Khm - unesdoc - Unesco

KH/ED/2009/RP/22 Phnom Penh, August 2009 Original: Khmer

Peer and Outreach Education for Improving the Sexual Health of Men who have Sex with Men Khmer version

karGb;rM

RkummitþGb;rMmitþ nigbuKÁlikpSBVpSay Gb;rMedIm,IeFVI[

suxPaBpøÚvePT rbs;bursRslaj; burskan;Et RbesIreLIg

esovePAÉksareyag sRmab;RkummitþGb;rMmitþ nig buKÁlikpSBVpSayGb;rM

karGb;rM RkummitþGb;rMmitþ nigbuKÁlik

suxPaBpøÚvePT

pSBVpSayGb;rM edIm,IeFVI[ rbs; Rslaj;burs kan;EtRbesIreLIg

burs

esovePAÉksareyagsRmab;RkummitþGb;rMmitþ nigbuKÁlikpSBVpSayGb;rM

GgÁkarEdlcUlrYmpþl;bec©keTskñúgsikçasalaEksMrYl Éksareyag sMrab;RkummitþGb;rMmitþ nigbuKÁlikpSBVpSayGb;rM

Cambodia

KaMRTfvika nigbec©keTseday ³

Cambodia

karGb;rMRkummitþGb;rMmitþ nigbuKÁlikGb;rM pSBVpSayedIm,IeFVI[suxPaB pøÚvePTrbs;burs Rslaj;burs kan;EtRbesIreLIg esovePAÉksareyagsRmab;RkummitþGb;rMmitþ nigbuKÁlikGb;rMpSBVpSay

esckþIEføgGMNrKuN

esckþIRBagelIkdMbUgénesovePAenH RtUv)ancgRkgeLIgedayelak Jan W de Lind van Wijngaarden EdlCaGñkBieRKaHeyabl;[GgÁkarsuxPaB RKYsarGnþrCati¼kmµvFi tI bM n;GasIu (FHI/ARP) nigCaTIRbwkSaénbursEdlrYmePT CamYyburs (MSM) nigemeraKeGds_dl;GgÁkarshRbCaCatiTTYlbnÞúkelI karGb;rM viTüasaRsþ nigvb,Fm’ (UNESCO). mtieyabl; nigKMnti sMxan;² edIm,I Eklm¥esovePAenH[kan;EtRbesIreLIg RtUv)anpþle; day Graham Neilsen, Celine Daly nig Philipe Girault ¬EdlCaGñkbeRmIkarenAkariyal½y FHI RbcaMtMbn;GasIu)a:sIuhVik¦ nig Clive Wing nig Simon Baker ¬beRmIkar enA UNESCO¦ RBmTaMgelak saRsþacarü Louis Gooren énsakl viTüal½y esrI Amsterdam ¬emeronTI11 sþIBIbBaðasuxPaBsRmab;GñkbþÚrePT¦. sUmEføgGMNrKuNcMeBaH Elden Chamberlain (beRmIkarenA International HIV/AIDS Alliance) Rakdaow Pritchard (beRmIkarenA Population Services International/PSI) Clifton Cortez (beRmIkarenA United States Agency for International Development/RDMA) Dr. Rutt Chauachuwong

beRmIkarenA mCÄmNÐlTb;sáat;CMgW¼kic©shkarRbtibtþikarrvagéf-shrdæ Gaemrik CDC/TUC) nig Xavier Alteresscu (beRmIkarenA PACT) Edl)an CYysRmbsRmYlkarerobcMsikçasalafñak;tMbn;Edl)anCYydl;karsresr bBa©be; sovePAenH nig)anpþlC; amtieyabl; nigKMnti l¥² edIm,IEklm¥esovePA enH[kan;EtRbesIreLIg. bEnßmelIenH sUmEføgGMNrKuNy:agRCaleRCA dl; Srisuman Sartsara nig Marisa Sanguankwamdee ¬beRmIkarenA UNESCO¦ Chutima Chomsookprakit ¬beRmIkarenA FHI¦ Edmund Settle ¬beRmIkarenA UNDP RbcaMRbeTscin¦ nig Jack Arayawongchai ¬beRmIkar enA Purple Sky Network¦Edl)anCYykñúgkarpÁt;pÁg; P½sþúPar nigerobcM sikaç salanana. sUmEføgGMNrKuNpgEdr cMeBaH Renata Zanetti ¬beRmIkar enA UNESCO¦ Edl)anCYykt;RtakarEkERbTaMgGs;Edl)anelIkeLIg)an (

y:agl¥itl¥n; nig)anCYyEksRmYlesckþIRBagénesovePAenH. sUmEføg GMNrKuN Dr. Rutt Chuachuwong Edl)anCYyeFVIkarBinitübBa¢ak;faB½t’man evC¢saRsþenAkñúgÉksarsRmab;sikçasalamanPaBRtwmRtUv. CacugeRkay sUmEføgGMNrKuNdl;GaCJaFrCatiRbyuTn§ gw CMgeW Gds_ Edl )anCYysRmbsRmYlEsVgrkkarKaMRTEpñkfvika nigbec©keTs GgÁkar UNESCO, UNAIDS, PACT, PSI, FHI nig KHANA Edl)anpþl;kar]btßmÖCaEpñkfvika nigbec©keTsdl;RkummitþGb;rMmitþ nigRkumGb;rM pSBVpSayTaMgGs; EdlmkBI bNþaGgÁkarnanaEdleFVIkargarCamYybursRslaj;burs Edl)ancUlrYmkñúg sikçasalaEksMrYlÉksarenHkalBIéf¶TI 11 mifuna qñaM 2008 )anelIk nUvmtiEklm¥CaeRcIn mkdak;bBa©Úl kñúgesovePAÉksarenH. RbsinebIKµan karCYy]btßmÖ b¤KaMRT esovePAenHR)akdCaminGacmanlkçN³gayRsYl sRmab;GñkGan nigmanlkçN³lMGitdUcenAeBlenHeT. eQµaHsmaCikRkum kargarenH manenAkñúg]bsm>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>7 esckþIepþIm ³ etIesovePAÉksareyagenHcg;niyayBIGVI?>>>>>>>>>>>>>>>>>> >>>8

emeronTI1 ³ tYnaTIrbs;RkummitþGb;rMmitþ nigbuKÁlikGb;rMpSBVpSay>>>>>>> 12 emeronTI2 ³ B½t’manmUldæansþIBIemeraKeGds_> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>19 emeronTI3 ³ emeraKeGds_ nigkarcmøg nigbgáar>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>28 emeronTI4 ³ karpþl;RbwkSa nigkareFVIetsþQamedaysµ½RKcitþ nigkarrkSakarsMgat;> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>41 emeronTI5 ³ CMgWkameraK nigrebobEdlCMgWkameraKcmøg b¤mincmøg>>>>47 emeronTI6 ³ B½t’mansþIBIkarBüa)al karEfTaM nigkarpþl;karKaMRT dl;GñkpÞúkemeraKeGds_> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>57 emeronTI7 ³ B½t’manmUldæansþIBIeRsamGnam½y nigTwkrMGil>>>>>>>>>>>>>> 71 emeronTI8 ³ karkat;bnßybBaðaRbQmpøÚvePT nigeKalkarN_ nigkarGnuvtþkarEkERb\riyabf>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>85 emeronTI9 ³ karbgáarviC¢man>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> >99 emeronTI10 ³ karrYmePT nigGtþsBaØaNpøÚvePT>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>107 emeronTI11 ³ bBaðasuxPaBCamUldæansRmab;mnusSbþÚrePT>>>>>>>>>>>>>>117 eronTI12 ³ karRbtibtiþpøÚvePTrbs;bursRslaj;burs>>>>>>>>>>>>>>>>>>>>>>125 emeronTI13 ³ dMeNaHRsaybBaðaesñha karrYmePT nigmitþPaB>>>>>>>>135 emeronTI14 ³ dMeNaHRsaybBaðaRKYsar GaBah_BiBah_ mitþRsI>>>>>>>>>>145 emeronTI15 ³ dMMeNaHRsayCamYynwgkarejon>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>151 emeronTI16 ³ KnøwHsRmab;RbQmnwgkarmak;gay nig karebotebonenAkñúgCIvitRbcaMéf¶> >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>153

