wyaloba, mzrunveloba da samartlianoba

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1 wyaloba, mzrunveloba da samartlianoba saxelmzrvanelo adamianis imunodeficitis virusisa (HIV) da Sidsis (AIDS) mimartulebit Casatarebeli samusaoebisatvis msoflio luteranuli federacia 1

2 wyaloba, mzrunveloba da samartlianoba saxelmzrvanelo adamianis imunodeficitis virusisa (HIV) da Sidsis (AIDS) mimartulebit Casatarebeli samusaoebisatvis msoflio luteranuli federacia 1

3 Patients and caregivers are advised wherever possible and appropriate to seek the advice of medically trained personnel. Design: LWF Office for Communication Services Editorial assistance and layout: LWF Department for Theology and Studies Published by The Lutheran World Federation Department for Mission and Development 150, rte de Ferney P.O. Box 2100 CH 1211 Geneva 2 Switzerland 2007, The Lutheran World Federation Printed in Switzerland by SRO-Kundig ISBN

4 sarcevi winasityvaoba... 5 Sesavali: ratom unda CaerTon adgilobrivi eklesiebi... 7 Tavi 1: samedicino faqtebi da prevencia ra aris adamianis imunodeficitis virusi (HIV) da Sidsi (AIDS)? rogor utevs virusi CD4 ujredebs? rogor vrceldeba adamianis imunodeficitis virusi? gansxvaveba adamianis imunodeficitis virussa da Sidss Soris adamianis imunodeficitis virusis stadiebi Sidsis stadia adamianis inficirebis dadgena antiretrovirusuli (ARV) medikamentebi adamianis imunodeficitis virusis prevencia winamdebare Tavis wyaroebi Tavi 2: sqesi, sqesobrivi urtiertoba da simartlis Tqma qalebi, gogonebi da adamianis imunodeficitis virusi da Sidsi sqesobrivi urtiertoba simartlis Tqma sqesobrivi kavsiris gamocdilebis Sesaxeb winamdebare Tavis wyaroebi Tavi 3: pasuxi rwmenastan dakavsirebul SekiTxvebze ra qna iesom? rogoria RmerTi? adamianebi RmerTTan mimartebasi mas, ra aris codva? ltolva gankurnebisatvis tanjvis sapirispirod ras nisnavs gankurneba? mas, rogor moviqcet RvTisnierad? ras ifiqreben sxvebi?

5 Tavi 4: mzrunvelobiti da rceva-damrigeblobiti msaxureba mzrunveloba da rcevis micema adamianis imunodeficitis virusisa da Sidsis konteqstebsi davupirispirdet damcirebasa da diskriminacias virusze testis Catarebis aucilebloba narkotikebis gamoyeneba da matdami midrekileba sqesobrivi urtiertobis stili kulturuli gamocdilebis gadafasebis sawiroeba gaucxoeba sircxvili da braleuloba ratom damemarta es? dakrzalva, rogorc rcevisa da mzrunvelobis gawevis SesaZlebloba rcevis micemis unar-cvevebi da metodi sulieri mzrunveloba mattvis, vinc zrunavs sxvebze winamdebare Tavis wyaroebi Tavi 5: movla ojaxis pirobebsi momvlelebis mtavari roli Sin movlis upiratesobebi adamianis imunodeficitis virusisa da Sidsisagan gamowveuli saerto mdgomareobis martva swori kveba inficirebuli bavsvebisa da mozardebis movla profilaqtikuri zomebi momvlelebisatvis momakvdavis movla winamdebare Tavis wyaroebi Tavi 6: interesebis dacva ilocet, imoqmedet wesisamebr da SecvaleT damokidebulebebi SecvaleT damkvidrebuli wesebi da tendenciebi imoqmedet sxvadasxva arxebis mesveobit unda cnot xelisuflebis mtavari roli SexvdiT mat, romlebsac SeuZliaT vitarebis Secvla monawileoba miiret saertasoriso qselebsa da gaertianebebsi, romlebic musaoben cvlilebebze daskvna: mas, sad aris xsna? winamdebare Tavis wyaroebi danartebi danarti 1: janmrtelobis dacvis msoflio organizaciis (WHO) mier SemuSavebuli adamianis imunodeficitis virusis daavadebis klinikuri stadiebi bavsvebsa da mozardebsi danarti 2: antiretrovirusuli medikamentebi danarti 3: bibliuri wyaroebi mzrunvelobiti saqmianobis msaxurtatvis danarti 4: momvlelebisatvis damaxasiatebeli stresi da mosliloba danarti 5: rekomendebuli damatebiti sakitxavi masalebi

6 winasityvaoba 5

7 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi 1980-iani wlebidan dawyebuli, msoflio luteranuli federacia (LWF) CarTulia adamianis imunodeficitis virusisa (HIV) da Sidsis (AIDS) krizis Tan brzolasi. msoflio luteranuli federaciis samoqmedo gegma - TanagrZnoba, gardaqmna, zrunva: eklesiebi adamianis imunodeficitis virusisa da Sidsis pandemiis sapasuxod - daiwyo 2002 wels da mas Semdeg adamianis imunodeficitis virusi da Sidsi iqca strategiul prioritetad msoflio luteranuli federaciis dargobriv programebs Soris - virusit dazaralebul adgilebsi da kvlavac rceba globalur prioritetad arnisnuli federaciisatvis. misi mravali wevri eklesia sul ufro metad gaaqtiurda mocemuli rtuli amocanis gadawyvetis saqmesi. regionuli konsultaciebi imarteba afrikasi, aziasi, evropasa da latinur amerikasi. mzardi gadaudebeli motxovnilebaa, yuradreba gamaxvildes prevenciuli zomebis gatarebis mnisvnelobaze sicocxlis dasacavad. mimdinare RonisZiebebis processi nateli gaxda, rom sawiroa, Tavi movuyarot Teologiur da samozrvro perspeqtivebs, rata Cven, rogorc eklesiebis luteranulma ertianobam, CamovayaliboT midgoma Cvens gverdit mcxovreb imunodeficitis virusita da SidsiT inficirebulta mimart. winamdebare saxelmzranelosi Cven gavitvaliswinet samedicino, prevenciuli, saojaxo pirobebsi movlis, uflebebis dacvisa Tu sxva saorientacio principebi mattvis, vinc musaobs arnisnuli amocanis gadaswrelad adgilobrivad. Cven vicit, rom gacilebit metis Tqma SeiZleba pandemiis mocemul Tu sxva aspeqtis Sesaxeb da vimedovnebt, rom SemdgomSi ganvaaxlebt da mogawodebt masalebs winamdebare saxelmzrvanelos srulyofisatvis. es saxelmzrvanelo Sedga mocemul saqmianobasi aqtiurad CarTuli uamravi piris monawileobit. igi Seicavs 2005 wlis dekembersi SveicariaSi lozantan axlos Catarebul Teologiur konsultaciebs. aseve, konsultaciebs, romelic Catarda 2006 wlis ivnissi nairobsi, keniasi eklesiis liderebisatvis, eqimebis, eqtnebis, socialuri musakebis, mrcevlebisa Tu sxvebisatvis, romlebic eweodnen am metad mnisvnelovan saqmes. mat ertoblivad didi wvlili Seitanes sxvadasxva Tavis SeqmnaSi. administraciulma jgufma Seasrula masalebis werilobiti da saredaqcio samusaoebi. Cven madlobas vuxdit yvelas, vinc usualod iyo Cabmuli arnisnul processi. vimedovnebt, rom winamdebare saxelmzrvanelo principi iqneba sasargeblo wyaro ara mxolod luteranuli eklesiebisa da mattan dakavsirebuli programebisatvis, aramed sxva qristianuli tradiciebis mimdevrebistvisac. miuxedavad imisa, rom winamdebare saxelmzrvanelos safuzvlad udevs askarad gamoxatuli qristianuli principebi, bevri perspqetiva da rekomendacia gaziarebulia sxva sarwmuneobis mqone da saero organizaciebtan. luteranul eklesias amit wvlili Seaqvs mimdinare ekumenur da rwmenatsorisi Zalisxmevis saqmesi. msoflio luteranuli federacia (LWF) ekumunur, rwmenatsorisi, samtavrobo Tu samoqalaqo sazogadoebis partniorebtan SeTanxmebulad da ertgulad imusavebs. 6 ismael noko generaluri mdivani

