{"id":27328,"date":"2023-09-30T00:06:16","date_gmt":"2023-09-29T21:06:16","guid":{"rendered":"https:\/\/www.klimikdergisi.org\/?p=27328"},"modified":"2023-09-30T09:45:03","modified_gmt":"2023-09-30T06:45:03","slug":"hiv-aids-kongresi-2022nin-ardindan","status":"publish","type":"post","link":"https:\/\/www.klimikdergisi.org\/tr\/2023\/09\/30\/hiv-aids-kongresi-2022nin-ardindan\/","title":{"rendered":"HIV\/AIDS Kongresi 2022\u2019nin Ard\u0131ndan: T\u00fcrkiye\u2019de HIV \u0130nfeksiyonu ile M\u00fccadelede Kazan\u0131mlar, Zorluklar ve \u00d6neriler"},"content":{"rendered":"<h2>G\u0130R\u0130\u015e<\/h2>\n<p class=\"p2\"><span class=\"s1\">HIV infeksiyonu D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan kronik hastal\u0131klar listesine al\u0131nm\u0131\u015ft\u0131r ve g\u00fcn\u00fcm\u00fczde HIV ile uzun ve kaliteli bir ya\u015fam s\u00fcrd\u00fcrmek m\u00fcmk\u00fcnd\u00fcr. <\/span><span class=\"s2\">Birle\u015fmi\u015f Milletler HIV\/AIDS <\/span><span class=\"s1\">Program\u0131 (The Joint United Nations Programme on HIV\/AIDS &#8211; UNAIDS)\u2019n\u0131n 2022 raporuna g\u00f6re son y\u0131llarda d\u00fcnyada infeksiyonun insidans\u0131nda \u00f6nemli \u00f6l\u00e7\u00fcde azalma sa\u011flanm\u0131\u015ft\u0131r; g\u00fcn\u00fcm\u00fczde daha \u00e7ok epidemiyi sonland\u0131rmaya y\u00f6nelik stratejiler \u00fczerinde \u00e7al\u0131\u015f\u0131lmaktad\u0131r. Buna kar\u015f\u0131l\u0131k, T\u00fcrkiye\u2019nin de i\u00e7inde bulundu\u011fu Orta ve Do\u011fu Avrupa b\u00f6lgesinde infeksiyon h\u0131z\u0131nda art\u0131\u015f katlanarak devam etmektedir. T\u00fcrkiye, 2020 y\u0131l\u0131nda Orta Avrupa \u00fclkeleri aras\u0131nda bildirilen yeni tan\u0131 say\u0131lar\u0131 en y\u00fcksek olan iki \u00fclkeden biri olmu\u015ftur (1). Bu ba\u011flamda, \u00fclkemizde HIV epidemisine h\u0131zl\u0131 ve gerekti\u011fi \u015fekilde yan\u0131t verebilmek her zamankinden \u00e7ok daha \u00f6nem kazanm\u0131\u015ft\u0131r. <\/span><\/p>\n<p class=\"p2\">Kongreler, belli bir alanda \u00e7al\u0131\u015fan ya da o alana ilgi duyan sa\u011fl\u0131k \u00e7al\u0131\u015fanlar\u0131n\u0131n ve sivil toplum \u00f6rg\u00fctlerinin bir araya gelerek, veri ve deneyim payla\u015ft\u0131\u011f\u0131, bilimsel tart\u0131\u015fmalar yapt\u0131\u011f\u0131, ortakl\u0131klar arad\u0131\u011f\u0131 ve \u00e7\u00f6z\u00fcm \u00f6nerileri geli\u015ftirdi\u011fi platformlard\u0131r. Ayn\u0131 anlay\u0131\u015fla, T\u00fcrkiye\u2019de HIV infeksiyonu ile ilgili faaliyet g\u00f6steren be\u015f hekim derne\u011finin bir araya gelerek olu\u015fturdu\u011fu T\u00fcrkiye HIV\/AIDS Platformu\u2019nun her y\u0131l d\u00fczenledi\u011fi Ulusal HIV\/AIDS Kongresi 24-27 Kas\u0131m 2022 tarihlerinde Antalya\u2019da yap\u0131ld\u0131. S\u00f6z konusu platform; AIDS ve Cinsel Yolla Bula\u015fan Hastal\u0131klar Derne\u011fi (AIDS ve CYBH Derne\u011fi), HIV\/AIDS Korunma ve E\u011fitim Derne\u011fi (HAKED), HIV Enfeksiyonu Derne\u011fi (HIVEND), T\u00fcrkiye Enfeksiyon Hastal\u0131klar\u0131 ve Klinik Mikrobiyoloji Uzmanl\u0131k Derne\u011fi (EKMUD) ve T\u00fcrk Klinik Mikrobiyoloji ve \u0130nfeksiyon Hastal\u0131klar\u0131 (KL\u0130M\u0130K) Derne\u011fi\u2019nin temsilcilerinden olu\u015fmaktad\u0131r. Ayr\u0131ca bu alanda faaliyet g\u00f6steren K\u0131rm\u0131z\u0131 Kurdele Derne\u011fi, Pozitif-\u0130z Derne\u011fi ve Pozitif Ya\u015fam Derne\u011fi de platforma katk\u0131lar\u0131n\u0131 sundular. Kongrede kendi alanlar\u0131nda yetkin 60 konu\u015fmac\u0131, 25 farkl\u0131 oturumda bilimsel verilerini payla\u015ft\u0131. Kongreye ayr\u0131ca, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 Halk Sa\u011fl\u0131\u011f\u0131 Genel M\u00fcd\u00fcrl\u00fc\u011f\u00fc Bula\u015f\u0131c\u0131 Hastal\u0131klar ve Erken Uyar\u0131 Daire Ba\u015fkanl\u0131\u011f\u0131 temsilcisi davetli konu\u015fmac\u0131 olarak kat\u0131ld\u0131.