BakübMRBYj AIDS ART CBC CD4 CCR5 DNA

kartmminrYmePT esµaHRtg; eRbIeRsamGnam½y CMgWeGds_ karBüa)aledayeRbIR)as;fñaMRbqaMgemeraKeGds_ brimaNekasikaQamTaMgGs; Cluster of Deviation 4 ¬kMNt;cMNaMenAelIekasikaQams¦ Chemokine Receptor 5 ¬eRbIR)as;edayemeraKeGds_edIm,I eCotcUlkñúgekasika¦ GasIutDIGuksIurIbUnuyekøGiuc ¬mU:elKulGasIutnuyekøGiuc¦ ELISA Enzyme Linked ImmunoSorbent Assay ¬RbePTénkareFVI eraKvinicä½yevC¢saRsþ¦ FHI GgÁkarsuxPaBRKYsarGnþrCati HAART karBüa)alkRmitx bBa¢ÚnGñkCMgWbnþeTAesvakameraKsRmab; MSM nigPaBcaM)ac;kñúgkar Büa)alCMgWkameraK edIm,ICameFüa)aykñúgkarkat;bnßyeRKaHfñak;én karqøgemeraKeGds_. skmµPaBmYycMnYneTotEdlminsUvepþatsMxan;xøaMgmandUcCa ³ 5> BiPakSaBIkareFVIetsþQamrkemraKeGds_ tRmUvkarénkareTAeFVIetsþ Qam nigGtßRbeyaCn_énkardwgfabuKlÁ mñak;man b¤Kaµ npÞkú emeraKeGds_ 6> BiPakSaBIkarBinitürkemIlCMgWkameraKtRmUvkarénkareTABinitürk emIlCMgWkameraK[)aneTogTat; ¬CaBiesssRmab;buKÁlEdl)an RbRBwtþnUv\riyabfRbkbedayeRKaHfñak;¦nigGtßRbeyaCn_énkareTA eFVIeraKvinicä½y nigkareTABüa)alCMgWkameraK Edlpþl;edayGñkEfTaM suxPaB edIm,Ikat;bnßyeRKaHfñak;énkarqøg nigcmøgemeraKeGds_. 7> CMruj[mitþPkþi nigédKU[GnuvtþkarrYmePTRbkbedaysuvtßiPaB 8> CMruj nigKaMRT[RbCaCn[eTATTYlykesva STI nig VCCT 9> BiPakSaBIrebobbgáareraKCamYymitPþ kþi nigédKUEdlmanpÞkú emeraKeGds_ nigGtßRbeyaCn_énkareTATTYlesvaBinti ütamdaneraK[)aneTogTat;.; 10> bBaðaTak;TineTAnwgkarrYmePT b¤karrYmePTCamYyePTdUcKña TidæPaB 13

xagcitþsaRsþ GarmµN_ nigsgÁménkarmanGtþsBaØaN b¤\riyabf pøÚvePT b¤cMNUlcitþrYmePTxusBImnusSTUeTA 11> edaHRsayCamYykarebotebonpøÚvePT kareCosvagGMeBIhigSa nig karrMelaP 12> edaHRsaycMeBaHkarmak;gay nigkarerIseGIgedaysarGtþsBaØaN pøÚvePT b¤cMNUlcitþrYmePT PaBmanb¤KµanpÞúkemeraKeGds_rbs; buKlÁ mñak; nigkarcUlBak;Bn½ r§ bs;bKu lÁ mñak;CamYynwgkargarpøvÚ ePT. skmµPaBEdleTIbnwg)anerobrab;enAb:unµancMNuccugeRkayenH k¾man sar³sMxan;dcU KñaeTAnwgskmµPaB 4xagedImpgEdr. eyIgsgÇwmfa esovePA enH nwgGacCYyBRgIknUvsarEdlRtUvpSBVpSay nigRbFanbT sRmab;kar BiPakSarbs;RkummitþGb;rMmitþ nigbuKÁlikGb;rMpSBVpSay. sMNYrmYycMnYnEdlRtUv)anecaTsYrCajwkjab;enAeBlbMeBjkargar nwgRtUvelIkykmkbgðajenAEpñkxageRkam ehIyk¾manpþl;nUvcemøIyEdl elakGñkGacykeTAeqøIytam)anpgEdr.

ehtuGVI)anCaelakGñkeFVIkargarenH?

elakGñk)anseRmceFVCI amitGþ b;rmM ti þ nigbuKlÁ ki Gb;rpM SBVpSay RbEhl CaedaysarEtelakGñkmankarCMrujTwkcitþdUcxageRkam ³ 1> elakGñkmankarxVayxVl;BIkarqøgraldalénemeraKeGds_CaTUeTA 2> elakGñkmankarRBYy)armÖBIkar)at;bg;mitþPkþiedaysarCMgWeGds_ 3> elakGñkeCOfa karGb;rMpSBVpSay nigmitþGb;rMmitþ nwgGacCYypøas; bþÚr\riyabfmitþPkþirbs;elakGñk)an 4> eRkayeBlmitþPkþi)anENnaMkargarenH elakGñkk¾mancitþcg;cUl rYmeFVIkargarenH 5> elakGñkmanCMenOcitþfa elakGñkmansmtßPaBnwgGacCYypøas;bÚþr 14

mitPþ k½ rþi bs;elakGñk)an tamry³kareRbIR)as;nvU \T§Bi lrbs;elakGñk 6> elakGñkcg;eFVICamnusSmanRbeyaCn_cMeBaHsgÁm nigshKmn_ 7> enARbeTsmYycMnYn GtßRbeyaCn_énkareFVICamitþGb;rMmitþ nigbuKÁlik Gb;rMpSBVpSay manrab;bBa©ÚlTaMgkarTTYl)ankarBüa)aledayeRbI R)as;fñaMRbqaMgemeraKeGds_ nigkarEfTaMsuxPaB)anRbesIrCagmun 8> elakGñkcab;GarmµN_CamYynwgkareFVIkarEsVgrkkarKaMRTmtikñúg cMeNamsaFarNCn edIm,IbegáInkaryl;dwgBI MSM nigedIm,Ikat; bnßykarmak;gay nigkarerIseGIg 9> elakGñkGaceBjcitþnwg»kasEdlelakGñkGacP¢ab;bNþaj nig CYbCamYymnusSfµI²

ehtuGVIGñkRtUvxVayxVl;BIbBaðasuxPaBrbs;´?

CYnkalsMNYrenHRtUv)anecaTsYrkñúglkçN³cMGkLkLWy¬sMNYrRtUv )anecaTsYrkñúgn½ymYyRsedogeTAnwgXøafa {sUmecjeTA[q¶ay¡ ehIy KitEterOgxøÜnÉgeTA¡}¦. GñkEdlecaTsYrsMNYrenHmin)andwgfa ¬b¤k¾min cg;[eKrMlwkR)ab;fa¦ BYkeK b¤édKUrYmePTrbs;BYkeK kMBugRbQmmuxnwgkar qøgemeraKd¾F¶n;F¶reLIy. ehtudUecñH Rbtikmµrbs;BYkeKGacEsþgeLIgdUcCa karRBegIykenþIy karmincab;GarmµN_ b¤karRbqaMgtbt ehIykarRbQm edaHRsay CamYyGakb,kiryi aEbbenH minEmnCakargayRsYlenaHeT. eTaH bICay:agenHkþI elakGñkGaceqøyI tbCamYynwgsMNrY enH edaykarniyayfa³ 1> ´mankarRBYy)armÖBsI hKmn_rbs;eyIg {mnusSRbePTdUcBYkeyIg} ehIy´mincg;)at;bg;rUbGñk b¤mitþPkþirbs;´edaysarCMgWenHeT. 2> ´mankarRBYy)armÖBIbBaðaenH eRBaHfaemeraKeGds_ nigkameraK KW CaemeraKEdlGacbgáar)anedaygayRsYl. sUmGñksakl,gKit emIlfa RbsinebIGñkqøgCMgWEdlGacbgáar)anenH etI)anGñkNaemIl EfTaMrUbGñk nigRKYsarrbs;Gñk? 15

3> ´mankarRBYy)armÖBIbBaðaenH eRBaHfa RbsinebIGñk)anqøgemeraK eGds_rYcehIy karTb;sáat;emeraKedayeRbIfñaMTMenIb² minEmnCakar lM)akeBkenaHeT ehIyfñaMTaMgenaH GacnwgCYy[Gñk nigédKUman suxPaBkan;EtRbesIrEfmeTotpg. 4> etIGñknwgmanGarmµN_EbbNa RbsinebIGñkmin)andwgfaxøÜnGñkpÞúk emeraKeGds_ EtGñk)ancmøgemeraKenHeTA[GñkdéT edaysarEt GñkmincUlcitþeRbIeRsamGnam½y? 5> ´mankarxVayxVl;BIbBaðaemeraKeGds_ eRBaHfa bursPaKeRcInEdl rYmePTCamYyburs )anqøgemeraKenHrYceTAehIy. 6> ´mankarRBYy)armÖ eRBaHfa siTTi§ TYl)anB½tm’ an KWCasiTmi§ lU dæanEdl eyIgKYrman ehIy´GacCYymnusSEdleKRtUvkarB½t’manTaMgenH.