8 Sesavali ratom unda CaerTon adgilobrivi eklesiebi 7

9 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi 8 C ven ver uarvyoft zegavlenas, romelsac adamianis imunodeficitis virusi da Sidsi axdens Cvens samyaroze. pandemia zemoqmedebs Cvens sazogadoebaze, Cvens ojaxebze, Cvens eklesiebze, Cvens megobrebsa da piradad Cvenze. arnisnuli faqti, rasakvirvelia, sagangasoa, Tu Cven, an isini, vistanac gvaqvs urtiertoba, inficirebulni arian da imyofebian adamianis imunodeficitis virusisa da Sidsis zemoqmedebis qves. Cven gvinaxavs an gamogvicdia SiSi da tanjva, gamowveuli im pirebis mier, romlebic gaurbian an devnian adamianis imunodeficitis virusisa da Sidsis matarebel xalxs. SesaZloa, Cven vuvlidit SidsiT gardaclilebs, an iqneb gvesinoda amgvarad movqceuliyavit. iqneb, Cumadac viyavit, an davmalet mati gardacvalebis namdvili mizezi. yovelive es, imedia, TanagrZnobasac argvizravda, rom davxmarebodit daavadebulebs, rom mxari dagvewira, mierot sicocxlisatvis sawiro medikamentebi da mzurnveloba, da prevenciuli zomebis gatarebit dagvecva sxvebis sicocxlec. arsebobs mravali mizezi, Tu ratom CaerTo uamravi sxvadasxva religiuri rwmenisa da profesiis adamiani arnisnul saqmianobasi. Zalze mnisvnelovania, rom, vimusaot mattan, romlebic SesaZloa, ar iziareben Cvens konkretul rwmenas an me mesinoda eklesiasi siarulis, radganac mesinoda, rom RmerTi ganmsjida. aseve mesinoda, sxvebs ar elaparakat Cemze da ar ganvesaje mat. magram wavedi... araferi ar SemTxvevia imis magvari, rasac vfiqrobdi.. aravis daucinia CemTvis. aravin ar gamridebia. yvela momesiyvarula. da me mivxvdi, rom iesos vuyvardi. ELCA nius servisi 22 noemberi 2006 ixilet: mrwamss da amastanave, ar vecadot mati Zireuli rwmenis Secvla. miuxedavad amisa, mnisvnelovania, rom, Cven, rogorc adgilobriv eklesiebsa da eklesiastan dakavsirebul organizaciebs, natlad gvaqvs warmodgenili, Tu ratom vart Cabmulebi am saqmesi. umtavresad, amgvarad imitom xdeba, rom Cven RmerTi gvixmobs viqcet gansakutrebul gaertianebad misi mowyalebisa, romelic vixilet ieso qristesi. luteran qristianebs esmit, rom eklesia unda iyos iq, sadac RmerTis sityva iqadageba da saeklesio saidumloebani sworad aresruleba. Cven movdivart, rata mivirot RvTis wyaloba, miteveba da axali cxovreba da Tan gacnobierebuli gvaqvs yvela is gza, romlitac vagrzelebt Cvens kavsirs codvastan. wminda ziarebis purisa da Rvinis mesveobit, SesaZlebelia, Segvexos da vigemot RvTis madli. swored aq virebt RvTis mfarvel da ganmkurnebel siaxloves. Cven vzlierdebit da vicvlebit, rataviyot qristes sxeuli am wutisofelsi. qriste gviwvevs Tavis trapezze; yvela monatlulis gza xsnilia. sruliad sapirispirod im sistemebisa da praqtikisa Cvens samyarosi, romlebic adamianebs imis mixedvit gamoricxaven, Tu vin arian isini an ra saqmianobas ewevian. uflis seroba moicavs yvelas, visac ki misdami rwmena aqvs. eklesias ekisreba iyos kontrkulturuli, rom Caabas yvela, vinc gariyulia sazogadoebisagan. swored aq, gariyulta (stigmatizirebulta) Soris aris jvarcmuli RmerTi. Cven vxvdebit mkvdretit armdgar qristes gatexil pursi (luka 14:13-35), da amit

10 ratom unda CaerTon adgilobrivi eklesiebi veziarebit mas. Cven vertiandebit mattan, vinc sxvebistvis SeiZleba iyos uwminduri, sasisi an skandaluri. monatvlis gzit Cven vxdebit qristes sxeulis nawili. Cven usualod vekutvnit qristes, aqedan gamomdinare, ertmanetsac, rogorc qristesmieri Zmebi da debi. imisda miuxedavad, vart Tu ara Cven adamianis imunodeficitis virusisa da Sidsis matarebeli, Cven mivekutvnebit ertsa da imave sxeuls da vqmnit ertsa da imave sarwmunoebas. am TvalsazrisiT, qristes sxeulic aris adamianis imunodeficitis virusisa da Sidsis matarebeli. qriste CvenTan aris wminda ziarebasi; da Cvenc mowodebulni vart, viyot mattan, vinc inficirebulia adamianis imunodeficitis virusita da SidsiT, an imyofeba mati zegavlenis qves. Sesavali diakonia (msaxureba) aris qristes sxeulis arsebobis nawili. igi warmoadgens eklesiis enas, ritac is mowmobs Tavis yofnas wutisofelsi: gamoicinos TanagrZnoba da emsaxuros yvelas, vinc gasawirsia, gansakutrebit ki adamianis imunodeficitis virusita da SidsiT Sepyrobilebisadmi. mxarsi unda amoudges da daicvas isini. qristes upirobo siyvarulia diakoniis WeSmariti suliskveteba iyo mattan, iaro, Seexo, gaugo, gaiziaro, izruno da ibrzolo mattan ertad. 1 igi moicavs eklesiis vinaidan msioda da sawmeli momecit,... mwyuroda da masvit,... ucxo viyavit da mimiret,... SiSveli viyavi da SemmoseT,... sneuli viyavi da momakitxet,... WeSmaritad geubnebit Tqven: rac ki gauketet erts am Cems mcire ZmaTagans, me gamiketet (mate 25:35-40). winaswarmetyvelur movaleobas mivsdiot samartlianobas, Tanasworuflebianobasa da Tavisuflebas, imattan mimartebasi, vinc inficirebulia adamianis imunodeficitis virusita da SidsiT, an imyofeba misi zemoqmedebis qves. eklesia unda iyos adgili sulieri mxardaweristvisa da sazogadoebrivi mkurnalobisatvis, sadac isaxeba da xorcieldeba momavlis imedi. eklesiam, rogorc diakonuri movaleobis nawilma, Tavisi arsebobis manzilze xma miawvdina sxvadasxva daavadebebit dasneulebulebs. magram, ratom ikavebs Tavs sxva mravali eklesia msgavsi saqcielisagan, daupirispirdes adamianis imunodeficitis virussa da Sidss? swored eklesiebi da qristianebi qmnian xsirad problemas, gansakutrebit ki masin, rodesac mati damokidebulebebi da wesebi amcireben (adamianta jgufs uaryofiti nisnit ganixilaven) da devnian mat, vinc inficirebulia adamianis imunodeficitis virusita da SidsiT an imyofeba misi zemoqmedebis qves. tragikulia, rom adgilobrivi samrevloebi, xsirad imgvar adgilebad moiazrebian, sadac arnisnuli adamianebi Tavs yvelaze gariyulad, mozulebulad an upativcemulod grznoben. zogjer mat uarsac eubnebian, miiron wminda ziareba, an Sesvan saerto barzimidan. wminda pavles mixedvit, eklesia aris qristes sxeuli. magram, rogorc ertma adamianma Tqva, romelic mogvianebit SidsiT gardaicvala, xandaxan 1 One Body: North-South Reflections in the Face of HIV and AIDS (The Nordic-FOCCISA Church Cooperation, 2005), vol. 1, p. 30, at 9

