Revista Brasileira de Psiquiatria
Uhlobo lokuphrinta I-ISSN 1516-4446Uhlobo oluku-inthanethi I-ISSN 1809-452X
UMfu Bras. IPsiquiatr., Ngaphambi kokuphrinta i-Epub Juni 07, 2018
http://dx.doi.org/10.1590/1516-4446-2017-2476
KUFUNDWA
U-Ana Ventuneac3
UCarmita HN Abdo2
UHermano Tavares2
UMaria LS Amaral1
UBruna Messina1
AmaJoão PLB Martins1
1I-Ambulatório de Impulso I-sex Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Ucansi (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
2Departamento de Psiquiatria, Faculdade de Medicina, USP, São Paulo, SP, Brazil
3Isikhungo Sezifundo Nokuqeqeshwa Kwe-HIV (CHEST), eNew York, NY, e-USA
4UMnyango Wezengqondo, iHunter College, iCity University of New York (CUNY), New York, NY, USA
5I-Health Psychology ne-Clinical Science Doctoral Programme, Isikhungo Sothweswa Iziqu, CUNY, New York, NY, USA
UKUQALA
Injongo:
Kukhona ukuntuleka kwezifundo ezikhundleni ezingezinhle zokuziphatha okubi kanye nokuziphatha okuyingozi kwezocansi emadodeni azo zonke izinkomba zokwenza ucansi ngokweqile (ESB). Sihlose ukuhlola ukuvivinya umzimba ngokocansi (i-SC), ukukhathazeka, ukucindezelwa, kanye nokuziphatha okuyingozi kwezocansi kusampula yokufuna amadoda kanye nezilawuli.
Izindlela:
Sabhalisa i-88 (37 [42%] gay or bisexual and 51 [58%] heterosexual) Ukuphuma kwe-ESB nokulawulwa kwe-64. Ukuhlola kufaka phakathi i-Sexual Compulsivity Scale (SCS), i-Beck Anxcare Inventory (BAI), i-Beck Depression Inventory (BDI), kanye nezindlela zokuziphatha okuyingozi kwezocansi.
Ezenye:
Kuqhathaniswa nezilawuli, ukuphuma kwe-ESB kukhombise ukwanda kwe-SC, ukukhathazeka nokudangala, obekuhlangene. Mayelana nokuya ocansini nabantu abathandana nabo, abebephuma ngaphandle kwe-ESB babike ukulala ngocansi okuningana, inani elikhulu labalingani, ukuhlangana okuningi kwe-anal, kanye nokulala okungavikelekile kwe-anal. Ukukhathazeka, ukudangala, kanye ne-SC kuhlotshaniswa nokuya ocansini okuvikelekile nomlingani ophambili, kanti bekuhlotshaniswa nokulalana okungavikelekile komlingani nomuntu ongathandani naye. Ukudana komoya bekuhlotshaniswa nokuya ocansini olungavikelekile nophathina ongathandani naye. Ukuhlangana kwe-anal engenamakhondomu kwabikezelwa yi-SC futhi kwabikwa ngabakhipha ubulili be-ESB abangaphandle (36%).
Isiphetho:
Imininingwane ifaka endle ngokunikeza imininingwane ngamadoda azo zonke izinkomba zobulili afuna usizo lwezempilo lwengqondo. Ukuxhumana phakathi kwalezi zinto ezinengqondo kanye nokuziphatha okuyingozi kwezocansi kunethonya empilweni yomphakathi, odokotela kanye nocwaningo.
Amazwi Key: Ukuphoqelelwa ngokobulili; thinta; ukukhathazeka; ukudangala; I-HIV; ekuziphatheni kobungozi bocansi
Isingeniso
Kusukela i-2013, lapho imigomo ehlongozwayo yokuxilongwa kwesifo se-hypersexual ingafakwanga ku-DSM-5,1 inani elandayo lezifundo lihlose ukuphenya kangcono abantu abafuna ukwelashwa ngokweqile kweziphathamandla zokuziphatha ngokocansi (i-ESB) emzamweni wokunqoba izingqinamba eziphikisanayo nemodeli echazayo ye-ESB. Ucwaningo lukhombisa ukuthi ukushintshwa okukhulu kubantu abane-ESB kungukuxoshwa,2,3 esekela izindlela zokuxilonga zokushayela ngokweqile kwe-sex drive ku-ICD-10.2,4 Olunye ucwaningo luphawulile ukuthi ushintsho oluphambili lwe-psychopathological lubandakanya ukuthuthukisa ukuphoqelelwa kokubhekana nokukhathazeka, okufanayo ne-obsessive-activive disorder (OCD) mechanism,5,6 evumela izindlela zokuhlonza zamanje eziphakanyisiwe ku-ICD-11 njengengxabano yokuziphatha kokuziphatha kobulili okuphoqelekile.7 Eminye imininingwane isekela umqondo we-ESB osebenza ngokufana nomlutha,8 okubandakanya ukuthonya okungabekezelelekiyo nokuphoqelela, ukuthanda izindlela zokuxilonga zokulutha ngokocansi.9 Izindlela ezintsha zokuphazamiseka kwe-hypersexual zachazwa ngokwezifundo zezilwane lapho ukuhlangana kwezinguquko kwe-brain monoamine metabolism kanye ne-testosterone receptors kuholele ekuphakameni kwesifiso sobulili,10 esekelwa izifundo ezintsha.11 Ngaphandle komehluko, yonke imibono ye-ESB iyazi ukuthi, ngaphandle kokwethula imicabango eyeqisayo futhi ephindaphindayo yocansi, ukunxusa, nokuziphatha ngaphakathi kwesikhathi esithile, laba bantu babika usizi ngenxa yezimpawu futhi behlangabezana nemiphumela emibi ezingxenyeni eziphambili zempilo, okunjalo njengomsebenzi, impilo, nobudlelwano.
Ngenxa yokuphoqelela kanye nokulahleka kokulawula kwezinto,12 I-ESB ikhonjwe njengeqagela ngokuziphatha okuyingozi kobulili kubantu abahlukahlukene e-United States, ikakhulukazi phakathi kwamadoda athandana nobungqingili.13,14 Ngokuqondile, lolu cwaningo luveze ukuxhumana phakathi kokucindezelwa ngokocansi (i-SC) kanye nemiphumela eminingana emibi yocansi, njengokuya ocansini ngaphandle kokuya ocansini nabalingani abaningi abathandana nabo, izehlakalo eziphakeme zegciwane lokugonywa komuntu (i-HIV) nezinye izifo ezithathelwana ngocansi.15,16 futhi ngamabomu ngifuna ubulili bo-anal ngaphandle kwekhondomu.17 Kodwa-ke, lezi zifundo zihlole izimpawu ze-SC kubantu abaningi kakhulu esikhundleni samasampula afuna ukwelashwa.
