Ngonyaka wakhe wokuqala ehhovisi, uMongameli u-Obama wesula umthetho ovimbela abantu bakwamanye amazwe abane-HIV ukuthi bangene. Onyakeni wakhe wokugcina kulesi sikhundla uzosusa umthetho ovimbela ukungena kwezinye izifo ezintathu ezithathelana ngocansi (STD). UMnyango kaMengameli wezeMpilo kanye Nezinsizakalo Zabantu uthi lokhu kuqinisekisa ukwanda kwezifo e-United States, okufakazela futhi ukuthi ukuthuthela kwelinye izwe kuyindaba ecacile kosopolitiki abafana no-Obama. Ukwanda kokufika kwabantu kwamanye amazwe kwehlisa zonke ezinye izinkathazo.
Okokuqala, isizinda esithile. Ngo-1993, isigatshana esasiklanyelwe ukwehlisa ukubhebhetheka kwe-HIV/AIDS e-United States sengezwa kuMthetho Wokufuduka Nesizwe. Iphasise iSigele ngamavoti angama-76 kwangama-23. Ifundeka kanje:
Noma yimuphi umfokazi ozimisele (ngokuhambisana nemithethonqubo ebekwe uNobhala Wezempilo Nezinkonzo Zabantu) ukuthi unesifo esithathelwanayo esibalulekile empilweni yomphakathi, okuzohlanganisa ukutheleleka nge-etiologic ejenti ye-immune deficiency syndrome [AIDS] ... akwamukeleki. 1
Nakuba umthetho ucacile ukuthi ingculazi kufanele ithathwe “njengesifo esithathelwanayo esibalulekile empilweni yomphakathi”, namuhla kuwumsebenzi woMnyango Wezempilo Nezinkonzo Zabantu (HHS) ukunquma ukuthi isifo siyawufinyelela yini lowo mkhawulo. Lokhu kungenxa yomthetho owasayinwa ummeli wabokufika uMongameli uGeorge W. Bush ngo-2008.2 Abaphathi baka-Obama bathatha ibhola bagijima ngombono kaBush wokuvula umngcele futhi banquma ngo-2009 ukuthi i-HIV ayisona “isifo esithathelwanayo esibalulekile empilweni yomphakathi”. 3
Naphezu kwesimemezelo sokuthi i-HIV ayisesona isifo esithathelwanayo esibalulekile empilweni yomphakathi, i-CDC ilinganisela ukuthi cishe abantu abangu-50,000 e-United States basanda kutheleleka nge-HIV unyaka ngamunye nokuthi abantu abangaphezu kwezigidi ezingu-1.2 ezweni bane-HIV. I-United States inenani eliphakeme kakhulu lokutheleleka nge-HIV kunanoma yiliphi izwe elithuthukile.4
I-HHS inikeze ezinye izilinganiso zomphumela walolu shintsho lomthetho futhi yathola ukuthi minyaka yonke kusukela kwabayizi-1,073 kuya ku-6,409 abokufika abanegciwane lesandulela ngculaza bazonikezwa imvume yokuhlala unomphela ngokusemthethweni. isisekelo sesikhashana; ngamanye amazwi, inani labantu abane-HIV abavunyelwe ukungena lizoba likhulu kakhulu. Futhi lokhu akubandakanyi abantu abeqa umngcele, kunjalo.
I-National Institutes of Health (engaphansi kwe-HHS) iphawule ukuthi uma ukuhlolwa kwe-HIV kungeyona ingxenye yokuhlolwa kwabokufika, abokufika abasha “bazokwengeza izibalo zalabo abane-HIV kodwa abangazi ngokutheleleka kwabo”, okungenzeka ukuthi bahole. “eningini labantu abane-HIV engakahlonzwa … okungenzeka ukuthi badlulisele leli gciwane kwabanye, cishe emiphakathini yabo yokufika.” 6 HHS ikubeka ngokungagwegwesi: “Izindleko eziyinhloko zalo mthetho amandla okudlulisela phambili izakhamuzi zase-US ezingenalo i-HIV.”
I-HHS iphinde yalinganisela ukuthi ngemva kweminyaka emihlanu cishe abantu abayi-170 kuya ku-1,014 e-United States bazongenwa yilesi sifo ngenxa yokushintsha kwenqubomgomo, kubiza noma yikuphi ukusuka ku-$4 million kuya ku-$22 million ezindlekweni zokunakekelwa kwezempilo kulokhu “kuqhubekela phambili”. Lesi silinganiso sicabangele izinga eliphansi lokutheleleka okusha okungamaphesenti angu-1.51 - okusho ukuthi bonke abantu abayi-100 abane-HIV bazothelela abantu abangu-1.51. Kodwa i-HHS yaphawula ukuthi ingase ibe phezulu, ichaza ukuthi “isilinganiso sakamuva kakhulu sokusuleleka okujwayelekile okuqhubekayo, lapho kulinganiselwe ekudluliseleni ngokobulili, e-United States singu-3.02 kubantu abavela kwamanye amazwe abayikhulu abayikhulu.”
