Revista Brasileira de Psiquiatria
Inguqulelo yoshicilelo ISSN 1516-4446Inguqulelo ye-intanethi I-ISSN 1809-452X
Umfundisi Bras. Psiquiatr., phambi kokuprintwa kwe-Epub ngoJuni 07, 2018
http://dx.doi.org/10.1590/1516-4446-2017-2476
KUFUNDWA
Ana Ventuneac3
UCarmita HN Abdo2
Hermano Tavares2
UMaria LS Amaral1
UBruna Messina1
João PLB Martins1
1Ambulatório de Impulso Sexual Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, São Paulo
2Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
3Iziko le-HIV Educational Studies & Training (CHEST), New York, NY, USA
4ISebe lePsychology, i-Hunter College, iYunivesithi yeSixeko saseNew York (CUNY), eNew York, NY, eU.SA
5I-Psychology yezeMpilo kunye neNkqubo yobuGqirha beNzululwazi yezoNyango, iZiko labaDadi, iCUNY, eNew York, NY, eU.SA
KWI-ABSTRACT
Injongo:
Kukho ukunqongophala kwezifundo malunga neemeko zengqondo ezingathandekiyo kunye nokuziphatha okusemngciphekweni ngokwesondo kumadoda azo zonke iindlela zesini abafuna unyango lokuziphatha ngokwesondo okugqithisileyo (ESB). Sijonge ukuphonononga ukunyanzeliswa ngokwesondo (SC), ixhala, ukudakumba, kunye nokuziphatha okusemngciphekweni ngokwesondo kwisampulu yokufuna unyango yamadoda kunye nolawulo.
Iindlela:
Siye sabhalisa ama-88 (37 [42%] gay okanye abathandana besini esibini kunye nama-51 [58%] abathandana besini esingafaniyo) nezigulane ezingalaliswayo zeESB kunye ne-64 yolawulo. Uvavanyo lubandakanya iSikali sokuNyanzeliswa kwezesondo (SCS), i-Beck Anxiety Inventory (BAI), i-Beck Depression Inventory (BDI), kunye nokuziphatha okuyingozi ngokwesondo.
iziphumo:
Xa kuthelekiswa nolawulo, izigulane zangaphandle ze-ESB zibonise ukwanda kwe-SC, ukuxhalaba, kunye nokudakumba, ezihambelanayo. Ngokuphathelele ngesondo kunye namaqabane aqhelekileyo, izigulane ze-ESB zichaza ukwabelana ngesondo ngakumbi, inani elikhulu lamaqabane, ukwabelana ngesondo okungaphezulu, kunye neentlobano zesini ezingakhuselekanga. Ukuxhalaba, ukudakumba, kunye ne-SC zayanyaniswa nokwabelana ngesondo okukhuselweyo kunye neqabane eliphambili, ngelixa zazidityaniswa neentlobano zesini ezingakhuselekanga kunye neqabane eliqhelekileyo. Ukudakumba kwakunxulunyaniswa neentlobano zesini ezingakhuselekanga kunye neqabane eliqhelekileyo. Ukwabelana ngesondo ngaphandle kweekhondom ngaphandle kweekhondom kwaqikelelwa yi-SC kwaye kwachazwa nazizigulane ezingalaliswayo ze-ESB ezinesini esingafaniyo (36%).
Isiphelo:
Idatha inegalelo ebaleni ngokubonelela ngolwazi kumadoda azo zonke iziqhelaniso zesini ezifuna ukhathalelo lwempilo yengqondo. Unxibelelwano phakathi kwezi zinto ze-psychopathological kunye nokuziphatha okusemngciphekweni ngokwesondo kuneempembelelo kwimpilo yoluntu, oogqirha, kunye nophando.
amagama angundoqo: Ukunyanzeliswa ngokwesondo; chaphazela ixhala; ukudakumba; HIV; ukuziphatha okuyingozi ngokwesondo
intshayelelo
Ukususela ngo-2013, xa iindlela zokuxilonga ezicetywayo ze-hypersexual disorder zingabandakanywa kwi-DSM-5,1 Inani elandayo lezifundo lijolise ekuphandeni ngcono abantu abafuna unyango lokuziphatha ngokwesondo ngokugqithisileyo (ESB) kwinzame yokoyisa imiba ephikiswanayo ejikeleze imodeli ecacisayo yeESB. Uphononongo lubonisa ukuba olona tshintsho luphambili kubantu abaneESB kukungxama,2,3 exhasa i-criteria yokuxilonga yokugqithiswa kwesondo kwi-ICD-10.2,4 Olunye uphononongo luqaphele ukuba olona tshintsho luphambili lwe-psychopathological lubandakanya ukuphuhlisa ukunyanzeliswa kokujongana nexhala, elifana ne-obsessive-compulsive disorder (OCD) indlela,5,6 ethanda iindlela zokuxilonga ezicetywayo ngoku kwi-ICD-11 njengesinyanzelo sokuziphatha ngokwesondo.7 Ezinye iinkcukacha zixhasa umbono we-ESB esebenza ngokufanayo kumlutha,8 okubandakanya zombini iimpembelelo kunye nokunyanzeliswa, ukukhetha iindlela zokuxilonga ukuba likhoboka lesondo.9 Indlela entsha yokuphazamiseka kwe-hypersexual disorder yacatshangelwa ngokusekwe kwizifundo zezilwanyana apho ukusebenzisana kotshintsho lwengqondo ye-monoamine metabolism kunye ne-testosterone receptors kubangele umnqweno wesini,10 exhaswa zizifundo ezitsha.11 Ngaphandle kweeyantlukwano, zonke iithiyori ze-ESB ziphawula ukuba, ngaphaya kokubonisa iingcinga zesondo ezigqithisileyo neziphindaphindayo, izibongozo, kunye nokuziphatha ngexesha elithile, aba bantu baxela uxinzelelo ngenxa yeempawu kwaye bafumana iziphumo ezibi kwiindawo eziphambili zobomi, ezinje. njengomsebenzi, impilo kunye nobudlelwane.
Ngenxa yokungxama kwayo kunye nemiba yokulahleka kokulawula,12 I-ESB ichongiwe njengengqikelelo yokuziphatha ngokwesondo okuyingozi kubantu abahlukeneyo e-United States, ngakumbi phakathi kwamadoda angqingili kunye nesini esibini.13,14 Ngokukodwa, olu phononongo luchonge unxibelelwano phakathi kokunyanzeliswa ngokwesondo (SC) kunye neziphumo ezininzi zesondo ezingalunganga, ezinje ngesondo ngaphandle kwekhondom ezimpundu kunye namaqabane amaninzi angaqhelekanga, izehlo eziphezulu zentsholongwane ye-HIV kunye nezinye izifo ezosulela ngokwabelana ngesondo (STIs),15,16 kwaye ngenjongo yokufuna ukwabelana ngesondo ezimpundu ngaphandle kwekhondom.17 Nangona kunjalo, olu phononongo luye lwavavanya iimpawu ze-SC kuluntu olubanzi lwabantu endaweni yeesampulu ezifuna unyango.