Kwabanye abantu abane-ESB, ukusebenza kwabo kocansi akubandakanyi abalingani bezocansi, kepha kunalokho kugxile ekushaya indlwabu kanye / noma ukusetshenziswa kwezithombe zocansi. Kodwa-ke, ngokuvamile ngaphezu kwengxenye yalabo abane-ESB babika izinkinga ezibandakanya ukuya ocansini okuphoqelela nabalingani abangathandani nabo18 futhi ocwaningweni olulodwa lwamadoda athandana nobungqingili abane-SC, i-92% ibike ukuthi ubulili nabalingani abathandana nabo abusekho emandleni abo.19 Abantu abane-ESB abahlanganyele kubantu besifazane abaningi abavumelana nabesifazane abavumayo bengozi enkulu kakhulu yokulimala okubi kakhulu kokushona kwabantu nokufa okuhlobene ne-ESB, okuwukudluliselwa kwezifo ezithathelwana ngocansi, kubandakanya ne-HIV.17,20,21 Ucwaningo e-United States lukhombisile ukuthi amaphuzu aphezulu ngesilinganiso esivame ukusetshenziswa kwe-ESB, i-Sexual Compulsivity Scale (SCS), abikezela ubulili nabantu abathandana kakhulu nabaziphatha kabi, indlela yokuziphatha ebeka engcupheni enkulu (isib. Ukusetshenziswa kwekhondomu ephansi kanye nokwanda kobulili obuhlangene), nokutholwa kwama-STI.3,22 Ngeshwa, idatha iyashoda ekuxhumaneni phakathi kwe-ESB nokuziphatha okuyingozi kobulili kumadoda aqondile.13,23 Idatha encane eyengeziwe ayizange ibandakanye amasampula afuna abantu abathobekile abane-ESB futhi yethule izincazelo ezinqunyelwe.
Izimo zemood ezingezinhle, ikakhulukazi ezikhathazayo nezidabukisayo, ziye zahlotshaniswa ne-ESB.24 Ama-Behaviours afana nokuhlangana nabalingani abaningi abathandana nabobulili obuhlukile kanye nokwanda kokushaya indlwayi kuye kwabikwa emadodeni aphethwe yilezi zimo ezingezinhle zemizwa.25 Lezi zimo ezingezinhle zezwe kucatshangwa ukuthi zisebenza njengezimbangela ze-ESB26 futhi ingahle yenze ezinye iziqephu zocansi olungenamakhondomu, yandisa ubungozi bokuthola i-HIV ne-STI. Kodwa-ke, abanye abacwaningi bathole ukuthi bambalwa kuphela (i-15-25%) yabantu ababika ngokwanda kwezindlela zokuziphatha zocansi lapho bebhekene nokukhathazeka noma ukucindezelwa.27
Eminye imininingwane iphakamisa ukuthi ukubhekana nokukhathazeka, ukudana, noma intukuthelo kungathinta ukwenza izinqumo zocansi ngezindlela ezingezinhle.28 Ngakolunye uhlangothi, olunye ucwaningo luthole ukuthi abanye abantu ababhekene nezimo ezingezinhle zezimo zomoya kungenzeka benze izinqumo zokugwema ubungozi.29 Mayelana nokuthatha ubungozi bocansi, le mininingwane izophakamisa ukuthi abantu ababhekene nengcindezi noma ukukhathazeka babe mancane amathuba okuzibandakanya ekuziphatheni kwengozi yezocansi. Noma kunjalo, uMustanski28 kutholwe ukuthi ukwanda kokukhathazeka kuhlobene nengozi ethe xaxa yocansi ekuthatheni amadoda athile athandana nobungqingili futhi kwagcizelelwa ukuthi izingxenye ezivusa amadlingozi zingaxhunyaniswa nemizwa yenjabulo engase ibe nokuziphatha okuyingozi.
Ngenkathi kuye kwenziwa ucwaningo olufanele ku-ESB e-United States, imininingwane ye-ESB eBrazil nakwezinye izingxenye zomhlaba incane kakhulu, ikwenza kungabi bikho kolwazi, ngoba ukuziphatha kocansi kuhlobene nokuhlukahluka kosiko. Kunokushoda okuthile kwezifundo mayelana nomthelela we-ESB kanye nesimo esingesihle ekuziphatheni kwengozi ye-HIV kumasampula afuna ukwelashwa.
Inhloso yalolu cwaningo olukhona kwakuwukuhlola i-ESB, ukukhathazeka, ukudangala, kanye nokuziphatha okuyingozi kwezocansi phakathi kwabaxhasi be-ESB nokulawulwa enhlokodolobha yesifundazwe saseSão Paulo, eBrazil. Ngokusekelwe ebufakazini obuvela e-United States, sathola ukuthi abantu abane-ESB bazokwethula ubukhulu bokukhathazeka nokudangala futhi babike nokuziphatha okuyingozi kakhulu ocansini kunokulawula. Siphinde sathola ukuthi ubukhulu bokukhathazeka, ukudangala, kanye ne-ESB kungahle kuhlotshaniswe nokuziphatha okuyingozi ngocansi.