I-HHS ilinganisela ukuthi ngemva kweminyaka emihlanu yokuqala yalo mthetho oshintshile, kungenzeka kube nabantu abavela kwamanye amazwe abayizi-3,956 kuya kwezingu-23,622 abasha abane-HIV e-United States. Futhi, lokhu kugxile kuphela kubafuduki abasemthethweni abahlala unomphela. Noma yibaphi abeqa emngceleni abane-HIV noma izivakashi ezihlala ngokweqile kuma-visa azo azifakwanga kulesi silinganiso.
Sekukonke, izindleko zokunakekelwa kwezempilo ezilinganiselwe zokususa i-HIV ekuvinjweni kohambo kungenzeka zisukela ku-$19 million kuya ku-$173 million ngonyaka wokuqala kuphela. U-HHS wachaza ukuthi lokhu ngokusobala kuzophinda kabili unyaka wesibili njengoba kufika igagasi elisha labafika, liphindeke kathathu onyakeni wesithathu, njalo njalo. I-HHS ilinganisela ukuthi ngemva kweminyaka emihlanu izindleko zokunakekelwa kwezempilo zizoba izigidi ezingu-$86 kuya ku-$513 million. Kepha ukuze singakhathazeki, i-HHS iphawule ukuthi izindleko kubakhokhintela “kungenzeka zibe zincane uma kubhekwa imingcele yezinzuzo zikahulumeni kwabafuduki abasha.” Kunjalo, lezi zilinganiso zenziwa ngo-2009, ngaphambi kwe-Obamacare.
Muva nje, uMongameli Obama wenze izinguquko ezengeziwe, evula imingcele yethu kuma-STD amaningi. Nokho yinye kuphela imithombo yezindaba enenzalo ekhethekile eke yaqaphela.7
Ngaphambi kuka-2009, i-HHS yabala izifo eziyisishiyagalombili “njengezifo ezithathelwanayo ezibalulekile empilweni yomphakathi”: isifo sofuba, uchoko, Igciwane Lokuntuleka Kokuzivikela Komzimba (i-HIV), ugcunsula, i-chancroid, i-gonorrhea, i-granuloma inguinale, ne-lymphogranuloma venereum. Ngemva kokubili kokuqala ohlwini, okusele zonke izifo ezithathelwana ngocansi. Ngemva kokuba abaphathi beyehlise i-HIV ohlwini, kwasala ama-STD amahlanu kuphela: ugcunsula, i-chancroid, i-gonorrhea, i-granuloma inguinale, ne-lymphogranuloma venereum.
Ngaleso sikhathi ngangizibuza ukuthi ngabe amanye ama-STD nawo azosuswa yini ohlwini ngoba awacishe abulale njenge-HIV. Kumthathe iminyaka eyisikhombisa, kodwa muva nje u-Obama unqume ukususa i-chancroid, i-granuloma inguinale, ne-lymphogranuloma venereum njengezimo eziphathelene nempilo ezingamukeleki kwabafokazi abafuna ukungena e-United States.8
Okuwukuphela kwezifo ezithathelwanayo ezisele ezibhekwa “njenganoma ikuphi ukubaluleka kwezempilo yomphakathi” isifo sofuba, uchoko, ugcunsula, nesipatsholo. Okungenani kuze kube yilapho indawo yokwamukela abantu abanochoko ikhuluma.
Kube noshintsho olulodwa olwengeziwe olwenziwe abaphathi mayelana nesifo sofuba, nokho, okufanele sikuqaphele. Ngaphambi kokushintshwa kwalo mthetho, imithetho yombuso yayidinga ukuthi bonke abafake izicelo abafakwe i-x-ray yesifuba, "futhi labo i-radiograph ebonisa ukungavamile okusikisela kwesifo sofuba, kuyodingeka ukuthi bahlolelwe isifo sofuba okwengeziwe." Ukuguqulwa komthetho kwehlisa imfuneko "yokuba". Manje ifundeka kanje: “Bonke abafake izicelo kungase kudingeke ukuthi bahlolwe okwengeziwe ngesifo sofuba ngokusekelwe emiphumeleni yokuhlolwa kwezokwelapha.” Kuwushintsho olucashile olungase lungabi namphumela obalulekile; ngakolunye uhlangothi, kungase kusho ukuvikela okuqinile esifweni sofuba.