Kwabanye abantu abaneESB, indlela abaziphatha ngayo ngokwesondo ayibandakanyi abantu ababelana ngesondo, kodwa igxile ekuphululeni amalungu esini ngokugqithisileyo kunye/okanye ekusebenziseni imifanekiso engamanyala. Nangona kunjalo, ngaphezulu kwesiqingatha sabo bane-ESB baxela iingxaki ezibandakanya ukwabelana ngesondo okunyanzelekileyo kunye namaqabane aqhelekileyo18 kwaye kolunye uphononongo lwamadoda athandana nesini kunye ne-bisexual kunye ne-SC, i-92% yabika ukuba isondo kunye namaqabane angaqhelekanga ayengaphandle kolawulo lwabo.19 Abantu abane-ESB ababelana ngesondo ngokungaqhelekanga nabantu abadala abavumayo basengozini enkulu yolona nyango luqatha kunye nokufa okunxulumene ne-ESB, ekukusasazeka kwee-STIs, kuqukwa ne-HIV.17,20,21 Uphando eUnited States lubonise ukuba amanqaku aphezulu kumlinganiselo osetyenziswa ngokuqhelekileyo we-ESB, i-Sexual Comulsivity Scale (SCS), uqikelele ngesondo kunye namaqabane angaqhelekanga, ukuziphatha okubi kakhulu (umzekelo, ukusetyenziswa kwekhondom ephantsi kunye nokwanda kwesondo ezimpundu), kunye nokufumana ii-STIs.3,22 Ngelishwa, idatha inqabile kunxibelelwano phakathi kwe-ESB kunye nokuziphatha okusemngciphekweni ngokwesondo kumadoda athe tye.13,23 Idatha encinci ekhoyo ayikhange ibandakanye iisampulu ezifuna unyango zabantu abaneESB kwaye ibonise iinkcazo ezinqongopheleyo.
Iimeko zengqondo ezingalunganga, ngakumbi ixhala kunye neemvakalelo zoxinzelelo, ziye zadityaniswa neESB.24 Iindlela zokuziphatha ezinjengokudibana namaqabane amaninzi athandanayo kunye nokwanda kokuphulula amalungu esini kuye kwaxelwa kumadoda aphethwe zezi meko zimbi.25 Iimo zengqondo ezinjalo zicingelwa ukuba zisebenza njengezinto ezibangela iESB26 kwaye inokuququzelela iziqendu ezininzi zokwabelana ngesondo ngaphandle kwekhondom, okonyusa ingozi yokosulelwa yi-HIV kunye ne-STIs. Nangona kunjalo, abanye abaphandi bafumanise ukuba ligcuntswana kuphela (15-25%) labantu abaxela ukonyuka kokuziphatha ngokwesondo xa benoxinzelelo okanye uxinzelelo.27
Ezinye iinkcukacha zibonisa ukuba ukuxhalaba, ukudakumba, okanye umsindo kunokuchaphazela ukwenziwa kwezigqibo ngesondo ngeendlela ezingalunganga.28 Ngokwahlukileyo, olunye uphononongo lufumanise ukuba abanye abantu abanengxaki yokumomotheka banokwenza izigqibo zokuthintela umngcipheko.29 Ngokumalunga nokuthatha umngcipheko ngokwesondo, ezi datha zinokucebisa ukuba abantu abanengxaki yokudakumba okanye abanxungupheleyo abanakukwazi ukuzibandakanya kwindlela yokuziphatha esichengeni ngokwesondo. Noko ke, Mustanski28 Ufumanise ukuba ukonyuka kwamaxhala kwakunxulumene nomngcipheko wesondo ongaphezulu othatha amadoda athile athandana nesini esibini kwaye acingela ukuba izinto ezivuselela ixhala zinokunxulunyaniswa neemvakalelo zochulumanco ezinokuthi zibe yingozi yokuziphatha.
Ngelixa iqela elifanelekileyo lezifundo kwi-ESB liye laqhutywa e-United States, idatha yobungqina malunga ne-ESB eBrazil nakwezinye iindawo zehlabathi ilinganiselwe kakhulu, ibeka esichengeni ukwenziwa kolwazi ngokubanzi, kuba ukuziphatha ngokwesondo kunxulumene nokwahluka kwenkcubeko. Kukho ukunqongophala okuthile kwamaphononongo malunga nefuthe le-ESB kunye nomoya ongalunganga kwindlela yokuziphatha emngciphekweni we-HIV kwiisampulu ezifuna unyango.
Injongo yolu phononongo lwangoku yayikukuvavanya i-ESB, ukuxhalaba, ukudakumba, kunye nokuziphatha okusemngciphekweni ngokwesondo phakathi kwezigulane ezingaphandle kwe-ESB kunye nolawulo kwikomkhulu lelizwe laseSão Paulo, eBrazil. Ngokusekwe kubungqina obuvela e-United States, sicinge ukuba abantu abane-ESB banokubonisa ukonyuka koxinzelelo kunye noxinzelelo kwaye baxele ukuziphatha okusemngciphekweni ngokwesondo kunolawulo. Siphinde saqikelela ukuba ubukhali bexhala, ukudakumba, kunye ne-ESB buya kunxulunyaniswa ngokuqinisekileyo nokuziphatha okusemngciphekweni ngokwesondo.
indlela yokwenza
Abathathi-nxaxheba kunye neenkqubo
Eli phepha libonisa idatha evela kuphononongo oluqhutywe kwi-Ambulatório de Impulso Sexual Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Sexual (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, UniversidadeP . Abathathi-nxaxheba bagaywa ngeentengiso kwiziko nakuluntu olukufutshane kusetyenziswa amajelo eendaba amaninzi, afana nonomathotholo, iimagazini kunye neejenali. Igagasi lokuqala lokugaya elijoliswe kubathathi-nxaxheba abaneempawu ze-ESB, kwaye abo bafuna unyango lwe-ESB balufanelekele uphononongo ukuba bahlelwa njengabanokuziphatha okugqithisileyo ngokwesondo ngokusekwe kwi-ICD-10 criterion F52.7, nto leyo ethetha ukuba bakhalazela i inkanuko yesondo egqithisileyo edla ngokukhokelela kwiESB,4 kunye nokulutha ngesondo okusekelwe kwiikhrayitheriya zikaGoodman, oku kuthetha ukuba kukho i-ESB engafanelekanga ekhokelela ekukhubazekeni kweklinikhi okanye uxinzelelo olubonakaliswe kwixesha elifanayo le-12-inyanga ezintathu okanye ngaphezulu kwezi zilandelayo: ukunyamezela (ukunyuka kokuziphatha ngokwesondo); ukuhoxiswa (izimpawu zomzimba kunye / okanye zengqondo, ezifana nokufumana ukuziyeka); ukuziphatha rhoqo ngokwesondo; ulawulo olungaphumelelanga; ukuchitha ixesha ekulungiseleleni izenzo zesondo; ukunciphisa imisebenzi yentlalo okanye yomsebenzi; kunye nokuqhubekeka ngaphandle kweziphumo ezibi.9 Igagasi lesibini lokufuna abathathi-nxaxheba ekujoliswe kubo ngaphandle kweempawu ze-ESB. Abantu abafuna ukuthatha inxaxheba njengolawulo bebefanelekile ukuba abakhange bahlangabezane neendlela zokuqhuba ngokwesondo ngokugqithisileyo ngokusekwe kwi-ICD-10 ikhrayitheriya F52.7 okanye kumlutha wesondo osekelwe kwiikhrayitheriya zikaGoodman. Ukongezelela, abo babenenxaxheba kwakufuneka babe neminyaka eli-18 ubudala nangaphezulu, bafunde ukulesa, yaye kwakufuneka babe behlala eBrazil kangangeminyaka eli-10 edluleyo. Iikhrayitheriya zokukhutshwa kuphononongo zibandakanya ukuxilongwa kwazo naziphi na iziphazamiso zilandelayo: i-paraphilias (ICD-10 F65), ukuphazamiseka kwesazisi ngokwesini (ICD-10 F64), i-schizophrenia, i-schizotypal kunye ne-delusional disorders (ICD-10 F20-F29), i-manic yangoku. okanye isiqephu se-hypomanic (F 30.0, F31.0, kunye ne-F 31.1, F 31.2), kunye nezinye izifo zengqondo ngenxa yokungasebenzi kwengqondo okanye ukulimala okanye isifo somzimba (ICD-10 F0.6).
