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Ukumelana Nemithi - Treatment Action Campaign

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Magazine of the <strong>Treatment</strong> <strong>Action</strong> <strong>Campaign</strong><br />

treatment<br />

<strong>Ukumelana</strong> <strong>Nemithi</strong><br />

Umzabalazo wami wokumelana nomuthi:<br />

Indaba kaMzi<br />

<strong>Ukumelana</strong> nemithi ye-HIV: Isayensi<br />

eyenziwe lula<br />

Izimpi zamalungelo: Ukulwela ama-ARV<br />

esikhathi esizayo<br />

June 2011<br />

i


Umhleli: Marcus Low<br />

Umhleli Wezithombe: Andrea Zeelie<br />

Umhleli Wekhophi: Cathy Goudie<br />

Abafake isandla: Nathan Geffen, Mara Kardas-Nelson,<br />

Thandeka Vinjwa, Adam Malapa, Elizabeth Mills,<br />

Nondumiso Hlwele, Mary-Jane Matsolo, Nokuphumelela<br />

Zwane, Elizabeth Nosizwe Vale, Elsa Oliveira, Catherine<br />

Tomlinson, Luckyboy Mkhondwane.<br />

Isithombe sekhava: Phiwokuhle Budaza we-Iliso Labantu<br />

Izithombe: Phiwokuhle Budaza, Marius Potgieter,<br />

Maureen Sill, Samantha Reinders, Richard Heaven,<br />

Luckyboy Mkhondwane, Market Photo Workshop,<br />

Thandeka Vinjwa, Adam Malapa, Faizel Slamang.<br />

Imifanekiso esekhasini 6-9 nguBrice Reignier. Umfanekiso<br />

osekhasini 23 nguSizwe Nguqe.<br />

Sibonga ngokukhethekile kuMziwethu Faku,<br />

Nokuphumelela Zwane we-The Reproductive Health<br />

and HIV Research Unit eNyuvesi yase-Witwatersrand,<br />

umculi nesishoshovu uNondumiso Hlwele, Elsa Oliveira<br />

we-African Centre for Migration and Society, naku Simon<br />

Collins we-HIV i-Base..<br />

Ukuhambisa: Market Insertion Bureau.<br />

Ukuhlelwa kwebhuku: Designs 4development,<br />

info@d4d.co.za<br />

Ukuphrinta: CTP Book Printers<br />

Ukuhumusha: Bohle Conference and Language Services<br />

I-TAC izinikele ekuhlinzekeni abantu abane-HIV,<br />

imindeni yabo kanye nabanikezeli bokunakekela ulwazi<br />

olungenaphutha ngemithi esindisa impilo kanye<br />

nokwelashwa. I-TAC kanye nabaholi bayo bazimele abekho<br />

embonini eyenza imithi yezokwelapha kanjalo nezimboni<br />

zemithi yemvelo kanye nehlukile futhi ayinantshisekelo<br />

yemali kuzo.<br />

Leli hlelo le-Equal <strong>Treatment</strong> lixhaswe ngezimali yi-Global<br />

