mukumanga ubale kapena kunja, khalidwe la kugonana (kuphatikizapo kutenga chiopsezo cha kugonana) silinawoneke kusintha kwambiri mwa anthu omwe anasankha kugwiritsa ntchito PrEP.
M'malo mwake, PrEP inawoneka kuti ikuwongolera khalidwe lochepetsa kuchepetsa chiopsezo kwa iwo amene adziwona kuti ali pachiopsezo chachikulu. Izi zinali zowona makamaka kwa anthu osiyana-siyana , omwe ali ndi zida zambiri (kuphatikizapo makondomu ndi chithandizo cha HIV monga kupewa ) kuti asatengere HIV kwa wokondedwa.
PrEP Sinadalidwe Mofanana
Age, komabe, zikuwoneka kuti ndicho chomwe chinachititsa PrEP ndi kugonana kosakondwera kukhala ndi gulu limodzi. Maphunziro a 2016 ochokera ku Adolescent Medicines Trial Network (ATN) Othandiza pa HIV / AIDS adanena kuti 90 peresenti ya MSM a zaka 18 mpaka 22 anagonana ndi abambo panthawi ya PrEP, komanso kuti chiwerengerochi chinakula kwambiri kuti munthu akhale wodalirika . (Kugonjera kunali koyenerera ndi kuwonjezeka kwa Truvada m'magazi a munthu.)
Zomwe anapezazo zinali zofunika kwambiri malinga ndi momwe ankanenera kuti PrEP sichingowonjezera chiopsezo cha munthu kuti ali ndi kachilombo ka HIV koma kuwonjezeka kwa chiopsezo cha kugonana, makamaka kwa achinyamata. Zowonjezereka, kuchuluka kwa mankhwala osokoneza bongo kunawoneka kuchepa mofulumira mu gulu lino-kuchokera pamwamba pa 56 peresenti pa Sabata lachinayi mpaka 36 peresenti pa sabata 48-panthawi yomwe chiŵerengero chachikulu cha matenda opatsirana pogonana (22 peresenti) sanasinthe .
Kaya zizoloŵezi zoopsa zingasinthe mogwirizana ndi kuchepa kwa chiŵerengero chotsatira chikhalabebe bwino. Chomwe chiri chowonekera ndi chakuti ma high syphilis, gonorrhea, ndi chlamydia amangowonjezera mwayi wa HIV ndipo akhoza kutaya phindu la PrEP, makamaka kwa achinyamata amene ali ndi chiwerengero chosauka kwambiri .
Chigwirizano chimathandizanso kuti ntchito ya PrEP ikhale yogwira mtima, ndipo, pambaliyi, palibenso kusiyana kotheka kumvetsetsa kwathu kwa PrEP kwa amayi.
Kuyambira kale, PrEP ankaonedwa kuti ndi njira yodzidziletsa pa akazi omwe analibe mphamvu zogonana. Komabe, mosiyana kwambiri ndi mayesero a MSM, kufufuza koyambirira kunawonetsa kuti chiwerengero cha kulephera chinali chachikulu kwambiri kwa akazi pa PrEP ndipo kuti kulephera koteroku kunayambika makamaka chifukwa chotsutsana.
Koma kodi kugwiritsira ntchito mankhwala osokoneza bongo kunali koipa kwambiri kuposa akazi kuposa amuna? Kapena kodi pali zinthu zina zomwe zinapangitsa kulephera?
Phunziro la 2014 kuchokera ku yunivesite ya North Carolina (UNC) linapereka chitsimikizo, kutsimikizira kuti PrEP sichitha kuchepetsa amayi chifukwa cha kuchepa kwa mankhwala omwe ali pachiopsezo cha mimba komanso m'mimba.
Ofufuza a UNC adapeza kuti kutenga ndi kupezeka kwa Truvada mkati mwa maselowa kunagwa pansi kwambiri pamatenda a ana ndi aang'ono; makamaka, kuti ngakhale osasokonezeka tsiku ndi tsiku, 75% okha azimayi adatha kukwaniritsa njira yomweyo ya chitetezo monga MSM. Mosiyana ndi izo, zinanenedwa kuti PrEP angathe kutenga chitetezo ku MSM ndi ochepa kapena awiri piritsi pa sabata.
