I-PrEP Yokuvikela I-HIV: Okudingeka Ukwazi Ngaphambi Kokuqala

Umhlahlandlela we-PrEP nokuVikela i-HIV ngesiZulu

Sawubona, nginguDokotela George Forgan-Smith. Ngingudokotela womndeni (GP) osebenza e-Australia. Lo mhlahlandlela ukhona ukukusiza wenze isinqumo esinolwazi sokuthi ingabe i-PrEP ikulungele yini. Zinike isikhathi nawo, futhi imibuzo yakho yonke uyiyise kudokotela wakho.

Iyini i-PrEP?

I-PrEP (i-pre-exposure prophylaxis, okusho ukuvimbela ngaphambi kokuvelelana negciwane) iwumuthi owuphuzayo ukuvikela i-HIV. Iqukethe izithako ezimbili ezisebenzayo (i-tenofovir disoproxil ne-emtricitabine) ephilisini elilodwa. Uma iphuzwa njengoba kunqatshelwe, ivimbela i-HIV ukuba ikwazi ukwanda emzimbeni wakho. Ucwaningo lukhombisa ukuthi, uma iphuzwa kahle, i-PrEP isebenza kahle kakhulu ekuvikeleni i-HIV.

Okumele wazi ngaphambi kokuqala

  • Kumele ungabi nayo i-HIV (negative) ukuze uqale. Ngaphambi kokuqala udokotela wakho uzokuqinisekisa lokhu ngokuhlolwa, futhi uzophinde uhlolwe njalo ngenkathi uyisebenzisa.

  • I-PrEP isebenza kahle kakhulu uma iphuzwa njengoba kunqatshelwe. Ucwaningo lukhombisa ukuthi i-PrEP yansuku zonke yehlisa ingozi yokuthola i-HIV ngocansi ngaphezu kuka-99%. Inani elincane labantu emhlabeni wonke libe ne-HIV ngenkathi liphuza i-PrEP; lezi zimo ezingavamile ngokuvamile zihilela noma uhlobo lwegciwane olumelana nomuthi noma umuthi ongenele emzimbeni. Ukuyiphuza njengoba kunqatshelwe yikho okwenza isebenze.

  • I-PrEP ivikela kwi-HIV kuphela. Ayikuvikeli ezinye izifo ezithathelwana ngocansi (ama-STI) ezifana ne-syphilis, i-gonorrhoea noma i-chlamydia. Amakhondomu ehlisa ingozi yalezo zifo, futhi ukuhlolwa njalo kwama-STI kuyingxenye yokusebenzisa i-PrEP.

  • I-PrEP ingathinta izinso zakho. Ngokungavamile kungehla ukuhluza kwezinso. Lo mthelela ngokuvamile mncane futhi ubuyela esimweni esejwayelekile uma kuyekwa i-PrEP. Tshela udokotela wakho uma uke waba nezinkinga zezinso noma uphuza eminye imithi ethinta izinso. Udokotela wakho uhlola ukusebenza kwezinso zakho ngaphambi kokuba uqale futhi kanye nasekuhloleni kwakho okujwayelekile.

  • Kunomthelela omncane esibalulekini sethambo. Tshela udokotela wakho uma une-osteoporosis, amathambo abuthakathaka, noma uma kunomlando wezi-zimo emndenini wakho.

  • Udokotela wakho uzohlola isimo sakho se-hepatitis B ngaphambi kokuba uqale, ngoba imithi ese-PrEP futhi isebenza nakwi-hepatitis B.

  • Abanye abantu baba nesisu esixhomayo kancane ekuqaleni (isicanucanu, ukufutha kwesisu, indle ethambile). Lokhu ngokuvamile kuyaphela emasontweni okuqala ambalwa.

  • Ukuhlolwa njalo kubalulekile. Hlela ukuhlolwa okugcwele kwempilo yocansi nokuhlangana nodokotela wakho njalo ezinyangeni ezi-3.

Uma kwakheka noma yikuphi ukugula okukukhathazayo nganoma yisiphi isikhathi, khuluma nodokotela wakho.