Indlela
Abahlanganyeli nezinqubo
Leli phepha linemininingwane evela ocwaningweni olwenziwe e-Ambulatório de Impulso sex Excessivo e Prevenção de Desfechos Negativos Associados ao Comportamento Ngocansi (AISEP), Instituto de Psiquiatria (IPq), Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP) . Ababambiqhaza baqashwa ngokukhangiswa esikhungweni nasemphakathini oseduzane ngezindawo eziningi zemithombo yezindaba, njengomsakazo, amamagazini kanye namajenali. Igagasi lokuqala lokuqashwa kwabhekiswa kwabahlanganyeli abanezimpawu ze-ESB, nalabo abafuna ukwelashwa kwe-ESB babefanelekile ukuthola lolu cwaningo uma behlukaniswa ngokuthi banomdlandla wezocansi ngokweqile ngokususelwa ku-ICD-10 criterion F52.7, okusho ukuthi bakhalaza ngokweqile ngokweqile kwezocansi idrayivu evame ukuholela ku-ESB,4 kanye nokulutha okuya ocansini okususelwa kunqubo yeGoodman, okusho ukuthi kukhona i-ESB engalungiseki eholela ekunciphiseni komzimba noma ekuxinekeni okuboniswe esikhathini esiyinyanga eyodwa ye-12 ngabathathu noma ngaphezulu kwalokhu okulandelayo: ukubekezelela (ukwanda kokuziphatha kobulili); ukuhoxa (izimpawu zomzimba kanye / noma zengqondo, njengokuhlangabezana nokuchithwa); ukuzibandakanya njalo ocansini; ukulawulwa okungaphumelelanga; ukuchitha isikhathi elungiselela ukwenza ucansi; kuncishiswe imisebenzi yezenhlalo noma yomsebenzi; nokuqhubeka naphezu kwemiphumela emibi.9 Igagasi lesibili lokuqashwa kwababambiqhaza ngaphandle kwezimpawu ze-ESB. Abantu abafuna ukuhlanganyela njengezilawuli babefanelekile uma bangahlangabezani nezindlela zokuya ocansini ngokweqile ngokuya nge-ICD-10 criterion F52.7 noma umlutha wobulili osuselwa enkambisweni kaGoodman. Ngaphezu kwalokho, ababambiqhaza bekufanele babe neminyaka engu-18 noma ngaphezulu, babe nolwazi lokufunda, futhi bekufanele ngabe bahlala eBrazil iminyaka engu-10 yokugcina. Izindlela zokuxoshwa ocwaningweni zifake ukutholakala kwanoma yikuphi ukuphazamiseka okulandelayo: i-paraphilias (ICD-10 F65), ukuphazamiseka kobunikazi bobulili (ICD-10 F64), i-schizophrenia, i-schizotypal kanye ne-delusional (ICD-10 F20-F29), i-manic yamanje noma isiqephu se-hypomanic (F 30.0, F31.0, ne-F 31.1, F 31.2), nokunye ukuphazamiseka kwengqondo ngenxa yokungasebenzi kwengqondo noma ukulimala noma isifo somzimba (ICD-10 F0.6).
Ingqikithi yabantu abathile be-204 baphendule ezikhangisweni ezifundwayo phakathi ne-wave yokuqala kwathi i-130 yeza kuxoxwa nabo. Kulaba, amadoda e-114 nabesifazane be-10 babethathwa njengabakulungele futhi babhaliswa ocwaningweni, kepha amadoda akwa-26 akazange aqede konke ukuhlolwa ngezizathu ezahlukahlukene, kufaka phakathi ukuthuthela kwelinye idolobha, afune ukwelashwa ngesimo se-comorbid ehlukile, noma ubunzima bokuqonda izindlela zokuziphendula. Inani eliphelele labantu be-121 lifune ukubamba iqhaza njengezilawuli futhi i-78 yeza kuzolalelwa inhlolokhono. Kodwa-ke, ezinhlanu zalezi zahlangabezana nezindlela zokusebenzisa kabi i-sex drive kanye nokulutha ngokweqile kwezocansi futhi azikhange kusampula yokulawula. Abasele ukhetho lwe-73, amadoda e-64 nabesifazane abayisishiyagalolunye, babonwa njengabalungele njengezilawuli futhi babhaliswa ocwaningweni. Kuleli phepha, sibika idatha evela kwabesilisa be-88 abafeze imigomo yokusebenzisa i-sex drive ngokweqile kanye nokulutha ngokweqile kwezocansi, esizobabiza ukuphuma kwe-ESB, kanye nabesilisa be-64 abangazange bafeze imigomo yokusebenzisa kakhulu ubulili nokulutha ngokweqile kwezocansi. Izilawuli zezingcingo. Zonke izivivinyo zokufunda zaqedwa kusuka ngo-Okthoba 2010 kuya kuNovemba 2011.
Bonke ababambiqhaza banikeze imvume enolwazi futhi baqedela ukuhlolwa kwehora elilodwa le-2 okubandakanya izindlela zokuphendula ezijwayelekile nokuhlolwa kwengqondo. Ababambiqhaza bagcwalise izindlela bebodwa besebenzisa iphepha nepensela. Abasizi bocwaningo bahlinzeka ngesibalo sezinyathelo zokuzibika futhi baqoqa imininingwane ye-socialodemographic. Udokotela wezengqondo wenza inhlolokhono yomtholampilo ukuphenya inqubo yokufaneleka. Izilawuli zithole ukusekelwa kwezezimali zokuhamba. Ukwelashwa kwanikezwa labo abane-ESB. Lolu cwaningo lubukeziwe futhi lwavunywa yikomidi lesimilo se-Hospital das Clínicas, Faculdade de Medicina, USP.
Izindlela
Abahlanganyeli bacelwe ukuthi babike iminyaka yabo, ubulili, isimo somshado esisemthethweni, ubuhlanga, iminyaka yemfundo, umsebenzi, imali engenayo yomndeni yanyanga zonke, isimo sezocansi kanye nesimo se-HIV.
Izenzo zokuziphatha zocansi ngokweqile (i-ESB)
I-SCS yathuthukiswa ukuze ihlole izinkambiso zokuphindaphindeka kwezokwazisa ngocansi nokuphoqelelwa.30 Isikali siqukethe izitatimende ze-10 (isib., "Imicabango yami yokuziphatha kanye nokuziphatha kwami kubangela izinkinga empilweni yami.") Kukalwe ngesilinganiso samaphoyinti amane ukusuka ku-1 = hhayi njengami, kuya ku-4 = njengami. Kuyindlela esetshenziswa kabanzi ye-ESB. Uhlobo lwaseBrazil luye lwaboniswa lunokwethenjwa okuhle (i-Cronbach's alpha ye0.95).31
Izindlela ze-Psychopathology
Uhlobo lwePutukezi lwe-Beck Anxcare Inventory (BAI) lwaqinisekiswa ukuthi lusetshenziswe eBrazil32 futhi kutholakale ukuthi ayithembekile (Cronbach's alpha = 0.76). Lesi yisikali se-21-nto esizenzele yona esiklanyelwe ukukala ubukhulu bezimpawu zokukhathazeka ngesilinganiso samaphoyinti amane alandelayo: I-0 = nakanjani, 1 = kancane, 2 = ngokulinganisa, kanye ne-3 = kakhulu. Uhlobo lwesiPutukezi lwe-Beck Depression Inventory (BDI) lwaqinisekiswa ukusetshenziswa eBrazil (eCronbach's alpha = 0.81)33 Lesi isikali se-21-nto esizibike ngayo senzelwe ukukala ubukhulu bezimpawu ezicindezelayo, ezinjengobumnene, obulinganiselayo, futhi obukhulu.
