Mibvunzo Yakamutswa Mushure mekunge "Zvirwere" Zvirwere Zvakarehwa
HIV pre-exposure prophylaxis (PrEP) isimba rekudzivirira iro iro zuva rega reTruvada rinogona kuderedza dambudziko revanhu rokutapukirwa neHIV neanenge 92 muzana. Izvi zvinoita sokuti ndezvechokwadi kune varume vanoita zvepabonde nevarume (MSM) , neongororo dzechangobva kuitika dzinofunga kuti PrEP inogona kunge inoshanda kune varume vanoita zvepabonde kana varume vanoita zvepabonde vanotora mashoma kana mapiritsi mana pavhiki.
Sezvo kugamuchirwa kwevoruzhinji kwePrEP kuchiri kukura, saka, zvakare, unetseka kuti urongwa hunozoita kuti kupararira kwekondomu kuve kwakapararira semhando yepamusoro (kana inowanikwa) yehutachiwana hweHIV.
Ndicho chinetso chaicho here? Kana kuti PrEP inobudirira zvakakwana kubvumira kuita zvepabonde pasina kondomu pane zvimwe, mamiriro ezvinhu chaiwo?
Kunzwisisa PrEP, makondomu, uye zvepabonde
Nyaya dzakawanda dzinoongorora kuongorora PrEP uye kushandiswa kwekondomu kwakaitwa muMSM vanhu, boka iro rinoramba richiendesa mutoro unorema weHIV muUnited States Vakawanda veizvi vakawana kuti kusangana pabonde pasina chivimbo-kana kuti kunyanya kushamwaridzana kwepabonde - chinhu chinoita kuti vanhu vakaroorana nevamwe vanhu vasarudze PrEP senzira yavo yekudzivirira.
Kuwedzera kuwedzerwa kwezvinyorwa zvinotaridzika zvinoratidza kuti chikamu chimwe chetatu cheSMSM zvirwere chinowanikwa mukati mehukama hwakagadzikana. Kunyangwe mune vakaroorana apo vaviri vari vaviri vane HIV, vasati varova zvepabonde dzisina kukondombera mukati uye kunze kwehukama (maonero 90 uye 34 muzana, pamwe chete) inowedzera mazinga akaenzana ekutapukirwa.
Asi kunyange kupfuura nyaya dzehukama hwepedyo uye kuzvidzivirira, zvimwe zvikonzero zvinopa zvakakosha kumusarudzo wemunhu wekushandura makondomu nePrEP (kusiyana nekumashandisa mumutsara). Izvi zvinogona kusanganisira kuderedzwa kwehutano hwehutachiona hweHIV, hunofungidzirwa kutarisira hutano hwepabonde, kana chido chekuita vana.
Mumwe nemumwe anogona kuzivisa mafungiro evanhu nezvekuti chii kana kuti hachisi "chiitiko chinogamuchirwa."
Asi iyo PrEP inokurudzira kuita zvepabonde zvisina kukodzera, kunyanya muhutano hwehutano hwakaroorana apo mumwe wavo ane HIV uye imwe haina HIV-haina?
Kazhinji tsvakurudzo inoratidza kuti hazviiti. Ichokwadi, kana mukati mekuvakwa kweukama kana kuti kunze, maitiro ekuita zvepabonde (kusanganisira kubatwa kwepabonde) haana kuonekwa kuchinja zvikuru kune vanhu vakasarudza kushandisa PrEP.
Pane kudaro, PrEP yakaonekwa sekusimbisa maitiro ekuderedza maitiro kune avo vanozviona ivo vari pangozi yakanyanya. Izvi zvaive zvakanyatsoitika kune vakaroorana-vakaroorana , avo vanowanzoshandisa zvishandiso zvakasiyana-siyana (kusanganisira makondomu nehutano hweHIV sekudzivirira ) kudzivirira kutapurira HIV kune avo vasina hanya.
PrEP Yakanga Isina Kuumbwa Safanana
Zera, zvisinei, zvinoita sechimwe chinhu icho PrEP uye zvepabonde vasina kondomu vane musangano wakananga. Chidzidzo che 2016 kubva kuAdolescent Medicines Trial Network (ATN) yeParamende yeHIV neAIDS yakashuma kuti 90 muzana yeMSM ane makore 18 kusvika 22 kusvika 22 kusvika kumakore makumi maviri nemasere kusvika pamakore makumi mapfumbamwe nemakumi maviri kusvika kumakumi mapfumbamwe nematanhatu (18-22) vakapinda muchirwere chepabonde pasina kondomu panguva yePrEP, uye kuti chiitiko chacho chawedzera kukurudzira munhu aive kurapa . (Kubvuma kwakagadziriswa nehukuru hweTruvada muropa romunhu.)