11 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi iseti STabeWdileba mrceba, rom zogierti adamiani... kbilebia, me ki, is nivtiereba, romelic sxeulma unda moicilos! 2 es skandaluri gancxadebaa, radganac qristianebs evalebat, daamowmon da ataron RvTis usazrvro siyvaruli, rogorc es ieso qristesia gamjravnebuli. winamdebare saxelmzrvanelo principi gamiznulia, daexmaros nebismieri poziciisa Tu samsaxuris mqone xalxs, ufro gaaqtiurdes da nayofierad amoudges mxarsi adamianebs, romlebic inficirebuli arian adamianis imunodeficitis virusita da SidsiT an imyofebian misi zemoqmedebis qves da amgvari saqcielit, daamowmos RvTis wyaloba, mzrunveloba da samartlianoba yvela adamianis mimart. 2 Ibid., tomi 2, gv. 7 10

12 Tavi 1: samedicino faqtebi da prevencia 11

13 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi radganac adamianis imunodeficitis virusisa (HIV) da Sidsis (AIDS) irgvliv uamravi miti, varaudi da moraluri gansja arsebobs, qristianebisatvis mnisvnelovania, gaitvaliswinon samedicino mecnieruli kvlevebis Sedegebi. Cven gvwams RmerTis, Cveni Semoqmedis, romlis namorvawari cnobilia da ganvitarebuli samedicino mecnierebisa da im pirta mesveobit, romlebic musaoben medicinis sferosi. Cven pirdapiri samedicino faqtebisa da aprobirebuli prevenciuli strategiebis ganxilvit viwyebt, radganac adamianis imunodeficitis virusi virusia da ara moraluri piroba. 3 ra aris adamianis imunodeficitis virusi da Sidsi? SeZenili imunitetis deficitis sindromi (Sidsi) aris daavadeba, gamowveuli virusit, romelsac ewodeba adamianis imunodeficitis virusi. arnisnuli virusi utevs da anadgurebs sxeulis imunitets an Tavdacvis sistemas, romelic Cveulebriv icavs sxeuls infeqciebisagan. sisxlis TeTri ujredebi gvevlinebian imunuri sistemis jariskacebad; isini ibrzvian sxeulis dasacavad mikrobebis (baqteriebi, virusebi da sxva organizmebi, romlebic iwveven daavadebas) Semotevis wimaarmdeg. adamianis imunodeficitis virusi utevs sisxlis TeTri ujredis gansakutrebul tips, romelsac ewodeba CD4 limfocitebi (gansakutrebuli T-formis ujredis qvetipi), rac Zalian mnisvnelovan rols Tama- Sobs imunur sistemasi. adamianis imunodeficitis virusi ipyrobs CD4 ujreds, SeuSvebs Tavis sakutar reproduqciul masalas ujredsi da SerCevis gzit anadgurebs mas. sxvagvarad rom vtqvat, adamianis imunodeficitis viruss Tavisi kontrolis qves hyavs CD4 ujredi da iyenebs mas sakutari tipis ujredis Semdgomi reproduqciisatvis. rodesac CD4 ujredi ganadgurdeba, axali virusis nawilakebis didi raodenoba Tavisuflad gadadis sisxlis nakadsi. arnisnuli procesi meordeba TviT CD4 ujredsic. sabolood ki, gamoileva CD4 ujredis raodenoba sxeulsi. arnisnulis Sedegad, qveitdeba sxeulis unari, winaarmdegoba gauwios da SeebrZolos infeqciebs. saboloo jamsi ki, dgeba kritikuli momenti, rodesac inficirebuli adamiani xdeba SidsiT daavadebuli. janmr- Tel, zrdasrul adamianebsi, normaluri CD4+ atvla meryeobs 600-dan 1,800-mde sisxlis ert kubur ml-ze. rodesac atvla 500-mde daiklebs, adamiani avaddeba umnisvnelo infeqciebit, xolo, roca 200-s qvemot ecema - Tavs icens Sidsis NniSnebi da simptomebi. rogor utevs virusi CD4 ujredebs? adamianis imunodeficitis virusi miekutvneba virusebis klass, romelsac retrovirusebi ewodeba. yvela baqteriasa da viruss aqvs wodebuli gare safari, romelsac garsi ewodeba, da romelic Sedgeba cilebisagan. es ukanaskneli specifiuria organizmis TiToeuli konkretuli tipisatvis. adamianis imunodeficitis virusi Zalian gonivrulad icavs 12 3 j. p hiti, afrikis religiuri liderebis qseli, romlebic SidsiT cxovroben an personalurad imyofebian misi zemoqmedebis qves (ANERELA+), mimartva gaertianebuli erebis generaluri asambleis specialuri sesiisadmi adamianis imunodeficitis virusisa (HIV) da Sidsis sakitxebze, 2006 wlis ivnisi.

14 samedicino faqtebi da prevencia an icilebs sakutar gare safars, sanam SeaRwevdes CD4 ujredsi, ris Sedegadac adamianis imunodeficitis virusi ar ariqmeba ucxo organizmad da misarebia CD4 ujredisatvis. amitomac, adamianis imunodeficitis virusi SesaZloa arsebobdes adamianis CD4 ujredebsi ramdenime wlis manzilze raime SesamCnevi problemis garese. pirveli rogor vrceldeba adamianis imunodeficitis virusi? adamianis imunodeficitis virusi arsebobs virusit inficirebulta sisxlsi, sasqeso organoebidan gamonaden sitxeebsa da qalis rzesi. igi gadadis erti inficirebuli adamianis sxeulis gamonayofi sitxeebidan meore adamianze. sqesobrivi kavsiri adamianis imunodeficitis virusi gadadis inficirebul pirtan daucveli sqesobrivi kavsiris damyarebis gzit (prezervativis gamoyenebis garese). arnisnuli virusi arwevs sxeulsi sqesobrivi kavsiris dros vaginis lorwovani garsis, penisis, ukana tanis (anusis) an piris Rrus mesveobit. aseve, kanze axali Wrilobis, natkeni da gadatyavebuli adgilis gzitac. daucveli analuri da vaginaluri seqsi warmoadgens yvelaze metad sarisko seqsualur kavsirs. adamianze virusis gadadebis riski zrdis sqesobrivi kavsiris gzit gadacemul infeqcias (STI), ramdenadac dazianebuli an damskdari kani aadvilebs arnisnuli virusis SeRwevis process. sqesobrivi gzit gadacemuli infeqciebis dauyovnebeli mkurnaloba aris erti-erti sasualeba adamianis imunodeficitis virusis gadadebis riskis Semcirebisa- Tvis. msrali seqsi nacadi xerxia msoflios zogiert nawilsi: garkveul niv- Tierebas atavseben vaginasi simsralis gamosawvevad. igi qmnis met SeWidulobas (xaxuns) aqtis dros, rac met siamovnebas hgvris mamakacebs. arnisnuli xerxis Sedegad iglijeba vaginis nazi membranuli qsovili, ritac advildeba adamianis imunodeficituri virusis SeRweva. garda amisa, vaginalur sekreciebsi bunebrivi antiseptikebis Semcveloba uunaro xdeba, SeebrZolos sqesobrivi gzit gadacemul infeqciebs (STIs). da bolos, prezervativebi gacilebit advilad ziandeba momatebuli xaxunis gamo. oraluri seqsi naklebad sariskoa, vidre vaginaluri an analuri seqsi, magram aranairad ar CaiTvleba absoluturad usafrtxod. piris Rrus wylulebi, antebiti an sisxlmdeni RrZilebi, yelis tkivili an oralurvaginaluri seqsi adamianis imunodeficitis virusit. inficirebul qal- Tan menstruaciis dros, iwvevs arnisnuli virusis gadadebis mzard albatobas. gamokvlevam acvena, rom winadacveta mamakacebs Soris amcirebs adamianis imunodeficitis virusis gadacemis risks 60-70%-iT, radganac penisis CuCis garkveuli maxasiatebeli aadvilebs adamianis imunodeficitis virusis SeWras. aqedan gamomdinare, inficirebis riski didia im mamakacebsi, romlebsac ara aqvt winadacveta. roca CuCi mosordeba peniss winadacvetis mesveobit, mcirdeba virusis gadadebis albatoba. 13