Ukuziphatha okuyingozi ngocansi
Ukuhlaziya ubungozi bezocansi kwavuselelwa ngumlobi wokuqala waleli phepha ngokususelwa ocwaningweni lwedlule34,35 ukuqoqa imininingwane ngokuziphatha kocansi nabalingani bakho abaphambili nabathandanayo, kufaka phakathi imvamisa yenyanga yokuhlangana kwezitho zangasese nezangasese, ukusetshenziswa kwamakhondomu, kanye nenombolo yabalingani abathandanayo. Ukuhlaziya ubungozi bezocansi kwaklanyelwa njengephepha lemibuzo elizibika lona ukuze kuhlolwe ukuthi kunobungozi yini ocansini ezinyangeni eziyisithupha ezedlule Leli phepha lemibuzo laqhutshwa nabantu be20 ukuze bahlole izindaba ze-semantic nezokuqukethwe futhi babene-alpha yeCronbach ye83.35%. Kuhlanganisa nezinto ezihambisana nokuzibandakanya ocansini ngaphansi kwethonya lotshwala nezidakamizwa.
Ukuhlaziywa kwesitatimende
Ukuhlaziywa kwezibalo kwenziwa nge-STATA version 10 ngezinga lokubaluleka le-p <0.05. Izibalo ezichazayo zethulwa njengezilinganiso zokuhlukahluka ngokwezigaba nezindlela nokuphambuka okujwayelekile kokuguquguqukayo okuqhubekayo. Ukuqhathaniswa kweqembu kwenziwa ngokusebenzisa ukuhlolwa kwe-chi-square noma ama-ratios ratios kanye nesikhawu sokuzithemba esingu-95% (95% CI) ngokuhlukahluka ngokwezigaba, futhi t-Izivivinyo zokuguquguquka okuqhubekayo.
Ukuhlola umbono wethu wokuqala wokuthi ukuphuma kwe-ESB kungabika ukwanda kokukhathazeka nokucindezelwa nokuziphatha okuyingozi kakhulu kwezocansi kunokulawula, sihlole umehluko kuzimpawu zomhlanganyeli, ukukhathazeka, ukucindezelwa nezimpawu ze-SC, nokuziphatha kocansi phakathi kokuphuma nokulawulwa kwe-ESB. Ukuhlola umbono wethu wesibili wokuthi ubukhulu bokukhathazeka, ukudangala, kanye ne-SC kungahlotshaniswa kahle nokuziphatha okuyingozi ngocansi, senze ukuhlaziywa kwezibalo bese sibonisa amamodeli wokucabanga ngendlela efanelekile ukuze sihlole iminikelo ehambelana nemibuso yezimo ezingezinhle (ukukhathazeka, ukudangala) ) kanye ne-SC ekuziphatheni kwengozi yezocansi, okuyi: 1) ukuhlangana kwe-anal ngaphandle kwekhondomu nomlingani ophambili; I-2) ukuya ocansini ngaphandle kwamakhondomu nomlingani ophambili; I-3) ukuzibandakanya kwe-anal ngaphandle kwekhondomu nomlingani ongathandani naye; kanye ne-4) ukuya ocansini ngaphandle kwekhondomu nomlingani ongathandani naye. Onke amamodeli alungiswa ngobudala, ubuhlanga, isimo sezomthetho esisemthethweni, ukunakwa kocansi, kanye nesimo se-serological.
Imiphumela
Izici zomhlanganyeli zivezwa Ithebula 1. Izikhathi zokuphuma ze-ESB zazimdala kakhulu kunokulawula (t(150) = 2.53; p = 0.006). Iminyaka yokuphuma kwe-ESB ibanga eliphakathi kweminyaka engu-21 ne-66 ubudala kanye nezikhathi zokulawula eziphakathi kweminyaka eyi-18 ne-59. Ukuphuma okuningi kwe-ESB ngaphezu kwezilawuli bekuyiCaucasian (χ2(2) = 8.20; p = 0.01). Ngokuphathelene nobunikazi bezocansi, ukuphuma kwe-ESB okuningi kubikwe ukuthi kunobungqingili noma ubungqingili kunokulawula (χ2(1) = 12.10; p = 0.001) nokuphuma okuningi kwe-ESB (χ2(2) = 16.66; p <0.001). Kube khona umehluko osezingeni eliphansi esimeni somshado phakathi kweziguli ze-ESB nezilawuli, neziguli ezingaphansi kwe-ESB ezingase zishade (χ2(2) = 4.64; p <0.09).
Ithebula 1 Idatha yezenhlalo yabantu abaneziguli ezingaphandle kwe-ESB ezingama-88 kanye nezilawuli zabesilisa ezingama-64 eSão Paulo, eBrazil
| Imiphumela ye-ESB (n = 88) | Izilawuli (n = 64) | Ingqikithi (n = 152) | χ2/t hlola izibalo | |
|---|---|---|---|---|
| Race | ||||
| I-Caucasian | 70 (79.5) | 38 (59.4) | 108 (71.1) | |
| Izizukulwane zase-Afrika | 16 (18.2) | 25 (39.1) | 41 (27.0) | |
| Izincwajana zemininingwane | 2 (2.3) | 1 (1.6) | 3 (2.0) | 8.20* |
| Isimo somshado esisemthethweni | ||||
| ushadile | 38 (43.2) | 17 (26.6) | 55 (36.2) | |
| Single | 42 (47.7) | 41 (64.1) | 83 (54.6) | |
| Wehlukanisile | 9 (9.1) | 6 (9.4) | 15 (9.87) | 4.64† |
| Isimo socansi | ||||
| Gay and bisexual | 37 (42.1) | 10 (15.0) | 47 (30.9) | |
| Heterosexual | 51 (58.0) | 54 (84.4) | 105 (69.1) | 12.10‡ |
| Isimo somsebenzi | ||||
| Ayisebenzi | 14 (15.9) | 1 (1.6) | 15 (9.9) | |
| Iqashwe | 69 (78.4) | 48 (75.0) | 117 (77.0) | |
| Student | 5 (5.7) | 15 (23.4) | 20 (13.2) | 16.66‡ |
| Isimo se-Serological sibikiwe | ||||
| Unknown | 15 (17.0) | 13 (20.3) | 28 (18.4) | |
| Negative | 64 (72.7) | 48 (75.0) | 112 (73.7) | |
| Positive | 9 (10.2) | 3 (4.7) | 12 (7.9) | 0.43 |
| Iminyaka, kusho (SD) | 38.17 (8.91) | 33.98 (11.41) | 36.40 (10.21) | 2.53* |
| Iminyaka yemfundo, kusho (SD) | 14.20 (4.18) | 13.47 (4.02) | 13.89 (4.12) | 1.09 |
| Imali engenayo yanyanga zonke (R $), i-Median (95% CI)§ | I-3,000 (2,500-3,942) | I-3,000 (2,700-4,000) | I-3,000 (3,000-3,800) | 0.90 |
| Ukuphoqelelwa ngokobulili, kusho (SD) | 31.93 (5.02) | 15.44 (5.44) | 24.99 (9.67) | 19.30‡ |
| Ukukhathazeka, kusho (SD) | 13.43 (9.98) | 6.48 (8.42) | 10.51 (9.94) | 4.52‡ |
| Ukudana, kusho (SD) | 16.51 (8.60) | 6.21 (5.66) | 12.18 (9.06) | 8.88‡ |
Idatha ekhonjiswe njenge-n (%), ngaphandle uma kuchazwe ngenye indlela.