eKalkarN_mUldæansRmab;mitþGb;rMmitþ b¤buKÁlikGb;rMpSBVpSay

1> karrkSakarsm¶at; ³ bBaðaEdlmitþPkþi nigédKU)anelIkeLIg RtUvEt rkSaTukCakarsm¶at;. elakGñkGacelIkykerOgrbs;mnusSNamñak; EdlGñksÁal;enAkEnøgeFVIkar b¤BIkñúgbNþaj mkeFVICa]TahrN_ b:uEnþ RtUvFanafa GñkEdlelakGñkkMBugniyayCamYyenaH nwgminGacdwg BIGtþsBaØaNrbs;mnusSEdlelakGñk)anelIkykmkeFVCI a]TahrN_ eLIy. elakGñkRtUvEtrkSakarsm¶at;edIm,I[GñkcUlrYm b¤ mitþPkþi manTMnukcitþmkelIrUbGñk. 2> kareKarB ³ RtUvEtTTYlykKMnti rbs;mnusSEdlelakGñkniyayCamYy RKb;eBlTaMgGs; ebIeTaHCabuKÁlenaH mineCOGVIEdlelakGñkniyay b¤bdiesFminsþab;tamkarENnaMrbs;elakGñk b¤manKMnitxusBIKMnit rbs;elakGñkk¾eday. kMueFVIkarvaytémøbuKÁlenaH[esaH. 3> GnamikPaB ³ RbsinebImnusSEdlelakGñkniyayCamYy mincg;R)ab; eQµaH b¤Gayu b¤Bt½ m’ anpÞal;xnÜø epSgeTot enaHminEmnCabBaðaeLIy. elakGñkRtUveKarBtamkarseRmccitþrbs;BYkeK¡ 16

4> karKitKUrdl;GñkdéT ³ ral;eBlniyayCamYymitþPkþi nigédKU RtUvKit BIplRbeyaCn_rbs;BYkeKCacm,g. 5> karkat;bnßyeRKaHfñak; ³ eKaledArbs;elakGñk KWkat;bnßykarRbQm nwgkarqøgemeraKeGds_ nigkameraKrbs;mitþPkþi nigédKU ³ kMurMBwgfa BYkeKnwgRbkan;ykkarGnuvtþkarrYmePT EdlRbkbedaysuvtßPi aBPøam enAeBlelakGñkcab;epþImENnaMBYkeK. kic©karenH RtUvkarcMNay Blevla nigkarxitxMRbwgERbg. karQaneq PaBsmrmü ³ RtUvBüayampþl;B½t’man karKaMRT nigCMnajeTAtamtRmUv karrbs;mitþPkþi nigédKUrbs;Gñk. minRtUvpSBVpSaysardEdl² eLIy. RtUvBüayamkMNt;[)anfaetIGñkcUlrYm¼mitþPkþirbs;elak GñkkMBugsßitenAkñúgdMNak;kalNamYyénkarEkERb\riyabf ¬sUm emIlemeronTI6¦. 7> RbkbedayviC¢aCIv³ RbsinebIelakGñkCYbnrNamñak;EdlelakGñkcUlcitþ ehIycg;eFVICamitþ b¤ cg;mansm karmindwgGVIesaHKWCaerOgFmµta ³ karminpþl;B½t’manGVIesaH RbesIrCag karpþl;B½t’manxus. karniyayR)ab;nrNamñak;fa {´minGaceqøIy sMNYrenH)aneTenAeBlenH Et´nwgpþl;cemøIyCUnenAeBleyIgCYb KñaelIkeRkay} CaerOgFmµtaenaHeT. dUecñH elakGñkKYrEtEsVgrk cMeNHdwgfµI² BIGñkRKb;RKgrbs;elakGñk b¤BIesovePAenH. 9> pSBVpSayB½t’mantamry³bNþaj³ elIkTwkcitþmitþPkþi nigédKU[Rbkan; yktYnaTIskmµ kñúgkarCUndMNwg nigGb;rM nigCMrujmitþPkþirbs;BYkeK 17

[pøas;bþÚr\riyabf nigecHbgáarxøÜnBIemeraKeGds_. 10> RtUvecHGaNitGasUr ³ Büayamdak;xøÜnelakGñkeTAkñúgsßanPaBCIvit rbs;mnusSEdlelakGñkkMBgu niyayCamYy. BüayamemIlBI]bsKÁ EdlBYkeKRtUvRbQmmux enAeBlBYkeKseRmceFVkI arpøas;brÚþ [\riyabf nigEsVgrkkarEfTaM ehIybnÞab;mkRtUvCYyBYkeKCMnHelI]bsKÁTaMg enH. RtUvecHGt;Fµt; ehIyminRtUvxwg b¤Gs;sgÇwm RbsinebImitþrbs; elakGñkminTan;seRmceFVItamsMeNIrbs;elakGñk b¤RbsinebIBYkeK RtLb;eTARbRBwtþkarrYmePTEdlKµansuvtßiPaBvij. 11> bgðajPsþútagnUvGVIEdlGñkeFVI ³ GñkRtUvR)akdfa Gñk)ankt;Rtakargar rbs;Gñk ehIyFana[)anfaGñkRKb;RKgrbs;Gñk )andwgBIkargar EdlGñk)anbMeBjtamry³karrkSaTukkMNt;Rta nigeRbIR)as;]bkrN_ RtYtBinitütamdan. kareFVIEbbenH nwgGacCYyGñk k¾dUcCaGgÁkar EdlGñkeFVkI ar edIm,IelIkkMBs;kmµvFi sI Rmab;eKaledAry³eBlEvg.

fteday ³ Jan W de Lind van Wijngaarden 18

emeraKeGds_

2 mUB½tl’mdæanansþIBI

B½t’man mUldæansþIBI emeraKeGds_

2

emeronTI2 ³ B½t’manmUldæansþIBIemeraKeGds_ emeraKeGds_KWCavIrus

emeraKeGds_KWCasrIragÁd¾tUcl¥itEdlmnusSminGacemIleXIjnwgEPñk TeT. vIrusenAkñúgsarBagÁkay mnusSmaneRcInRbePT b:uEnþminEmnvIrusTaMg Gs;suT§EtCH\T§iBlmkelIeyIgdUc²KñaenaHeT. ]TahrN_ CMgWpþasaybgá eLIgedayvIruspþasay Edlqøgtamxül;Gakas enAeBlEdleyIgk¥k b¤ kNþas;. ehIyk¾manRbePTvIrusepSgeTotEdlqøgtamcMNIGahar EdlGac eFVI[eBaHrbs;eyIgmanbBaða. emeraKeGds_ CavIrusmüa:g EdlGacbNþal [ekItCMgeW Gds_ b¤GacbNþal[søab;)an. emeraKenH qøgtamQam Twkkam TwkedaH nigTwkrMGilTVarmas ¬b¤ehAfavtßúravenAkñúgragkay¦. CaP½BVsMNag Nas;EdlemeraKeGds_minEmnCaemeraK EdlgayqøgdUcCaemeraKpþasay enaHeT ehIyeyIgBitCaGacbgáarkarcmøgenH)an¡

emeraKeGds_CaGVI?ehIyemeraKenHeFVIskmµPaBGVIxøH? emeraKEdleFVI[RbB½n§PaBs‘uaMénragkaymnusScuHexSay ¬ehAkat;fa emeraKeGds_¼HIV¦ KWCavIrsu EdleFV[I lT§PaBkñgú karRbqaMgeTAnwgCMgeW pSg² rbs;mnusSkan;EtexSayeTA². lT§PaBkñúgkarRbyuT§RbqaMgnwgCMgWepSg² rbs;ragkaymnusSehAfa {kareqIøytbrbs;PaBs‘uaM} ehIyEdlRtUv)anRKb; RKgeday {RbB½nP§ aBs‘au }M . enAkñgú RbB½nP§ aBs‘au mM an ¬kñgú cMeNamsmasFatu epSgeTot¦ man {ekasikakarBar} EdlmanenAkñúgQam b¤ehAfa {ekasika Qams} EdlenAkñúgekasikaenHmanekasikaesedkat; (CD4= CaRkummYy énGnuRkum rbs;ekasikaQams¦. emraKeGds_ vayRbhareTAelIRbB½n§ PaBs‘uaMénragkaymnusS edaysmøab;ekasika esedkat;TaMgenaH EdlCa 20

Fmµta ekasikaesedkat; manmuxgarkm©at;CMgW nigkarqøgepSg²EdleRCot cUlkñúgragkay. bnÞab;BImYyry³mk emeraKeGds_nwgbnþvayRbhareTA elIekasikaQamsbnþci mþg² ehIyRbB½nP§ aBs‘au nM gw ElgdMeNIrkardUcFmµta. CalT§pl CMgW nigkarqøgepSg²EdlFøab;EtvayRbhar)antictYcelIragkay eBlenHGacman»kaskan;EteRcIn. mnusSEdlqøgemeraKeGds_nwgsøab;enA eBlEdlRbB½n§PaBs‘uaM RtUv)anbMpøajTaMgRsug edaysarmUlehtuxus²Kña CaeRcIn. dMeNIrkarénkarvayRbhareTAelIRbB½nP§ aBs‘au M GacnwgRtUvcMNay eBlCaeRcInqñaM ehIyenAkñúgGMLúgeBlenH mnusSEdl)anqøgemeraKeGds_ GacnwgminmanecjeraKsBaØaGVITaMgGs; b:uEnþGacqøgnigcmøgemeraKenHeTA [mnusSdéT)an.