Manje-ke kuthiwani ngezindleko ezihambisana noshintsho lomthetho omusha kuma-STD amathathu asele? Ungakhathazeki, unobhala ka-Obama we-HHS uyena ophethe izinombolo futhi wachaza ku-Federal Register ukuthi “Imiphumela ayibalulekile ngokwezomnotho, okusho ukuthi izindleko nezinzuzo ezingaphezu kwezigidi ezingu-100 ngonyaka owodwa.”9 Ngamanye amazwi, izindleko zokwamukela kwabafokazi abanalawa ma-STD azoba ngaphansi kwezigidi ezingu-100 zamaRandi minyaka yonke.
Unobhala uthi kukhona “okungenzeka” “kokwanda okungenandaba kwezibalo zezifo ezingena e-United States”, kodwa ukuthi “ukwethulwa okungenzeka kwenani elincane kakhulu lamacala ngeke kushintshe ukwakheka kwezindleko zamanje ezihambisana nesimanjemanje. ubunzima bezifo.” Kodwa-ke unobhala ubika nokuthi kulezi zifo i-chancroid iyona kuphela ebikwa ku-CDC, okusho ukuthi kunzima ukulinganisa umthelela walo mthetho kwezinye izifo. Eqinisweni, i-HHS iphawula ukuthi “[d]ata ku-chancroid, granuloma inguinale, ne-lymphogranuloma venereum akuqoqwa ngokuhlelekile yinoma yiliphi izwe elingaphandle kwe-United States noma ngamazwe athile noma izifunda ezisohlwini lwe-DHS yabafokazi, noma kusukela ku-World Health Organization. .” Asazi ngempela ukuthi singenisa ini.
Futhi ingakhathazeki, i-HHS ichaza nokuthi lezi “zifo ngokuyinhloko zasezindaweni ezishisayo zingavinjelwa ngokusebenzisa inhlanzeko yomuntu siqu ethuthukisiwe kanye nobulili obuvikelekile” nokuthi uma uzithola, ama-STD angelapheka “ngokwelashwa okufushane, okungelula kwemithi elwa namagciwane.” Ngethemba ukuthi batshela abokufika lokho.
Abaphathi baphikisa ngokuthi lolu shintsho luzuzisa ngoba odokotela abebezophatha izivivinyo “bazokwazi ukunikela isikhathi esengeziwe nokuqeqeshwa kwezinye, ezindabeni ezivamile kanye/noma ezibucayi kakhulu zezempilo.” Uzwakala ujwayelekile? Lena yimpikiswano efanayo eyenziwa ngabaphathi baka-Obama yokuqondisa i-ICE ukuthi igxile kuphela ekuxosheni izigebengu “ezimbi kakhulu” izifiki. Ngokungazinaki izifiki ezigaywayo ngokungemthetho, abomthetho bangagxila kangcono ezigebengwini ezimbi kakhulu, bathi.10 Kodwa kusho ukuthi inqwaba yabafokazi abayingozi bathola ukuphasa futhi kusho ukuthi udlame seluphenduke imfuneko enkulu ukuphoqelelwa kwabokufika. Ngokufanayo, ukuguqulwa kwezinqubomgomo ze-STD kusho ukuthi izifo eziningi zingase zinganakwa.
I-United States inesibalo esiphezulu sokutheleleka nge-HIV kunanoma yiliphi izwe elithuthukile. Ukushintsha kwenqubomgomo yokuphatha kuka-Obama kungase kuqinisekise ukuthi i-United States iyasigcina leso sihloko. Okungenani, izinguquko zika-2009 no-2016 zizonciphisa ikhono lesistimu yethu yokuthuthela kwelinye izwe ukuvikela abantu baseMelika ezifweni ezithathelwanayo.
LOKHO ONGAKUTHATHE KULESI SIHLOKO:
- The National Institutes of Health (which falls under HHS) noted that if HIV screening is not part of the immigration examination, the new immigrants “will add to the numbers of those who are HIV-positive yet are unaware of their infection”, potentially leading to “a larger population of persons with undiagnosed HIV ….
- Though the law is clear that AIDS is to be considered “a communicable disease of public health significance”, today it is the responsibility of the Department of Health and Human Services (HHS) to determine whether a disease meets that threshold.
- Despite the declaration that HIV was no longer a communicable disease of public health significance, the CDC estimates that approximately 50,000 people in the United States are newly infected with HIV each year and that over 1.