Fund to Fight AIDS, Tuberculosis and Malaria, kanye ne-<br />

Oxfam Australia.<br />

Leli phephabhuku liyatholakala futhi ngesiTsonga,<br />

isiXhosa nesiNgisi.<br />

Ungakhiphela la mahlelo e-Equal <strong>Treatment</strong> kanye<br />

nelangaphambilini kuleli kheli: www.tac.org.za/<br />

community/equaltreatment/<br />

Ikheli Leposi: PO Box 2069, Cape Town 8001<br />

Ikheli Lendawo: Westminster House, 122 Longmarket<br />

Street, 3rd Floor, Cape Town 8000<br />

Ucingo: 0861 END HIV<br />

Ifeksi: +27 21 422 1720<br />

Iwebhusayithi: www.tac.org.za<br />

Amahhovisi Esifunda e-TAC<br />

Khayelitsha District: 021 364 5489<br />

Ekurhuleni District: 011 873 4130<br />

Lusikisiki District: 039 253 1951<br />

Pietermaritzburg District: 033 394 0845<br />

Gert Sibande District: 017 811 5085<br />

Mopani District: 015 307 3381<br />

ii<br />

I-Equal <strong>Treatment</strong><br />

ishicilelwa yi-<strong>Treatment</strong><br />

<strong>Action</strong> <strong>Campaign</strong>.<br />

Okuqukethwe<br />

amakhasi 1–9<br />

amakhasi 10–19<br />

amakhasi 20–28<br />

Ihlelo 38 – Juni 2011<br />

isisZulu<br />

<strong>Ukumelana</strong> nemithi ye-HIV<br />

Kungaba isikhathi esikhathaza kakhulu uma<br />

ama-ARV akho eyeka ukusebenza. U-Mara<br />

Kardas-Nelson ukhuluma noMziwethu Faku<br />

ngolwazi lwakhe ngokumelana nemithi<br />

ye-HIV. Emva kwendaba kaMzi, sikulethela<br />

incazelo enemininingwane nokulula<br />

ukuyilandela yesayensi yokumelana nomuthi<br />

we-HIV.<br />

Ukuphila ne-HIV nama-ARV<br />

Ukubambelela ekwelashweni okuhle<br />

kungaba nzima kakhulu ezinganeni -<br />

ikakhulukazi uma zingaqondi ukuthi<br />

kungani zidinga amaphilisi zonke izinsuku.<br />

U-Mary-Jane Matsolo ubuza ukuthi ingane<br />

uyitshela nini futhi kanjani ukuthi ine-HIV.<br />

Sizwa kumsebenzi wocansi ngempilo yakhe<br />

ne-HIV kanye nama-ARV. Futhi, ungeqi<br />

ikhalenda yakho yokubambelela ekhasini 13<br />

kanye nephakathi nendawo lencwadi elazisa<br />

ngama-ARV.<br />

Ukubambelela, ilungelo lobunikazi kanye<br />

nesayensi entsha<br />

Emva kwe-athikili ehlola izizathu zokuthi<br />

kungani abantu benza amaphutha<br />

ngokuphuza imithi, u-Catherine Tomlison<br />

wasitshela ngomthetho wezohwebo<br />

wamazwe omhlaba ongasho ukuphela<br />

kwama-ARV athengekayo. Okokugcina,<br />

sikulethela isifingqo socwaningo<br />

oluthokozisayo olusha olwabikwa<br />

kuNgqungquthela yeZidambisigciwane<br />

Nezifo Ezibona Intuba (Conference on<br />

Retroviruses and Opportunistic Infections)