15 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi saerto moxmarebis Spricebis an sxeulis dasacxvleti instrumentebis gamoyeneba saerto Spricebis an sxeulis dasacxvleti instrumentebis gamoyeneba didi riskis matarebelia adamianis imunodeficitis virusis gadasadebad. aseve, saerto quris (mowyobilobebi, romlebic gamoiyeneba narkotikuli nivtierebebis dasamzadeblad, rata isini ufro gafiltruli gaxdes), Sezaveba/SeRebvis dros bambisa da wylis sargeblobam SesaZloa, gaavrcelos adamianis imunodeficitis virusi, ramdenadac arnisnuli virusit inficirebuli sisxlis mcire raodenoba SeiZleba darces zemot arnisnul xelsawyoebze gamoyenebis Sedegad. swored aqedan gamomdinare, SesaZloa man SeaRwios morigi momxmareblis sisxlis nakadsi. inficirebuli sisxlis gadasxma 14 mcirea imis albatoba, rom adamianis imunodeficitis virusi gadaeces im sisxlit an sisxlis produqtebit, romlebmac gaiares testi da es albatoba ert memilionedze naklebia. TiTqmis igive itqmis organoebis gadanergvis gzit adamianis imunodeficitis virusis SeZenis riskze. dres sisxlisa da organoebis Cabarebis bankebi avlenen yvelaze potenciur donorebs, romlebic adamianis imunodeficitis virusis infeqciis riskis matareblebi arian, xolo sisxlis nimusebi, sisxlis produqtebi da organoebi zedmiwevnit isinjeba arnisnul virustan da sisxlis sxva mikrobebtan mimartebasi. miuxedavad amisa, arsebobs patara Sansi, rom sisxlis donorma ar icodes rom is inficirebulia, Tu is imyofeba inficirebis adreul stadiasi, rodesac testi infeqcias aer acvenebs (ix., adamianis inficirebis dadgena ) arsebobs, adamianis imunodeficitis virusis gavrcelebis realuri riskis kidev erti mcire riskis faqtori - patientebisagan janmrtelobis dacvis musakebis dainficireba, rodesac mat nemsi ecxvlitebat an didi raodenobis sisxlsi moeqcevian. aseve, riskis qves imyofebian laboratoriebsi momusave adamianebi, romlebic sisxls amusaveben. igive itqmis personalze, romelsac Sexeba aqvs narcenebis da dabinzurebuli TeTreulis damusavebastan. dedidan Svilze gadacema adamianis imunodeficitis virusi SesaZloa gadavides vertikalurad dedidan Svilze sasosi yofnis dros an ZuZuTi kvebis mesveobit. bavsvebi, romlebic gacndnen adamianis imunodeficitis virusit inficirebuli dedisagan, virusis SeZenis 20-30% riskis matareblebi arian. gadadeba xdeba sami gzit: orsulobis dros (msobiarobamdeli gadacema), bavsvis dabadebis dros (msobiarobis dros gadacema) da ZuZuTi kvebis dros (msobiarobis Semdgom gadacema). virusis gadacemis yvelaze marali riski modis msobiarobis processi. msobiarobis arxis sekreciebi (gamonayofebi) Seicavs virusis did raodenobas. msobiarobis dros ki, SesaZloa, Cvilis kani ramdenadme daikawros da amgvarad moxdes virusis SeRweva. mesame tipis dros Cvilis inficireba SesaZlebelia ZuZuTi kvebis gzit. adamianis imunodeficitis virusit inficirebuli qalis rze Seicavs viruss da rac ufro xangrzlivia ZuZuTi kvebis periodi (6-9 Tveze meti), mit ufro didia gadadebis riski.

16 samedicino faqtebi da prevencia rogor ar gadadis adamianis imunodeficitis virusi mecnierebi da samedicino dargis wamyvani specialistebi ertxmad acxadeben, rom adamianis imunodeficitis virusi ver Zlebs Cveulebriv garemosi da garemos mesveobit gavrcelebis SesaZlebloba SeiZleba TiTqmis gamoricxulad CaiTvalos. mas Semdeg, rac inficirebuli sitxeebi absuluturad dasreba, garemos gzit virusis gavrcelebis Teoriuli riski arsebitad nuli gaxdeba. pirveli adamianis imunodeficitis virusi ar vrceldeba Semdegnairad: haerit, xvelebita da daceminebit kocnit, moxvevit, xelis CamorTmeviT an masajebit saerto TefSebiT, WiqebiTa Tu mwreli xelsawyoebit unitasze SexebiT mwerebisa Tu cxovelebis kbenit (koroebs da barlinjoebs ar gadaaqvt adamianis imunodeficitis virusi) sacurao auzebis sasualebit adamianis imunodeficitis virusit inficirebuli piris mier momzadebuli kerzis mirebit saerto tansacmlita Tu pirsaxocit gansxvaveba adamianis imunodeficitis virussa da Sidss Soris adamianis imunodeficitis virusit inficirebul adamianebs aqvt dadebiti pasuxi arnisnuli virusis mimart; isini jansarad gamoiyurebian da avadmyofobis aranairi simptomi ar arenisnebat. amgvar adamianebs didxans SeuZliaT icxovron, gaitvaliswinon konsultaciebi, adeqvaturi kveba, cxovrebis jansari wesis midevneba, gansazrvruli profilaqtikuri zomebis mireba, da Tu xelmisawvdomia da/an SesaZlebeli miiron antiretrovirusuli medikamentebi (ARV). adamiani, romelmac miarwia Sidsis stadias, Cveulebriv, simptomaturia da xsirad izens sxvadasxva daavadebebs. Tu isini ar imkurnaleben antiretrovirusuli medikamentebit, wesisamebr, mati sicocxlis xangr- Zlivoba SeizRudeba. gansxvaveba adamianis imunodeficitis virussa da Sidss Soris Zalian mnisvnelovania. msoflios mraval nawilsi amjerad SesaZlebelia adamianis imunodeficitis virusis martva. sicocxle SesaZloa gaxangr- Zlivdes Tu xelmisawvdomia sawiro samkurnalo sasualebebi. amdenad, termini adamianis imunodeficitis virusi/sidsi unda avicilot da SevcvaloT igi terminit adamianis imunodeficitis virusi da Sidsi, ramdenadac isini warmoadgenen or ganyenebul, Tumca ertmanettan dakav- Sirebel pirobas. 15

17 rac ufro ziandeba imunuri sistema, is kargavs unars, SeebrZolos daavadebas. mosalodnelia mwvave diarea, mkvetri kleba wonasi, filtvebis anteba, tvinis infeqciebi, gonebis dakargva da a. S. avadmyofi daucveli xdeba mtel rigi oportunistul infeqciebis winase, romlebic gamowveulia Cvens garsemo arsebuli baqteriebit, sokoti da paraziteadamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi adamianis imunodeficitis virusis infeqciis stadiebi Tavdapirveli infeqcia infeqciis dros adamianma ar icis, rom inficirebulia. pirveli 6-8 kviris ganmavlobasi, adamianta imunodeficitis virusit daavadebul- Ta TiTqmis naxevars arenisneba gripismagvari simptomebi, rac gulisxmobs cxelebas, sisustes, gamonayars, saxsrebis tkivils, Tavis tkivilsa da limfuri kvanzebis Sesivebas. arnisnuli simptomebis ioli formebis gamo, xsirad isini SeumCnevelia da adamiani male gamojanmrteldeba, xolme. da mainc, Tavdapirveli infeqciis dros virusi Tavis gzas poulobs limfuri kvanzebisken. am process 3-5 dre swirdeba. Semdeg, adamianis imunodeficitis virusi aqtiurad mravldeba da SeuSvebs virusis axal nawilakebs sisxlis nakadsi. adamianis imunodeficitis virusis amgvari eskalacia grzeldeba 2-3 Tves. arnisnuli stadiis ganmavlobasi, sisxlsi didi raodenobitaa arnisnuli virusi da imunuri sistema iwyebs reagirebas antisxeulebis warmoqmnit. arnisnuli procesi cnobilia, rogorc serokonversia. asimptomuri infeqcia arnisnuli stadia, sasualod, 10 wels grzeldeba, romlis ganmavloba- Sic adamians arsebitad ar arenisneba ZiriTadi simptomebi, Tumca Sesa- Zloa, nusura jirkvlebis Sesiveba. inficirebulebs SeuZliaT jansari cxovreba ramdenime wlis ganmavlobasi, sasualod weli, antiretrovirusuli mkurnalobis garese. zemot arnisnuli, rasakvirvelia, individualuria; zogiert SemTxvevaSi, adamiani avlens simptomebs ukve 2 wlis Semdeg, masin roca sxvebi 12 welze meti dro swirdebat Sidsis Camosayalibeblad. simptomuri stadia rogorc ki imunuri sistema moisleba, adamiani iwyebs uamravi mcire infeqciebis SeZenas, rogoricaa sinusiti (sasuntqi gzebis antebis erterti saxe), bronqiti (gulmkerdis anteba), drodadro temperaturis mateba, kanis msubuqi garizianebebi da gamonayari, kanis sokovani daavadebebi, frcxilebis infeqciebi, piris Rrus wylulebi, da wonis umnisvnelo kleba. adamianis imunodeficitis virusis ufro maral stadieb- Si mat SeiZleba gaucndet tuberkulozi (TB), rziana (motetro gamonayari piris RruSi, yelsa da enaze), herpesuli gamonayari piris RruSi an sasqeso organoebze. Sidsis stadia 16