rUb ³ KMnsU tagemeraKeGds_

CMgWeGds_ ¬AIDS¦ CaGVI? AIDS CaGkSkat;rbs;Baküfa Acquired Immune Deficiency Syndrome ¬cegáameraKsBaØaEdlekIteRkayBIRbB½n§PaBs‘uaMrbs;mnusScuHexSay¦. cegáameraKsBaØa KWCabNþúMeraKsBaØaepSg²EdleRcInekIteLIgRBmKña ehIy 21

kñúgkrNICMgWeGds_ eraKsBaØaTaMgenHekIteLIgeRkayeBlEdlRbB½n§PaBs‘uaM RtUvrgkarxUcxaty:agF¶n;F¶r. eRkayeBlEdlRbB½n§PaBs‘uaMRtUv)anbMpøajBI emeraKeGds_y:agF¶n;F¶r ¬mann½yfabrimaNekasika esedkat;minmanenA sl;eRcInRKb;RKan;¦ enaHRbB½n§PaBs‘uaMminGackarBarragkayRbqaMgnwg {CMgW »kasniym} Cak;lak;mYycMnYn)aneLIy. CMgW»kasniymTaMgenH RtUv)an sÁal;faCa {CMgWEdlbgáeLIgedayCMgWeGds_}. eBlenH mnusSGacnwggay rgeRKaHedaysarCMgWCaeRcInRbePT dUcCa CMgWrebg rlaksYt nigCMgWmharIk epSg². mindUcCaCMgWPaKeRcIneLIy mnusSEdlekItCMgWeGds_ GacnwgCYb RbTHbBaðalkçNvinicä½yeraKsBaØaxus²Kña GaRs½yeTAelIRbePTCMgW»kas niymEdlBYkeK)anqøg. edaysarEtehtuenHehIy eTIb)anCaCMgW eGds_ minGaceFVIeraKvinicä½yedayeraKsBaØaEtmYymuxenaHeT ehIymanEtRKUeBTü b:ueNÑaH EdlGaceFVIkarbBa¢ak;)an.

GVICaPaBxusKñarvagemeraKeGds_ nigCMgWeGds_? mnusSEdl)anqøgemeraKeGds_ emIleTAmansPaBFmµta nigman suxPaBl¥dUcmnusSdéT. RbsinebI min)anTTYlkarBüa)al ehIyRbB½n§ PaBs‘au eM nAEtbnþrgkarvayRbharBIemeraKeGds_ mnusSenaHGacekItCMgW nig eraKsBaØadéTeTot ehIykan;EtcuHexSayeTA²y:agqab;rh½s. bnÞab;mk GñkpÞkú emeraKeGds_ngw vivtþeTArkdMNak;kalmYyEdlehAfa {GñkCMgeW Gds_}. GñkminGacdwgfa mnusSNamñak;manpÞúkemeraKeGds_edayemIlBIxag eRkA b¤edaysµan)aneLIy. GñkpÞúkemeraKeGds_ GacnwgminmanecjeraK sBaØaenAelIragkaykñúgry³eBld¾yUr. dMNak;kalénkarqøgenH ehAfa {KµaneraKsBaØa} ¬Edlmann½yfa {KµanecjeraKsBaØaGVITaMgGs;}¦. eday sarEtemeraKeGds_bnþbMpøajRbB½n§PaBs‘uaMbnþicmþg² mnusSGacnwgekItCMgW epSg²EdlbgáeLIgedayemeraKeGds_. enAeBlEdlCMgWTaMgenH ekIteLIg RBmKña mann½yfaemeraKeGds_cab;epþImelcecjnUv {eraKsBaØa} EdlGac emIldwg b¤ehAfaCMgWeGds_. RbsinebIbuKÁlmñak;pÞúkemeraKeGds_Edlman 22

elcecjnUveraKsBaØa b¤ehAfaCMgeW Gds_ ehIyenAEtminTan;)anTTYlfñaeM BTü karEfTaM nigkarKaMRTeTenaH buKÁlenaHnwgRtUvsøab;edaysarCMgWeGds_Cak; Caminxan. mnusSGacrs;enAtamFmµtaedaymin)andwgfaBYkeK)anqøgemeraK eGds_eLIy ehtuenH mnusSGaccmøgemeraKenHeTA[mnusSdéTeToteday mindwgxøÜn. emeraKeGds_ k¾)aneFVI[mnusSkan;EtgayrgeRKaH edaykarqøg CMgWkameraKepSgeTotpgEdr.

etIry³eBlb:unµanEdlGñkpÞúkemeraKeGds_ køayeTACa GñkekItCMgWeGds_? GaRs½yelIktþasuxPaBpøÚvkay nigpøÚvcitþrbs;buKÁlmñak;² nigktþadéT eTot dUcCakRmitEdlbuKÁlmanpÞúkemeraKeGds_TTYl)ankarKaMRT nigman rebobrs;enARtwmRtUvl¥dl;kRmitNa ¬dUcCa maneBlsRmakeRcIn elg kILa TTYlTanGaharmanCIvCatiRKb;RKan; nigmanGarmµNs_ b¶ s; a¶ t;¦ ry³eBl EdlemeraKeGds_ vivtþeTACaCMgWeGds_ Gacmanry³eBleRcInqñaM ¬BI3qñaM eTA10qñaM eRkayBIqøgemeraKeGds_ b¤BI 9qñaM eTA10qñaM¦. edaysarman karekIneLIgénkarpþl;esvaBüa)alemeraKeGds_ RbsinebIGñkpÞúkemeraK eGds_sßiteRkamkartamdansuxPaB nigcab;epþImTTYlTanfñaMRbqaMgemeraK eGds_ ¬emIlemeronTI6¦ buKÁlenaHGacnwgrs;enAedaymansuxPaBl¥)an 20qñaM b¤eRcInCagenH.

etIGkñ manCMgeW Gds_Gacrs;enA)anry³eBlb:unaµ n muneBlsøab;? enAeBlEdlbuKÁlmñak;)anQandl;dMNak;kalekItCMgWeGds_ ehIy enAEtminTan;TTYl)anfñaMBüa)al b¤karEfTaM[)anl¥eTenaH CaFmµtabuKÁl enaHnwgsøab;kñúgGMLúgeBl1qñaM. b:uEnþ RbsinebIbuKÁlenaHTTYl)ankarEfTaM suxPaB nigfñaMRbqaMgemeraKeGds_ ¬emIlemeronTI6¦ CIvitrbs;buKÁlenaH GacnwgRtUv)anBnüarCaeRcInqñaM. edaysar mankMeNInénkarTTYl)anfñaM 23

RbqaMgemeraKeGds_ GñkCMgeW Gds_CaeRcIn )anTTYleCaKC½ykñgú karkat;bnßy brimaN emeraKeGds_ nigeFV[I RbB½nP§ aBs‘au dM eM NIrkarl¥eLIgvij ehIyragkay k¾RtLb;eTArkdMNak;kalEdlKµanelcecjeraKsBaØaGVIeLIy. qøg F¶n;F¶r

Chronic lymphadenopathy

Skin and mucous membrane immune defects

Sub-clinical immune dysfunction

kgVHPaB su‘aMTUeTA

kMhab;RKab;Qamesedkat;

emeraK ¬EhSnRbqaMg p24¦ Gg;TIk½rRbqaMgemeraKeGds_ ¬gp120¦ ekasikaesedkat;

eBlevla ¬cMnYnExeRkayqøgemeraK ¦

RbPB³ pathmicro.med.sc.edu/lecture/HIV3.htm

etIGkñ manCMgeW Gds_Gacrs;enA)anry³eBlb:unaµ n muneBlsøab;? ebIemIlBIsMbkxageRkA b¤emIleTAelIeraKsBaØa GñkminGacdwgfa buKÁl mñak;man b¤Kaµ npÞkú emeraKeLIy manEtkareFVeI tsþvni ci y½ä eraKsBaØaeT ¬]TahrN_ kareFVIetsþQam¦ eTIbGacdwgfamnusSmñak;man b¤KµanpÞúkemeraKeGds_. sUmemIlemeronTI4 nig]bsm TwkrMGilnarI 4> TwkedaHmþay

25

nigbgáar

3 niemeraKeGds_ gkarcmøg

3 emeraKeGds_ nigkarcmøg nigbgáar

emeronTI3 ³ emeraKeGds_

nigbgáar

nigkarcmøg

etIemeraKeGds_qøgtamrebobNa?