Photo by Faizel Slamang.<br />

Imithi yenzelwe ukuhlasela izinhlobo ezithize<br />

zamagciwane. Kodwa ngokuhamba kwesikhathi<br />

amagciwane ayashintsha; ayakhula; aguquke. Ngezinye<br />

izikhathi ashintsha ngokwanele ukuze imithi efanele<br />

ukuthi isebenze ngempumelelo ukulwa nawo iyeke<br />

ukusebenza. Lokhu kujwayelekile, iyindlela amagciwane<br />

asebenza ngayo. Kuyiqiniso ngebhaktheriya ye-TB;<br />

yiqiniso ngegciwane leNgculazi futhi kuyiqiniso ngawo<br />

wonke amagciwane kanye namabhaktheriya athelele<br />

abantu nezilwane.<br />

Ngakho-ke asikho isizathu sokuthi abantu abane-TB<br />

ne-HIV emelana nemithi babe yihlazo. Banokugula<br />

nje futhi kufanele senze konke okusemandleni ethu<br />

ukwelapha isifo sabo ngalokho okunomkhawulo okukhona<br />

okukhethayo. Kodwa-ke, uma iziguli zibambelela<br />

ezinhlotsheni zemithi yazo futhi izinhlelo zezempilo<br />

zisebenza kahle ngaphandle kokuphela kwesitokwe kanye<br />

nemisebenzi yokunikezela ngemithi okubi, kuthatha<br />

isikhathi eside ukuthi ukumelana nemithi kwenzeke.<br />

Abanye abantu ababambelela kakhulu banokuphuza<br />

uhlobo lwezidambisigciwane ezifanayo amashumi<br />

eminyaka, mhlawumbe impilo yabo yonke ngaphandle<br />

kokushintsha ngenxa yokumelana nemithi. Kodwa<br />

ngezinye izikhathi ngisho bona abantu ababambelelayo<br />

bazoba nokumelana nemithi. Kubantu abaningi kakhulu<br />

ababambelela ekwelashweni zonke izinsuku zokuphila<br />

impilo ibanzima nje.<br />

I-HIV<br />

Umbiko Womhleli<br />

ENingizimu Afrika, ngeshwa sinabantu abaningi kakhulu<br />

abaphila ne-HIV emhlabeni, kodwa ngenhlanhla, uma<br />

kuqhathaniswa neMelika neYurophu, bambalwa kakhulu<br />

abantu abangazweli emthini ye-HIV. Ngonyaka ka-2010<br />

abantu abangama-3% kuphela abantu abasohlelweni<br />

lwezibhedlela zikahulumeni bashintshela emugqeni<br />

wesibili wezidambisigciwane ngenxa yokuthi babene-HIV<br />

emelana nemithi. Kodwa-ke ngokuhamba kwesikhathi,<br />

abantu abaningi bazomelana nemithi. Inkinga ukuthi uma<br />

umelana nemithi eminingi, ukhetho lwakho lube selubiza<br />

kakhulu.<br />

Isibonelo, uhulumeni waseNingizimu Afrika uthenga<br />

uhlobo lomugqa wokuqala elisezingeni lwe-tenofovir,<br />

emitricitabine kanye ne-efavirenz oluwu-R150 isiguli<br />

ngasinye ngenyanga. Kodwa uma ushintshela ohlotsheni<br />

lomugqa wesibili olune-lopinavir (ebhustwe nge-ritonavir<br />

ephawulwe njenge-Kaletra) inani lentengo lalo mkhiqizo<br />

lingaphezu kwe-R300, noma ngaphezu kwezindleko<br />

eziphindwe kabili zohlobo lomugqa wokuqala lonke.<br />

Kodwa kuba kubi kakhulu. Inkampani eyenza imithi<br />

i-Roche yenza umuthi obizwa ngokuthi i-raltegravir,<br />

engakatholakali engxenyeni kahulumeni. Lona ngumuthi<br />

obaluleke kakhulu onemiphumela emibi embalwa<br />

kakhulu uma iqhathaniswa nezidambisigciwane eziningi<br />

ezindala. Ibizwa ngokuthi i-integrase inhibitor ngenxa<br />

yokuthi iyekisa iphrotheyini ebizwa ngokuthi i-integrase<br />

efaka ikhodi yofuzo ye-HIV ku-DNA yomuntu. Isebenza<br />

ngokuhlukile kwezinye izidambisigciwane ezisetshenziswa<br />

engxenyeni kahulumeni, ngakho-ke abantu abamelana<br />

nemithi etholakala engxenyeni kahulumeni njengamanje<br />

bazosizakala ku-raltegravir. Engxenyeni ezimele ibiza u-R2<br />

400 wonke ngenyanga! Ababaningi abantu abadinga lo<br />

muthi eNingizimu Afrika okwamanje, kodwa bazowudinga<br />

abaningi esikhathini esizayo.<br />

I-TB<br />

Ngonyaka ngamunye abantu abayizinkulungwane eziningi<br />

batholakala bene-TB emelana nomuthi eNingizimu<br />

Afrika. Nakuba kuyifashini ukuphakamisa ukuthi abantu<br />

abathola i-TB emelana nomuthi ababambeleli, abaningi<br />

kulabo abayitholayo batholakala bene-TB okokuqala<br />

ngqa. Ngakho-ke angeke kube ngenxa yokungabambeleli<br />

esimeni sabo! Ukuzama ukusola abantu ngegciwane<br />

elimelana nomuthi akusisizi nje.<br />

Esimeni sabantu abane-TB emelana nomuthi kuyinkinga<br />

kakhulu kunabantu abane-HIV emelana nomuthi.<br />

Kunemithi eminingi emihle ye-HIV manje, kodwa imbalwa<br />

kuphela emihle eye-TB. Abantu abane-TB emelana<br />

nomuthi banethuba eliphezulu lokufa. Izindaba ezinhle<br />

ukuthi imithi emisha ye-TB iyenziwa. Owodwa kulena<br />

ubizwa ngokuthi i-TMC207 kanti wenziwa yi-Tibotec,<br />

inkampani engaphansi kwe-Johnson & Johnson. Umuthi<br />

usadinga ukuthi uhlolwe kakhulu kodwa imiphumela<br />

ezinhlolweni zokwelapha zokuqala zakhombisa ukuthi<br />

kungenzeka isebenze ngempumelelo ukulwa ne-TB<br />

emelana nemithi eminingi.<br />

Umsebenzi we-TAC eminyakeni embalwa ezayo ucacile-ke:<br />

kufanele sisize ngokuthola imithi efana ne-raltegravir<br />

kanye ne-TMC207 kubantu abane-HIV kanye ne-TB.<br />

Ukwenza ukuthi le mithi itholakale, kuzosindisa izimpilo<br />

eziningi.<br />

ngu-Nathan Geffen, Usikhwama we-TAC<br />

1


UKUMELANA NEMITHI<br />

2<br />

Umfanekiso oncike esithombeni esithathwe ngu- Marius Potgieter


nokumelana<br />

Ngu-Mara Kardas-Nelson<br />

Uma uMziwethu Faku engasebenzi, usejimini noma uchitha isikhathi nonkosikazi wakhe<br />

omusha. Uyaphumula kusheduli yomsebenzi wakhe emenza abe matasatasa wokusitshela<br />

ngempilo yakhe ne-HIV nempi yokulwa nokumelana nemithi eyizidambisigciwane .<br />

UMzi wazalelwa e-Cathcart, eMpumalanga Kapa<br />

ngonyaka ka-1977. Ephakathi neminyaka engama-20<br />

wayesesukile edolabhaneni langakubo elandela<br />

impilo edolobheni elikhulu i-Jo’burg. Nangale<br />

kokuthi uMzi wagula kakhulu ngonyaka ka-2001,<br />

odokotela bendawo akaya kubo azange bazi<br />

ukuthi kwakonakalephi. Uthi, “Akukho kodokotela<br />

owacabanga ukuthi kahle hle nganginani ngaze<br />

ngafika ekhaya.” “ Udokotela [e-Cathcart]<br />

wangeluleka ukuthi ngihlolelwe i-HIV. Imiphumela<br />

yabuya iphozithivu.<br />

“Ngahlala ekhaya ngizama ukubhekana nesimo,<br />

futhi ngicabanga nokuzibulala, zonke izinto ezinjalo,<br />

he? Ngangizibuza ukuthi kwakuzokwenzekani<br />

enganeni yami. Nganquma ukuthi mangiphilele<br />

yona. Ngempela ngangingenalo elinye ithemba.<br />

Ngangingazi lutho ngegciwane futhi ngangicabanga<br />

ukuthi ngangizofa nje - angazanga ukuthi kufanele<br />

ngenzeni.”<br />

“Ngakho-ke nganquma ukufunda nge-HIV.<br />

Ngajoyina inhlangano edolobheni, senza<br />

imihlangano yokufundisana yokuqwashisa, kodwa<br />

azange sikhulume kakhulu ngezidambisigciwane<br />

(ama-ARV) ngoba sasingazi ngawo kabanzi ngaleso<br />

sikhathi . Ngonyaka ka-2003, kwafika owesifazane<br />

evela ku-<strong>Treatment</strong> <strong>Action</strong> <strong>Campaign</strong> (TAC) evela<br />