<\/p>\n<p class=\"p2\">Bu yaz\u0131n\u0131n amac\u0131, kongre boyunca sunulan verileri ve y\u00fcr\u00fct\u00fclen tart\u0131\u015fmalar\u0131 ba\u015fl\u0131klar halinde \u00f6zetlemek ve bunlar\u0131n \u0131\u015f\u0131\u011f\u0131nda \u00fclkemizdeki g\u00fcncel durumun analizini yap\u0131p gereksinim ve \u00f6nerileri payla\u015fmakt\u0131r.<\/p>\n<h3 class=\"p4\">HIV Epidemiyolojisi<\/h3>\n<p class=\"p2\">Pandeminin ba\u015f\u0131ndan g\u00fcn\u00fcm\u00fcze dek 84.2 (64.0-113) milyon ki\u015finin HIV ile infekte oldu\u011fu bilinmektedir. UNAIDS raporuna g\u00f6re 2021 y\u0131l\u0131nda d\u00fcnyada 1.5 milyonu yeni infeksiyon olmak \u00fczere 38.4 milyon HIV ile ya\u015fayan ki\u015fi (HYK) bulunmaktad\u0131r. 2021 y\u0131l\u0131 i\u00e7inde 650 000 ki\u015fi AIDS ile ili\u015fkili hastal\u0131klar nedeniyle hayat\u0131n\u0131 kaybetmi\u015ftir. Yine ayn\u0131 y\u0131l i\u00e7inde, bildirilen g\u00fcnl\u00fck 4000 yeni HIV infeksiyonunun %60\u2019\u0131n\u0131n Sahra alt\u0131 Afrika b\u00f6lgesinde bulundu\u011fu, %51\u2019inin kad\u0131nlar ve k\u0131z \u00e7ocuklar\u0131ndan olu\u015ftu\u011fu ve yeni olgular\u0131n %70\u2019inin hassas grup<b> <\/b>(seks i\u015f\u00e7ileri ve m\u00fc\u015fterileri, erkeklerle seks yapan erkekler, damar i\u00e7i madde kullananlar, \u201ctransgender\u201d) \u00fcyeleri oldu\u011fu konular\u0131na \u00f6zellikle dikkat \u00e7ekilmi\u015ftir (2).<\/p>\n<p class=\"p2\">D\u00fcnya genelinde uygulanan \u00f6nlemler ve antiretroviral tedavi (ART) ile elde edilen ba\u015far\u0131lar sayesinde HIV ile infekte yeni olgularda 1996 y\u0131l\u0131ndan beri %54, 2010 y\u0131l\u0131ndan beri %32 azalma oldu\u011fu belirtilmi\u015ftir (2). Ancak k\u00fcresel \u00f6l\u00e7ekte HYK\u2019lerin %75 (%66-85)\u2019i ART\u2019ye ula\u015fabilmektedir; HIV ile infekte gebe kad\u0131nlarda ART\u2019ye eri\u015fimin %81 olmas\u0131 nedeniyle de yenido\u011fan infekte bebek say\u0131s\u0131 hen\u00fcz s\u0131f\u0131rlanamam\u0131\u015ft\u0131r.<\/p>\n<p class=\"p2\">Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 verilerine g\u00f6re \u00fclkemizde 1985 y\u0131l\u0131ndan Kas\u0131m 2022\u2019ye kadar ge\u00e7en d\u00f6nemde 36 630 ki\u015fi HIV ile infekte olmu\u015ftur; bunlar\u0131n %81.2\u2019si erkektir. Yine Kas\u0131m 2022 tarihi itibariyle 2971 yeni tan\u0131 bildirimi yap\u0131lm\u0131\u015ft\u0131r; olgular\u0131n %82.9\u2019u erkektir. Bula\u015fma yollar\u0131 aras\u0131nda heteroseks\u00fcel (%22.1) ve homoseks\u00fcel\/biseks\u00fcel ili\u015fki (%11.2) \u00f6n s\u0131rada yer almaktad\u0131r (3).<\/p>\n<h3 class=\"p4\">HIV \u0130nfeksiyonunun Tan\u0131s\u0131 ve Ge\u00e7 Tan\u0131n\u0131n Olas\u0131 Sonu\u00e7lar\u0131<\/h3>\n<p class=\"p5\">HIV infeksiyonu tan\u0131s\u0131n\u0131n gecikmesi, bir yandan HYK a\u00e7\u0131s\u0131ndan olumsuz t\u0131bbi sonu\u00e7lara yol a\u00e7arken, di\u011fer yandan toplum i\u00e7inde HIV\u2019in bula\u015fmas\u0131n\u0131n yayg\u0131nla\u015fmas\u0131na ve sa\u011fl\u0131k hizmetlerinin maliyetinin artmas\u0131na neden olmaktad\u0131r. \u0130lk olarak 2010 y\u0131l\u0131nda \u201cHIV infeksiyonunun ge\u00e7 tan\u0131s\u0131\u201d kavram\u0131 g\u00fcndeme gelmi\u015f ve tan\u0131m 2022\u2019de g\u00fcncellenmi\u015ftir. Yeni tan\u0131ma g\u00f6re; CD4<sup>+<\/sup> T lenfosit say\u0131s\u0131 &lt;350 h\u00fccre\/\u03bclt olan veya CD4<sup>+<\/sup> T lenfosit say\u0131s\u0131na bak\u0131lmaks\u0131z\u0131n ilk kez AIDS tan\u0131mlay\u0131c\u0131 bir olayla HIV infeksiyonu tan\u0131s\u0131 alan ki\u015filer ge\u00e7 tan\u0131 alm\u0131\u015f olarak kabul edilmektedir (4).