karcmøgemeraKeGds_ sarFaturavmYykñúgcMeNamsarFaturavTaMg 4 Edl)anerobrab;enAkñúgemeronTI2 ¬dUcCa Qam Twkkam TwkrMGil b¤TwkedaH mþay¦ RtUveRCotcUleTAkñgú ragkayrbs;mnusSmñak;EdlKµanpÞkú emeraKeGds_. RbsinebIkrNIenHekIteLIgEmn enHCa»kasEtmYyKt;EdlemeraKGaccmøg mkmnusS)an b:uEnþenHminEmnBitR)akd 100PaKry enaHeT ¬sUmemIl taragxageRkam¦. rebobqøgd¾manRbsiT§PaBbMputkñúgkarcmøgemeraKeGds_ KWkarRCab cUledaypÞal;nUvQamrbs;Gñk EdlmanpÞúkemeraKcUleTAkñúgsrésQam rbs;mnusSmñak;eTotEdlKµanpÞkú emeraK ]TahrN_ tamry³kareRbIR)as;mlú¢ nigsWuraMugrYmKña CamYyGñkpÞúkemeraKeGds_ b¤tamry³karbBa©ÚlQamEdl manpÞúkemeraKeGds_. emeraKeGds_ k¾Gacqøgtamry³karrYmePTpgEdr. meFüa)ayd¾gay bMptu kñgú karcmøgemeraKeGds_ KWkarrYmePTtamrn§KfU edaymin)ankarBarrvag édKUEdlman nigKµanpÞúkemeraKeGds_. karrYmePTtamTVarmas edaymin )ankarBar k¾RbQmmuxnwgkarqøgemeraKeGds_pgEdr. cMENkkarrYmePT tammat;vij mankRmitqøgtictYcb:ueNÑaH eBalKW luHRtaEtbuKÁlEdlrYmePT tammat;enaH manbBaðasuxPaBmat;eFµj Edlbgá[manQam b¤dMe)Atam GBa©ajeFµj. eTaHy:agNak¾eday karqøgCMgWkameraKtamry³karrYmePT tammat; mankarRbQmmuxx Gnam½y R)as;eRsam Gnam½y r)aMgeFµj Gnam½y nigbnÞH )aøsÞikman suvtßiPaB

karrYm ePTtam GIuneFI ENt efIb (Dry >

CagRbsin ebIKµankar beBa©jTwk mat;enA kñúgmat;¦ Kissing) eRbIvtßú rYmePT karmin sib,nimµit eRbIvtßúrYm Edlmin Tsib,ni )anlag mµitrYmKña sMGatrYm karrYmePT Kña b¤min CamYy eRbIeRsam buKÁlEdl Gnam½yfµI manédKU karrMejac EtmYy GarmµN nigKµanpÞúk pøÚvePT emeraK rbs;édKU eGds_ edayeRbI édEdl mansñam rbYs b¤dac; rlat;man suvtßiPaB Kissing) Cag ¬Rb sinebIKµan karb:HCa mYyvtßúrav Twkkam b¤QamrdUv¦ KµaneRKaHfñak; eRKaHfñak; eRKaHfñak; eRKaHfñak; eRKaHfñak;x RbsinebIGñkrYmePT ³ k> RtUvrYmePTEtCamYymnusSmñak; minRtUvmanédKUeRcIneT ehIyRtUv elIkTwkcitþxøÜnÉg nigédKU[eTABinitüQamrkemeraKeGds_ Ca Biess RbsinebIGñkTaMgBIrRtUvkarrYmePTedayKµankarkarBar. x> eRbIR)as;eRsamGnam½y nigTwkrMGli CatiTkw enAerogral;eBlrYmePT tamrn§KUf nigtamTVarmas. K> RbsinebIGñkrYmePTCamYyédKUeRcInCagmñak; yuT§saRsþxageRkam enH GacCYykat;bnßyeRKaHfñak;énkarqøgemeraKeGds_)an³ kat;bnßycMnYnédKU nigkarrYmePT kat;bnßy b¤kRmitRbePTénkarrYmePTEdlGñkRbRBwtþCamYy édKU mann½yfa GñkKYrgakmkrkkarrYmePTtammat; karrYmePT edayeRbIéd karrYmePTedayeRbIePøA karRtdus nigkareGabKña [)aneRcInCagkarrYmePTtamrn§KUf. eRbIR)as;eRsamGnam½yEdlmanTwkrMGilCatiTwkenAral;eBl rYmePTtamTVarmas nigrn§KUf X> niyayedaycMhCamYyédKUrbs;GñkGMBIkarrYmePTknøgmkrbs; Gñk nigsuxPaBpøÚvePTrbs;Gñk 3> RbsinebIGñkeRbIR)as;fñaMejón sUmkMueRbIR)as;m¢úlsWrMaugrYmKña

{CYypg¡ ´)anrYmePTedaymin)ankarBarkalBIyb;mij¡ etI\LÚvenH´manemeraKeGds_ehIy EmneT?} enHKWCasMNYrEdlGñkGacCYbRbTHenAeBlGñkeFVIkar. karelIkTwkcitþ [mitþPkþi b¤GñkcUlrYm eFVIkar rYmePTRbkbedaysuvtßiPaBCanic© mansar³ sMxan;Nas;. b:Eu nþeBlxøH mnusS)anbegánI karRbQmmuxnwgeRKaHfñak; dUcCa enAeBlBYkeKRsvwg b¤sßitenAeRkam\T§iBlrbs;fñaMejón BYkeKGacnwgRtUv )aneKpþl;luy[CaeRcIn edIm,IrYmePTedaymineRbIeRsamGnam½y b¤BYkeK 34

GacmanGarmµN_ {BuHkeRBa¢alxøaMg} enAeBlkMBugrYmePT. CYnkal mnusSxøH minGaceFVIkar crcaBIkareRbIR)as;eRsamGnam½yCamYyédKUEdlman\T§iBl CagxøÜn CYnkaleTot edaysarEtvaCakrNIcab;rMelaP. GñkRtUvR)akdkñúg citþfaGñk)anyl;BImUlehtuEdlnaM[KµankareRbIeRsamGnam½y b¤ehtuGVI )anCaeRsamGnam½yrEhk edIm,IbgáarkMu[ekIteLIgmþgeTottamry³pþl;nUv CMnaj nigB½t’manEdlsmRsb ³ etIGñkcUlrYmeRbIR)as;RbePTTwkrMGilxus EmneT? etIBYkeKeRbIR)as;eRsamGnam½yEdlcas;eBkEmneT? ¬eRsam Gnam½yEdlhYskalbriecäT>>>¦ GñkKYrGgÁúyCamYyBYkeK ehIyBnül;R)ab;BYkeKfa karrYmePTeday KµankarkarBar KWCakarpþl;»kas[emeraKeGds_eRCotcUlmkkñúgragkay ¬EtenHminR)akdfa emeraKeGds_nwgGaceRCotcUlkñúgragkayenaHeT¦. TImYy GñkcUlrYmenaH)anqøg b¤minqøgemeraKeGds_ GaRs½yfaetIédKU rYmePTman b¤KµanpÞúkemeraKeGds_. krNIenH Canic©kaleRcInEtBi)ak eFVkI arbBa¢ak; luHRtaNaEtédKUrmY ePTrbs;Gkñ cUlrYmenaH niyayR)ab; édKUeTAvijeTAmkedaypÞal;. TIBIr RbsinebIédKUrYmePTenaHmanpÞúkemeraKeGds_ »kasénkarqøg GaRs½yeTAelIbrimaNemeraKeGds_rbs;buKÁlenaH. brimaNemeraK mankarERbRbYleTAtamry³eBlEdlbuKÁlenaH)anqøgemeraK ¬sUm emIlemeronTI2¦ TIbI GaRs½yeTAelIfaetIPaKITaMg2 b¤PaKImñak;kñúgcMeNamPaKITaMgBIr man b¤KµanCMgWkameraK. RbsinebIPaKImanCMgWkameraK karqøgemeraK eGds_GacnwgekItman. TIbYn GaRs½yelI\riyabfrYmePTEdlPaKI)anRbRBwtþkalBIyb;miuj ]TahrN_ etImankarrYmePT tamrn§KUf b¤tammat;? etIPaKI)anbeBa©j TwkkamenAxagkñúg b¤xageRkArn§KUf? etITwkkamEdl beBa©jmuneBl seRmcbMNg man b¤KµancUlkñúgragkayenAGMLúgeBlrYmePT? 35

TI5 GaRs½yeTAelIfaetIPaKImaneRbITwkrMGilRKb;RKan;Edrb¤eT? kareRbI TwkrMGilRKb;RKan; GacCYykat;bnßykarecjQam nigdac;rlat;. elIsBIenH k¾GaRs½yelIsPaBrbs;Gvyv³ePTpgEdr ]TahrN_ TMhM ligÁ nig¼b¤PaBrlas;rbs;rn§KfU ¬EdlmYyEpñkGaRs½yelIbTBiesaFn_ nigCMnajpøÚvePT¦ edayykktþaTaMgenHmkKitBicarNa ¬sUmemIlelxeyagcugTMB½renA TMB½rbnÞab;¦ tamkar)a:n;RbmaN edayRbPBd¾KYr[TukcitþmYy)an[dwgfa RbsinebImanmnusS 10>000nak; )anb:HCamYyQammanpÞúkemeraKeGds_ ¬]TahrN_ eRkayeBlmaneRKaHfñak;¦ mnusS 9>000nak; nwgqøgCMgWeGds_ EdlenHKWCaGRtaqøgd¾xs< m; yY ¬90PaKry qøgtamry³Qam¦. k¾bEu: nþ Rbsin ebImnusS 10>000nak; )anrYmePTtamrn§KUf edaymin)ankarBarCamYy GñkmanpÞúkemeraKeGds_ enaHmanmnusSRbEhlCa 50nak;b:ueNÑaHEdlqøg emeraKeGds_ ¬GRtaqøgmanEt 0/5 PaKryb:ueNÑaH¦. enHmann½yfa karrYmePTedayKµansuvtßiPaB ¬eTaHbIkarrYmePTenaH eFVIeLIgCamYyGñkpÞúkemeraKeGds_k¾eday¦ minEmnmann½yfa buKÁlmñak; nwgRtUvqøgemeraKeGds_Pøam²enaHeT b:uEnþRKan;Etmann½yfa buKÁlenaHGac RbQmnwgkarqøgemeraKeGds_. sUmemIltaragxageRkamBIlT§PaBénkarcmøg. enAkñúgkrNInImYy² eyIgsnµtfamnusS 10>000nak; RbRBwtþ\riyabfEdlGacqøgemeraK. tYelxenAkUeLanxageRkam KWCakar)a:nR; bmaNBIcnM nY mnusSEdlGacqøgeraK. sUmKitfa ebIeTaHCa»kasqøgmantictYck¾eday k¾mnusSBitCa)aneFVIkarrYm ePT ehIy»kastictYcTaMgenH )anbgá[manGRtaqøgemeraKeGds_BI 15-28PaKryenAtambNþaTIRkugmYYycMnYnenAtMbn;GasIu ¬»kasénkarRtUv eqñatmantictYcb:eu NÑaH EtmanmnusSrab;rynak;RtUveqñatCaerogral;s)aþh¡_ ¦ 36