Kusagwirizana kumagwirizana kwambiri ndi kugwiritsa ntchito PrEP monga mokondweretsa, m'malo mosiyana, chida choletsa HIV mwa amayi.
PrEP Imalephera Amuna Amene Amagonana Ndi Amuna
Ngakhale pakati pa MSM, nkhani ya PrEP ndi kugonana kosakondabe imakhalabe yotsutsana ndipo nthawi zina imasokoneza. Ndipo ngakhale PrEP sinavomerezedwe ngati njira yokhazikika, ambiri amavomereza kuti kugwiritsa ntchito kwake kulimbikitsidwa kwambiri ndi chiwerengero chokwanira cha kugonana kosakwatirana pakati pa amuna okhaokha ndi amuna kapena akazi okhaokha.
Komanso, umboni wochuluka wa momwe PrEP amathandizira mu MSM, ngakhale pakati pa omwe ali ndi vuto losavomerezeka , wachepetsa chiopsezo chomwe chimawoneka ngakhale anthu omwe ali ndi chiopsezo chachikulu (mwachitsanzo, iwo omwe amagonana nawo, kugonana molakwika, kapena kugwiritsira ntchito mankhwala osokoneza bongo ).
Koma kodi malingaliro ameneŵa akugwirizana bwanji ndi chiwopsezo chenichenicho?
Funsoli linayikidwa mwatsatanetsatane mu 2016 pamene lipoti linati amuna awiri achiwerewere anali atachilomboka HIV ngakhale adatenga Truvada tsiku ndi tsiku. Pazochitika zonsezi, mauthenga a pa TV adanena kuti amunawa ali ndi kachilombo ka HIV kamene kamakhala kosavuta ku tenofovir ndi emtricitabine (omwe amagwiritsira ntchito mankhwala osokoneza bongo omwe ali mu Truvada).
Akatswiri ambiri amachepetsera nkhaniyi, kunena kuti palibe chifukwa chochitira mantha komanso kuti phindu la PrEP linali lalikulu kwambiri. Ndipo pankhaniyi, iwo anali olondola.
Zochepa zenizeni zinali zonena kuti mtundu uwu wa kachilombo ka HIV ungatengedwe ngati "wosazolowereka," kapena kuti kukana mankhwala osokoneza bongo omwe amapezeka mwa amuna onsewa kunalibe kokha.
Posachedwapa mu 2016, kafukufuku wodwala matenda a matenda opatsirana pogonana kuchokera ku Centers of Disease Control and Prevention, adagonjetsa tenofovir-mankhwala osokoneza bongo ku Truvada-anali atagwidwa ndi 20% kumpoto kwa America ndi Europe , ndipo akhoza kukhala 50% pa Africa.
Ngakhale kuti pali chiwerengero chochepa kwambiri pa kukanikiza kwa emtricitabine, maphunziro ambiri a nyama asonyeza kuti kukana tenofovir yekha kungokwanire kupititsa patsogolo matendawa ngakhale kumatsatira tsiku ndi tsiku PrEP.
Kuwonjezera pamenepo, mankhwala osokoneza bongo ambiri-kapena ngakhale mankhwala ambiri osagwiritsa ntchito mankhwala - sizinthu zachilendo zomwe zimafala kufalitsa kachilombo ka HIV. Ndipo pakadutsa munthu mmodzi kupita kwina, zowonjezereka zimangowonjezera, zomwe zimapangitsa kuti anthu ambiri atsopano atenge kachilombo ka HIV asakanike .
Kotero Kodi Izi Zikutiuza Chiyani?
Kuchokera kuwonongeka kwa thanzi la anthu, uthengawu umakhalabe wosakayika: PrEP ikulimbikitsidwa ngati gawo la njira yodziwitsa HIV, yomwe ikuphatikizapo kugwiritsira ntchito kondomu komanso kuchepetsa khalidwe labwino.