<span class=\"s3\"> \u00dclkemizde ge\u00e7 tan\u0131 alan olgular\u0131n s\u0131kl\u0131\u011f\u0131 %50 civar\u0131nda olup bu durum son 10 y\u0131lda de\u011fi\u015fiklik g\u00f6stermemi\u015ftir (5). <\/span><\/p>\n<p class=\"p2\">Ge\u00e7 tan\u0131n\u0131n en s\u0131k kar\u015f\u0131la\u015f\u0131lan nedenleri olarak a\u015fa\u011f\u0131daki hususlar \u00f6ne \u00e7\u0131kmaktad\u0131r:<\/p>\n<ul>\n<li class=\"p6\">Teste eri\u015fimin \u00f6n\u00fcndeki engeller.<\/li>\n<li class=\"p7\">Test yapt\u0131rman\u0131n \u201cmaliyeti\u201d.<\/li>\n<li class=\"p7\">Damgalanma, ayr\u0131mc\u0131l\u0131\u011fa u\u011frama ve reddedilme korkusu.<\/li>\n<li class=\"p7\">Ki\u015fide HIV edinme riski alg\u0131s\u0131n\u0131n bulunmamas\u0131.<\/li>\n<li class=\"p7\">Sonucun pozitif olmas\u0131 korkusu.<\/li>\n<li class=\"p7\">\u0130kamet ba\u015fvurusunda karar bekleyen g\u00f6\u00e7menler i\u00e7in HIV infeksiyonu tan\u0131s\u0131n\u0131n g\u00f6\u00e7menlik stat\u00fcs\u00fc \u00fczerindeki olas\u0131 olumsuz etkisi.<\/li>\n<li class=\"p7\">Belgesiz g\u00f6\u00e7menler i\u00e7in sa\u011fl\u0131k hizmetlerine eri\u015fememe korkusu.<\/li>\n<\/ul>\n<p class=\"p2\">Kongrede y\u00fcr\u00fct\u00fclen tart\u0131\u015fmalarda ge\u00e7 tan\u0131n\u0131n \u00f6nlenmesi i\u00e7in a\u015fa\u011f\u0131daki \u00e7\u00f6z\u00fcm \u00f6nerileri ortaya \u00e7\u0131kt\u0131:<\/p>\n<ul>\n<li class=\"p6\">Y\u00fcksek riskli topluluklara eri\u015fimin yenilik\u00e7i yakla\u015f\u0131mlar kullan\u0131larak sa\u011flanmas\u0131\/art\u0131r\u0131lmas\u0131.<\/li>\n<li class=\"p7\">HIV infeksiyonunu d\u00fc\u015f\u00fcnd\u00fcrecek belirti ve bulgular\u0131n ya da g\u00f6sterge hastal\u0131klar\u0131n bulunmas\u0131 durumunda testin akla gelmesi ve test f\u0131rsatlar\u0131n\u0131n ka\u00e7\u0131r\u0131lmamas\u0131. Bu ba\u011flamda, t\u00fcberk\u00fclozda oldu\u011fu gibi, di\u011fer g\u00f6sterge hastal\u0131klar\u0131n da zorunlu test listesine d\u00e2hil edilmesi.<\/li>\n<li class=\"p7\">Ki\u015filerin damgalanma kayg\u0131s\u0131 ya\u015famadan teste ba\u015fvurabilmeleri i\u00e7in rutin tarama hizmetlerinin \u00fccretsiz ve anonim olarak sunulmas\u0131. Bu ba\u011flamda, y\u0131llard\u0131r infeksiyon hastal\u0131klar\u0131 camias\u0131 taraf\u0131ndan G\u00f6n\u00fcll\u00fc Test ve Dan\u0131\u015fmanl\u0131k Merkezleri\u2019nin yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 ve daha etkin \u00e7al\u0131\u015ft\u0131r\u0131lmas\u0131 konusunda Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019na iletilen taleplerin tekrar g\u00fcndeme getirilmesi.<\/li>\n<li class=\"p7\"><i>Kendin yap\/kendi kendine<\/i> HIV testlerine, \u00fclkemizde de kullan\u0131lmak \u00fczere onay verilmesi.<\/li>\n<\/ul>\n<h3 class=\"p4\">HIV Tedavisinde G\u00fcncellemeler<\/h3>\n<p class=\"p5\">Kongrede g\u00fcncel rehberler (7) e\u015fli\u011finde ART irdelenmi\u015f olup HIV ile infekte ki\u015filerde,<b> <\/b>CD4<sup>+<\/sup> T lenfosit say\u0131lar\u0131 dikkate al\u0131nmadan ART\u2019ye en k\u0131sa s\u00fcrede ba\u015flanmas\u0131n\u0131n \u00f6nemi vurguland\u0131. Erken ba\u015flanan uygun ART\u2019nin, hastal\u0131\u011f\u0131n ilerlemesini durdurarak HIV ile ili\u015fkili ve\/veya ili\u015fkili olmayan mortalite ve morbiditeyi azaltarak toplum i\u00e7inde bula\u015fmay\u0131 engelleyece\u011fi belirtildi.