kardas;etOn B½t’manxageRkamenHmanlkçN³gayb:HBal;xøaMgNas;. CaFmµta GñkCMnajsuxPaBsaFarN³ minpþl;B½t’manTaMgenaH CasaFarN³eT eRBaHfa eKGacKitfa ³ {GUh+ »kasén karqøgmanEt 0>5 PaKry? ´nwgRbfuynwgeRKaHfñak;enH>>>} sUmeRbIR)as;B½t’manTaMgenH sRmab;\EtGñkEdl)anrYmePT edaymin)ankarBarb:ueNÑaH edIm,IRbemIlemIlBIbBaða RbQmrbs;buKÁlenaH. minRtUveRbIR)as;B½t’manenH eFVICa yuT§saRsþbgáarsRmab;xøÜnGñk b¤édKUGñkeLIy. KYrkt;smÁal;pgEdfa enHKWCa»kasEdl)an)a:n;sµan sRmab;skmµPaBrYmePTmYyelIk. RbsinebImnusSmñak;rYmePT 2-3dgkñúgmYys)aþh_ b¤1mYyEx »kasénkarqøgnwgekIneLIg¡ tamkarGegátqñaM2005 TIRkug)agkk 28PaKry énburs Rslaj;burs Edl)aneTAkEnøg\kMsanþnanaCajwkjab; RtUv)anrkeXIjfa manpÞúkemeraKeGds_. rIÉ\enAtambNþa TIRkugepSg²enAGasIu RtUv)anrkeXIjfa tYelxenH manelIsBI5PaKry.

Griensven F van, Thanprasertsuk S, Jammaroe 1 Griensven F van, Thanprasertsuk S, Jammaroeng R, Manserg G, Naorat S, Jenkins RA, Ungchusak K, Phanuphak P, Tappero JW and Bangkok MSM Study Group., Evidence of a previously undocumented epidemic of HIV infection among men who have sex with men in Bangkok, Thailand. AIDS 2005, 19:521-526. 1

37

tarag³ kar)a:n;RbmaNtamskmµPaBnImYy²BIhaniP2½yén karqøgemeraKeGds_ tamry³meFüa)ayEdlGacqøg meFüa)ayEdlGacqøg

kar)a:nR; bmaNBIkarqøgkñgú cMeNammnusS 10>000nak; EdlRbQmmuxnwgRbPBqøg karcak;bBa©ÚlQam 9>000 karsRmalkUn 2>500 karcak;fñaMedayeRbIm¢úlsWrMaugrYmKña 67 * GñkTTYlkarrYmePTtamrn§KUf 50 30 mutm¢úl * 10 GñkTTYlkarrYmePTtamTVarmas * 6/5 GñkRbRBwtþkarrYmePTtamrn§KUf * 5 GñkRbRBwtþkarrYmePTtamTVarmas * 1§ GñkTTYlkarrYmePTtammat; * GñkRbRBwtþkarrYmePTtammat; * 0/5 § *snµtfaKµankareRbIeRsamGnam½y §RbPBenHsMedAeTAelIkarrYmePT tammat;EdlRbRBwtþ cMeBaHburs

CYypg¡¡ eRsamGnam½y´Føay¡ etIenAeBlenH´RtUveFVIdUcemþceTA? dMbUg GñkRtUveFVIcitþ[s¶b;. dUc)anCRmabxagelI karb:HBal;CamYy emeraKeGds_ minEmnsuT§EtnaMeTArkkarqøgTaMgGs;enaHeT. 2 See European Study Group on Heterosexual Transmission of HIV (1992). “Comparison of female to male and male to female transmission of HIV in 563 stable couples”. BMJ. 304 (6830): 809-813. PubMed and Varghese, B., Maher, J. E., Peterman, T. A., Branson, B. M. and Steketee, R. W. (2002). “Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use”. Sex. Transm. Dis. 29 (1): 38-43. PubMed.

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RbsinebIGñkCaPaKIRbRBwtþkarrYmePT GñkRtUvlagsm¥atligÁrbs;Gñk e hIyTajEs,kcugligÁmkeRkay ehIylagsm¥atedayRbugRby½tñ. Rbsin ebITwkkam)ancUleTAkñúgrn§KUfrbs;Gñk sUmGñkGgÁúyenAelIbgÁn; edIm,I[Twk kamenaHhUrcuHmk. minRtUveRbITwkpáaQUk b¤TwkGnam½yedIm,Ilagsm¥at Epñkxagkñgú eLIy eRBaHfa kareFVEI bbenHeFV[I karRbQmnwgkarqøgekIneLIg. RbsinebIGñkrYmePTtammat; GñkGacesþaH b¤elbTwkkamcUlkñúgeBaH. elIsBIenH GñkGaclag sm¥atmat; edayeRbITwkebtaDIn ¬Betadine¦. min RtUvduseFµj b¤eRbIsrésGMe)aHsm¥ateFµjy:agehacNas; k¾2em:agEdr BIeRBaHkareFVIEbbenHGaceFVI[GBa©jeFµjrbs;GñkGacecjQam EdleFVI[ emeraKeGds_GaceRCotcUl)an. RbsinebIman»kasRbQmmuxnwgkarqøgemeraKeGds_mankRmitx eRbITwkrMGilCatiTwk dUcCa TwkrMGilm:akexv:ay søIbePIrIsþahV hVrepø (K-Y Jelly, Slippery Stuff, ForPlay) nigPaKeRcIn EdllabkarBarkMu [mankUn. TwkrMGilTaMgenH GacrkTij)anenA»sfsßanTaMgLay Edlmanlk;eRsamGnam½y.

GVIeTACaeRsamGnam½yRsþI? etIbursRslaj;burs GaceRbIeRsamGnam½yRsþI )anEdrb¤eT? eRsamGnam½yRsþImanTMhM FMCag nigTUlayCageRsamGnam½y burs b:uEnþeRsamGnam½yTaMgenH 83

manRbEvgesµKI añ eT. eRsamGnam½yRsþmI ankgebIkmat;myY EdlGacbt;Ebn )an nigRtUv)anrcnaeLIgedIm,Idak;bBa©ÚlkñúgTVarmas. eRsamGnam½yRsþIk¾ enAmankgmYyeTotenAxagkñúgeRsam EdlmantYnaTICYysRmYldl;kardak; eRsambBa©ÚleTAkñúgRbdab;ePTRsþI nigCYyrkSaeRsamGnam½ykMu[rbUtecj BITVarmaskñúgxN³eBlkMBugeFVIkarrYmePT. fµI²enH enAtambNþaRbeTsmYy cMnYn bursRslaj;burs ¬CaBiessGñkbþÚrePT¦ )ancab;epþIm eRbIR)as;eRsam Gnam½yRsþIenAeBleFVIkarrYmePTtamrn§KUf. kñúgkrNIenH kgEdleRbI sRmab;dak;kñúgTVarmasminRtUv)aneRbIeLIy. KuNsm,tþirbs;eRsamGnam½yRsþI eRsamGnam½yRsþIminrwttwgenACMuvij ligÁburseLIy ehtuenH )anpþl;nUvGarmµN_ esrIPaBdl;kardak;bBa©ÚlRbdab;ePT. eRsamGnam½yRsþI GaceRbICamYy TwkrMGilCatieRbg ¬b¤ CamYyTwkrMGilCati Twkk¾)an¦. eRsamGnam½yRsþIpþl;GMNaceRCIserIs kareRbIR)as;eRsamGnam½ydl;édKUEdl TTYlkarrYmePT CaCagédKUEdldak;bBa©Úl Rbdab;ePT EdlCamUlehtueFVI[karcrca BIkareRbIR)as;eRsamGnam½yrbs;édKUTTYl karrYmePTkan;EtmanPaBgayRsYl.