Bebonke abantu abangama-204 baphendule kwizibhengezo zophononongo ngexesha lomdlalo wokuqala kwaye abali-130 beza kudliwanondlebe lovavanyo. Kulawa, amadoda angama-114 kunye nabasetyhini be-10 babonwa njengabafanelekile kwaye babhaliswa kuphononongo, kodwa amadoda angama-26 awazange agqibe zonke iimvavanyo ngenxa yezizathu ezahlukeneyo, kubandakanya ukufudukela kwesinye isixeko, ukukhangela unyango lwemeko eyahlukileyo ye-comorbid, okanye ubunzima bokuqonda imilinganiselo yokuziphendulela. Bebonke abantu abali-121 bafuna ukuthatha inxaxheba njengolawulo kwaye abangama-78 beza kudliwano-ndlebe oluhloliweyo. Nangona kunjalo, ezintlanu kwezi zadibana neendlela zokuqhuba ngokwesondo ngokugqithisileyo kunye nokuba likhoboka lezesondo kwaye zakhutshelwa ngaphandle kwisampulu yolawulo. Abaviwa abaseleyo be-73, amadoda angama-64 kunye nabasetyhini abalithoba, bathathwa njengabafanelekileyo njengolawulo kwaye babhaliswe kuphononongo. Kweli phepha, sinika ingxelo yedatha evela kumadoda angama-88 azalisekise iindlela zokuqhutywa ngokwesondo ngokugqithisileyo kunye nokuba likhoboka lezesondo, esiza kubabiza ngokuba zizigulane ezingaphandle kwe-ESB, kunye namadoda angama-64 angazange azalisekise imilinganiselo yokuqhutywa ngokwesondo ngokugqithisileyo kunye nokulutha ngokwesondo, esiya kuthi ulawulo lokufowuna. Zonke iimvavanyo zophononongo zagqitywa ukususela ngo-Oktobha 2010 ukuya kuNovemba ka-2011.
Bonke abathathi-nxaxheba banikezela imvume enolwazi kwaye bagqibezela uvavanyo lwexesha elilodwa le-2 eliquka amanyathelo okuziphendulela asemgangathweni kunye novavanyo lwengqondo. Abathathi-nxaxheba bagqibezela imilinganiselo bebodwa besebenzisa inguqulelo yephepha nepensile. Abancedisi bophando banike isishwankathelo samanyathelo okuzixela kwaye baqokelele idatha ye-sociodemographic. Ugqirha wengqondo wenza udliwano-ndlebe lweklinikhi ukuphanda iindlela zokufaneleka. Ulawulo lufumene inkxaso yemali yezothutho. Unyango lwanikezelwa kwabo baneESB. Olu pho nonongo lwahlaziywa lwaza lwavunywa yikomiti yokuziphatha yeSibhedlele das Clínicas, Faculdade de Medicina, USP.
Amanyathelo
Abathathi-nxaxheba bacelwa ukuba bachaze iminyaka yabo, isini, ubume babo bomtshato obusemthethweni, uhlanga, iminyaka yokufunda, ingqesho, umvuzo wenyanga wosapho, ukuziqhelanisa nesondo, kunye nesimo se-HIV se-serological.
Umlinganiselo wokuziphatha ngokwesondo ngokugqithisileyo (ESB).
I-SCS yaphuhliswa ukuvavanya iintsingiselo zesondo eziphindaphindiweyo kunye nokunyanzeliswa.30 Isikali siqukethe iinkcazo ze-10 (umzekelo, "Iingcinga zam zesini kunye nokuziphatha kwam kubangela iingxaki ebomini bam.") ezilinganiswe kwisikali se-1 ukusuka kwi-4 = kungekhona konke njengam, kwi-0.95 = kakhulu njengam. Ngumlinganiselo osetyenziswa ngokubanzi weESB. Inguqulo yaseBrazil ibonakaliswe ukuba inokuthembeka okulungileyo (i-alpha ye-Cronbach ye-XNUMX).31
Amanyathelo e-Psychopathology
Inguqulelo yesiPhuthukezi ye-Beck Anxiety Inventory (BAI) yaqinisekiswa ukuba isetyenziswe eBrazil32 kwaye ifunyenwe ithembekile (i-alpha kaCronbach = 0.76). Lo ngumlinganiselo we-21-self-reported scale eyenzelwe ukulinganisa ubunzima beempawu zokuxhalaba kunye ne-0-point response response scale: 1 = ngokupheleleyo, 2 = kancinane, 3 = ngokumodareyitha, kunye ne-0.81 = kakhulu. Inguqulelo yesiPhuthukezi ye-Beck Depression Inventory (BDI) yaqinisekiswa ukuba isetyenziswe eBrazil (Cronbach's alpha = XNUMX)33 Esi sisikali esizixeliweyo se-21 eyenzelwe ukulinganisa ubunzulu beempawu zokudakumba, ezinje ngobumnene, obuphakathi, kunye nobunzima.