I-95% CI = 95% isikhathi sokuzethemba; ESB = ukuziphatha ngokweqile ngokobulili; I-SD = ukuphambuka okujwayelekile.
*p <0.05;
†p <0.10;
‡p <0.001.
§Mann Whitney U ukuhlolwa.
Iziphululi ze-ESB zineS SC ephakeme (t(150) = 19.30; p <0.001), ukukhathazeka (t(150) = 4.51; p <0.001), nezikolo zokudangala (t(149) = 8.88; p <0.001) kunezilawuli. Sithole ukuhlangana okuphawulekayo phakathi kwe-SC nokudangala (iziguli eziphuma ngaphandle ze-ESB: r = 0.38; p <0.001; izilawuli: r = 0.25; p = 0.04), i-SC nokukhathazeka (iziguli eziphuma ngaphandle ze-ESB: r = 0.27; p = 0.01; izilawuli: r = 0.33; p = 0.007), nokudangala nokukhathazeka (iziguli eziphuma ngaphandle ze-ESB: r = 0.66; p <0.001; izilawuli: r = 0.70; p <0.001).
Ukuqhathaniswa phakathi kwezifo eziphuthumayo ze-ESB kanye nokulawulwa kokuziphatha ngokocansi ezinyangeni eziyisithupha zangaphambili kuhanjiswa Ithebula 2. Abaphuluki be-ESB babenenkinga enkulu yokuhlanganyela ocansini ngaphansi kwethonya lezidakamizwa kunokulawula. Iqembu lokulawula libize ukuziphatha okuningi kobulili nabalingani abakhulu, ubudlelwano bobulili obuningi nabalingani abakhulu, kanye nobulili obungaphephile obungasondelene nabalingani abakhulu. Abahlinzeki be-ESB babika ukulala ocansini nabalingani abangavamile kanye nenani elikhulu labalingani abangavamile. Iziguli ezivela e-ESB zibike ukulala komuntu ocansini kakhulu nabalingani abangenayo futhi abathandana nabo abangavikelekile nabo. Kulabo ababika ukulala nomuntu ongathandanga naye nge-condomless nabalingani abangavamile (n = 28), i-18 (64%) eyaziwa njenge-gay noma abesilisa nabesifazane, kuyilapho i-10 (36%) ehlonishwa njengeyoqondile. Ithebula 3 ikhombisa ukusatshalaliswa kokuziphatha ngokocansi kweziguli eziphuthumayo ze-ESB ngokusho kocansi. Ngokuphathelene nobuhlobo bobulili nabalingani abakhulu, labo abazihloniphayo ngokuya ocansini babika ucansi ocansini, ubulili bobulili, nokulala nomzimba okungavimbelwe. Ngokuqondene nobuhlobo bobulili nabalingani abangathandana nabo, labo abazihlonipha ukuthi babesilisa nabesifazane babecala ubulili obuningi kanye nobulili obuvikelekile, kodwa labo abazihloniphayo njengabesilisa noma abesilisa nabesifazane bobulili babonisa inombolo ephakeme kakhulu yabalingani abangavamile futhi babika ubulili obuningi obuningi.
Ithebula 2 Ukuziphatha ngokocansi kweziguli ezingama-88 ze-ESB nezilawuli ezingama-64, eSão Paulo, eBrazil
| Imiphumela ye-ESB (n = 88) | Izilawuli (n = 64) | OR | 95% CI | inani le-p | |
|---|---|---|---|---|---|
| Ukulala ngokocansi ezinyangeni eziyisithupha zokugcina | 74 (84.1) | 50 (78.1) | 1.48 | 0.65-3.37 | 0.350 |
| Ukulala ngokocansi nomlingani oyinhloko ezinyangeni eziyisithupha zokugcina | 39 (44.3) | 43 (67.2) | 0.39 | 0.20-0.76 | 0.006 |
| Ukulala ngokobulili nomlingani oyinhloko | 32 (36.4) | 39 (60.9) | 0.37 | 0.19-0.71 | 0.003 |
| Ukusetshenziswa okungajwayelekile kwamakhondomu ngesikhathi sokulala ngokobulili nabalingani abakhulu | 26 (29.6) | 29 (45.3) | 0.51 | 0.26-0.99 | 0.047 |
| Ukulala ngokobulili nomlingani oyinhloko | 21 (23.9) | 17 (26.6) | 0.87 | 0.41-1.82 | 0.710 |
| Ukusetshenziswa okungajwayelekile kwamakhondomu ngesikhathi sokulala nomlingani oyinhloko | 14 (15.9) | 10 (15.6) | 1.02 | 0.42-2.47 | 0.960 |
| Ubulili nomlingani ongathandeki ezinyangeni eziyisithupha zokugcina | 62 (70.5) | 22 (34.4) | 4.55 | 2.28-9.07 | <0.001 |
| Inani labantu abathandana nabo ngokocansi ezinyangeni eziyisithupha zokugcina, kusho (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 |
| I-2 noma ngaphezulu | 52 (59.1) | 10 (15.6) | 8.4 | 3.64-19.36 | <0.001 |
| Ukulala ngokobulili nomlingani ongavamile | 35 (39.8) | 18 (28.1) | 1.69 | 0.84-3.37 | 0.140 |
| Ukusetshenziswa kakhudlwana kwamakhondomu ngesikhathi sokulala nomuntu ongathandana naye | 23 (26.1) | 12 (18.8) | 0.62 | 0.70-3.37 | 0.290 |
| Ukulala nobulili nomlingani ongavamile | 46 (52.3) | 17 (26.6) | 3.03 | 1.51-6.07 | 0.020 |
| Ukusetshenziswa okungajwayelekile kwamakhondomu ngesikhathi sokulala nomlingani ongathandana naye | 28 (31.8) | 9 (14.1) | 2.85 | 1.24-6.58 | 0.010 |
| Ubulili ngaphansi kwethonya lokuphuza utshwala | |||||
| Cha | 55 (63.2) | 38 (59.4) | 1 | ||
| Ngezinye izikhathi | 29 (32.9) | 25 (39.1) | 0.76 | 0.39-1.50 | 0.440 |
| Ngokuvamile | 4 (4.6) | 1 (1.6) | 1.14 | 0.58-2.21 | 0.700 |
| Ubulili ngaphansi kwethonya lezidakamizwa | |||||
| Cha | 74 (84.1) | 63 (98.4) | 1 | ||
| Ngezinye izikhathi | 11 (12.8) | 1 (1.6) | 9.00 | 1.07-75.27 | 0.010 |
| Ngokuvamile | 3 (3.5) | 0 | - |
Idatha ekhonjiswe njenge-n (%), ngaphandle uma kuchazwe ngenye indlela.