KuNvibtþirbs;eRsamGnam½yRsþI maneBlxøH eRsamGnam½yRsþI begáIt[lan;B¤semøgcEmøkenAxN³ eBlEdlkMBugeFVIkarrYmePT. eRsamGnam½yRsþImanTMhMFM ehIy eBleXIjdMbUg GacnwgmanGarmµN_ faKYr[ex cMNg;pøÚvePT b¤kamtNða GacmanTMgn;elIslubeFVI[samICnminnwk Kitdl;eRKaHfñak; EdlGacnwgekItmanenAeBlrUbeKkMBgu eFVkI arrYmePT. 86

dMNak;kalmunkarsBa¢wgKit dMNak;kalsBa¢wgKit dMNak;kaleRtom dMNak;kaleFVIskmµPaB dMNak;kalrkSaTuk

KµanbMNgnwgcab;epþImeRbIR)as;eRsamGnam½y enARKb;eBlénkarrYmePTenAkñúgry³eBl 6 Ex xagmux. manbMNgnwgcab;epþImeRbIR)as;eRsamGnam½y enARKb;eBlénkarrYmePT enAkñúgry³eBl 30éf¶-6Ex xagmux. eRbIR)as;eRsamGnam½ymþgmáal b¤esÞIEtRKb; eBlevlaénkarrYmePT ehIymanbMNgnwgcab; epþImeRbIR)as;eRsamGnam½yenARKb;eBlén karrYmePT enAkñúgry³eBl30éf¶-6Exxagmux. eRbIR)as;eRsamGnam½yenARKb;eBleFVIkar rYmePT nig)aneRbIR)as;eRsamGnam½yy:ag eTogTat;enARKb;eBleFVIkarrYmePTenAkñúg ry³eBl6Excug eRkayenH. eRbIR)as;eRsamGnam½yenARKb;eBleFVIkar rYmePT nig)aneRbIR)as;eRsam Gnam½yy:ag eTogTat;enARKb;eBleFVIkarrYmePTenAkñúg ry³eBl6Ex cugeRkayenH b¤elIsBIenH.

4> Cajwkjab; mnusSeRcInEtRsvwg enAeBlBYkeKeFVIkarrYmePT EdlCa ktþaCMruj[BYkeKRbfuynwgeRKaHfñak;kan;EtxøaMgCagxN³eBlEdl BYkeKminRsvwg. 5> {esckþIRslaj; nigTMnukcitþ} cMeBaHédKU k¾CaktþaCMruj[bursRslaj; bursCaeRcInseRmcQb;eRbIR)as;eRsamGnam½y. karcmøgemeraK eGds_CaeRcIn eXIjekItmaneLIgenAkñúgcMeNammnusSEdlmanTMnak; TMngesñhar:UEmnTik EdlCaTUeTAmanry³eBlEtBIrbIs)aþh_ b¤BIrbIEx b:ueNÑaH. 6> CaTUeTA yuvv½yhak;dUcCacUlcitþRbfuynwgeRKaHfñak;CagmnusSv½y cMNas;. yuvv½ycUlcitþsakl,gnUvGVIEdlfµI ehIymaneBlxøHBYkeK 87

emIleXIjxøÜnÉgfaCamnusSEdlminecHbraC½y b¤min)anKitBicarNa [)anl¥itl¥n;BIGVIEdlBYkeKkMBugeFVIenaHeT. 7> buKlÁ Edl[témøelIxnÜø ÉgTab hak;dcU CacUlrYmeFVkI arRbfuynwgeRKaH fñak;pgEdr RbsinebIBYkeKyl;faBYkeKCamnusSKµantémø etImanehtu plGVIEdlBYkeKRtUvemIlEfxøÜnÉg[)anl¥enaH? kar[témøelIxøÜnÉg k¾qHúø bBa©agM pgEdrBI\riyabfEsVgrkkarEfrkSasuxPaB³ enAeBlmnusS [témøelIxnÜø ÉgTabBYkeKhak;dcU CaminxVayxVl; b¤mni cg;EsVgrkB½tm’ an BIkarEfrkSasuxPaBeLIy. 8> mnusSmYycMnnY Gacnwgmin)armÖBeI RKaHfñak;énkarqøgemeraKeGds_eLIy enAeBlEdlBYkeKRtUvRbQmmuxCamYybBaðaEdlsMxan; nigbnÞan;Cag enH dUcCa bBaðaPaBRkIRkF¶n;F¶r bBaðarkR)ak; edIm,IciBa©wmxøÜnÉg nig RkumRKYsar CaBiessenAeBlmankarpþl;R)ak;eRcInCagmunedIm,IesñIsMu min[eRbIR)as;eRsamGnam½y b¤mankarKMramKMEhgeRbIGMeBIhigSaenA kñgú shKmn_ b¤manvtþmanénCMgEW dlKMramKMEhgdl;GayuCvI ti epSgeTot. 9> mnusSmYycMnYnGacnwg)andwgBIeRKaHfñak; EtKµanlT§PaBkñúgkarkat; bnßyeRKaHfñak;enaHeLIy ¬]TahrN_ BYkeKminGaccrca[édKU eRbIR)as;eRsamGnam½y)an.¦ 10>mnusSmYycMnYnmankarRBYy)armÖBIeRKaHfñak;EdlBYkeKGacCYbRbTH b:uEnþkarRBYy)armÖBIplvi)ak EdlekIteLIgeRkayBIkarlatRtdagBI pøÚvePTrbs;BYkeKmanlkçN³xøaMgkøaCag ¬]TahrN_ burs Rslaj; burs nigGñkEdl)anvHkat;bþÚrePT ¬RkumRsIRss;¦ GacnwgxøacTTYl karBüa)alCMgWkameraK eRBaHfaBYkeKmincg;TTYlsarPaBfaBYkeKCa mnusSRslaj;mnusSmanePTdUcKña¦. 11>mnusSmYycMnYnmin)andwwg ¬b¤mincg;dwg¦ faédKUrYmePTrbs;BYkeK Føab;)anRbfuynwgeRKaHfñak;pøÚvePTCamYymnusSCaeRcInBImunmk. 12>mnusSmYycMnYnKitfa eRsamGnam½yKµanRbsiT§PaBeLIy. BYkeK 88

niyayEbbenHTMngRKan;Et sRmaleRKaHfñak;énkarrYmePTedaymineRbI eRsamGnam½yb:eu NÑaH. 13>mnusSCaeRcInyl;fa eRsamGnam½y)ankat;bnßyPaBsñiT§sñalCa mYyédKUrYmePTrbs;BYkeK ehtuenHehIyBYkeKmincUlcitþeRbIeRsam Gnam½yeLIy. 14>mnusSCaeRcInKitEtBI{RkummnusSEdlmanbBaðaRbQm}b:ueNÑaHeday snµtfa manEtGñkdéTb:ueNÑaHEdlmanpÞúkemeraKeGds_ b¤Gacnwgqøg emeraKeGds_. ]TahrN_ bursRslaj;burs Gacnwgniyayfa man EtbursrksIupøÚvePT b¤ :RkumRsIRss; : b:ueNÑaH EdlmanpÞúkemeraK eGds_. cMENkRkumGñkeRbIR)as;fñaMejón b¤ :RkumRsIRss; : Gacnwg niyayfa manEtRsþIrksIupøÚvePTb:ueNÑaHEdlmanpÞúkemeraKeGds_.

GVIeTACa “bare-backing” ¬xageRkayTeTs¥at¦ b¤ehAkat;fa BB? “bare-backing” KWCaBaküEdlmanRbPBecjmkBIRkumexÞIyRbus Edlmann½yfa {eFVIkarrYmePTtamrn§KUTedaymanectnamineRbIR)as;eRsam Gnam½y}. BB manPaBxusKñadac;RsLHBIkarrEhk b¤rbUtFøak;eRsamGnam½y edayécdnü¡ BB manPaBeBjniymxøaMgNas;kñúgcMeNamRkumbursRslaj; bursCak;lak;mYycMnYn EdlrYmePTCamYybursdUcKña. ehtuenHeyIgcaM)ac; RtUveFVIkarRbqaMgCMTas;nwgkareBjniymEbbenH ehIyRtUvCMruj[mankar EkERb\riyabf.

ehtuGVI)anCabursmYycMnYnRbRBwtþkarrYmePTEbb BB?8 GacmanehtuplmYycMnYndUcxageRkam ³ mincab;GarmµN_nwgkarqøgemeraKeGds_. bursCaeRcInEdlrYmePT CamYyburs ElgmankarP½yxøacemeraKeGds_teTAeTotehIy. BYk eKGacnwgeCOfa emeraKeGds_minGaceCosput)aneLIy b¤k¾fakar 8

dkRsg;BI³ http://www.queerid.com/html/articles_support.asp

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Büa)aledayeRbIR)as;fañ RM bqaMgemeraKeGds_ (ART) )anCYyraraMgemeraK eGds_rYceRscehIy ehtuenHeTIbeFVI[GñkEdl)anqøgGacrs;enA)an yUrCagmun. xVayxVl;BIkarqøgemeraKeGds_. manbursmYycMnYnFM manectnacmøg emeraKeGds_eTA[GñkdéT b¤[GñkdéTcmøgemeraKenHmk[xønÜ . man bursmYycMnYneTot h‘anrhUtdl;Büayam[GñkdéTcmøgemeraKmk [xønÜ BIeRBaHEtkarxVayxVlB; kI arqøgemeraKeGds_rbs;BkY eK mankRmit x kat;bnßycMnYnédKUrYmePT 91