Indlela yokuziphatha emngciphekweni ngokwesondo
UVavanyo loMngcipheko wokuZiphatha ngokweSondo lwaphuhliswa ngumbhali wokuqala weli phepha ngokusekelwe kuphando lwangaphambili34,35 ukuqokelela ulwazi malunga nokuziphatha ngokwesondo kunye namaqabane aphambili kunye namaqabane aqhelekileyo, kubandakanywa namaxesha enyanga okwabelana ngesondo ngeempundu kunye nelungu lobufazi, ukusetyenziswa kwekhondom, kunye nenani lamaqabane angaqhelekanga. UVavanyo loMngcipheko wokuZiphatha ngokweSondo lwayilwa njengoluhlu lwemibuzo lokuzixela ngokwakho ukuvavanya indlela yokuziphatha emngciphekweni ngokwesondo kwiinyanga ezintandathu ezingaphambili Le khweshine yalingwa kunye nabantu abangama-20 ukujonga imiba ye-semantic kunye nomxholo kwaye yayinealpha kaCronbach yama-83.35%. Kwakhona yayiquka izinto ezihambisanayo malunga nokwabelana ngesondo phantsi kweempembelelo zotywala neziyobisi.
Uhlalutyo lwesatisatisti
Uhlalutyo lwamanani lwenziwa kusetyenziswa i-STATA version 10 enenqanaba lokubaluleka p <0.05. Iinkcukacha-manani ezichazayo zinikezelwa njengemiba yokuguquguquka ngokweendidi kunye neendlela kunye nophambuko olusemgangathweni lweeyantlukwano eziqhubekayo. Uthelekiso lweqela lwenziwe kusetyenziswa iimvavanyo ze-chi-square okanye iireshiyo ze-odds kunye ne-95% yexesha lokuzithemba (95% CI) kwizinto eziguquguqukayo zecategorical, kunye t-uvavanyo lweenguqu eziqhubekayo.
Ukuvavanya i-hypothesis yethu yokuqala yokuba i-ESB izigulane zangaphandle ziya kuxela ukwanda kobunzima boxinzelelo kunye nokudakumba kunye nokuziphatha okungaphezulu kwengozi yesondo kunokulawula, sivavanye umahluko kwiimpawu zokuthatha inxaxheba, ixhala, ukudakumba kunye namanqaku e-SC, kunye nokuziphatha ngokwesondo phakathi kwe-ESB ngaphandle kunye nolawulo. Ukuvavanya ingqikelelo yethu yesibini yokuba ubukhali bexhala, ukudakumba, kunye ne-SC buya kunxulunyaniswa ngokufanelekileyo nokuziphatha okusemngciphekweni ngokwesondo, senze uhlalutyo lwezibalo ze-bivariate emva koko iimodeli zohlengahlengiso ukuze sivavanye igalelo elihambelanayo lemeko yemo engathandekiyo (ixhala, uxinzelelo. ) kunye ne-SC malunga nokuziphatha okusemngciphekweni ngokwesondo, oko kukuthi: 1) ukulala ngokungenakhondom ngaphandle kwekhondom kunye neqabane eliphambili; 2) ukwabelana ngesondo ngaphandle kwekhondom kunye neqabane eliphambili; 3) ukwabelana ngeempundu ngaphandle kwekhondom kunye neqabane eliqhelekileyo; kunye 4) neentlobano zesini ngaphandle kwekhondom neqabane eliqhelekileyo. Zonke iimodeli zahlengahlengiswa ngokobudala, uhlanga, imeko yomtshato esemthethweni, ukuziqhelanisa nesondo, kunye nobume be-serological.
iziphumo
Iimpawu zomthathi-nxaxheba zithiwe thaca kwi 1 Table. Izigulane zangaphandle ze-ESB zazindala kakhulu kunolawulo (t(150) = 2.53; p = 0.006). Ubudala bezigulane ezingaphandle kwe-ESB zaziphakathi kwe-21 kunye ne-66 yeminyaka ubudala kwaye ubudala bolawulo buphakathi kwe-18 kunye ne-59 yeminyaka ubudala. Uninzi lwezigulane ezingaphandle ze-ESB kunolawulo zaziyiCaucasian (χ2(2) = 8.20; p = 0.01). Ngokubhekiselele kwisazisi ngokwesondo, uninzi lwezigulane ezingaphandle ze-ESB zixelwe ukuba zithandana nesini esibini kunolawulo (χ2(1) = 12.10; p = 0.001) kunye nezigulane ezininzi ze-ESB ezingaphandle zaqeshwa (χ2(2) = 16.66; p <0.001). Bekukho umahluko osecaleni kwimeko yomtshato phakathi kwezigulana ezingaphandle kwe-ESB kunye nolawulo, kunye nezigulana ezingaphandle kweESB ezilindeleke ukuba zitshate (χ2(2) = 4.64; p <0.09).
Itheyibhile yoku-1 yedatha ye-Sociodemographic ye-88 yamadoda ezigulane ze-ESB kunye nolawulo lwamadoda angama-64 eSão Paulo, eBrazil
| Izigulana ezingaphandle ze-ESB (n=88) | Ulawulo (n=64) | Iyonke (n=152) | χ2/t uvavanyo lweenkcukacha-manani | |
|---|---|---|---|---|
| Race | ||||
| ECaucasian | 70 (79.5) | 38 (59.4) | 108 (71.1) | |
| Inzala yaseAfrika | 16 (18.2) | 25 (39.1) | 41 (27.0) | |
| omnye | 2 (2.3) | 1 (1.6) | 3 (2.0) | 8.20* |
| Ubume bomtshato obusemthethweni | ||||
| tshatile | 38 (43.2) | 17 (26.6) | 55 (36.2) | |
| enye | 42 (47.7) | 41 (64.1) | 83 (54.6) | |
| bahlukana | 9 (9.1) | 6 (9.4) | 15 (9.87) | 4.64† |
| Ukwaziswa ngezesondo | ||||
| Izitabane kunye nesini esibini | 37 (42.1) | 10 (15.0) | 47 (30.9) | |
| Heterosexual | 51 (58.0) | 54 (84.4) | 105 (69.1) | 12.10‡ |
| Isimo sengqesho | ||||
| Ngasebenzi | 14 (15.9) | 1 (1.6) | 15 (9.9) | |
| I sebenza | 69 (78.4) | 48 (75.0) | 117 (77.0) | |
| umfundi | 5 (5.7) | 15 (23.4) | 20 (13.2) | 16.66‡ |
| Ubume be-serological buxeliwe | ||||
| unknown | 15 (17.0) | 13 (20.3) | 28 (18.4) | |
| Udandathekile | 64 (72.7) | 48 (75.0) | 112 (73.7) | |
| Positive | 9 (10.2) | 3 (4.7) | 12 (7.9) | 0.43 |
| Iminyaka, ndithetha (SD) | 38.17 (8.91) | 33.98 (11.41) | 36.40 (10.21) | 2.53* |
| Iminyaka yemfundo, ithetha (SD) | 14.20 (4.18) | 13.47 (4.02) | 13.89 (4.12) | 1.09 |
| Umvuzo wenyanga (R$), umndilili (95%CI)§ | 3,000 (2,500-3,942) | 3,000 (2,700-4,000) | 3,000 (3,000-3,800) | 0.90 |
| Ukunyanzeliswa ngokwesondo, kuthetha (SD) | 31.93 (5.02) | 15.44 (5.44) | 24.99 (9.67) | 19.30‡ |
| Ixhala, lithetha (SD) | 13.43 (9.98) | 6.48 (8.42) | 10.51 (9.94) | 4.52‡ |
| Ukudakumba, kuthetha (SD) | 16.51 (8.60) | 6.21 (5.66) | 12.18 (9.06) | 8.88‡ |
Idatha enikezelwe njenge-n (%), ngaphandle kokuba kuchazwe ngenye indlela.