eKapa, wangishelela ukuthi ngijoyine i-TAC.<br />

Ngokuhamba kwesikhathi ngaya emhlanganweni<br />

wokufundiswa ngokwelashwa lapho engafunda<br />

khona ngezidambisigciwane. Ngamangala kakhulu<br />

ukubona amadoda kanye nabesifazane betoyitoya<br />

bethi kunethemba. Ngaqala ukusebenza ne-TAC<br />

ngokushesha.”<br />

Umugqa wokuqala nomugqa wesibili<br />

Umuthi womugqa wokuqala inhlanganisela (uhlobo lwemithi) yemithi<br />

abantu abayithola uma beqala ukwelashwa ngezidambisigciwane ohlelweni<br />

lwezempilo lukahulumeni. Le mithi yakhethelwa umugqa wokuqala ngenxa<br />

yokuthi isebenza ngempumelelo, iphephile futhi iyathengeka.<br />

Uma imithi yomuthi wokuqala iyeka ukusebenza, iziguli zishintshelwa<br />

ekwelashweni ngomugqa wesibili. Imithi yomugqa wesibili nayo iphephile<br />

futhi isebenza ngempumelelo, kodwa ihlasela i-HIV ngendlela ehlukile<br />

emithini yomugqa wokuqala futhi kaningi ibiza kakhudlwana.<br />

Uhlelo lwezempilo lukahulumeni namhlanje alunikezeli ngohlobo lwemithi<br />

yomugqa wesithathu futhi kunethemba elincane ezigulini ezimelana<br />

nokwelashwa komugqa wesibili. Lezi ziguli kaningi kufanele zihlale ziphuza<br />

imithi ezinokumelana nayo okuncane noma kufanele zikhokhe amanani<br />

aphezulu emithi yomugqa wesithathu engxenyeni kahulumeni. Imithi<br />

engasetshenziswa njengemithi yokwelapha yomugqa wesithathu iyabiza<br />

ngokuthe xaxa. kunemithi yomugqa wokuqala nowesibili. (Bheka amakhasi<br />

22-25 ukuthi singawehlisa kanjani la manani entengo.)<br />

“Ngonyaka ka-2004 isibalo se-CD4 yami sehla<br />

[saya ku-17] ngase ngiqala ukwelashwa<br />

ngezidambisigciwane.[…] Iphrojekthi Yokwelapha<br />

ye-TAC […] yangitholela umuthi, okwakuyi-<br />

Triomune, iphilisi elilodwa ngelanga,ene-nevirapine,<br />

lamivudine (3TC), ne-stavudine (d4T). I-TAC yalithola<br />

eNdiya yaliletha e-East London.<br />

“Ngonyaka ka-2008 ngaphawula [izimpawu]<br />

zokumelana, engingazange ngempal ngikuqonde<br />

ngoba ngangisebenzisa ikhondomu futhi imithi<br />

ngiyiphuza njengoba ngitsheliwe. Kodwa [ngibonga]<br />

ukufundiswa ngokwelashwa ngangazi ukuthi<br />

ngezinye izikhathi ngisho uyiphuza imithi yakho<br />

UKUMELANA NEMITHI<br />

3


Isithombe ngu-Marius Potgieter.<br />

Isu<br />

Lokubambelela<br />

“Ibhokisi lami lamaphilisi ngilibeka phezu kwe-TV futhi<br />

ngisebenzisa imibukiso ye-TV njengezikhumbuzi. Imithi yami<br />

ngiyiphuza ngo-21:00 kanti leso yisikhathi okungena ngaso<br />

uMuvhango. Uma umbukiso ungadlali, isb. ngoLwesihlanu<br />

nangempelasonto, ngingakwazi ukuthembela ku-alamu yefoni<br />

yami ekhala ngesikhathi esifanayo ngqo.”<br />

4<br />

ayihlali isebenza njalo. Emva kwezinyanga eziyisithupha<br />

ngayokwenza ukuhlolwa okuyisisekelo udokotela wathi<br />

isibalo samaseli e-CD 4 yami sasehle saya ku-180 sisuka<br />

kuma-300. Savuma ukuthi kwakunokumelana nemithi<br />

nokuthi kwakudingeka ukuthi ngishintshe imithi.<br />

“Ngaqala ngaphuza i-Alluvia (lopinavir/ritonavir) ne-<br />

Inverase (saquinavir), yomibili okungama- protease<br />

inhibitors* ngokujwayelekile engeke inikezelwe<br />

[ndawonye]. Kodwa udokotela wami wathi ayikho into<br />

engingayenza ngoba ngangingazweli kuyona yonke<br />

imithi ekhona ezweni lethu ngaphandle kwale emibili.<br />

“[…] Ekuhambeni kwezinyanga eziyisithupha ubuningi<br />

begciwane emzimbeni babungasatholakali kanti<br />

nesibalo se-CD4 yami sase siphezulu. Ngonyaka<br />

olandelayo, ngeshwa, ngadilizwa kwa-TAC usizo lwami<br />

lokwelashwa lwamiswa. Nganquma ukuqhubeka<br />

nomuthi. Nakuba i-Alluvia yayitholakala ezingxenyeni<br />

zikahulumeni, i-Inverase yayingekho, futhi [yayibiza]<br />

R820-R850 ngokunikezelwa kwangenyanga. Kwafika<br />

lapho engingakwazanga ukuyikhokhela khona.<br />

Ngangikhokha irenti, nganginemoto, kwakufanele<br />

ngidle, kwakufanele ngondle umndeni wami kanti<br />

umsebenzi wawungangikhokheli kahle ngokwanele<br />

ukukwazi ukukhokhela konke lokhu.<br />

“Okokugcina, ngosizo luka-Dkt. Francois Venter<br />