I-95% CI = 95% isikhathi sokuzethemba; ESB = ukuziphatha ngokweqile ngokobulili; OR = ukulinganisa isilinganiso.
Ukusebenzisa ikhondomu okungapheli kusho ukusebenzisa amakhondomu ku-0-75% yezikhathi.
Ithebula 3 Ukuziphatha ngokocansi kweziguli ezingama-37 zobungqingili / abesilisa nabesifazane kanye nabangama-51 abesilisa nabesifazane abangaphandle kwe-ESB, eSão Paulo, eBrazil
| Gay / abesilisa nabesifazane | Heterosexual | inani le-p | |
|---|---|---|---|
| Ukulala ngokocansi ezinyangeni eziyisithupha zokugcina | 31 (83.8) | 43 (84.3) | 0.950 |
| Ukulala ngokocansi nomlingani oyinhloko ezinyangeni eziyisithupha zokugcina | 8 (21.6) | 31 (60.8) | <0.001 |
| Ukulala ngokobulili nomlingani oyinhloko | 2 (5.4) | 30 (58.8) | <0.001 |
| Ukusetshenziselwa ikhondomu engapheli ngesikhathi sokulala ngokobulili nabalingani abakhulu | 1 (2.7) | 25 (49) | <0.001 |
| Ukulala ngokobulili nomlingani oyinhloko | 8 (21.6) | 13 (25.5) | 0.670 |
| Ukusetshenziswa kwekhondomu engapheli ngesikhathi sokulala nomlingani oyinhloko | 6 (16.2) | 8 (15.7) | 0.950 |
| Ubulili nomlingani ongathandeki ezinyangeni eziyisithupha zokugcina | 31 (83.8) | 31 (60.8) | 0.020 |
| Inani labantu abathandana nabo ngokocansi ezinyangeni eziyisithupha zokugcina, kusho (SD) | 23.8 (39.5) | 4.5 (8.9) | 0.006 |
| Ukulala ngokobulili nomlingani ongavamile | 6 (16.2) | 29 (56.9) | <0.001 |
| Ukusetshenziswa kwekhondomu engapheli ngesikhathi sokulala nomuntu ongathandana naye | 4 (10.8) | 19 (37.6) | 0.007 |
| Ukulala nobulili nomlingani ongavamile | 29 (78.4) | 17 (33.3) | <0.001 |
| Ukusetshenziswa kwekhondomu engapheli ngesikhathi sokulala nomlingani ongathandana naye | 18 (48.7) | 10 (19.6) | 0.004 |
Idatha ekhonjiswe njenge-n (%), ngaphandle uma kuchazwe ngenye indlela.
ESB = ukuziphatha ngokweqile ngokocansi.
Ukusebenzisa ikhondomu okungapheli kusho ukusebenzisa amakhondomu ku-0-75% yezikhathi.
Umfanekiso we-1 ikhombisa iphethini ehlukile yokulinganisa yeziguquguquko ze-psychopathological nobuhlobo bezocansi nabalingani abakhulu nabangabambisani nabo. Labo ababika ngokungajwayelekile amakhondomu nabalingani abakhulu baveza izibalo ezingezansi ezingokwengqondo kunezo ezibika ukusetshenziswa kwamakhondomu njalo. Ngakolunye uhlangothi, labo ababika ukusetshenziswa okungavamile kwamakhondomu nabalingani abangathandana nabo baveza izikolo eziphakeme kakhulu ezingaphezu kwalezo ezibika ukusetshenziswa kwamakhondomu njalo.
Umdwebo 1 Ukusetshenziswa kwamakhondomu nabalingani abasemqoka nabangajwayelekile phakathi kweziguli kanye nezilawuli zokuziphatha ngokweqile ngokocansi (ESB) (n = 152). A: ukusetshenziswa kwekhondomu ekuhlanganyeleni kwesitho sangasese sowesifazane nomlingani omkhulu. Labo ababika ukusetshenziswa kwamakhondomu okungajwayelekile okulethwa ukucindezeleka okunciphile (kusho [M] = 9.3; ukuphambuka okujwayelekile [SD] = 7.5 vs. 13.8; SD = 9.5) (t[134.5] = 3.2; p = 0.001) nezinombolo zokukhathazeka (M = 8.0; SD = 9.3 vs. M = 11.9; SD = 10.0) (t[150] = 2.4; p = i-0.02); B: ukusetshenziswa kwekhondomu ngokulala nomlingani oyinhloko; C: ukusetshenziswa kwekhondomu ekuziphatheni kobulili nomlingani ongavamile. Labo ababika ukusetshenziswa kondomu okungavamile kwenza kube nokwanda kwamanani okucindezeleka (M = 14.8; SD = 9.0 vs. 11.4; SD = 9.0) (t[150] = -2.0; p = i-0.05); D: Ukusebenzisa ikhondomu ngokulala nomlingani ongathandeki. Labo ababika ukusetshenziswa kwekhondomu okungavamile kukhuliswe ukucindezelwa kobulili (SC) (M = 29.8; SD = 9.8 vs. 23.5; SD = 9.5) (t[150] = -3.6; p <0.001), ukudangala (M = 17.6; SD = 8.9 vs. M = 10.4; SD = 8.4) (t[150] = -4.4; p <0.001), nezikolo zokukhathazeka (M = 15.4; SD = 10.6 vs. M = 8.9; SD = 9.2) (t[150] = -3.6; p <0.001). Akukho mehluko obalulekile ngokwezibalo obonwe ku-SC ku-A, kunoma yiluphi udaba lwe-psychopathological ku-B, noma ekukhathazekeni nase-SC ku-C. Okusho njalo kusho izikhathi ezingama-76-100%. Akuvamile kusho u-0-75% wezikhathi.