I-95% CI = i-95% yexesha lokuzithemba; ESB = ukuziphatha ngokugqithisileyo ngokwesondo; SD = ukutenxa okusemgangathweni.
*p <0.05;
†p <0.10;
‡p <0.001.
§UMann Whitney U vavanyo.
Izigulane zangaphandle ze-ESB zine-SC ephezulu (t(150) = 19.30; p <0.001), ixhala (t(150) = 4.51; p <0.001), kunye namanqaku oxinzelelo (t(149) = 8.88; p <0.001) kunolawulo. Sifumene ukulungelelaniswa okubalulekileyo phakathi kwe-SC kunye nokudakumba (izigulane ze-ESB: r = 0.38; p <0.001; ulawulo: r = 0.25; p = 0.04), i-SC kunye nexhala (izigulane ze-ESB: r = 0.27; p = 0.01; ulawulo: r = 0.33; p = 0.007), kunye nokudandatheka kunye nokuxhalaba (izigulane ze-ESB: r = 0.66; p <0.001; ulawulo: r = 0.70; p <0.001).
Uthelekiso phakathi kwezigulana zangaphandle ze-ESB kunye nolawulo lokuziphatha ngokwesondo kwiinyanga ezintandathu ezingaphambili zibonisiwe 2 Table. Izigulana ezingalaliswayo ze-ESB zazinamathuba aphezulu okuba neentlobano zesini phantsi kweempembelelo zeziyobisi kunolawulo. Iqela lolawulo lichaze ukuziphatha okuthe kratya kwezesondo kunye namaqabane aphambili, ukwabelana ngesondo okungaphezulu kunye namaqabane aphambili, kunye neentlobano zesini ezingakhuselekanga kunye namaqabane aphambili. Izigulana ezingalaliswayo ze-ESB zinike ingxelo yokwabelana ngesondo okuthe kratya kunye namaqabane aqhelekileyo kunye nenani elikhulu lamaqabane aqhelekileyo. Izigulana ezingalaliswayo zeESB zinike ingxelo yokwabelana ngesondo ezimpundu ngakumbi kunye namaqabane aqhelekileyo kunye neentlobano zesini ezingakhuselekanga kunye nazo. Kwabo baxele ukwabelana ngesondo ngaphandle kweekhondom ngaphandle kwekhondom kunye namaqabane aqhelekileyo (n=28), i-18 (64%) bazichaza njengabantu abathandana nesini esibini, ngelixa i-10 (36%) bezichaza ngokuthe ngqo. 3 Table ibonisa ukuhanjiswa kokuziphatha ngokwesondo kwe-ESB izigulane ezingaphandle ngokwesondo. Ngokumalunga nobudlelwane bezesondo kunye namaqabane aphambili, abo bazichongileyo njengabantu abathandana nabesini esahlukileyo baxela ngakumbi ukwabelana ngesondo, ukwabelana ngesondo, kunye nokwabelana ngesondo okungakhuselekanga. Ngokuphathelele kubudlelwane bezesondo kunye namaqabane aqhelekileyo, abo bazichonge njengabathandana besini esahlukileyo baxela ngakumbi ukwabelana ngesondo kunye nesondo elingakhuselekanga, ngelixa abo bazichonge njenge-gay okanye abathandana nesini esibini baveze inani eliphezulu lamaqabane aqhelekileyo kwaye baxela ngakumbi ukwabelana ngesondo ezimpundu.
Itheyibhile 2 Ukuziphatha ngokwesondo kwe-88 ESB izigulana ezingaphandle kunye nolawulo lwe-64, eSão Paulo, eBrazil
| Izigulana ezingaphandle ze-ESB (n=88) | Ulawulo (n=64) | OR | 95%CI | xabiso-p | |
|---|---|---|---|---|---|
| Ukwabelana ngesondo kwiinyanga ezintandathu ezidlulileyo | 74 (84.1) | 50 (78.1) | 1.48 | 0.65-3.37 | 0.350 |
| Ukwabelana ngesondo neqabane eliphambili kwiinyanga ezintandathu ezidlulileyo | 39 (44.3) | 43 (67.2) | 0.39 | 0.20-0.76 | 0.006 |
| Ukwabelana ngesondo kwilungu lobufazi kunye neqabane eliphambili | 32 (36.4) | 39 (60.9) | 0.37 | 0.19-0.71 | 0.003 |
| Ukungasetyenziswa rhoqo kweekhondom ngexesha lokwabelana ngesondo kwilungu lobufazi kunye namaqabane aphambili | 26 (29.6) | 29 (45.3) | 0.51 | 0.26-0.99 | 0.047 |
| Ukwabelana ngesondo ngeempundu neqabane eliphambili | 21 (23.9) | 17 (26.6) | 0.87 | 0.41-1.82 | 0.710 |
| Ukungasetyenziswa rhoqo kweekhondom ngexesha lokwabelana ngesondo ngeempundu namaqabane aphambili | 14 (15.9) | 10 (15.6) | 1.02 | 0.42-2.47 | 0.960 |
| Ukwabelana ngesondo kunye neqabane eliqhelekileyo kwiinyanga ezintandathu ezidlulileyo | 62 (70.5) | 22 (34.4) | 4.55 | 2.28-9.07 | <0.001 |
| Inani lamaqabane okwabelana ngesondo okwethutyana kwiinyanga ezintandathu ezidlulileyo, kuthetha (SD) | 12.63 (27.98) | 0.86 (1.76) | t(150) = -3.36 | 0.001 | |
| 0 | 26 (29.6) | 42 (65.6) | 1 | ||
| 1 | 10 (11.4) | 12 (18.8) | 1.35 | 0.51-3.56 | 0.550 |
| 2 okanye ngaphezulu | 52 (59.1) | 10 (15.6) | 8.4 | 3.64-19.36 | <0.001 |
| Ukwabelana ngesondo kwilungu lobufazi kunye neqabane eliqhelekileyo | 35 (39.8) | 18 (28.1) | 1.69 | 0.84-3.37 | 0.140 |
| Ukungasetyenziswa rhoqo kweekhondom ngexesha lokwabelana ngesondo kwilungu lobufazi kunye namaqabane aqhelekileyo | 23 (26.1) | 12 (18.8) | 0.62 | 0.70-3.37 | 0.290 |
| Ukwabelana ngesondo ngeempundu neqabane eliqhelekileyo | 46 (52.3) | 17 (26.6) | 3.03 | 1.51-6.07 | 0.020 |
| Ukungasetyenziswa rhoqo kweekhondom ngexesha lokwabelana ngesondo ngeempundu kunye namaqabane aqhelekileyo | 28 (31.8) | 9 (14.1) | 2.85 | 1.24-6.58 | 0.010 |
| Ukwabelana ngesondo phantsi kweempembelelo zotywala | |||||
| Hayi | 55 (63.2) | 38 (59.4) | 1 | ||
| Ngamaxesha athile | 29 (32.9) | 25 (39.1) | 0.76 | 0.39-1.50 | 0.440 |
| Ngokuqhelekileyo | 4 (4.6) | 1 (1.6) | 1.14 | 0.58-2.21 | 0.700 |
| Ukwabelana ngesondo phantsi kweempembelelo zeziyobisi | |||||
| Hayi | 74 (84.1) | 63 (98.4) | 1 | ||
| Ngamaxesha athile | 11 (12.8) | 1 (1.6) | 9.00 | 1.07-75.27 | 0.010 |
| Ngokuqhelekileyo | 3 (3.5) | 0 | - |
Idatha enikezelwe njenge-n (%), ngaphandle kokuba kuchazwe ngenye indlela.