<\/p>\n<p class=\"p2\">G\u00fcncel kullan\u0131mda olan ART\u2019lere ek olarak kabotegravir ve rilpivirin ikili tedavisinin parenteral (kas i\u00e7i) kullan\u0131m\u0131 Amerika Birle\u015fik Devletleri ve Avrupa\u2019da onay alm\u0131\u015ft\u0131r (8). Ayr\u0131ca giri\u015f inhibit\u00f6rlerinin (ilk uzun etkili ART ibalizumab 2018\u2019de, fostemsavir 2020\u2019de) diren\u00e7li<i> <\/i>olgularda viral y\u00fck\u00fcn d\u00fc\u015f\u00fcr\u00fclmesinde \u00f6nemli \u00f6l\u00e7\u00fcde ba\u015far\u0131 g\u00f6sterdi\u011fini kan\u0131tlayan \u00e7al\u0131\u015fmalar\u0131n sonu\u00e7lar\u0131 tart\u0131\u015f\u0131ld\u0131 (9). Farkl\u0131 etki mekanizmas\u0131yla etki eden ART\u2019lere ili\u015fkin g\u00fcncel veriler irdelendi ve \u015fifa sa\u011flanana dek aray\u0131\u015flar\u0131n devam edece\u011fi vurguland\u0131.<\/p>\n<h3 class=\"p4\">HIV ile Ya\u015fayan Ki\u015filerin Sa\u011fl\u0131\u011f\u0131 ve Hastal\u0131klar\u0131n Y\u00f6netimi<\/h3>\n<p class=\"p5\">Kongrede, HYK\u2019lerde ortaya \u00e7\u0131kabilecek di\u011fer sa\u011fl\u0131k sorunlar\u0131 irdelendi. HIV ile ya\u015fayanlarda kardiyovask\u00fcler hastal\u0131k (KVH)\u2019lar; geleneksel risk fakt\u00f6rlerinin, HIV ile ili\u015fkili yarg\u0131n\u0131n ve ART\u2019ye ba\u011fl\u0131 istenmeyen olaylar\u0131n karma etkisi sonucunda HIV ile infekte olmayan ki\u015filere g\u00f6re daha s\u0131k ortaya \u00e7\u0131kmaktad\u0131r. Yine HYK\u2019lerde ani kardiyak \u00f6l\u00fcm\u00fcn, t\u00fcm \u00f6l\u00fcmlerin %13\u2019\u00fcn\u00fc ve kardiyak \u00f6l\u00fcmlerin %86\u2019s\u0131n\u0131 olu\u015fturdu\u011fu bildirilmi\u015ftir (10).<\/p>\n<p class=\"p2\">HIV ile infekte ki\u015filerde KVH\u2019lere yakla\u015f\u0131m; d\u00fczenli egzersiz ve diyet \u00f6nerilerini, sigara kullan\u0131m\u0131n\u0131n b\u0131rak\u0131lmas\u0131n\u0131, hiperlipidemi ve diyabetin y\u00f6netimini ve hipertansiyonun kontrol\u00fcn\u00fc i\u00e7ermektedir (7). \u0130nfekte ki\u015filerde yanda\u015f hastal\u0131k ve\/veya f\u0131rsat\u00e7\u0131 bir infeksiyon varsa ART\u2019ye olabilecek en erken d\u00f6nemde ba\u015flanmas\u0131 gerekti\u011fi bildirilmi\u015ftir (11).<\/p>\n<h3 class=\"p4\">HIV ile Ya\u015fayan Ki\u015filerde Ba\u011f\u0131\u015f\u0131klama<\/h3>\n<p class=\"p2\">HIV ile infekte ki\u015filerde a\u015f\u0131lama birka\u00e7 farkl\u0131 uygulama d\u0131\u015f\u0131nda genel yeti\u015fkin pop\u00fclasyonla ayn\u0131d\u0131r. Kongrede, ki\u015filerde CD4<sup>+<\/sup> T lenfosit say\u0131s\u0131 &lt;200 h\u00fccre\/ml ise canl\u0131 a\u015f\u0131n\u0131n kontrendike oldu\u011fu, inaktive edilmi\u015f mikroorganizma a\u015f\u0131lar\u0131n\u0131n k\u00e2r-zarar hesab\u0131na (risk fakt\u00f6r\u00fc yok ise bekle) g\u00f6re yap\u0131lmas\u0131 gerekti\u011fi bildirilmi\u015ftir. COVID-19, hepatit B, hepatit A, pn\u00f6mokok, tetanos, difteri (Td) ve mevsimsel influenza a\u015f\u0131lar\u0131n\u0131n Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 taraf\u0131ndan \u00fccretsiz kar\u015f\u0131land\u0131\u011f\u0131 vurgulanm\u0131\u015f ve hasta reddetmedi\u011fi s\u00fcrece bu a\u015f\u0131lar\u0131n yap\u0131lmas\u0131 \u00f6nerilmi\u015ftir. HIV ile ya\u015fayan ki\u015filerde koruyuculu\u011fu kan\u0131tlanm\u0131\u015f olan HPV, zona, su\u00e7i\u00e7e\u011fi, polisakkarid pn\u00f6mokok a\u015f\u0131s\u0131 (PPSV23) ve Tdap (Td asel\u00fcler bo\u011fmaca) a\u015f\u0131lar\u0131n\u0131n da HYK\u2019lere \u00f6nerilmesinin yararl\u0131 olaca\u011f\u0131 belirtilmi\u015ftir (12). Kongrede, maliyeti nedeniyle yapt\u0131r\u0131lamayan a\u015f\u0131lar\u0131n da sa\u011fl\u0131k otoritesi taraf\u0131ndan kar\u015f\u0131lanmas\u0131 gerekti\u011fi konusu hem konu\u015fmac\u0131lar hem de s\u00f6z alan izleyiciler taraf\u0131ndan vurguland\u0131.