Indlela yokuphuza i-PrEP

Indlela oyiphuza ngayo i-PrEP incike ohlotsheni locansi olwenza kakhulu, ngoba umuthi uthatha isikhathi esahlukene ukufinyelela emazingeni avikelayo ezicutshini ezahlukene zomzimba.

Kwabesilisa abangcansa ngababesilisa abathandanayo nabesilisa abathandana nezinhlangothi zombili (i-anal sex)

Kule qembu kunezindlela ezimbili, futhi zombili zisebenza kahle.

I-PrEP yansuku zonke

  • Ukuqala: Qala ukuphuza iphilisi elilodwa nsuku zonke. Ngemva kwamaphilisi ansuku zonke acishe abe-3 usulondolozekile ekungcanseni ngomuva (anal sex). Uma udinga ukuvikeleka ngokushesha, ungaphuza amaphilisi amabili ndawonye njengomthamo wakho wokuqala, lokhu kufinyelela emazingeni avikelayo phakathi nesikhathi esicishe sibe amahora ama-2. Ngemva kwalokho, qhubeka nephilisi elilodwa nsuku zonke.
  • Ukuqhubeka: Phuza iphilisi elilodwa nsuku zonke. Akudingeki ukuthi kube isikhathi esifanayo nsuku zonke, kodwa ukukhetha isikhathi esimisiwe kwenza kube lula ukukhumbula.
  • Ukuyeka: Uma ufuna ukuyeka, qhubeka uphuza i-PrEP ngemva kocansi lwakho lokugcina lwe-anal: iphilisi elilodwa emva kwamahora angama-24, nephilisi elilodwa emva kwamahora angama-48. Lezi zinsuku ezimbili ezengeziwe zigcina amazinga avikelayo esesimweni ukuze avikele noma yikuphi ukuvelelana kwakamuva. Bese uyeka.

I-PrEP yangokwesidingo (2-1-1)

Umthamo wangokwesidingo ucwaningwe kahle kwabesilisa abathandana nabesilisa nabathandana nezinhlangothi zombili abangcansa ngomuva (anal sex). Ocwaningweni lwe-IPERGAY yehlise ingozi ye-HIV ngocishe abe-86%, yenyuka ifinyelele kucishe abe-97% ocwaningweni oluqhubekayo uma iphuzwe kahle.

  • Amaphilisi ama-2, ndawonye, emahoreni ama-2 kuya kwangama-24 ngaphambi kocansi.
  • Iphilisi eli-1 emahoreni angama-24 ngemva komthamo wokuqala ophindwe kabili.
  • Iphilisi eli-1 emahoreni angama-24 ngemva kwalelo (amahora angama-48 ngemva komthamo wokuqala).

Uma ucansi luqhubeka izinsuku ezimbalwa, qhubeka uphuza iphilisi elilodwa njalo emahoreni angama-24, futhi uphuze elakho lokugcina emahoreni angama-48 ngemva kwesikhathi sokugcina owenze ngaso ucansi.

Amaphuzu abalulekile:

  • Umthamo wangokwesidingo usebenza kuphela ngohlobo lwe-PrEP lwe-tenofovir disoproxil/emtricitabine (TDF/FTC) (Truvada nama-generic ayo).
  • Hlela ama-alamu amaphilisi amahora angama-24 nangama-48. Indlela evame kakhulu yokuthi umthamo wangokwesidingo wehluleke ukukhohlwa amaphilisi alandelayo uma ucansi seluphelile. Lawo maphilisi alandelayo yiwo avikelayo.
  • Uma uphila ne-hepatitis B, i-PrEP yangokwesidingo ayikulungele. I-PrEP yansuku zonke iyona engcono.

Kubantu abangcansa ngegolo (i-vaginal) noma nge-neovaginal (abesifazane, abesilisa abathandana nabesifazane, nabantu abanolwazi lwe-trans)

Kucansi olwamukelayo (receptive) lwe-vaginal nelwe-neovaginal, i-PrEP yansuku zonke yiyona ndlela enconywayo. I-tenofovir ithatha isikhathi eside ukufinyelela emazingeni avikelayo kulezi zicubu kunokungcansa ngomuva (anal sex), ngakho-ke umthamo wansuku zonke unikeza ukuvikeleka okuthembeke kakhulu.