owayevela eNyuvesi yase-Witwatersrand, ngathola<br />

[uhlobo lwemithi olusha ] Alluvia, lamivudine (3TC)<br />

ne-tenofovir (TDF), konke okutholakalayo engxenyeni<br />

kahulumeni. Ngayiqala ngoJanuwari 2011 ngase<br />

ngithola imiphumela yokuhlolwa kwami. Izinga<br />

legciwane egazini alitholakali kanti i-CD4 yami<br />

ikhuphuke yafika ku-461.”<br />

UMzi manje usehlala e-East London, indawo akayibiza<br />

ngekhaya kusukela eqala ukusebenzela i-South Africa<br />

Partners ngonyaka ka-2009. Uyivakashela kaningi<br />

i-Cathcart ukuzobona indodakazi yakhe endala<br />

eneminyaka eyishumi, ehlala nogogo wayo. Yena<br />

nonkosikazi yakhe banethemba lokuba nengane.<br />

“Ngiphilile”, uMzi engitshela. “Ngiphilile ngempela<br />

impela.”<br />

Ukwesekwa umndeni wakhe bekubalulekile<br />

ekuqinisekiseni ukuthi uMzi uyabambelela emithini<br />

yakhe yokwelashwa.” Ekugcineni ngasemukela isimo<br />

sami se-HIV ngonyaka ka-2003, kanti umuntu wokuqala<br />

engakhuluma naye kwakungumfowethu omdala. Ngeza<br />

e-East London emhlanganweni wokufundisana ngase<br />

ngimcela ukuthi eze kimi ehhotela ngase ngimtshela,<br />

wathi ‘Mfowethu akusikhona ukuphela komhlaba.<br />

Awuwedwa.’ Wanganga futhi wajabula ukuthi wayazi<br />

ekugcineni ukuthi kwakwenzekani.<br />

“Labo abasondelene nami bayazi ukuthi ngiphila<br />

ne-HIV, futhi lokhu kuyangisiza ukuthi ngibambelele.<br />

Abantu abangizungezile bayazi ukuthi kufanele<br />

ngiphuze umuthi wami ngehora lesi-9 ekhanda.<br />

Uma ngingekho ekhaya ngo-9 unkosikazi wami<br />

uyangikhumbuza ukuthi kufanele ngithathe ama-ARV<br />

ami.”<br />

UMzi uyabonga ngempilo akanayo manje, kodwa<br />

ucela ukuthi umphakathi wabantu kanye nohulumeni<br />

bandise ukufinyelela kuma-ARV amasha nasekhona.<br />

Uthi, “Ngikhathazekile ngoba uma ubheka ezweni<br />

lethu uhlobo lwemithi engikulo ngolokugcina okwazi<br />

ukuluthola. Umngane wami unesibalo se-CD4 esiwu-4<br />

kanti usohlotsheni lwemithi lomugqa wesibili.<br />

Wayohlolwa [wathola ukuthi] akaphenduli emthini.<br />

Kodwa-ke unenhlanhla ngoba unosizo lokwelashwa.<br />

Kwenzekani ngathi esingenalo usizo lokwelashwa<br />

esimelana nohlobo lwemithi lomugqa wesibili?<br />

Sikuhlolelwa kanjani ukumelana nomuthi [ngaphandle]<br />

kosizo lwezokwelashwa. Uma sikwazile ukuyohlolwa,<br />

imithi yomugqa wesithathu esiyidingayo angeke ibe<br />

khona engxenyeni kahulumeni.”<br />

* I-Protease inhibitor: Uhlobo lwesidambisigciwane olubhloka umnyakazo<br />

we- protease, i-enzayimu edingekayo ukwenza amakhophi egciwane.<br />

UKelebokgile Kabanyane, <strong>Treatment</strong> <strong>Action</strong> <strong>Campaign</strong>, Ekurhuleni<br />

Isithombe<br />

nguLuckyboy<br />

Mkhonwane.


Photo by Marius Potgieter.<br />

Ama-ARV atholakala engxenyeni kahulumeni<br />

Umugqa wokuqala<br />

Zonke iziguli ezintsha,<br />

kubandakanya abesifazane<br />

abakhulelwe, kufanele bathole<br />

i-tenofovir + lamivudine/<br />

emtricitabine + efavirenz/<br />

nevirapine<br />

Iziguli njengamanje<br />

ezisohlotsheni<br />

oluncike ku-stavudine,<br />

abangenamiphumela emibi<br />

kufanele zithole<br />

i-stavudine +<br />

lamivudine + efavirenz<br />

Labo ababa nemiphumela<br />

emibi i- d4T bangashintshela<br />

okhethweni olukwesokunxele.<br />

Umugqa wesibili<br />

Iziguli ezehlulekayo ohlotsheni lwemithi yomugqa<br />

wokuqala encike ku-tenofovir kufanele zithole<br />

i-zidovudine + lamivudine + lopinavir/<br />

ritonavir<br />

Iziguli ezinezinkinga zezinso<br />

(ezingafanelwe yi-tenofovir)<br />

kufanele zithole<br />

i-zidovudine +<br />

lamivudine + efavirenz/<br />

nevirapine<br />

Iziguli ezehlukelayo ohlotsheni lomugqa<br />

wokuqala oncike ku-stavudine noma kuzidovudine<br />

kufanele zithole<br />

i-tenofovir + lamivudine/<br />

emtricitabine + lopinavir/ritonavir<br />

UKUMELANA NEMITHI<br />

5


UKUMELANA NEMITHI<br />

6<br />

isayensi<br />

Yokumelana <strong>Nemithi</strong><br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