Izindlela zokuziphatha zokuziphatha ngokobulili zifakwe ngaphakathi Ithebula 4. I-SC iboniswe ukuthi iyisimo sokuzimela esizimele sobulili obungalingani oluvikelekile nabalingani abangavamile ngemuva kokulawula iminyaka yobudala, ubuhlanga, isimo somshado somthetho, ukulinganisa ngokobulili, nesimo se-serological. Ukunyuka kwamaphuzu ngayinye ku-SC kwandise izinkinga zesandulela ngculazi ezingathandanga nabalingani abangathandeki nge-7%.
Ithebula 4 Amamodeli wokuhleleka kokusetshenziswa kwekhondomu ocansini ngokubhalisa iziguli kanye nokuzilawula ngokweqile kokuziphatha ngokocansi (ESB) (n = 152), eSão Paulo, eBrazil
| Ukusetshenziswa kwekhondomu ekuziphatheni ngokobulili nomlingani oyinhloko | Imodeli yokusebenzisa ikhondomu ekuxhumaneni kwe-anal nomlingani ophambili | Imodeli yokusetshenziswa kwekhondomu ekuhlanganyeleni ubulili nomuntu othandana naye | Imodeli yokusetshenziswa kwekhondomu ekuxhumaneni kwe-anal nomuntu ohamba naye ongathandani naye | |||||
|---|---|---|---|---|---|---|---|---|
| njalo* | Okwejwayelekile | njalo* | Okwejwayelekile | njalo* | Okwejwayelekile | njalo* | Okwejwayelekile | |
| Ukuphoqelelwa ngokobulili | ||||||||
| OR | Izikhombo | 1.00 | Izikhombo | 1.04 | Izikhombo | 0.98 | Izikhombo | 1.07† |
| 95% CI | - | 0.94-1.06 | - | 0.98-1.11 | - | 0.91-1.05 | - | 1.01-1.14 |
| Ukucindezeleka | ||||||||
| OR | Izikhombo | 0.95 | Izikhombo | 0.90† | Izikhombo | 1.03 | Izikhombo | 1.05 |
| 95% CI | - | 0.87-1.03 | - | 0.81-1.00 | - | 0.93-1.15 | - | 0.97-1.13 |
| ukukhathazeka | ||||||||
| OR | Izikhombo | 1.00 | Izikhombo | 1.03 | Izikhombo | 1.00 | Izikhombo | 1.02 |
| 95% CI | - | 0.95-1.07 | - | 0.96-1.11 | - | 0.92-1.09 | - | 0.96-1.08 |
I-95% CI = 95% isikhawu sokuzithemba; NOMA = isilinganiso sokungabikhona.
*76-100%.
†p <0.05.
Onke amamodeli alungiswa iminyaka yobudala, ubuhlanga, isimo somshado, ukutjheja ubulili, kanye nesimo se-serological.
Ingxoxo
Izinhlobo ezimbili zokuziphatha okuyingozi kwezocansi zingahlukaniswa. Okokuqala, maqondana nokuya ocansini nomuntu othandana naye oyinhloko, izilawuli zibike imvamisa ephakeme yokuhlangana kwesitho sangasese sowesifazane, iningi lazo bekungukuvikelwa kobulili okungavikelekile. Lokhu kungenzeka ukuthi kunamadoda aqonde ngqo kusampula yokulawula, enza ucansi nabalingani bawo ngaphandle kwamakhondomu, okuvamile esimweni sobudlelwano obuzinzile besikhathi eside. Okwesibili, maqondana nokuya ocansini nabantu abathandana nabo, abebephuma ngaphandle kwe-ESB babike abathandana abaningi abayitoho, imvamisa ephakeme yokulala nabalingani abajwayelene nabo, imvamisa ephakeme yokuhlangana kwezitho zangasese, nokuvama okuphezulu kokuya ocansini ngaphandle kwekhondomu kunokulawula. Le nhlanganisela iyakhathaza ngenxa yengozi yezifo ezithathelana ngokocansi kanye nokudluliselwa kwe-HIV. Ukuhlaziywa kwe-meta kubuyekeze indima yokuzibandakanya kwe-anal ekungeneni kwe-HIV futhi kwaphetha ngokuthi ukuhlangana ngocansi kuwumkhuba onobungozi obukhulu ekudluliseleni i-HIV noma ngesikhathi sokwelashwa okusebenza kakhulu kwezidambisigciwane.36 Ngaphezu kwalokho, bathola inani elikhulayo labobulili obuhlukile abahlanganyela ekuxhumaneni kwe-anal ngamazinga aphansi okusebenzisa amakhondomu,36 okuhambisana nedatha yethu, lapho i-36% yababambiqhaza be-ESB ababike ukuhlangana kokuxhumana okungenazikhondlame nabalingani abajwayelekile kwakungamadoda aqonde ngqo. Uma sigxila ekuziphatheni kwezocansi kwabangaphandle kwe-ESB, siphinde sabona inani elifanele labesilisa abathandana nabobulili obuhlukile abathandanayo bezitika ngocansi anal kanye nokuya ocansini anal ngaphandle kwekhondomu nabalingani abaphambili.
Kubalulekile ukuveza ukuthi i-16% yokuphuma kwe-ESB ne-22% yezilawuli azizange zizibandakanye ocansini nabalingani ezinyangeni eziyisithupha ezedlule. Ngakho-ke, ukuhlaziywa kwezindlela zokuziphatha eziyingcuphe yezocansi akuzange kubangele lonke isampula futhi kungenzeka kuye kwalulaza amandla alo wezibalo ukuthola umehluko. Kungenzeka ukuthi yilesi sizathu esenza ukuthi kube nomehluko omkhulu phakathi kwezibalo phakathi kwamaqembu ngokuya ngokuvama kokuya ocansini kanye nokuya ocansini ngaphandle kwekhondomu nabantu abathandana nabo, noma ngabe ukuphuma kwe-ESB, ikakhulukazi amadoda aqondile, kubike okuningi kwalemikhuba kunezilawuli.