18 samedicino faqtebi da prevencia bit. arnisnuli SemTxvevebi ar iwvevs daavadebas normaluri imunuri sistemis mqone adamianebsi, magram adamianis imunodeficitis virusis matareblebsi, msgavsi mikrobul agentebs gafurcqvnis SesaZlebloba (opportunity) ezlevat da aqedan gamomdinare cnobilni arian rogorc oportunistuli infeqciebi. pirveli adamianis inficirebis dadgena veravin imsjelebs adamianis garegnobit, inficirebulia is, Tu ara adamianis imunodeficitis virusit. aqvs Tu ara adamians adamianis imunodeficitis virusi an Tundac Sidsi? igi absoluturad janmrtelad gamoiyureba. arnisnuli virusit inficirebul nebismier adamians SeuZlia sxvebis inficireba, Tundac aranairi simptomi ar arenisnebodes. ertaderti gza dadgenisa, aris sisxlis analizis Semowmeba, romlis umetes SemTxvevaSi vlindeba adamianis imunodeficitis virusis antisxeulebi. antisxeulebi warmoadgenen daavadebastan mebrzol cilebs, romlebic warmoiqmneba adamianis organizmsi ucxo, SemoWrili sxeulebis sapasuxod, rogoricaa baqteriebi da virusebi. rodesac adamiani inficirebulia adamianis imunodeficitis virusit, sxeuli iwyebs arnisnuli virusis specifiuri antisxeulebis warmoqmnas. martalia, mocemuli antisxeuli ver ebrzvis efeqturad viruss, magram misi arseboba sisxlsi sarwmuno macvenebelia imisa, aris Tu ara vinme adamianis imunodeficitis virusit inficirebuli. Cveulebriv, antisxeulebi warmoiqmnebian infeqciis SeWridan daaxloebit 12 kviris ganmavlobasi. TiTqmis yvela adamians SeuZlia antisxeulebis gamomusaveba inficirebidan 6 Tvis man- Zilze. inficirebidan pirveli 12 kviris ganmavlobasi, adamianis sisxlsi ar arsebobs antisxeulebi. amdenad, testis Sedegad mivirebt adamianis imunodeficitis virus-uaryofits (HIV-negative). mas kritikuli saintervalo periodi ewodeba, romlis drosac inficirebul pirs SeuZlia gasces kidec sisxli ise, rom virusi arc ki gamomjravndes. Zalian isviat SemTxvevebSi, arnisnuli periodi savaraudod 6 Tves grzeldeba. Sesabamisad, adamianis inficirebac aris dasasvebi sqesobrivi urtiertobis dros arnisnuli virusit inficirebultan, magram testis Sedegi arnisnuli periodis dros jer kidev uaryofitia. swored amitom aris mnisvnelovani xelmeored testis Catareba 3 Tvis Semdeg mattvis, visi testic uaryofitia. virusuli datvirtva aris virusuli nawilakebis raodenoba sisxlis 1 ml-si. arnisnuli done imatebs, rodesac virusi swrafad mravldeba sisxlis nakadsi. virusuli datvirtva Zalian maralia swored Tavdapirveli infeqciis dros, vidre adamiani daiwyebdes antisxeulebis warmoqmnas. mocemuli periodis ganmavlobasi, adamiani Zlierad aris infeqciit daavadebuli, Tumca antisxeulebis mimart testi kvlav negatiuria. Semdeg virusuli datvirtva ecema da inarcunebs dabal dones masin, roca sxeuli aradgens kontrols infeqciaze. Tu mkurnaloba ar Catardeba, mravali wlis Semdeg sxeuli nakleb uunaro xdeba, akontrolos virusi da virusuli datvirtva iwyebs zrdas. rogorc ki daavadeba daiwyebs progresirebas, virusuli datvirtvac matulobs, xolo CD4 iwyebs klebas. 17

19 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi antiretrovirusuli medikamentebi adamianis imunodeficitis virusisa da Sidsis pandemiis dawyebidan moyolebuli, ganvitarda medikamentebis mteli seria, romlebic sicocxles uxangrzliveben mas, vinc adamianis imunodeficitis virusis mimart dadebitia (ix. danarti 2). arnisnuli antiretrovirusuli medikamentebi blokaven virusis gavrcelebas da awianureben Sidsis Camoyalibebas daavadebis progresiis SenelebiT. es ar nisnavs gankurnebas. yvelaze efeqturi mkurnaloba cnobilia, rogorc maralaqtiuri antiretrovirusuli Terapia (HAART), sami an meti antiretrovirusuli medikamentebis kombinacia, romlis mizania Seayovnos sxeulsi virusis gamravlebis siswrafe. antiretrovirusuli medikamentebis privilegia mdgomareobs Semdeg- Si: Seayovnos sxeulsi virusis gamravlebis siswrafe da aqedan gamomdinare, - virusuli datvirtva Seayovnos daavadebis progresireba SeinarCunos an aradginos imunuri sistemis moqmedeba gaxados adamiani nakleb infeqciuri da amgvarad Seamciros adamianis imunodeficitis virusis gavrcelebis riski. antiretrovirusuli medikamentebis riskebia: adamianis imunodeficitis virusis sawyisma mkurnalobam Sesa- Zloa Seamciros janmrtelobis mdgomareobis xarisxi samkurnalo sasualebebis gverditi movlenebisa da sizviris gamo. antiretrovirusuli medikamentebis mimart rezistentulobis SesaZlo ganvitareba. aqedan gamomdinare ki, mkurnalobis Semdgomi alternativebis limitireba. Terapia savaraudod moitxovs gagrzelebas upirobo droit. instruqciebi mattvis, romlebic mkurnaloben antiretrovirusuli medikamentebit danisnuli Terapiis mkacrad dacva: wesisamebr, inisneba sul mcire 2 sxvadasxva klasis 3-5 sxvadasxva medikamentis kombinacia ertdroulad (medikamentebis koqteili). Tu pacienti miirebs danisnulebaze nakleb raodenobas, an miirebs arasistematurad, masin ganvitardeba rezistentuloba an tolerantuloba medikamentis mimart. es ki imas nisnavs, rom medikamentebi Sewyveten moqmedebas. adamianis imunodeficitis virusi icvlis Tavis struqturas (ganicdis mutacias), virusis zogierti saxeoba rezistentuli xdeba medikamentebis mimart. amitomac, misi gakontrolebis Sansi ufro metia, Tu gamoviyenebt ramdenime medikaments ertad. adeqvaturi kvebis gatvaliswineba: medikamentebis mireba sa- Tanado da regularuli kvebis garese gamoiwvevs kuwnawlavtan dakavsirebul simptomebs, anemiasa da Rebinebas. 18