CD4<br />

Cell<br />

CD4<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

CD4<br />

Cell<br />

HIV<br />

Cell<br />

Uma umuthi uyeka ukusebenza kaningi sithi isifo (kungaba igciwane,<br />

ibhaktheriya noma ifangasi) asisezweli kulowo muthi. Ngale ndlela i-HIV<br />

ngezinye izikhathi ayibe isezwela emithini yomugqa wokuqala. Abantu<br />

kube sekufanele bashintshele emithini yomugqa wesibili njengamanje nje<br />

ebiza kakhulu. Kodwa kungani i-HIV imelana nomuthi kwasekuqaleni?<br />

CD4<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

CD4<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell HIV<br />

Cell<br />

Umfanekiso ngu-Brice Reignier. Uma ungawasebenzisi ama-ARV, i-HIV ikwazi<br />

ukuhlasela izivikeli mzimba ingaphazanyiswa<br />

yilutho.<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

HIV<br />

Cell<br />

Isiphindaphindi esisheshayo<br />

• I-human immunodeficiency virus (HIV) ingena<br />

kumaseli egazi amhlophe bese iwathumba.<br />

• Isebenzisa la maseli ukwenza enye i- HIV –<br />

mhlawumbe engaphezu kwama-300 kuseli ngayinye.<br />

• La makhophi amasha e-HIV abe esethelela amanye<br />

amaseli egazi amhlophe bese luyaqala futhi uhlelo<br />

phansi.<br />

• I-HIV ikwazi kahle kakhulu ukuziphindaphinda yona<br />

ngokwayo. Yingakho nje abantu abangelashwa<br />

kaningi benamashumi ezinkulungwane zamakhophi<br />

kumililitha elilodwa legazi labo.<br />

I-T-seli etheleleke nge-HIV esebenzayo iphila<br />

kuphela usuku nesigamu. Ngalesi sikhathi yenza<br />

amakhophi amasha angamakhulu amaningana<br />

egciwane ngaphambi kokuba life.