I-95% CI = i-95% yexesha lokuzithemba; ESB = ukuziphatha ngokugqithisileyo ngokwesondo; OKANYE = odds ratio.
Ukungasetyenziswa rhoqo kweekhondom kuthetha ukusebenzisa iikhondom kwi-0-75% yamathuba.
Itheyibhile 3 Ukuziphatha ngokwesondo kwe-37 gay / bisexual kunye ne-51 heterosexual ESB ngaphandle kwezigulane, eSão Paulo, eBrazil
| Gay / bisexual | Heterosexual | xabiso-p | |
|---|---|---|---|
| Ukwabelana ngesondo kwiinyanga ezintandathu ezidlulileyo | 31 (83.8) | 43 (84.3) | 0.950 |
| Ukwabelana ngesondo neqabane eliphambili kwiinyanga ezintandathu ezidlulileyo | 8 (21.6) | 31 (60.8) | <0.001 |
| Ukwabelana ngesondo kwilungu lobufazi kunye neqabane eliphambili | 2 (5.4) | 30 (58.8) | <0.001 |
| Ukungasetyenziswa rhoqo kwekhondom ngexesha lokwabelana ngesondo kwilungu lobufazi kunye namaqabane aphambili | 1 (2.7) | 25 (49) | <0.001 |
| Ukwabelana ngesondo ngeempundu neqabane eliphambili | 8 (21.6) | 13 (25.5) | 0.670 |
| Ukungasetyenziswa rhoqo kwekhondom ngexesha lokwabelana ngesondo ngeempundu namaqabane aphambili | 6 (16.2) | 8 (15.7) | 0.950 |
| Ukwabelana ngesondo kunye neqabane eliqhelekileyo kwiinyanga ezintandathu ezidlulileyo | 31 (83.8) | 31 (60.8) | 0.020 |
| Inani lamaqabane okwabelana ngesondo okwethutyana kwiinyanga ezintandathu ezidlulileyo, kuthetha (SD) | 23.8 (39.5) | 4.5 (8.9) | 0.006 |
| Ukwabelana ngesondo kwilungu lobufazi kunye neqabane eliqhelekileyo | 6 (16.2) | 29 (56.9) | <0.001 |
| Ukungasetyenziswa rhoqo kwekhondom ngexesha lokwabelana ngesondo kwilungu lobufazi kunye namaqabane aqhelekileyo | 4 (10.8) | 19 (37.6) | 0.007 |
| Ukwabelana ngesondo ngeempundu neqabane eliqhelekileyo | 29 (78.4) | 17 (33.3) | <0.001 |
| Ukungasetyenziswa rhoqo kwekhondom ngexesha lokwabelana ngesondo ezimpundu kunye namaqabane aqhelekileyo | 18 (48.7) | 10 (19.6) | 0.004 |
Idatha enikezelwe njenge-n (%), ngaphandle kokuba kuchazwe ngenye indlela.
ESB = ukuziphatha ngokugqithisileyo ngokwesondo.
Ukungasetyenziswa rhoqo kweekhondom kuthetha ukusebenzisa iikhondom kwi-0-75% yamathuba.
Umzobo 1 ibonisa ipateni eyahlukileyo yamanqaku kwizinto ezahlukeneyo zengqondo kunye nobudlelwane bezesondo kunye namaqabane aphambili kunye namaqabane aqhelekileyo. Abo banika ingxelo yokusetyenziswa rhoqo kweekhondom kunye namaqabane aphambili babonise amanqaku asezantsi e-psychopathological kunabo baxela ukusetyenziswa rhoqo kweekhondom. Ngokuchaseneyo, abo baxela ukusetyenziswa rhoqo kweekhondom kunye namaqabane aqhelekileyo babonise amanqaku aphezulu e-psychopathological kunabo baxela ukusetyenziswa rhoqo kweekhondom.
Umzobo 1 Ukusetyenziswa kweekhondom kunye namaqabane aphambili kunye namaqabane aqhelekileyo phakathi kokuziphatha ngokwesondo okugqithisileyo (ESB) izigulane ezingaphandle kunye nolawulo (n=152). IMPENDULO: Ukusetyenziswa kwekhondom xa ulalana ngelungu lobufazi kunye neqabane eliphambili. Abo baxela ukusetyenziswa rhoqo kweekhondom ezibonakaliswe ukudakumba okuhla (ithetha [M] = 9.3; ukutenxa okusemgangathweni [SD] = 7.5 vs. 13.8; SD = 9.5) (t[134.5] = 3.2; p = 0.001) kunye namanqaku okuxhalaba (M = 8.0; SD = 9.3 vs. M = 11.9; SD = 10.0) (t[150] = 2.4; p = 0.02); B: Ukusetyenziswa kwekhondom xa ulalana ngeempundu neqabane eliphambili; C: Ukusetyenziswa kwekhondom xa usabelana ngesondo nomntu ongatshatanga naye. Abo baxela ukusetyenziswa kwekhondom rhoqo babonise ukonyuka kwamanqaku okudakumba (M = 14.8; SD = 9.0 vs. 11.4; SD = 9.0) (t[150] = -2.0; p = 0.05); D: Ukusetyenziswa kwekhondom xa ulalana ezimpundu neqabane eliqhelekileyo. Abo banika ingxelo yokusetyenziswa kwekhondom okungaqhelekanga babonise ukwanda kokunyanzeliswa ngokwesondo (SC) (M = 29.8; SD = 9.8 vs. 23.5; SD = 9.5) (t[150] = -3.6; p <0.001), ukudandatheka (M = 17.6; SD = 8.9 vs. M = 10.4; SD = 8.4) (t[150] = -4.4; p <0.001), kunye namanqaku okuxhalaba (M = 15.4; SD = 10.6 vs. M = 8.9; SD = 9.2) (t[150] = -3.6; p <0.001). Akukho ntlukwano ebonakalayo ebonakalayo kwi-SC kwi-A, kuyo nayiphi na ingxaki ye-psychopathological kwi-B, okanye kwixhala kunye ne-SC kwi-C. Ngokuphindaphindiweyo kuthetha i-76-100% yezihlandlo. Ukungaxhaphakanga kuthetha i-0-75% yezihlandlo.