Iphethini ehlukile yokubonakaliswa kwengqondo ngokwengqondo iqhamuke ekuhlaziyeni kokuziphatha okuyingozi kobulili nabalingani abaphambili nabahlukumezanayo. Okukhathazayo kakhulu, labo ababika ukusetshenziswa kwamakhondomu okungajwayelekile nabalingani babo abajwayelekile baletha izikolo eziphakeme kakhulu ze-psychopathological, ikakhulukazi lapho benza ucansi oluku-anal. Lokhu okutholakele kuhambelana nezifundo ezibika umphumela oqondile wokuthinta (ukudangala, ukukhathazeka)28,37 kanye ne-SC17,30 ekuziphatheni kwengozi ye-HIV. Ngokunjalo, ukukhathazeka kungahle kuhlotshaniswe nokuthathwa kwengozi yezocansi, ikakhulukazi uma kucatshangelwa umbono wokudlulisela ukukhathazeka, lapho ukukhathazeka kanye nokuvuselela khona ezocansi kuhlanganyela izakhi ezithile, futhi abanye abantu benza kusebenze ukuvusa inkanuko ngokobulili ukunciphisa izimpawu zokukhathazeka,38 ngaleyo ndlela sithambekele ekuthatheni ubungozi bocansi.28 Ukudana komoya kungahle kube nomthelela kusebenze kokuziphatha kobulili,25 nayo, ibonakala ikakhulukazi lapho yenzeka ngasikhathi sinye ne-SC ephakeme.39 Ngaphezu kwalokho, ucwaningo oluningi lubike ukwanda kokusebenza kokuziphatha kobulili kubantu abane-ESB,40 ehlangene kakhulu ne-SC. Labo bethula ukuvuselelwa okukhulu kokuziphatha kocansi bavame ukuzibeka engcupheni yokudluliselwa kwe-HIV.26,28 Ngakho-ke, i-SC ibonakala inethonya elithile ekuziphatheni kwengozi yezocansi, ngoba ibikezela ukuhlangana kwe-anal ngaphandle kwekhondomu nabalingani abajwayelekile ocwaningweni lwethu. Ukudangala nokukhathazeka akuzange kugcine ukuzihlanganisa nokuziphatha okuyingozi ekuhlelweni kokuhle. Lokhu kungabangelwa ukuthi kuhlobene ne-SC futhi kungadlala indima engaqondile ekuziphatheni kobungozi bocansi, ngokwesibonelo, ukukhulisa ubucayi be-SC. Imininingwane yethu ivumelana nezifundo zesibalo sangaphambilini zabesilisa abalala nabesilisa (MSM)17 kanye nezifundo zemitholampilo nge-HIV,21 lapho i-SC ibikezela ukuziphatha okuyingozi kocansi.
Imininingwane yethu inemiphumela yezempilo yomphakathi, odokotela kanye nocwaningo. Ukuhlobana phakathi kokukhathazeka, ukudangala, kanye ne-SC nokuhlangana kwabo nokuhlangana kokuxhumana okungenazikhondlakhondla nabalingani abayitoho kusekela izifundo zakamuva eziphakamisa ukuthi indlela yokuziphatha engcupheni ye-HIV ingachazwa kangcono yi-syndemic conceptualization, okusho ukuthi ubungozi bokuthola isimo buvele ngaphezulu kokusebenzisana izici eziningana zobungozi kunomphumela ozimele wezinto ngazinye.22 Le mininingwane ibaluleke kakhulu kwimpilo yomphakathi, uma icabanga ukuthi ihlobene nabesilisa babo bonke ubunikazi bocansi esimweni somtholampilo wezengqondo. Ukuhlangana phakathi kwalezi zinto ezihambelana nokusebenza kwengqondo nakho kuthinta izinhloso zomtholampilo, ngoba kukhulisa ubulukhuni futhi kwenza ukwelashwa kube yinselele kakhulu,41 ikakhulukazi uma ucabanga ukuthi abantu abanjalo banezinkinga zokunamathela ekwelashweni. Okokugcina, ukuxhumana phakathi kwezimpawu ze-psychopathological (ukukhathazeka, ukudangala, kanye ne-SC) kufaka isandla ocwaningweni, ngoba kusekela enye inkomba yokuphazamiseka kwengqondo: isib, ukukhathazeka, ukucindezelwa, ukudangala, ukungabekezeleleki). "Ukwanda kokusebenza kocansi okuhlobene ikakhulukazi nalezi zimpawu zemood kuveza ukubaluleka kokucwaninga kwesikhathi esizayo ngezinqubo zesifiso sobulili nokuvuka komuntu kubantu abane-ESB ukwenza ngcono ukuqonda kwe-psychopathological main and pathophysiological izici ezihilelekile.
Ukutadisha kwethu kusekelwe kusampula yokuthola usizo emtholampilo, okuho ngemuva kokuthi abanye abantu abaxhumana nathi bengazange baqhubeke nenqubo yokuhlola futhi, ngenxa yalokho, asikwazanga ukuqoqa imininingwane kubo. Labo abaqeda inqubo yokuhlola babefakiwe, inqobo nje uma bekwazi ukufunda nokubhala. Lezi zici zivimbela ukwenziwa kwemininingwane yethu ngokujwayelekile. Ngeshwa, kunokwehluka okumbalwa komphakathi phakathi kokuphuma kwe-ESB nokulawula. Ngokuqondile, bekungaba ngcono ukube besinokulinganisela okwengeziwe ekusatshalaliswa kokuthanda ukuya ocansini phakathi kwamaqembu, ngoba abesilisa abathandana nobungqingili bavame ukubika ukukhathazeka okwengeziwe, ukudangala, kanye nokuya ocansini.17 Ngaphezu kwalokho, silungise ukucabanga okuvumayo kokuziphatha okuyingozi ngocansi iminyaka yobudala, ubuhlanga, isimo sezomthetho esisemthethweni, isimo se-serological, kanye nokuya ocansini ukugwema imiphumela edidayo. Okunye okukhawulelwe kulolu cwaningo ukungaphenyi kokuhlupheka kwengane. Izikhathi zokuphuma emzimbeni zibika ubunzima obukhulu bezingane, obuhlobene nezimpawu zokucindezela,42 futhi zombili lezi zici zingakhulisa amathuba okuziphatha okuyingozi ngocansi. Ngokolwazi lwethu lonke, lolu ucwaningo lokuqala lwe-SC, imizwa engemihle, nokuziphatha okuyingozi kwezocansi endaweni yezempilo yezengqondo efaka nabesilisa abathandanayo. Imininingwane yethu igcizelela ukubaluleka kokuphenya kwe-SC, ukukhathazeka, kanye nokuxineka kubantu abafuna ukwelashwa kwe-ESB, ngoba ukulungisa lezi zinkinga zengqondo kungasiza ekuvimbeleni ukudluliselwa kwe-HIV.
Ukubonga
Lolu cwaningo lusekelwa yi-Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP; nikeza i-2010 / 15921-6).
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Kwamukelwe: Agasti 30, 2017; Kwamukelwe: ngo-December 07, 2017
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