Hhayi nje ohlobo olulodwa<br />

lwamagciwane oluvela egciwaneni<br />

lokuqala<br />

Uma i-HIV yenza amakhophi ayo ngaphakathi<br />

kuseli, kaningi yenza amaphutha amancane abizwa<br />

ngezinguquko. Lezi zinguquko zisho ukuthi amanye<br />

ama-HIV amasha ahlukile kancane egciwaneni<br />

eliqale kuqala ukuthelela iseli. Eziningi kakhulu kulezi<br />

zinguquko zenza ukuthi igciwane libe buthakathaka<br />

lingaphili isikhathi eside.<br />

Uhlobo lwamagciwane oluvela egciwaneni lokuqala<br />

abantu abaningi kakhulu abatheleleke ngalo lubizwa<br />

ngokuthi igciwane oluwuhlobo lwasendle. Igciwane<br />

oluwuhlobo lwasendle likwazi ngempela ukulimaza<br />

izivikeli mzimba zakho uma ungayiphuzi imithi . Kodwake,<br />

uma sewuphuza izidambisigciwane ngokuvamile,<br />

igciwane lohlobo lwasendle liba nobunzima obukhulu<br />

bokuphila emzimbeni wakho.<br />

Kodwa-ke, noma umuntu ewaphuza ama-ARV<br />

igciwane lilokhu liguquguquka ngezinga elincane<br />

kakhulu. Okubalulekile, igciwane liyaqhubeka<br />

nokuziguqula ngezindlela ezahlukene lize lizishayise<br />

ngengozi oguqukweni olulisiza ukuthi lengamele<br />

izidambisigciwane. Ngesikhathi olulodwa lwalezi<br />

zinguquko lwenzeka, uhlobo oluguqukile olusha<br />

luzophindaphindeka ngokushesha kunezinye izinhlobo<br />

ngoba lingcono ekwengameleni ama-ARV athize ngqo<br />

aphuzwa ngumuntu.<br />

Amandla okwelashwa ngokuphindwe<br />

kathathu<br />

Ukwelashwa ngezidambisigciwane yiyona ndlela<br />

kuphela efakazisiwe yokucindezela i-HIV (ukwehlisa<br />

inani legciwane egazini) nokusiza ukubhusta izivikeli<br />

mzimba (kwandiswe isibalo se-CD4). Izidambisigciwane<br />

zenza lokhu ngokungenelela ukuyekisa i-HIV ukuthumba<br />

Izidambisigciwane zicindezela i-HIV bese<br />

ziyivimbela ukuthi ingalimazi izivikeli<br />

mzimba zakho.<br />

amaseli. Njengoba uzobona ekhasini 16-17, amakilasi<br />

ahlukene emithi ye-HIV angenelela ezigabeni ezahlukene<br />

zohlelo lokutheleleka (ukuthumba).<br />

Uma usebenzisa umuthi owodwa kuphela ukuhlasela<br />

igciwane, kungaba lula kakhulu egciwaneni ukuguquka<br />

nokuzisindisa kulowo muthi. Kodwa, uma uhlasela<br />

igciwane ezimeni ezintathu ezahlukene, kuba nzinyana<br />

ukuthi igciwane liguquke. Lokhu kungenxa yokuthi<br />

igciwane lenza uguquko elingakuhlula ukuhlasela<br />

okukodwa, okunye ukuhlasela kuzobe kusalilawula.<br />

Yingakho nje ukwelashwa ngezidambisigciwane<br />

ezisebenza kakhulu (active antiretroviral therapy<br />

(HAART)) zivamise ukuba nemithi eyizidakamizwa<br />

emithathu.<br />

Uma ucabanga ngokucindezela igciwane<br />

njengasemdlalweni webhola lezinyawo, ungathi<br />

kungenzeka ulimise igciwane uma izivikeli zakho<br />

zinamandla ahlukene. Kungenzeka udinge ovimbayo<br />

osheshayo ukuze kubhekwe emaceleni, umvimbi omude<br />

ukuthi ahede ibhola lize liyofika emapalini, kanye<br />

nomvimbi ohlakaniphile ukucabangela ukuthi abahlaseli<br />

bacabangani .<br />

Kwenzeka kanjani ukungazweli emthini<br />

Uma iphuzwa kahle, imithi yokwelapha emithathu<br />

isebenza kahle kakhulu ekulawuleni i-HIV. Ukwelashwa<br />

kusiza isiguli ukuthi inani legciwane egazini lehle<br />

ezinkulungwaneni eziningi zegciwane zamakhophi<br />

egciwane ngemililitha legazi ngalinye libe ngaphansi<br />

kwama-20.<br />

Ngeshwa, asikazi ukuthi singayiqeda kanjani ikhophi<br />

ngayinye yegciwane ukuze selaphe umuntu i-HIV. Ngisho<br />

nangemithi emihle kakhulu yokwelapha ekhona iphuzwa<br />

ngqo njengoba kufanele iphuzwe, enye i-HIV ihlala isele<br />

emzimbeni, ikakhulu ngokucasha kumaseli e-CD4 alele.<br />

Lokhu kuthiwa<br />

Igciwane le-HIV liguquka kungahleliwe lize<br />

libe noguquko oluyenza ukuthi ingazweli<br />

kuma-ARV athize.<br />

7


UKUMELANA NEMITHI<br />

8<br />

njengezingodla zamaselula. I-HIV kungenzeka ukuthi ibe<br />

kwamanye amathishu kodwa ukukhathazeka okukhulu<br />

kubantu abenza ucwaningo ngokwelapha, amaseli alele.<br />

Ngokushesha lapho kuyekwa ukwelapha, i-HIV<br />

ingaphuma ezingodleni ze-gciwane lapho kade<br />

icashe khona bese iqala ukuziphindaphinda futhi<br />

ngokukhululeka . Yingakho nje okwamanje ukwelashwa<br />

kwe-HIV kungokokuphila konke.<br />

Uma uyeka ukuphuza imithi igciwane lizosebenzisa<br />

leso sikhala ukuziphindaphinda ngokuguquka kakhulu<br />

ngokukhululeka. Ezinsukwini ezimbalwa inani lakho<br />

legciwane lizobe selitholakala futhi nasemasontweni<br />

ambalwa lingabuya ngezinkulungwane. Yingakho<br />

nje ukuphela kwesitokwe kubanga ukukhathazeka<br />

okungaka. Eminyakeni embalwa eyadlula<br />

kwakucatshangwa ukuthi kungenzeka ukuthi kuthathwe<br />