6> kat;bnßykarrYmePTtamrn§KUf edayeFVIkarrYmePTtammat; nigkarrYm ePTEdlKµankardak;bBa©ÚlRbdab;ePTmkCMnYsvij 7> kat;bnßykarrYmePT¼skmµPaBpøÚvePT 8> eCosvagkareRbIR)as;m¢úlrYmKña 9> eCosvagkarrYmePTenAeBlRsvwg 10>kat;bnßykareRbIR)as;eRKOgRsvwg b¤fñaMejón 11>eFVIetsþrkemeraKeGds_[)aneTogTat; 12>eFVIetsþrkCMgWkameraK[)aneTogTat;

etIdMNak;kalsMxan;²énkarbnþEkERb\riyabfmanGVIxøH?

buKlÁ mñak;Gacpøas;brÚþ BIdN M ak;kalmYyénkarEkERb\riyabfeTAdMNak; kalmYyeTot. dMNak;kalénkarEkERbmandUcteTA ³ 1> dMNak;kalmunkarsBa¢wgKit ³ minTan;TTYlsÁal;eLIyfa \riyabf rbs;xøÜnmanbBaða ehIyRtUveFVIkarEkERb. 2> dMNak;kalsBa¢wgKit ³ TTYlsÁal;fa\riyabfrbs;xøÜnmanbBaða b:uEnþ enAminTan;eRtomxøÜn b¤minmankarR)akdenAkñúgcitþfacg;eFVIkarEkERb.

92

3> dMNak;kaleRtom¼ebþCJacitþ ³ cab;epþImmankarcab;GarmµN_ nigeRtom xøÜnrYmeRscedIm,IEkERb\riyabf. 4> dMNak;kaleFVIskmµPaB¼rkdMeNaHRsay ³ cab;epþImeFVIkarEkERb \riyabf. 5> dMNak;kalrkSaTuk ³ rkSaTuknUvkarEkERb\riyabf. bBaðaRbQm enAkñúgdMNak;kalenH KWTb;sáat;kMu[manedIrfyeRkayEdlGacekIt manmþgmáalenAcenøaHdMNak;kalnImYy². sRmab;mnusSPaKeRcIn KMrUéndMNak;kalEkERb\riyabfxagelIenH )anbgðajBIkarEkERb\riyabfbnþicmþg²BIkarKµankarcab;GarmµN_min)andwg b¤KµanqnÞ³nwgeFVIkarEkERb ¬dMNak;kalmunkarsBa¢wgKit¦ eq>>>>>>>>>>>>>>>}¦ nigpl RbeyaCn_énkarEkERb \riyabf. BYkeKenAmin Tan; Kitfa xøÜnGacCaCn rgeRKaHénemeraKeGds_ b¤ kameraKenAeLIyeT. 9 sUmemIl Zimmermann et al (2000) at http://www.aafp.org/afp/20000301/1409.html

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dMNak;kal GtifiCneRtomxøÜneFVIkar eRtom EkERbCak;lak;mYycMnYn. GtifiCnGacnwgqøgkat; karEkERb\riyabfbnþicbnþÜc ehIymankarebþCJacitþnwg begáInkarEkERbbEnßmeTot. ]> karsakl,g eRbIR)as; eRsamGnam½yrbs;bKu lÁ mñak; enAeBleFVIkarrYmePTtam rn§KUf CamYyédKUCak;lak; mYycMnYn Cakar bgðajfa buKÁlenaHkMBugEtsBa¢wgKit BIkareFVIkarEkERb\riyabT edIm,IQaneq das;etOn GtifiCnkMu[Bisar eRKOgRsvwgrhUtdl;Rsvwg b¤kMu[ eRbIR)as;fñaMejón EdlsuT§swg CasßanPaBeFVI[mankaredIrfy eRkay cMeBaHbuKÁlEdlnwgRbRBwtþ karrYmePT EdlmansuvtßiPaB RbsinebIbuKÁlenaH sßitenAkñúg sßanPaBFmµta.

9 karbgáarviC¢man

karbgáar viC¢man 9

emeronTI9 ³ karbgáarviC¢man GVIeTACa {karbgáarviC¢man}? eBakü {karbgáarviCm¢ an} RtUv)aneRbIsRmab;seM dAeTAelIkarbgáaremeraK eGds_sRmab;buKÁlEdlpÞúkemeraKeGds_ b¤KUsVamIEdlmanesr:UmQammin RtUvKña ¬]TahrN_ mñak;manpÞúkemeraKeGds_ cMENkmñak;eTotKµanpÞúkemeraK eGds_eLIy¦. maneBlxøH karbgáartamrebobenHRtUv)anehAfa {karbgáar CMhanTI2}. {karbgáarviC¢man} maneKalbMNgcm,gcMnYnbI ³ 1> edIm,IFanafa GñkpÞúkemeraKeGds_nwgmincmøgemeraKeGds_eTA[Gñk déTeLIy. 2> edIm,IFanafa GñkpÞúkemeraKeGds_enAEtmansuxPaBl¥. 3> edIm,IFanafa GñkpÞúkemeraKeGds_nwgminqøgCMgWeGds_saCafµImþgeTot b¤qøgCMgWkameraKepSg²eTot.

ehtuG)IV anCakarbgáarsRmab;Gkñ pÞkú emeraKeGds_mansar³sMxan;? etIkarbgáarenHmanRbeyaCn_ GIV RbsinebIédKUrmY ePTk¾manpÞkú emeraK 10 eGds_EdrenaH? karbgáarsRmab;Gkñ pÞkú emeraKeGds_ GacCYydl;bKu lÁ enaH[eCosput BIkarqøgemeraKepSg²eTot ¬karqøgeraKeRcInkñúgeBlEtmYy¦ CaBiess KW CMgkW ameraK EdlGacnwgbgá[mansm karrYmePTEdlmankardak;bBa©ÚlepSgeTot ¬RbGb;éd b¤Rmaméd¦³ eRbIeRsamédekAs‘U nigTwkrMGilCatiTwk ¬RbsinebIcaM)ac;¦. 4> ]bkrN_rYmePT ³ sMGat]bkrN_rYmePT CamYynwgsab‘U nigTwk bnÞab; BIeRbIR)as;rYc. tamkarsikSaCaeRcIn)anbgðajfa cMnYnemeraKenAkñúgQam)ancUlrYm cMENkkñúgkareFVI[buKÁlmñak;cmøgemeraKeGds_eTA[buKÁlmñak;eTot. ehtu enH GñkpÞkú emeraKeGds_Gackat;bnßykarRbQmmuxénkarcmøgtamry³kar rkSacMnYnemeraKenAkñúgQam[)anTabtamEdlGaceFVIeTA)an edayeRbIfñaM BnüarCIvit[)aneTogTat; eRkamkarXøaMemIlevC¢saRsþy:agRtwmRtUv. tamkarsikSaepSgeTot)anbgðajfa cMnYnemeraKenAkñúgQam EtgEt manbrimaNxusBIcnM nY emeraK EdlmanenAkñgú Twkkam b¤Tkw rMGli TVarmasEdl Cajwkjy brimaNemeraKEdlmanenAkñúgTwkkam b¤rMGil TVarmasEtgman cMnnY eRcInCag. ehtuenH GñkpÞkú emeraKeGds_caM)ac;RtUvGnuvtþkarrYmePTEdl mansuvtßiPaBCamYyédKU. cMnYnemeraKmankRmitTab b¤esÞIrEtKµan ¬enAkñúg Qam¦ KWRKan;EtCaRsTab;mYyepSgeTot énkarkarBarédKUrYmePT edayeFVI karkat;bnßykarRbQmmuxénkarcmøg.

etI]bsKÁkúñgkarbgáarsRmab;Gkñ manpÞúkemeraKeGds_manGVxI Hø ? ]bsKÁcm,g²kñúgkarbgáarBIkarqøgemeraKeGds_ ¬karqøgmþgeTot b¤ karcmøgeTA[GñkdéT¦ sRmab;Gkñ pÞkú emeraKeGds_ mandUcxageRkamenH ³ Cabzm karlatRtdag[GñkdéTdwg ¬niyayR)ab;GñkdéTBIsßanPaB emeraKeGds_¦ KWCa]bsKÁcm,gsRmab;karbgáarkñgú cMeNamGñkEdlpÞkú emeraK eGds_. GñkTaMgenaH GaceRtomxøÜnniyaylatRtdagR)ab;GñkdéTtamkar Gnuvtþn_ ¬edayxøÜnÉg b¤CamYymitþP½kÖ¦ BIrebobkñúgkarniyayR)ab;GñkdéT fa xøÜnmanpÞúkemeraKeGds_. mnusSGacTTYl)anKMnitEbøk²sþIBIrebobkñúg karniyayedayebIkcMhBIGkñ pþlR; bwkSa RkumGñkKaMRT nigGñkpþle; svasuxPaB 104

nana. ¬emIl]bsm½