Iimodeli zokubuyisela umva kwindlela yokuziphatha emngciphekweni ngokwesondo zithiwe thaca 4 Table. I-SC yaboniswa ukuba yi-predictor ezimeleyo yokwabelana ngesondo okungakhuselekanga kunye namaqabane aqhelekileyo emva kokulawula iminyaka, uhlanga, imeko yomtshato esemthethweni, isini, kunye nesimo se-serological. Ukunyuka kwenqaku ngalinye kwi-SC kwandisa amathuba okuba neentlobano zesini ngaphandle kwekhondom ngaphandle kwekhondom kunye namaqabane aqhelekileyo nge-7%.
Itheyibhile yesi-4 imodeli yohlengahlengiso yokusetyenziswa kwekhondom ekuziphatheni ngokwesondo ngokubhaliswa ngokugqithisileyo kokuziphatha ngokwesondo (ESB) kwizigulane zangaphandle kunye nolawulo (n=152), eSão Paulo, eBrazil
| Imodeli yokusetyenziswa kwekhondom kukwabelana ngesondo kwilungu lobufazi kunye neqabane eliphambili | Imodeli yokusetyenziswa kwekhondom xa ulala ngeempundu neqabane eliphambili | Imodeli yokusetyenziswa kwekhondom kukwabelana ngesondo kwilungu lobufazi kunye neqabane eliqhelekileyo | Imodeli yokusetyenziswa kwekhondom xa usabelana ngesondo ngeempundu neqabane eliqhelekileyo | |||||
|---|---|---|---|---|---|---|---|---|
| rhoqo* | Isincoko | rhoqo* | Isincoko | rhoqo* | Isincoko | rhoqo* | Isincoko | |
| Ukunyanzelwa ngokwesini | ||||||||
| OR | isingqiniso | 1.00 | isingqiniso | 1.04 | isingqiniso | 0.98 | isingqiniso | 1.07† |
| 95%CI | - | 0.94-1.06 | - | 0.98-1.11 | - | 0.91-1.05 | - | 1.01-1.14 |
| ukudakumba | ||||||||
| OR | isingqiniso | 0.95 | isingqiniso | 0.90† | isingqiniso | 1.03 | isingqiniso | 1.05 |
| 95%CI | - | 0.87-1.03 | - | 0.81-1.00 | - | 0.93-1.15 | - | 0.97-1.13 |
| Ukuxhalabisa | ||||||||
| OR | isingqiniso | 1.00 | isingqiniso | 1.03 | isingqiniso | 1.00 | isingqiniso | 1.02 |
| 95%CI | - | 0.95-1.07 | - | 0.96-1.11 | - | 0.92-1.09 | - | 0.96-1.08 |
I-95% CI = i-95% yexesha lokuzithemba; OKANYE = odds ratio.
*76-100%.
†p <0.05.
Zonke iimodeli zahlengahlengiswa ngokweminyaka, uhlanga, ubume bomtshato, isini, kunye nobume be-serological.
ingxoxo
Iintlobo ezimbini zokuziphatha okusemngciphekweni ngokwesondo zinokwahlulwa. Okokuqala, malunga nokwabelana ngesondo neqabane eliphambili, ulawulo lunike ingxelo yokuxhaphaka okuphezulu kokwabelana ngesondo kwilungu lobufazi, uninzi lwayo ibilukwabelana ngesondo okungakhuselekanga. Oku mhlawumbi kwakungenxa yokuba kukho amadoda athe tye ngakumbi kwisampulu yolawulo, ababelana ngesondo kunye neqabane labo ngaphandle kweekhondom, eziqhelekileyo kumxholo wobudlelwane obude bexesha elide. Okwesibini, malunga nokwabelana ngesondo kunye namaqabane aqhelekileyo, izigulane ezingaphandle kwe-ESB zinike ingxelo yamaqabane amaninzi aqhelekileyo, i-frequencies ephezulu yokwabelana ngesondo kunye namaqabane aqhelekileyo, i-frequencies ephezulu yokwabelana ngesondo ezimpundu, kunye namaxesha aphezulu okwabelana ngesondo ngaphandle kwekhondom kunolawulo. Le ndibaniselwano iyakhathaza ngenxa yengozi ye-STIs kunye nokosulela kwe-HIV. Uhlalutyo lwe-meta luphonononge indima yokwabelana ngesondo ezimpundwini ekusasazekeni kwe-HIV kwaye kwaqukunjelwa ukuba ukwabelana ngeempundu sisenzo esisemngciphekweni omkhulu wosulelo lwe-HIV nangexesha lonyango olusebenza kakhulu lwe-antiretroviral.36 Ngaphezu koko, bafumene inani elandayo labantu abathandana besini esahlukileyo ababandakanyeka kwiintlobano zesini ngeempundu kunye namazinga aphantsi okusetyenziswa kwekhondom,36 engqinelana nedatha yethu, apho i-36% yabathathi-nxaxheba be-ESB abachaze ukwabelana ngesondo ngaphandle kweekhondom kunye namaqabane aqhelekileyo babengamadoda athe ngqo. Xa sigxile ekuziphatheni ngokwesondo kwezigulana ezingaphandle kwe-ESB, sikwaqwalasele inxenye efanelekileyo yamadoda abelana ngesini esahlukileyo abelana ngesondo ngeempundu kunye neentlobano zesini ngaphandle kwekhondom kunye namaqabane aphambili.
Kubalulekile ukucacisa ukuba i-16% ye-ESB izigulane kunye ne-22% yolawulo ayizange idibanise neentlobano zesini kunye namaqabane kwiinyanga ezintandathu zokugqibela. Ke ngoko, uhlalutyo lokuziphatha komngcipheko ngokwesondo aluzange luqwalasele isampula yonke kwaye lunokuthi luphazamise amandla ayo okubalwa ukuze lubone umahluko. Kusenokwenzeka ukuba esi sizathu sokuba bekungekho mahluko abalulekileyo phakathi kothelekiso phakathi kwamaqela ngokwemigaqo yokuphindaphinda ukulalana kwelungu lobufazi kunye neentlobano zesini ngaphandle kwekhondom kunye namaqabane angaqhelekanga, nangona i-ESB izigulane zangaphandle, ngakumbi amadoda athe tye, anika ingxelo yolu kuziphatha. kunolawulo.