20 samedicino faqtebi da prevencia pacientis ganatlebas udidesi mnisvneloba aqvs: arnisnuli moicavs iset sakitxebs, rogoricaa medikamentis danisnulebis mkacri dacva, rezistentuloba medikamentis mimart, regularuli mireba, adekvaturi kveba, toqsikuroba, uwyveti infeqciuri statusi (zogierti mcdarad varaudobs, rom radganac mkurnalobs, viruss sxvebs ar gadadeben), sisxlis analizebze dakvirveba da a.s. SesaZlebelia adgilobrivi moxaliseebis dasaqmeba arnisnuli ganatlebis ZalisxmevisaTvis. rezistentuloba medikamentta mimart: pacientebis mkurnaloba iwyeba medikamentebis umtavresi kombinaciis (rejimis pirveli xazi) mirebit. ramdenime wlis Semdeg, mititebuli medikamentebi ar moqmedeben da pacienti sawiroebs rejimis meore xazze gadartvas, romelic ufro ZviradRirebulia. sawiroa medikamentebis Secvla yovel sam weliwadsi. dresdreobit, bazarze gatanilia daaxloebit 20 sxvadasxva saxis medikamenti, romeltaganac mxolod mcire raodenobaraa xelmisawvdomi ganvitarebad qveynebsi. mkurnalobis mowinave rejimi, wesisamebr, Zviria da amdenad, amgvar qveynebsi mcxovrebi xalxi ver audis xarjebs. regularuli dakvirveba: mnisvnelovania, rom CD4 is da Tu Sesa- Zlebelia, virusuli datvirtvis analizebi, Catardes yovel 3-6 TveSi, rac moitxovs specialur mowyobilobas. pirveli adamianis imunodeficitis virusis prevencia gasatvaliswinebelia adamianis imunodeficitis virusisa da Sidsis gavrcelebis nebismieri prevenciuli metodi da aqedan gamomdinare sicocxlis dacva da SenarCuneba. metodi, romelic satanadoa erti situaciisatvis, SeiZleba sulac ar armocndes efeqturi meorisatvis. rac mudam unda gvaxsovdes, aris mocemuli konteqsti, pirovnebis survili da SesaZlebloba, miiros prevenciuli zomebi, da sazogadoebasi mirebuli Rirebulebebi. mizani aseti unda iyos: davicvat yvela adamianis sicocxle, rogorc RvTisgan bozebuli Zvirfasi sacuqari. adamianis imunodeficitis virusis sqesobrivi kavsirit gavrcelebis prevencia adamianis imunodeficitis virusis gavrcelebis prevencia SesaZlebelia, Tu ar eqneba adgili seqss im adamiantan, vinc inficirebulia an SesaZloa inficirebuli iyos arnisnuli virusit, an Tu gamoiyeneba prezervativi. satanadod da sistematurad gamoyenebis SemTxvevaSi, mamakacis prezevativi arsebitad mdgradi xdeba adamianis imunodeficitis virusis zomis nawilakebisatvis, Tumca aranairi damcavi metodi, garda TavSekavebisa, ar aris 100%-iT usafrtxo. wyvilebis SemTxveva- Si, rodesac ert-erti matgani virusis mimart dadebitia, xolo meore ki, uaryofiti, prezervativis gamoyeneba gardauvalia. Tundac orive matgani dadebiti iyos, prezervativis gamoyeneba aucilebelia, radganac mat SeiZleba virusis sxva daavadeba SeeyaroT. virusis yoveli daucveli Setakeba sxvadasxva winaarmdegobastan iwvevs virusuli tvirtis zrdas. prezervativis gamoyenebt xdeba adamianis imunodeficitis virusis xelaxali inficirebisagan dacva. 19

21 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi qalis mier kontrolirebadi prevenciuli metodebi qalebis prezervativi warmoadgens poliuretanis safars rgolebit TiToeul bolosi, romelic qals Sehyavs vaginasi sqesobrivi kavsiris damyarebamde 8 saatit adre. igi uzrunvelyofs rogorc orsulobisagan aseve, sqesobrivi gzit gadacemuli infeqciebisagan (STIs) Tavdacvas da gverditi movlenebi cnobili ar aris. arnisnuli prezervativis didi upiratesoba is aris, rom misi gamoyenebit qali TviTon akontrolebs sakutar sqesobriv janmrtelobas. magram, igi gacilebit Zviria, vidre mamakacis prezervativi da arc Tu ise xelmisawvdomi. amastanave, aucilebelia molaparakeba da TanamSromloba mamakactan. mikrobiocidis mesveobit SesaZlebelia sqesobrivi kavsiris gzit adamianis imunodeficitis virusisa da sxva msgavsi infeqciebis prevencia, Tu igi motavsdeba qalis sasqeso organos traqtsi. arnisnuli medikamenti xelmisawvdomi iqneba ramdenime weliwadsi gelis, kremis, santlis, firfitis, Rrublis an rgolis saxit. adamianis imunodeficitis virusis gavrcelebis prevencia narkotikebis intravenuri gzit momxmareblebisatvis adamianis imunodeficitis virusit narkotikebis intravenuri gzit momxmareblebis inficirebis albatoba SesaZloa Semcirdes saerto Spricebis gamoyenebis Tavidan acilebit. Cveulebriv, Zalian Znelia narkotikebis momxmareblebisatvis Sewyviton narkotikebisaken midrekileba. narkotikebis gauvnebelyofis programebi sawiroa im SemTxvevaSi, rodesac narkotikebis intravenuri gzit momxmareblebi sabolood gadaecvevian nemsebs adamianis imunodeficitis virusis infeqciis Tavidan asacileblad. programebi, romlebic uzruvelyofen sterilur nemsebs arnisnuli virusis Tavidan asacileblad, cnobilia, rogorc zianis Semamcirebeli programebi. rac Seexeba prezervativebs, mati gamoyenebis mizania adamianis imunodeficitis virusisisagan Tavdacva da sicocxlis SenarCuneba. 4 dedidan Svilze gadacemis prevencia antiretrovirusuli wamlebis gamoyeneba adamianis imunodeficitis virus-dadebiti dedebisatvis orsulobis dros aferxebs virusis gadacemas. arnisnuli wamlebi amcireben virusul datvirtvas dedis sxeulsi da aqedan gamomdinare, bavsvis inficirebis Sansebic klebulobs. msoflios umetes ganvitarebul qveynebsi, amjerad aprobirebulia sakeisro kvetit bavsvis gacena msobiarobis processi inficirebis Tavidan asacileblad, magram ver ganxorcieldeba im qveynebsi, sadac resursebi seriozulad limitirebulia. dedis rzit Cvili bavsvis inficirebis riski daizleva, Tu kvebas CavanacvlebT Cvili bavsvebisatvis gankutvnili receptit (dedis rzis Semcvleli sakvebi). bevr qveyanasi es arapraqtikuli, Zviri an kultu damatebiti informaciisatvis, Tu ramdenad Seesabameba arnisnuli luteranuli etikis midgomas, ixilet Tavi 2.

22 samedicino faqtebi da prevencia rulad miurebelia. steriluri, usafrtxo wyali arnisnuli receptis dasamzadeblad, SesaZloa, arc moipovebodes. arasteriluri botlebi ki, zrdian nawlavuri infeqciebis SesaZleblobebs. Tu dedis rzis Canacvleba ver xerxdeba, adamianis imunodeficitis virusis mimart dadebit dedebs urceven, rac SeiZleba male Seuwyviton Cvilebs ZuZuTi kveba. manamde ki, urceven mxolod ZuZuTi kvebon bavsvi da Tavidan aicilon Sereuli kveba (ZuZuTi da xelovnuri), ramdenadac igi zrdis gadadebis SesaZleblobebs. adamianis imunodeficitis virusisa da Sidsisgan prezervativebit Tavdacvis mtavari winaarmdegoba aris qalsa da mamakacs Soris urtiertopirveli gadadebis prevencia janmrtelobis dacvis dawesebulebebsi janmrtelobis dacvis uzrunvelmyofebma unda daicvan Tavi adamianis imunodeficitis virusit inficirebisagan infeqciuri kontrolis danisnuli procedurisa da universaluri profilaqtikuri wesebis dacvis gzit. arsebobs metodebi Spricebis uyuradrebod gamoyenebis Sedegad mirebuli kanis da lorwovani garsis dazianebebis gzit infeqciis gadadebis Tavidan asacileblad. msgavsi SemTxvevebisgan Tavis dasacavad xelsayrelia damcavi xeltatmanebis, gaumtari winsafrebis, damcavi fexsacmelebis, satvaleebisa da aseve, nirbebis gamoyeneba. Tu romelime SemTxvevas eqna adgili, dazianebuli monakveti dauyonebliv unda moibanos sapnita da wylit. Semdeg, virusze sabaziso testi unda Cautardes, rogorc dazaralebul pirs, aseve imasac, visganac sisxli an sitxe gadmodinda. Tu dazaralebul pirs arenisna uaryofi- Ti Sedegi (imis mititebit, rom manamade ar iyvnen inficirebulebi), meores ki armoacndeba dadebiti adamianis imunodeficitis virusis mimart, an Zalian didia albatoba, masin, riskebi sawiroebs Sefasebas gamocdili eqspertis mier. Tu riskebi didia, sasurvelia antiretrovirusuli preparatebis gamoyeneba gamovlenidan 24 saatis ganmavlobasi. arnisnuli cnobilia, rogorc posteqspoziciuri profilaqtika (PEP). gaupatiurebis SemTxvevaSi dasasvebia msgavsi proceduris dacva, romelsac unda mohyves adamianis imunodeficitis virusis testebi 3-6 Tvis Semdeg. midgoma ABC prevenciis ert-ert cnobil midgomas warmoadgens ABC: A - Tavis Sekaveba (sqesobrivi kavsirisagan), B - ertguleba (erti partnioris mimart) da C - prezervativis gamoyeneba. ABC efeqturia mxolod, rogorc prevenciuli instrumenti, magram qalebisatvis limitirebulia gansakutrebit im SemTxvevaSi, Tu Tavdacvis ertadert sasualebad moiazreba. Tavis Sekaveba azrs kargavs gogonebisa da qalebisatvis, romlebsac sakutari survilis winaarmdeg daiyolieben sqesobriv aqtsi an Zaldatanebis msxverplni xdebian. verc izulebiti qorwinebis dros xdeba Tavis Sekaveba da rogorc movaleobis nawili, bavsvis gacenacaa mosalodneli. analogiurad, ertguleba erti partnioris mimart Tavdacvis mcire sasualebas stavazobs qalebs, romelta qmrebic inficirebuli iyvnen qorwinebamde an hyavdat sxva partniori. 21