  • Ukuqala: Phuza iphilisi elilodwa nsuku zonke. Ngemva kwamaphilisi ansuku zonke acishe abe-7 unamazinga avikelayo ocansi lwe-vaginal nelwe-neovaginal. Ngokungafani nocansi lwe-anal, umthamo ophindwe kabili “wokuqala ngokushesha” awuwunqamuli lo mzila, ngakho wunike izinsuku ezi-7 ezigcwele.
  • Ukuqhubeka: Phuza iphilisi elilodwa nsuku zonke.
  • Ukuyeka: Uma ufuna ukuyeka, qhubeka uphuza iphilisi elilodwa nsuku zonke izinsuku ezingama-28 ngemva kwesikhathi sakho sokugcina osengozini. Lo mzila omude ugcina amazinga avikelayo esesimweni ukuvikela noma yikuphi ukuvelelana kwakamuva.

Ukukhulelwa nokuvimbela inzalo: Uma ungakhulelwa futhi ungcansa ngaphandle kwamakhondomu, khumbula ukuthi ungakhulelwa; cabanga ngokuvimbela inzalo uma ungazami ukukhulelwa. Uhlobo lwe-TDF/FTC lwe-PrEP lunconywa njengolufanele ukuqhubekwa nalo ngenkathi uzama ukukhulelwa, ngesikhathi sokukhulelwa, nangesikhathi sokuncelisa, futhi imihlahlandlela yamanje ayilubheki njengesithiyo sokuqala umndeni. Uma ukhulelwe, uhlela ukukhulelwa, noma uncelisa, tshela udokotela wakho.

Umthamo osekelwe esenzakalweni (inketho entsha okumele uxoxe ngayo nodokotela wakho): I-PrEP yansuku zonke iyinketho ejwayelekile, enconywayo kuleli qembu. Imihlahlandlela emisha yamazwe ngamazwe (i-BASHH, e-UK, ngo-2025) nayo isekela umthamo osekelwe esenzakalweni kwabanye abantu abangcansa ngokwamukela (receptive) nge-vaginal noma nge-neovaginal. Lokhu akukabi yinto ejwayelekile yonke indawo, ngakho kukhulume futhi ukuhlele nodokotela wakho kunokuthi uqale wedwa. Uma ungumlingani owamukelayo (receptive), uhlelo olusekelwayo lungu-2 bese 7: amaphilisi ama-2 emahoreni ama-2 kuya kwangama-24 ngaphambi kocansi, bese iphilisi eli-1 nsuku zonke izinsuku ezi-7 ngemva kwesikhathi sokugcina owenze ngaso ucansi. Uma ungumlingani ofakayo (insertive), uhlelo olusekelwayo lungu-2-1-1. Umthamo osekelwe esenzakalweni usebenza kuphela ngohlobo lwe-TDF/FTC.

Ukuhlolwa njalo

Njengengxenye yenqubo evamile ye-PrEP, uzobona udokotela wakho njalo ezinyangeni ezi-3. Lokhu kungokwesicwaningo esisha, ukuhlolwa okugcwele kwempilo yocansi, nokuhlolwa kwezinso, futhi kuyithuba elihle lokukhuluma ngemiphumela engemihle.

Bona udokotela wakho

I-PrEP iwumuthi odinga incwadi yokwelashwa (i-prescription). Ukuze uthole ukuthi ingabe ikulungele yini nokuthi iyiphi inketho efanele isimo sakho, khuluma nodokotela noma umtholampilo wempilo yocansi lapho ukhona. Bhukha uma kwakheka noma yikuphi ukugula okukukhathazayo, uma ucabanga ukuthi mhlawumbe uke wavelelana ne-HIV ungavikelekile, noma uma sekuyisikhathi sokuhlolwa kwakho kwezinyanga ezi-3.

Lolu lwazi lujwayelekile futhi alungeni esikhundleni sezeluleko zezempilo ezenzelwe wena. I-PrEP iwumuthi odinga incwadi yokwelashwa. Khuluma nodokotela wakho ngokuthi ingabe ikulungele yini.

— Dr George Forgan-Smith, GP (Udokotela Womndeni), osebenza eSydney naseMelbourne