Zvakawanikwa zvaive zvakakosha pane zvavakaratidza kuti PrEP haisi kungowedzera kukanganisa kwemaonero evanhu kwehutachiona asi kuwedzerwa ngozi yekuita zvepabonde, kunyanya kune vanhu vaduku. Kunyanya maererano, mukana wekuisa zvinodhaka wakaonekwa uchiderera nokukurumidza muboka iri-kubva kune yepamusoro ye 56 muzana paSvondo yechina kusvika 36 chete muzana nevhiki 48-panguva iyo yakawanda yehutachiona hwepabonde (22 muzana) yakaramba isina kuchinja .
Pasinei nokuti maitiro ekuzviisa mungozi aizodzoka maererano nekunonoka kwekutengesa mahara kunoramba kusina kujeka. Chinonyatsojeka ndechekuti mazinga ekurwisa, gonorrhea, uye chlamydia zvinongowedzera kuwandisa kweHIV uye zvinogona kukanganisa mararamiro ePPR, kunyanya kune vechidiki avo vane varombo vanoomerera pamatambudziko .
Gender inewo basa rinokosha pakusarudza kushanda kwePrEP, uye, pane izvi, pane zvakasara nezvekusaziva pakunzwisisa kwedu PrEP mune vakadzi.
PrEP yakanga yave ichionekwa kwenguva refu senzira yekuzvidziviririra kune vakadzi vakange vasina simba repabonde. Zvisinei, zvakasiyana zvakasiyana nemuedzo we MSM, kutsvakurudza kwepakutanga kwave kuratidza kuti kutadza kwekukundikana kwaive kwakakwirira kwazvo pakati pevakadzi paPPR uye kuti kukanganisa kwakadaro kwaiitwa kunonyanya kuenzaniswa kwekuita.
Asi kushandiswa kwemishonga zvechokwadi kwakanyanya kuipa kune vakadzi kupfuura varume? Kana kuti pane zvimwe zvikonzero zvakakonzera kukanganisa here?
Chidzidzo che2014 kubva kuYunivhesiti yeNorth Carolina (UNC) chakapa ruzivo, zvichiratidza kuti PrEP inogona kunge isingabatsiri kuvakadzi nekuda kwezvikamu zvakaderera zvechirwere munharaunda yakakanganisika yemudzimai uye yemadzimai.
Vatsvakurudzi veUnC vakawana kuti kushandiswa uye kuparadzirwa kwaTruvada mukati memasero aya kwakawira zvakanaka pasi peavo vakakuvara uye mahedheni; zvakanyanya kudaro, chaizvoizvo, kuti kunyange nekunetseka kwekuchengetedza zuva rega rega, 75% chete yevakadzi yakakwanisa kuwana huwandu hwekudzivirirwa sa MSM. Kusiyana neizvi, zvakarongerwa kuti PrEP inokwanisa kudzivirirwa muSMSM uye sevashoma kana maviri kusvika pamapiritsi matatu pavhiki.
Kuvhiringidza kwakanyatsotsigira kushandiswa kwePPR pane sarudzo, panzvimbo pekushandisa zvimwe, chidziviriro chekudzivirira HIV mune vakadzi.
PrEP Kukundikana Kwevarume Vanoroorana Nevanhu
Kunyangwe pakati peMSM, nyaya yePPREP uye zvepabonde isingabatsiri inoramba ichikakavara uye dzimwe nguva ichivhiringidza. Uye apo PrEP haina kumbobvumirwa sarudzo-maitiro, vazhinji vanozobvuma kuti kushandiswa kwayo kunonyanya kutungamirirwa nematunhu akakwirira ekurara kwekondomu pakati pevarume nevarume vanoita zvepabonde.
Uyezve, humwe uchapupu huri kuwedzera hwekushanda kwePPRP muSMSM, kunyange pakati pevaya vasina kukwanisa kuenzanisa , zvakaderedza dambudziko ravanoona kunyange kunyange kune vanhu vane ngozi (kureva, avo vanoita zvepabonde muchikwata, kusangana pabonde, kana kushandisa injecting drugs ).
Asi pfungwa idzi dzinowirirana zvakadini nechinetso chaiyo?
Mubvunzo wacho wakaiswa pachena munharaunda muna 2016 apo mitsara yakabuda yokuti varume vaviri vevarume vaiva nehutachiona hweHIV pasinei nekubata Truvada zuva rega rega. Muzviitiko zvose izvi, mitsara yemasangano yakaratidza kuti varume vacho vakanga vatapukirwa ne "zvisingawani" rudzi rwekusapindira kweHIV kune zvose tenofovir uye emtricitabine (maviri anoshandisa zvinodhaka ari muTruvada).
Nyanzvi dzakawanda dzakaderedza nhau idzi, dzichitsigira kuti pakanga pasina chikonzero chekutya uye kuti zvipo zvePrEP zvisati zvanyanya kuwandisa migumisiro. Uye munyaya iyi, vakanga vakarurama.
Pasina chokwadi chaive chirevo chokuti rudzi urwu rwekusagadzikana kweHIV rwaigona kuonekwa se "husingawanzoitiki," kana kuti kushorwa kwemishonga yakasiyana-siyana kwakaratidzwa kune varume vose kwaiva chinhu chisiri chenguva dzose.