<\/p>\n<h3 class=\"p4\">HIV ile Ya\u015fayan Ki\u015fileri Damgalama ve Ayr\u0131mc\u0131l\u0131k<\/h3>\n<p class=\"p2\">HIV\/AIDS\u2019e ili\u015fkin damgalama ve ayr\u0131mc\u0131l\u0131\u011f\u0131n; infeksiyonun halen ya\u015fam\u0131 tehdit eden<b> <\/b>bir durum olarak g\u00f6r\u00fcl\u00fcyor olmas\u0131n\u0131n yan\u0131 s\u0131ra, homoseks\u00fcellik ba\u015fta olmak \u00fczere cinsel y\u00f6nelim, uyu\u015fturucu kullan\u0131m\u0131 ve seks i\u015f\u00e7ili\u011fi gibi \u00f6nceden damgalanm\u0131\u015f<b> <\/b>davran\u0131\u015flar ile ili\u015fkili olabilece\u011fi d\u00fc\u015f\u00fcncesine ba\u011fl\u0131 olabilece\u011fi \u00fczerinde duruldu. Toplumun \u00e7o\u011funlukla bula\u015fma yollar\u0131yla ilgili yanl\u0131\u015f bilgilere<b> <\/b>sahip olmas\u0131n\u0131n, infeksiyonun ki\u015fisel sorumsuzlu\u011fun<b> <\/b>bir sonucu olarak edinildi\u011fi d\u00fc\u015f\u00fcncesinin ve hastal\u0131ktan ziyade durumun dini ve ahlaki y\u00f6nden ele al\u0131n\u0131p ki\u015fiye verilmi\u015f bir ceza olarak tan\u0131mlanmas\u0131n\u0131n bu alandaki sorunlar\u0131 kavramada son derece \u00f6nemli oldu\u011fu belirtildi.<\/p>\n<p class=\"p2\"><span class=\"s1\">Ulusal HIV\/AIDS Kongresi 2022\u2019de yakla\u015f\u0131k d\u00f6rt g\u00fcn boyunca hekimlerin d\u0131\u015f\u0131nda \u00f6zne derneklerinin temsilcileri de gerek kendileri sunum yaparak gerekse oturumlara ve oturum sonundaki tart\u0131\u015fmalara aktif olarak kat\u0131larak, HYK\u2019lerin ya\u015fad\u0131klar\u0131 toplumsal sorunlar\u0131 ve bu sorunlara ili\u015fkin \u00e7\u00f6z\u00fcm \u00f6nerilerini aktard\u0131lar. Farkl\u0131 s\u00f6zl\u00fc bildiri oturumlar\u0131nda da ger\u00e7ek olgular \u00fczerinden hastal\u0131\u011f\u0131n sadece t\u0131bbi de\u011fil sosyal boyutlar\u0131 da tart\u0131\u015f\u0131ld\u0131. <\/span><\/p>\n<h2 class=\"p1\">\u00dcLKEM\u0130ZDE KAR\u015eILA\u015eILAN SORUNLAR VE BUNLARA \u0130L\u0130\u015eK\u0130N \u00c7\u00d6Z\u00dcM \u00d6NER\u0130LER\u0130<\/h2>\n<p class=\"p9\">HIV\/AIDS Kongresi 2022 boyunca yap\u0131lan sunumlar ve tart\u0131\u015fmalar \u0131\u015f\u0131\u011f\u0131nda, \u00fclkemizde kar\u015f\u0131la\u015f\u0131lan sorunlar\u0131 ve bunlara ili\u015fkin \u00e7\u00f6z\u00fcm \u00f6nerilerini a\u015fa\u011f\u0131daki gibi \u00f6zetlemek m\u00fcmk\u00fcnd\u00fcr:<\/p>\n<ol>\n<li>\u00dclkemizde h\u00e2lihaz\u0131rda en \u00f6nemli sorun, HIV tan\u0131s\u0131ndaki yetersizlik ve gecikmedir. Bu ba\u011flamda, HIV edinme riski y\u00fcksek gruplar\u0131n tespit edilmesi ve bu ki\u015filerin yenilik\u00e7i y\u00f6ntemlerle test yapt\u0131rmaya te\u015fvik edilmesi en \u00f6ncelikle ele al\u0131nmas\u0131 gereken husustur. Bu ama\u00e7 i\u00e7in a\u015fa\u011f\u0131daki \u00f6neriler dikkate al\u0131nmal\u0131d\u0131r:<\/li>\n<\/ol>\n<ul>\n<li class=\"p11\">Halen \u00fclkemizde d\u00f6rt ilde (\u0130stanbul\u2019da iki merkez) bulunan ve a\u00e7\u0131ld\u0131\u011f\u0131 g\u00fcnden bu yana son derece etkin bi\u00e7imde hizmet veren G\u00f6n\u00fcll\u00fc Test ve Dan\u0131\u015fmanl\u0131k Merkezleri\u2019nin t\u00fcm co\u011frafi b\u00f6lgelere, \u00f6zellikle de HIV infeksiyonunun yo\u011fun oldu\u011fu yerlere yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 ve \u00e7al\u0131\u015fma saatlerinin, y\u00fcksek riskli gruplar\u0131n ba\u015fvurusunu kolayla\u015ft\u0131racak \u015fekilde d\u00fczenlenmesi.<\/li>\n<li class=\"p11\">T\u00fcm d\u00fcnyada \u00f6zellikle pandemi d\u00f6neminde de\u011feri anla\u015f\u0131lm\u0131\u015f olan ve yayg\u0131n olarak kullan\u0131lan <i>kendin yap\/kendi kendine<\/i> testlerinin \u00fclkemizde de kullan\u0131ma sunulmas\u0131.<\/li>\n<li class=\"p11\">Y\u00fcksek risk ta\u015f\u0131yan gruplara test hizmeti g\u00f6t\u00fcrecek projelerin geli\u015ftirilmesi.<\/li>\n<li class=\"p11\">Toplumu test yapt\u0131rmaya te\u015fvik edecek kampanyalar\u0131n d\u00fczenlenmesi.