Ipatheni eyahlukileyo yokubonakaliswa kwengqondo yavela kuhlalutyo lokuziphatha okuyingozi ngokwesondo kunye namaqabane aphambili kunye namaqabane aqhelekileyo. Okuxhalabisa kakhulu, abo baxela ukusetyenziswa kwekhondom rhoqo kunye namaqabane aqhelekileyo babonise amanqaku aphezulu e-psychopathological, ngakumbi xa belalana ngeempundu. Ezi ziphumo zihambelana nezifundo ezichaza umphumo othe ngqo wokuchaphazela (uxinzelelo, ukuxhalaba)28,37 kunye ne-SC17,30 kwindlela yokuziphatha emngciphekweni we-HIV. Ngokufanelekileyo, ixhala linokunxulunyaniswa nokuthatha umngcipheko ngokwesondo, ngakumbi xa kuthathelwa ingqalelo ithiyori yokudlulisa ixhala, apho ixhala kunye nokuvuseleleka ngokwesondo zabelana ngezinto ezithile, kwaye abanye abantu bavuselela inkanuko yesini ukunciphisa iimpawu zokuxhalaba,38 ngaloo ndlela utyekele ngakumbi ekuthatheni ingozi ngokwesondo.28 Ukudakumba kunokubangela ukuba kusebenze indlela yokuziphatha ngokwesondo,25 nto leyo, ebonakala ngakumbi xa isenzeka ngaxeshanye ne-SC ephezulu.39 Ngapha koko, izifundo ezininzi ziye zaxela ukwanda kokuziphatha ngokwesondo kubantu abane-ESB,40 ehambelana kakhulu ne-SC. Abo babonisa intshukumo enkulu yezesondo yokuziphatha ngokwesondo badla ngokuthatha imingcipheko eyongezelelekileyo yokosulela kwe-HIV.26,28 Ke ngoko, i-SC ibonakala inefuthe elithile ekuziphatheni okusemngciphekweni ngokwesondo, kuba yaxela kwangaphambili ukuba neentlobano zesini ngaphandle kwekhondom kunye namaqabane aqhelekileyo kuphononongo lwethu. Ukudakumba kunye nokuxhalaba akuzange kugcine unxibelelwano kunye nokuziphatha komngcipheko kwi-logistic regression. Oku kungenxa yokuba zihambelana ne-SC kwaye zinokudlala indima engathanga ngqo ekuziphatheni komngcipheko ngokwesondo, umzekelo, ukwandisa ubunzima be-SC. Idatha yethu iyavumelana nezifundo zabantu zangaphambili kumadoda abelana ngesondo namadoda (MSM)17 kunye nezifundo zeklinikhi kwi-HIV,21 apho i-SC yaxela kwangaphambili ukuziphatha okuyingozi ngokwesondo.
Idatha yethu ineempembelelo kwimpilo yoluntu, oogqirha, kunye nophando. Unxulumano phakathi koxinzelelo, ukudakumba, kunye ne-SC kunye nobudlelwane babo kunye nokwabelana ngesondo ngaphandle kwekhondom ngaphandle kwekhondom kunye namaqabane aqhelekileyo axhasa uphando lwamva nje olucebisa ukuba ukuziphatha okusemngciphekweni kwe-HIV kunokuchazwa ngcono ngengqikelelo ye-syndemic, okuthetha ukuba umngcipheko wokufumana imeko uphumela ngakumbi ekusebenzisaneni izinto ezininzi zomngcipheko kunesiphumo esizimeleyo sezinto zomntu ngamnye.22 Ezi datha zibaluleke kakhulu kwimpilo yoluntu, kuqwalaselwa ukuba zihlobene namadoda azo zonke iimpawu zesini kwisimo seklinikhi yengqondo. Unxulumano phakathi kwezi zinto ze-psychopathological kukwabhekiselele kwiinjongo zeklinikhi, kuba yonyusa ubukhali kwaye yenza unyango lube nzima ngakumbi,41 ngakumbi kuthathelwa ingqalelo ukuba abantu abanjalo bazisa iingxaki zokubambelela kunyango. Okokugqibela, unxibelelwano phakathi kweempawu zengqondo (ixhala, ukudakumba, kunye ne-SC) inegalelo kuphando ebaleni, kuba ixhasa inqobo yokuphazamiseka kwe-hypersexual disorder: "ukuzibandakanya ngokuphindaphindiweyo kwezi ngcinga zesini, izibongozo, kunye nokuziphatha ekuphenduleni imeko ye-dysphoric mood. umzekelo, ixhala, ukudakumba, ukukruquka, ukucaphuka). Ukonyuka kokuvuselelwa ngokwesondo ngokukodwa okunxulunyaniswa nezi mpawu zomoya kukhomba ukubaluleka kophando lwexesha elizayo kwiindlela zomnqweno wesini kunye nokuvusa inkanuko kubantu abaneESB ukuphucula ukuqonda eyona nto iphambili ye-psychopathological and pathophysiological ebandakanyekayo.
Uphononongo lwethu lusekwe kwisampulu eluncedo yeklinikhi, ebangele ukuba abanye abantu abanxibelelane nathi bangaqhubeki nenkqubo yovavanyo kwaye, ngenxa yoko, asikwazanga ukuqokelela idatha kubo. Abo bagqiba inkqubo yokuhluza babandakanyiwe, ngaphandle kokuba bafundile. Le miba ithintela ukwenziwa ngokubanzi kwedatha yethu. Ngelishwa, kukho iiyantlukwano ezimbalwa ze-sociodemographic phakathi kwe-ESB ngaphandle kwezigulane kunye nolawulo. Ngokukodwa, kuya kuba ngcono ukuba sinokulinganisela ngakumbi ekusasazeni i-sexual orientation phakathi kwamaqela, kuba amadoda angama-gay kunye ne-bisexual ahlala exela ngakumbi ixhala, ukudakumba, kunye neentlobano zesini.17 Ngapha koko, siye sahlengahlengisa uhlengahlengiso kwindlela yokuziphatha emngciphekweni ngokwesondo yobudala, ubuhlanga, ubume bomtshato obusemthethweni, ubume be-serological, kunye nokuziqhelanisa ngokwesondo ukunqanda iziphumo ezibhidayo. Omnye umda wolu phononongo kukungaphandwa kobunzima bomntwana. Izigulane ezingaphandle kwe-Hypersexual zixela ubunzima obungakumbi bomntwana, obunxulumene neempawu ezidakumba,42 kwaye zombini izinto zinokunyusa amathuba okuziphatha okunobungozi ngokwesondo. Ngokolwazi lwethu, esi sisifundo sokuqala kwi-SC, isimo sengqondo esingalunganga, kunye nokuziphatha okusemngciphekweni ngokwesondo kwimeko yeklinikhi yengqondo ekwabandakanya amadoda athandana nesini esahlukileyo. Idatha yethu igxininisa ukubaluleka kokuphanda i-SC, ixhala, kunye nokudakumba kubantu abafuna unyango lwe-ESB, njengoko ukujongana nale miba yengqondo kunganceda ukuthintela usulelo lwe-HIV.
Imibulelo
Olu pho nonongo luxhaswe yi Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; isibonelelo 2010/15921-6).
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Ifunyenwe: Agasti 30, 2017; Yamkelwe: Disemba 07, 2017
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