Munguva ichangopfuura muna 2016, kutsvakurudza kwezvirwere kubva kuCenters of Disease Control uye Prevention zvakagumisa kusagadzikana kwetenofovir-mutemo wekutanga muTruvada-yakanga yatotanga kuvhara kusvika 20% muNorth America neEurope , uye inogona kuva yakakwirira ye50 muAfrica.
Kunyange zvazvo pane zvishoma kudarika pamusoro pekudzivirira kwemtricitabine pasi rose, zvidzidzo zvezvipfuwo zvakawanda zvakaratidza kuti kupikisa tenofovir pachako kwakakwana kukonzera kubudirira mune zvirwere kunyange nekunamatira zuva nezuva PrEP.
Uyezve, kuwanda kwezvinodhaka-zvinodhaka-kana kunyange maitiro akawanda-kushandiswa kwezvinodhaka -hachisi mamiriro ezvinhu asina kujairika anopiwa kupararira kwehutachiona. Uye kana yakapfuudzwa kubva kune mumwe munhu kuenda kune inotevera, iyo inogona kuwedzera kuwedzera, zvichiita kuti kuwedzerwa kwekusawirirana kwemishonga inoparadzirwa kunoonekwa kune vakawanda vatsva vanotapukirwa.
Saka Izvi Zvinotiudzei?
Kubva pane hutano hwehutano hwevanhu, shoko rinoramba richijeka: PrEP inokurudzirwa sechikamu chechirongwa cheHIV chine ruzivo, chinosanganisira kushandiswa kwemakondomu uye kuderedzwa muzviito zvengozi.
Uyezve, PrEP haisi yevanhu vose asi pane avo vanofunga kuti vari pangozi yakanyanya . Kana yakashandiswa, PrEP inofanira kugara ichiitwa zuva rega rega, pasina kupesana, uye nekuedza nguva dzose kuongorora hutano hwevashandi uye kudzivisa kukura kwemigumisiro.
Nezvo zvichitaurirwa, zvisarudzo zvakasarudzwa hazviwanzogadziriswa pane zvinongororwa chete, uye izvi hazvisi zvokwadi kana zvasvika pamakondomu. Paunofunga nezvekushandisa makondomu, edzai nguva dzose kuchengetedza chinhu chimwe mupfungwa: kudzivirira haisi imwe nzira yemugwagwa.
Kuti uzvidzivirire zvizere, haufaniri kutarisana nekushungurudzika kwako kune hutachiwana asi hutachiwana hwehutano hwako. Kana ukama wako isingazivikanwe (uye iwe haugoni kana usingadi kukurukura izvi naye), iwe unogona kushandiswa zvakanakisisa kutora matanho ose ekudzivirira utachiona, kusanganisira kushandiswa kwemakondomu.
Kana, pane imwe, mumwe wako ane HIV, zvakakosha kuongorora kana iye ari kurapwa uye, zvinonyanya kukosha, kana mutachiona usina kutaridzika wakawanikwa.
Vakuru vakuru vehutano vemazuva ano vari kutamira pedyo nekuzivisa kuti vanhu vasina hutachiwana hwehutachiwana "havakwanise" kutapurira HIV (munguva pfupi yapfuura Demetre Daskalakis, mutungamiri weNew York City Bureau reHIV / AIDS Prevention and Control).
Saka, zvinonzwisisika kutaura kuti chirwere cheHIV, kana chichishandiswa pamwe chete nePrEP, chinogona kupa kudzivirirwa kwakakwana pamusoro peHIV musipo kwekondomu-asi chete kana basa revirari rakanyatsopedzwa uye kana kuchengetedzwa kwezuva nezuva kwePPR kunotsigirwa.
Zvisingatauri ndezvekuti pane 0 muzana yekana yekutapukirwa. Kuita zvekuita zvepabonde chete kunogona kuvimbisa kuti, uye kunyange izvozvi zvine zvikanganiso zvayo .
> Sources:
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> Cottrell, M ;; Yang, K .; Prince, H ;; et al. "Kufanotaura kushanda zvakanaka Truvada PrEP kudzokorora maitiro nemufananidzo wePK-PD unobudisa maitiro anoshanda emasabolites uye nucleotides asingagumi (EN)." Tsvakurudzo yeHIV yekudzivirira Musangano. 28-31 October, 2014; Cape Town, South Africa; nyanzvi yemusoro 22.06 LB.
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> Taniguchi, T .; Nuritdinova, D .; Grubb, J .; et al. "Kutapukiswa kwezvirwere zvinopesana nehutachiwana hwehutachiona hweHIV hunoramba hwakapararira uye hunoita kuti zvirwere zve virologic zvisati zvaitika pasinei neve genotype-inotungamirirwa nehutachiona hwehutachiona." AIDS Kuongorora Vanhu Retroviruses. March 5, 2012; 28 (3): 259-264.
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