<\/li>\n<\/ul>\n<p>2. Temas \u00f6ncesi profilaksinin HIV\u2019\u0131n bula\u015fmas\u0131n\u0131 \u00f6nleme konusunda etkinli\u011fi kan\u0131tlanm\u0131\u015f olup bu korunma y\u00f6ntemi t\u00fcm d\u00fcnyada yayg\u0131n olarak kullan\u0131lmaya ba\u015flanm\u0131\u015ft\u0131r; ge\u00e7ti\u011fimiz y\u0131l \u00fclkemizde de cinsel eyleme dayal\u0131 d\u00f6rt tabletlik ila\u00e7 ruhsat alm\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde HIV infeksiyonunu kontrol alt\u0131na almada en kritik y\u00f6ntemlerden olan temas \u00f6ncesi profilaksiye ili\u015fkin a\u015fa\u011f\u0131daki \u00f6neriler dikkate al\u0131nmal\u0131d\u0131r:<\/p>\n<ul>\n<li class=\"p13\">Temas \u00f6ncesi profilaksiye ili\u015fkin \u00f6nerilerin Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019n\u0131n ilgili rehberlerine eklenmesi.<\/li>\n<li class=\"p13\">G\u00fcnl\u00fck kullan\u0131lan temas \u00f6ncesi profilaksinin ruhsat almas\u0131 i\u00e7in \u00e7al\u0131\u015fmalar\u0131n y\u00fcr\u00fct\u00fclmesi.<\/li>\n<li class=\"p13\">Temas \u00f6ncesi profilaksinin maliyetinin azalt\u0131lmas\u0131 (d\u00fc\u015f\u00fck fiyatland\u0131rma, tam veya k\u0131smi geri \u00f6deme) i\u00e7in giri\u015fimlerde bulunulmas\u0131.<\/li>\n<li class=\"p13\"><span class=\"s5\">Toplumda temas \u00f6ncesi profilaksiyi tan\u0131tacak kampanyalar\u0131n yap\u0131lmas\u0131. <\/span><\/li>\n<\/ul>\n<p class=\"p12\">3. Kondom, HIV infeksiyonu ve di\u011fer cinsel yolla bula\u015fan infeksiyonlardan korunmada halen en etkili y\u00f6ntemlerden biridir; temas \u00f6ncesi profilaksi kullan\u0131ls\u0131n ya da kullan\u0131lmas\u0131n, cinsel ili\u015fkide kondom kullan\u0131lmas\u0131, HIV epidemisine verilen yan\u0131tta b\u00fcy\u00fck \u00f6nem ta\u015f\u0131maktad\u0131r. \u00dclkemizin i\u00e7inde bulundu\u011fu ekonomik ko\u015fullarda riskli ili\u015fkilerde kondom kullan\u0131lmas\u0131 ki\u015filere ciddi bir mali y\u00fck getirmektedir. Bu ba\u011flamda, ge\u00e7mi\u015fte oldu\u011fu gibi, birinci basamak hekimlikte \u00fccretsiz kondom da\u011f\u0131t\u0131m\u0131 uygulamas\u0131n\u0131n tekrar ba\u015flat\u0131lmas\u0131 ve kondom kullan\u0131m\u0131n\u0131 te\u015fvik edecek ulusal e\u011fitimlerin\/kampanyalar\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131 yararl\u0131 olacakt\u0131r.<\/p>\n<p class=\"p12\">4. Toplumun HIV\/AIDS infeksiyonu konusundaki bilgi ve bilin\u00e7 d\u00fczeyinin art\u0131r\u0131lmas\u0131 gerekmektedir. Bunun i\u00e7in ba\u015fta sa\u011fl\u0131k otoritesi olmak \u00fczere, kamuya ait ve \u00f6zel sa\u011fl\u0131k kurulu\u015flar\u0131n\u0131n, e\u011fitim kurumlar\u0131n\u0131n ve sivil toplum kurulu\u015flar\u0131n\u0131n i\u015f birli\u011fi ile yaz\u0131l\u0131 ve g\u00f6rsel medya ara\u00e7lar\u0131 kullan\u0131larak bilin\u00e7lendirme etkinlikleri yap\u0131lmal\u0131d\u0131r. Ayr\u0131ca, \u00f6rg\u00fcn ve yayg\u0131n e\u011fitim m\u00fcfredat\u0131nda; cinsel sa\u011fl\u0131k, cinsel yolla bula\u015fan infeksiyon hastal\u0131klar\u0131 ve bu hastal\u0131klardan korunma y\u00f6ntemlerine ili\u015fkin bilgilerin nitelikli bir \u015fekilde yer almas\u0131 sa\u011flanmal\u0131, odak grup e\u011fitimleri arac\u0131l\u0131\u011f\u0131yla akran e\u011fitimlerinin art\u0131r\u0131lmas\u0131na y\u00f6nelik aktiviteler hayata ge\u00e7irilmelidir.<\/p>\n<p class=\"p12\">5. \u0130\u015fe giri\u015flerde zorunlu HIV testinin kald\u0131r\u0131lmas\u0131 gerekmektedir. Bu nedenle i\u015f sa\u011fl\u0131\u011f\u0131 ve g\u00fcvenli\u011fi mevzuat\u0131n\u0131n de\u011fi\u015ftirilmesi konusunda \u00e7al\u0131\u015fmalar y\u00fcr\u00fct\u00fclerek HIV ile ya\u015fayan ki\u015filerin temel insan haklar\u0131 korunmal\u0131d\u0131r.