23 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi basi Zalauflebis mopoveba. xsirad qalebi ver aizuleben mamakac partniorebs, gamoiyenon prezervativi. mravali mamakaci, romelic uars ambobs sqesobrivi kavsiris damyarebis dros gamoiyenos prezervativi, Seuracxyofilad Tvlis Tavs da Tavisi partnioris motxovnas prezervativit sargeblobis Sesaxeb undoblobad da araertgulebad afasebs. ufro metic, prezervati mattvis warmoadgens bavsvis Casaxvisa da gacenis bariers. midgoma SAVE afrikis qselma religiuri liderebisatvis, romlebic inficirebuli arian adamianis imunodeficitis virusita da SidsiT (ANERE-LA+) an personalurad imyofebian mati zemoqmedebis qves, SeimuSava modeli saxelwodebit SAVE adamianis imunodeficitis virusis sapasuxod: usafrtxo metodebi: igi moicavs prevenciis yvela sasualebas Tavis Sekaveba, ertguleba, prezervativis gamoyeneba, steriluri Spricebi, usafrtxo sisxlis gamoyeneba, dedidan Svilze gadadebis prevencia da sxva. xelmisawvdomi samkurnalo sasualebebi: xelmisawvdomobis SemTxvevaSi, mkurnaloba rac SeiZleba swrafad unda daiwyos, infeqciis Semdgomi progresis Tavidan ascileblad da janmrtelobis gasaumjobeseblad. nebayoflobiti konsultaciebisa da testebis Catareba (VCT): nebayoflobit testebis Catarebas gadamwyveti roli akisria. igi uzrunvelyofs mnisvnelovan dasawyiss, rom adamianebma gaigon TavianTi mdgomareobis Sesaxeb imunodeficitis virusis mimart da aseve, izleva sasualebas arnisnuli virusis Semdgomi gavrcelebis prevenciisatvis. ndobit arwurva: virusit inficirebuli adamianebi unda ari- Wirvon ndobit, rom gamoimusaon dadebiti damokidebuleba da pozicia konsultaciebis, locvis da sxva sulieri mxardaweris armocenis gzit. arnisnuls didi mnisvneloba ekisreba infeqciis progresis SeferxebisaTvis. (ix. danarti 3). 22

24 samedicino faqtebi da prevencia winamdebare Tavis wyaroebi adamianis imunodeficitis virusisa da Sidsis acileba, Semdeg misamartze: jon bartleti, medicinis doqtori, jibis megzuri adamianis imunodeficitis virusisa da Sidsis mkurnalobisatvis 2006 (jon hopkinzis Sidsis servisi), Semdeg misamartze: pirveli gaertianebuli samefos janmrtelobis dacvis departamenti, adamianis imunodeficitis virusis gamomjravnebis Semdgomi profilaqtika: gaertianebuli samefos mtavar samedicino eqspertta sakonsultacio jgufis saxelmzrvanelo principebi Sidsis Sesaxeb, me-2 gamocema, PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT _ ID = &chk=qtPweH gaero Sidsis winaarmdeg (UNAIDS), angarisi Sidsis globaluri epidemiis Sesaxeb, 2006, Semdeg misamartze: gaero Sidsis winaarmdeg (UNAIDS), adamianis imunodeficitis virusis prevenciis gazliereba. gaero Sidsis winaarmdeg (UNAIDS) politikis dokumenti 2005 data.unaids.org/publications/irc-pub06/jc1165-intensif _ hiv-newstyle _ en.pdf ass janmrtelobis dacvisa da adamianis momsamsaxurebis departamenti, sainformacio seriebi Sidsis Sesaxeb, Semdeg misamartze: daavadebebis kontrolis centri, ass-s adamianis imunodeficitis virusis/sidsis prevenciis ganyofileba, Semdeg misamartze: janmrtelobis dacvis msoflio organizacia, adamianis imunodeficitis virusi & Sidsi: mzrunveloba da mkurnaloba, 2004, Semdeg misamartze: janmrtelobis dacvis msoflio organizacia, universaluri profilaqtikuri zomebi infeqciis usafrtxoebis CaTvliT, Semdeg misamartze: janmrtelobis dacvis msoflio organizacia, adamianis imunodeficitis virusisa & Sidsis prevencia axalgazrdebsi, faqtebi ganvitarebadi qveynebidan, janmrtelobis dacvis msoflio organizaciis teqnikuri angarisis seriebi, # 938, Semdeg misamartze: /IS BN _ 92 _ 4 _ _ 0.htm 23

25 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi 24

26 Tavi 2: sqesi, sqesobrivi urtiertoba da simartlis Tqma 25

27 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi adamianis imunodeficitis virusisa da Sidsis pandemiis SemTxvevaSi, rwmenaze damyarebuli mosazrebebi qalsa da mamkacs Soris fundamenturi Tanasworobis, sqesobrivi kavsiris siketisa da simartlis Tqmis aucileblobis Sesaxeb ganicdis Zalmomreobas, rasac savalalo Sedegebi aqvs. riski da tvirti aratanabrad daawva qalebsa da axalgazrda gogonebs, xolo sqesobrivi kavsiris irgvliv gamefebul sicumes sikvdilsken ufro mivyavart, vidre sicocxlisaken. qalebi, axalgazrda gogonebi da adamianis imunodeficitis virusi da Sidsi infeqciis macveneblebis uzarmazari sxvaoba gogonebsa da biwebs Soris asaxavs upirobo genderul tendeciurobasa da aratanasworuflebianobas Cvens sazogadoebasi. siraribe da adamianis imunodeficitis virusi da Sidsi mwidrodaa dakavsirebuli ertmanettan. msoflios mraval nawilsi, qalebi da gogonebi ufro arian adamianis imunodeficitis virusita da SidsiT inficirebulebi, vidre mamakacebi da axalgazrda biwebi. sagangasod izrdeba infeqciis macveneblebi qalebsa da gogonebsi. ratom xdeba amgvarad? ramdenad aisaxeba zemot arnisnuli im sasualebebze, romlitac Cven mivmartavt pandemias? 5 qalebi ufro eqvemdebarebian inficirebas, radganac sperma Seicavs adamianis imunodeficitis virusis ufro Warb raodenobas, vidre vaginaluri gamonayofi sitxeebi, da nazi qsovili gacilebit metia massi. virusi arwevs sisxlis nakadsi qsovilis odnavi garrvevitac, romelic dasasvebia sqesobrivi kavsiris dros. genitaluri wylulebi damatebit arxs qmnian adamianis imunodeficitis virusis SesaRwevad. aqedan gamodinare, virusis gadadebis albatoba ufro metia qalebsi kacebtan SedarebiT, sqesobrivi kavsiris damyarebis dros. gadawyvetilebis mirebis uflebis deficiti da materialuri damokidebuleba mravali qalisatvis finansuri, materialuri an tradiciuli damokidebuleba kacebze nisnavs, rom mat umnisvnelo an aranairi gavlena ara aqvt gadawyvetilebis mirebis dros sqesobriv aqttan dakavsirebul sakitxebsi. gacilebit met SemTxvevaSi, qalebsa da gogonebs ZaliT iyolieben sqesobriv kavsirze. isini, mitumetes, ver warmartaven molaparakebas inficirebis riskis Semcirebis sakitxebze, magalitad,adajinebit mostxovon prezervativis gamoyeneba. mravali saxis diskriminacia arrvevs genderul Tanasworobas. ukiduresi siratake aizulebs qalebsa da gogonebs daamyaron sqesobrivi kavsiri lukma-puris an sxva materialuri sargeblis mopovebis sanacvlod, rata Tavi gaitanon. zogierti gogona ebmeba asakovani mamakacebis xafangsi (cnobili tkbili mamikoebis saxelit), romlebic mat sqesobrivi kavsiris sanacvlod mimzidvel variantebs 5 ix. 26