Komanso, PrEP sichimangidwe kwa anthu onse koma makamaka omwe amawoneka kuti ali pachiopsezo chachikulu . Pogwiritsidwa ntchito, PrEP nthawi zonse imayenera kuchitidwa tsiku ndi tsiku, popanda kusokonezeka, ndi kuyesa nthawi zonse kuti adziwe momwe alili ogwiritsira ntchito ndikupewa chitukuko cha zotsatirapo.
Ndizinenedwa kuti, zosankha zodziŵika bwino sizinayambe zogwirizana ndi ndondomeko zokha, ndipo izi siziri zoona pokhudzana ndi makondomu. Poganizira ngati mungagwiritse ntchito makondomu, yesetsani kusunga chinthu chimodzi m'maganizo: kupewa kupewa njira imodzi.
Kuti muteteze nokha, muyenera kuthana ndi chiopsezo chanu ku kachilombo ka HIV koma chiopsezo cha wokondedwa wanu. Ngati mzanu sakudziwika (ndipo simungathe kapena simukufuna kukambirana naye), ndibwino kuti muteteze matenda, kuphatikizapo kugwiritsa ntchito makondomu.
Ngati, mnzanuyo ali ndi kachilombo ka HIV, nkofunika kuti aone ngati ali ndi mankhwala, komanso chofunika kwambiri, ngati nthendayi isakwaniritsidwe .
Akuluakulu a zaumoyo ambiri masiku ano akuyandikira kwambiri kulengeza kuti anthu omwe ali ndi kachilombo kosaoneka mosavuta ali ndi "vuto" lofalitsa HIV (posachedwapa Demetre Daskalakis, komiti yothandizira ku Bungwe la New York City la HIV / AIDS Prevention and Control).
Choncho, ndizomveka kunena kuti kachilombo ka HIV kamagwiritsidwa ntchito pothandizana ndi PrEP, chitetezo chokwanira ku HIV popanda makondomu - koma ngati kadoyo / kachilombo ka HIV kamakhala kosalephereka ndipo ngati chitsimikizo cha tsiku ndi tsiku chirimbikitsidwa.
Chimene sichikunena n'chakuti pali 0 peresenti ya mwayi wodwala. Kugonana kwathunthu kungathe kutsimikizira kuti, ndipo ngakhale izo ziri ndi zolephera zake .
> Zotsatira:
> Gamarel, K. ndi Golub, S. "Kukondana ndi chibwenzi choyamba ndi Pre-exposure Prophylaxis (PrEP) Kukwaniritsa zolinga pakati pa amuna omwe ali ndi HIV / Amuna Ogonana ndi Amuna (MSM) mu Ubale Wachikondi." Annals of Practice Medicine . April 2015; 49 (2): 177-189.
> Cottrell, M .; Yang, K.; Prince, H .; et al. "Kulosera njira zogwirira ntchito za Truvada PrEP zoyenera ndi njira yopangira PK-PD yomwe imaphatikizapo minofu yogwira ntchito yotchedwa metabolites ndi nucleotide yodalirika (EN)." Mndandanda wa Kafukufuku Wopewera HIV. 28-31 October, 2014; Cape Town, South Africa; zolemba zamlomo 22.06 LB.
> Ghorayshi, A. "Nkhani yachiwiri ya Wina pa Daily PrEP Kupeza HIV." BuzzFeedNews. Lofalitsidwa pa Intaneti October 19, 2016.
> Taniguchi, T .; Nuritdinova, D ;; Grubb, J .; et al. "Kupatsirana kwa HIV kosagwiritsidwa ntchito mankhwala osagwiritsidwa ntchito mopitirira muyeso kumafala kwambiri ndipo kumakhudza zotsatira za virologic ngakhale mankhwala opatsirana pogwiritsa ntchito antiretroviral." AIDS Research Retroviruses Anthu. March 5, 2012; 28 (3): 259-264.
> Parik, U. ndi Mellors, J. "Kodi tiyenera kuopa kutsutsidwa ndi tenofovir / emtricitabine preexposure prophylaxis?" Malingaliro amasiku ano pa HIV / AIDS. January 11, 2016; 11 (1): 49-55