<\/p>\n<p class=\"p12\">6. Antiretroviral tedavide son y\u0131llarda \u00f6nemli geli\u015fmeler kaydedilmi\u015ftir. \u00dclkemizde de genel sa\u011fl\u0131k sigortas\u0131 (GSS) kapsam\u0131ndaki her T\u00fcrk vatanda\u015f\u0131n\u0131n tedaviye eri\u015fimi sorunsuz sa\u011flanmakla birlikte halen baz\u0131 engeller bulunmaktad\u0131r. Bu engellerin en \u00f6nemlileri; tedaviye eri\u015fimde f\u0131rsat e\u015fitsizli\u011fi, mahremiyet ihlalleri, ayr\u0131mc\u0131l\u0131\u011fa u\u011frama korkusu, sistem sorunlar\u0131, yasal mevzuata ili\u015fkin sorunlar ve destek mekanizmalar\u0131n\u0131n yetersizli\u011fidir. Bu kapsamda a\u015fa\u011f\u0131da belirtilen baz\u0131 gruplarda sorun ciddi boyutlara ula\u015fmaktad\u0131r:<\/p>\n<ul>\n<li class=\"p13\">T\u00fcrk vatanda\u015f\u0131 olmayan, ancak T\u00fcrkiye\u2019de ya\u015fayan ki\u015filer, ge\u00e7ici T.C. kimlik numaras\u0131na sahip olsa da HIV infeksiyonunu T\u00fcrkiye d\u0131\u015f\u0131nda edindi\u011fi takdirde tedaviye eri\u015fememektedir.<\/li>\n<li class=\"p13\">Koruma alt\u0131nda olmayan g\u00f6\u00e7menlerin acil durumlar d\u0131\u015f\u0131nda hastaneye ba\u015fvurma, tetkik yapt\u0131rma ve tedavi kullanma hakk\u0131 bulunmamaktad\u0131r.<\/li>\n<li class=\"p13\">Herhangi bir nedenle sigortas\u0131 kesintiye u\u011frayan ki\u015filerin ART\u2019leri de kesilmektedir.<\/li>\n<li class=\"p13\">Uzun s\u00fcre \u00fclke d\u0131\u015f\u0131na \u00e7\u0131kmas\u0131 gereken ki\u015filer (\u00f6rne\u011fin gemi kaptanlar\u0131 veya \u00e7al\u0131\u015fanlar\u0131, y\u00fcksek lisans, doktora, Erasmus, vb. e\u011fitim program\u0131 \u00f6\u011frencileri), \u00fc\u00e7 ayl\u0131ktan fazla ila\u00e7 re\u00e7ete edilemedi\u011finden, \u00fc\u00e7 ay\u0131 a\u015fan s\u00fcreler i\u00e7in ya kendileri \u00f6deyerek ila\u00e7 almak zorunda kalmakta, ya da kliniklerden ila\u00e7 talebinde bulunmaktad\u0131r.<\/li>\n<\/ul>\n<p class=\"p2\">Antiretroviral tedavi kullanmayan HIV ile infekte ki\u015filerde viral y\u00fck\u00fcn y\u00fckselece\u011fi ve bula\u015ft\u0131r\u0131c\u0131l\u0131\u011f\u0131n artaca\u011f\u0131 dikkate al\u0131nd\u0131\u011f\u0131nda, bu sorunlar\u0131n acil olarak giderilmesinin \u00f6nemi ortaya \u00e7\u0131kmaktad\u0131r. Tan\u0131 konulmas\u0131ndan sonra en k\u0131sa s\u00fcrede herkesin ko\u015fulsuz ve kesintisiz tedaviye (GSS kapsam\u0131na al\u0131narak) eri\u015fme hakk\u0131 bulunmaktad\u0131r; toplum i\u00e7indeki bula\u015fman\u0131n azalt\u0131lmas\u0131 ve HIV epidemisinin kontrol alt\u0131na al\u0131nmas\u0131 a\u00e7\u0131s\u0131ndan bu son derece \u00f6nemlidir. K\u00fcresel olarak HIV epidemisinin bitirilmesine dair hedeflerin, tedavi konusunda yukar\u0131daki \u00f6neriler do\u011frultusunda at\u0131lacak ad\u0131mlar sayesinde sa\u011flanabilece\u011fi kan\u0131s\u0131nday\u0131z.<\/p>\n<p class=\"p10\">7. Damgalama ve ayr\u0131mc\u0131l\u0131k HIV ile ya\u015fayan ki\u015filerin temel haklar\u0131na eri\u015fmelerini engellemektedir. Hak ihlallerinin yo\u011fun olarak ya\u015fand\u0131\u011f\u0131 bu alanda izleme ve raporlama \u00e7al\u0131\u015fmalar\u0131n\u0131n art\u0131r\u0131lmas\u0131 \u00f6ncelikli olmal\u0131d\u0131r. HIV\/AIDS kapsam\u0131nda hasta haklar\u0131 ve \u00f6zel hayat\u0131n gizlili\u011fi ile ilgili olarak emsal olu\u015fturacak ulusal ve uluslararas\u0131 mahkeme kararlar\u0131 derlenmeli ve ayr\u0131mc\u0131l\u0131k eksenli kararlar\u0131n engellenmesi y\u00f6n\u00fcnde \u00e7al\u0131\u015fmalar y\u00fcr\u00fct\u00fclmelidir.<\/p>\n<p class=\"p12\">8. Belirlenemeyen=Bula\u015ft\u0131rmayan (B=B) yakla\u015f\u0131m\u0131 sa\u011fl\u0131k sisteminde yayg\u0131n olarak bilinmemektedir. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc, UNAIDS gibi sayg\u0131n otoritelerce kabul edilen ve baz\u0131 \u00fclkelerin ulusal HIV tedavi k\u0131lavuzlar\u0131na da d\u00e2hil edilen bu yakla\u015f\u0131m; hem bula\u015fman\u0131n \u00f6nlenmesi a\u00e7\u0131s\u0131ndan g\u00fc\u00e7l\u00fc bir halk sa\u011fl\u0131\u011f\u0131 mesaj\u0131 hem de tedaviye uyumu g\u00fc\u00e7lendiren bir unsur olarak HIV infeksiyonuna verilen ortak cevab\u0131n temel \u00f6gelerinden biri olarak de\u011ferlendirilmelidir (13). Bu ba\u011flamda, B=B yakla\u015f\u0131m\u0131n\u0131n Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 HIV\/AIDS Tedavi K\u0131lavuzu\u2019na d\u00e2hil edilmesi ve bu mesaj\u0131n yayg\u0131nla\u015ft\u0131r\u0131lmas\u0131na ili\u015fkin \u00e7e\u015fitli \u00e7al\u0131\u015fmalar\u0131n yap\u0131lmas\u0131 \u00f6nerilir.<\/p>\n<h2 class=\"p1\">SONU\u00c7<\/h2>\n<p class=\"p2\">\u00dclkemizde HIV epidemisiyle m\u00fccadele konusunda pek \u00e7ok alanda ba\u015far\u0131l\u0131 \u00e7al\u0131\u015fmalar yap\u0131lm\u0131\u015f olmakla birlikte, olgu say\u0131s\u0131ndaki art\u0131\u015f t\u00fcm h\u0131z\u0131yla devam etmektedir. COVID-19 pandemisinin araya girmesi, HIV alan\u0131nda yap\u0131lan \u00e7al\u0131\u015fmalar\u0131n da h\u0131z kesmesine, hatta durmas\u0131na neden olmu\u015ftur. T\u00fcrkiye HIV\/AIDS platformu taraf\u0131ndan d\u00fczenlenmekte olan HIV\/AIDS kongreleri, HIV alan\u0131ndaki g\u00fcncel bilgileri payla\u015fmam\u0131za ve tart\u0131\u015fmam\u0131za zemin haz\u0131rlarken, \u00fclkemizdeki sorunlar\u0131 irdelememiz ve sorunlara \u00e7\u00f6z\u00fcm \u00f6nerileri sunmam\u0131z a\u00e7\u0131s\u0131ndan da vazge\u00e7ilmez bir platform olu\u015fturmaktad\u0131r. Kas\u0131m 2022\u2019de ger\u00e7ekle\u015ftirdi\u011fimiz son kongrede ortaya konan \u00e7\u00f6z\u00fcm \u00f6nerilerinin, \u00fclkemize \u00f6zg\u00fc, do\u011fru ve etkin stratejileri geli\u015ftirmek ve hedefleri belirlemek i\u00e7in t\u00fcm payda\u015flar taraf\u0131ndan dikkate al\u0131naca\u011f\u0131n\u0131 umuyoruz.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>G\u0130R\u0130\u015e HIV infeksiyonu D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) taraf\u0131ndan kronik hastal\u0131klar listesine al\u0131nm\u0131\u015ft\u0131r ve g\u00fcn\u00fcm\u00fczde HIV ile uzun ve kaliteli bir ya\u015fam s\u00fcrd\u00fcrmek m\u00fcmk\u00fcnd\u00fcr. Birle\u015fmi\u015f Milletler HIV\/AIDS Program\u0131 (The Joint United Nations Programme on HIV\/AIDS &#8211; UNAIDS)\u2019n\u0131n 2022 raporuna g\u00f6re son y\u0131llarda d\u00fcnyada infeksiyonun insidans\u0131nda \u00f6nemli \u00f6l\u00e7\u00fcde azalma sa\u011flanm\u0131\u015ft\u0131r; g\u00fcn\u00fcm\u00fczde daha \u00e7ok epidemiyi sonland\u0131rmaya y\u00f6nelik stratejiler [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":27704,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[5783],"tags":[5785,5648,5784,5786,4015],"class_list":["post-27328","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-gorus-rapor","tag-5785","tag-hiv-aids","tag-kongre","tag-rapor","tag-turkiye"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27328","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/comments?post=27328"}],"version-history":[{"count":3,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27328\/revisions"}],"predecessor-version":[{"id":27710,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/posts\/27328\/revisions\/27710"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media\/27704"}],"wp:attachment":[{"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/media?parent=27328"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/categories?post=27328"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.klimikdergisi.org\/tr\/wp-json\/wp\/v2\/tags?post=27328"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}