28 sqesi, sqesobrivi urtiertoba da simartlis Tqma Tavazoben, mat Soris ojaxebisatvis finansur daxmarebas. qalis ormagi tvirti kidev ufro mzimdeba, Tu misi ojaxi inficirebulia imunodeficitis virusita da SidsiT an ganicdis mat zemoqmedebas, radganac qalisagan moelian mzrunvelobas garda imisa, rom ojaxsac arcens. imavdroulad, mas uxdeba ebrzolos sakutar daavadebasac. sqesobrivi kavsiris irgvliv gamefebuli sicume sazogadoebrivi normebi sasis uvicobas aweseben qalebsa da axalgazrda gogonebze, romlebisganac xsirad moelian mcire codnas seqsisa da sqesobrivi kavsiris Sesaxeb. bevr sazogadoebasi kargi gogonebi ar saubroben an ar undat gamoamjravnon codna seqsis Sesaxeb. arnisnuli uvicoba zrdis adamianis imunodeficitis virusit inficirebis risks, radganac bevrma axalgazrda qalma arc ki icis, rogor daicvas Tavi gadamdebi imunodeficitis virusisagan. ganatlebis simcire mraval adgilas, sadac adamianis imunodeficitis virusi da Sidsi far- Todaa modebuli, qalebsa da gogonebs gacilebit naklebi SesaZleblobebi aqvt ganatlebis misarebad, vidre kacebsa da biwebs. sasualo skolis damtavreba SesaZlebels xdis, gaumjobesdes qalebis sazogadoebrivi roli, mati dasaqmebis sasualebebi, TviTdajerebuloba da Seamciros mati inficirebis riski. ganatlebas moaqvs gazrdili gacnobiereba da codna - prezervativebis moxmarebis marali macvenebeli da meti komunikacia partniorebs Soris adamianis imunodeficitis virusis prevenciastan dakavsirebit. meore genderuli Zaladoba qalebsa da gogonebze Zaladoba ert-erti umtavresi faqtoria, romelic xels uwyobs infeqciis gavrcelebas. arnisnuli gulisxmobs imgvar savalalo danasauls, rogoricaa gaupatiureba da fizikuri Zaladobis sxva formebi, aseve, iset sasis kulturul tradicias, rogoricaa qalis genitaluri dasaxicreba. bevri matgani ojaxis an sazogadoebis SigniT xdeba. gaertianebuli erebis mier qvemot moyvanili detaluri ganmarteba exeba ara marto pirovnuli Zalmomreobis usualo formebs, aramed Zaladobis daufaravad damkvidrebul sistemebsa da struqturebsac. termini Zaladoba qalebis winaarmdeg nisnavs genderuli Zaladobis nebismier aqts, romelic iwvevs an gamoiwvevs qalebis SesaZlo fizikur, sqesobriv an fsiqologiur dazaralebas an tanjvas, msgavsi qmedebebit damuqrebis, izulebis an Tavisuflebis pirobiti arkvetis CaTvliT, sajarod Tu pirad cxovrebasi. 6 qalebisa da gogonebis gaupatiurebisas, mati inficirebis riski gacilebit didia sasqeso organoebisa da ukana tanis fizikuri dazianebis gamo. gaupatiureba xdeba Sin an sazogadoebriv adgilebsi, policiis 6 gaertianebuli erebis me-4 msoflio konferencia qalta dacvis sakitxebze, samoqmedo platforma (pekini, seqtemberi 1995 w), paragrafi 113, womenwatch/daw/beijing/platform/violence.htm 27

29 adamianis imunodeficitis virusis (HIV) saxelmzrvanelo principi sapatimroebsa da cixeebsi, konfliqtisa da omis situaciebsi. SiSi da sircxvili bowavs qalebs, moizion informacia adamianis imunodeficitis virusis Sesaxeb an Caitaron testi Tu mkurnaloba masinac ki, rodesac askarad arian daewvebulebi sakutar Tavze inficirebis Sesaxeb. mravali qalisatvis sakutriv qorwinebac sarisko armocnda. axalgazrda, daqorwinebul qalebsi arinisneba adamianis imunodeficitis virusit inficirebis mnisnvnelovnad marali macvenebeli, vidre mat dauqorwinebel, seqsualurad aqtiur TanatolebSi. es imitom xdeba, rom daqorwinebuli qalebi ufro didi riskis qves eqcevian, Tu mati partniori inficirebulia. aseve, uamravi magaliti arsebobs, roca adamianis imunodeficitis virusit inficirebuli qmrebi colebs aizuleben iqonion mattan seqsi. amgvari izulebiti sqesobrivi kavsirebi iwvevs inficirebis did Sansebs. memkvidroebisa da sakutrebis uflebis CamorTmeva arsebuli praqtika arasteriluri samarteblis, danisa da nemsebis mravaljeradi gamoyeneba klitorisa da vaginas mimdebare adgilebis mosakvetad, qalebsa da gogonebs uqmnis adamianis imunodeficitis virusit inficirebis did risks. warmoqmnili dazianebuli qsovilis gamo metia sasqeso organoebis (genitaliebis) gaglejis albatoba sqesobrivi kav- Siris dros, rac didad uwyobs xels sqesobrivi gzit virusis gadadebis albatobasac adamianis imunodeficitis virusit inficirebuli ma- qalebi ufro daucvelebi arian sakutrebasa da memkvidreobaze aratanaswori uflebis qonis gamo. moqmedebs mzitevis faqtoric. miuxedavad imisa, rom arnisnuli gamocdilebebi gansxvavdeba mtels msofliosi, genderuli aratanasworuflebianoba sagrznobladaa gavrcelebuli. wesisamebr, qorwinebis dros, isviati gamonaklisis garda, rodesac qalebi xdebian mesakutreebi, mamakacebi euflebian qonebas. zogiert qveyanasi, rodesac qalis mamakaci partniori kvdeba SidsiT, ramdenadac ar arsebobs kanonieri qals qmris natesavebi artmeven ufleba qonebisa da miwis mflobelobis qonebas, ris Sedegadac igi an mekvidreobit mirebis Sesaxeb, qalebi ekonomiurad ukiduresad da gogonebi garatakebis riskis winase daucveli rceba. armocndebian msoblebis an qmrebis gardacvalebis Semdeg. sanacvlod, siraribe da ekonomiuri damokidebuleba kidev ufro tovebs mat seqsualuri eqspluataciisa da Zaladobis anabara. colis memkvidreobit gadacema mocemuli SemTxvevis dros, qvrivi colad mihyveba gardacvlili qmris axlo natesavs. igi memkvidreobit gadadis, zogjer poligamiur ojax- Si, da SesaZloa dakargos sakutari Svilebi. Tanmdevi sqesobrivi kav- Siri xsirad ZaldatanebiTia da daucveli. Tu romelime coli an axali qmari ukve inficirebulia adamianis imunodeficitis virusit, didia gadadebis da Sesabamisad, virusis gavrcelebis riskic. qalis genitaluri dasaxicreba 28

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