ikhefu ekuphuzeni imithi, kodwa uhlolo olukhulu<br />

lwathola ukuthi abantu abathatha ikhefu emithini bagula<br />

kakhulu kunabantu abangazange balithathe. Isizathu<br />

esisodwa salokhu ukuthi amakhefu ekwelashweni<br />

avumela igciwane ukuthi liguquke ngokukhululeka.<br />

Isibonelo, isimo esincane soguquko lwegciwane<br />

singalawuleka kodwa ngenxa yokuthi isiguli siyeke<br />

imithi lolu hlobo oluguqukile lungaba isimo se-HIV<br />

esingazweli nhlobo ekwelashweni. Uma isiguli sesiqala<br />

futhi siphuza umuthi ofanayo nangaphambilini,<br />

kungenzeka ukuthi ungasasebenzi. Izinhlobo ezindala<br />

zisazobe lokhu zicindezelwa yimithi, kodwa izinhlobo<br />

Uma ngabe uguquko selwenzekile<br />

olumelana nama-ARV athize, lolo guquko<br />

luphindaphindana ngesivinini.<br />

ezintsha eziguqukile angeke zilawulwe futhi zizozalana<br />

zande, zibe uhlobo olukhulu emzimbeni walowo<br />

muntu. Esimeni esinjalo isiguli kufanele sishintshele<br />

enhlanganiseleni yama-ARV entsha uhlobo lwe-HIV<br />

olungakamelani nalo.<br />

Kungadluliseleka yini ukumelana<br />

nemithi?<br />

Uma umuntu otheleleke ngohlobo lwe-HIV olumelana<br />

nomuthi edlulisela igciwane komunye umuntu, umuntu<br />

osanda kutheleleka uzoba nokumelana nomuthi<br />

okufanayo. Ngale ndlela umuntu osandakutheleleka<br />

angangazweli emithini ethize kusukela ngosuku<br />

lokutheleleka. Ngeshwa asinawo umqondo ocacile<br />

wokuthi inkinga yokumelana nomuthi inkulu<br />

kangakanani eNingizimu Afrika. Ngokuhlambekisela<br />

okuwuhlaka, kungaphansi kwama-5% ukutheleleka<br />

okusha kwe-HIV okubandakanya izinhlobo ezimelene<br />

nemithi.<br />

Kwamanye amazwe acebile ukuhlolwa kokungazweli<br />

kuyatholakala ezigulini ezisandakuxilongwa. Lokhu<br />

kuhlola kusiza ukucabangela ukuthi yimuphi umuthi<br />

ozosebenza ngempumelelo nokungenzeka ungasebenzi<br />

ngempumelelo. Kodwa-ke, ukuhlolwa kokungazweli<br />

akukabi bikho njengamanje ohlelweni lwezempilo<br />

lukahulumeni eNingizimu Afrika ngenxa yokubiza<br />

kwalo kakhulu nokuthi uhlelo lwezempilo lukahulumeni<br />

lusebenzisa izinhlobo zemithi ezisezingeni kunemithi<br />

eyenzelwe umuntu ngamunye.<br />

Uma i-HIV ingasezweli emithini yomugqa wokuqala,<br />

imithi yomugqa wesibili isuke isasebenza<br />

ngempumelelo ngokuvamile.


Igrafu A: Amazinga emithi kanye nokumelana nayo<br />

Izinga lomuthi elihlosiwe lidinga ukuthi libe ngaphezu kwe-MEC ukugwema<br />

ukumelana kodwa lingabi phezulu lize libange imiphumela emibi<br />

i-MEC<br />

Igrafu B: Amazinga omuthi kanye nokumelana nawo<br />

Uma weqe umthamo noma wephuze ukuwuphuza, amazinga omuthi<br />

angehla ukufika ezingeni lapho kungenzeka khona ukumelana nawo.<br />

i-MEC<br />

Ingozi ekhulile yemiphumela emibi<br />

Ingozi ekhulile yokumelana nemithi<br />

umthamo umthamo umthamo umthamo<br />

i-MEC = Minimum Effective Concentration (Ukujiya Okusebenza<br />

Ngempumelelo Okuphansi)<br />

Ingozi ekhulile yokumelana nemithi<br />

umthamo umthamo<br />

Umthamo<br />

oweqiwe<br />

Umthamo<br />

ophuzwe<br />

ngemuva<br />

kwesikhathi<br />

umthamo<br />

Imifanekiso incike kumagrafu avela ku-HIV i-Base.<br />

“Imithi yakho<br />

ungayibeka endaweni<br />

lapho okuzokwenzeka<br />

khona ukuthi uma<br />

sekuyisikhathi<br />

sokuyiphuza<br />

uyithathe. Isibonelo,<br />

uma ukuxubha<br />

amazinyo kuyinto<br />

yokuqala neyokugcina<br />

ekuseni, ukubeka<br />

imithi yakho<br />

eduze kwesixubho<br />

kusebenza<br />

njengesikhumbuzi.”<br />

U-Stephen Ngcobo,<br />

<strong>Treatment</strong> <strong>Action</strong><br />

<strong>Campaign</strong>, Ekurhuleni<br />

Ngeshwa i-HIV angeke icindezelwe ngokuphelele ngama-ARV amanje. Enye<br />

i-HIV iyacasha ezingodleni zamagciwane ilindele ukusebenza futhi uma<br />

sekuyekwa ukwelashwa noma kwenzeka ukungezweli.<br />

Isu<br />

Lokubambelela<br />

Isithombe ngu Luckyboy Mkhonwane.<br />

UKUMELANA NEMITHI<br />

9


UKUPHILA NE-HIV NAMA-ARV<br />

10<br />

Photo by Richard Heaven.<br />

obala<br />

Ngu-Mary-Jane Matsolo<br />

Uyitshela kanjani ingane<br />

ukuthi ine-HIV?


Ngibheka isikhathi ewashini lami. 15:30. Ulwesihlanu<br />

ntambama olushisayo. Ngingena emtholampilo i-Ubuntu<br />

eKhayelitsha ngethemba lokuthi umphathi wezindawo<br />

zokusiza – uSisi Mpumie, njengoba aziwa kanjalo –<br />

akakakhohlwa ngomhlangano wethu. .<br />

Emtholampilo manje kunabantu abaningi abasale<br />

endaweni yokulinda kodwa indlu isenomuzwa wokuthi<br />

ngelinye lamalanga amatasatasa emtholampilo. USisi<br />

Mpumie ungaphakathi ehhovisi lakhe nomunye unesi.<br />

Ngamazisa ngokufika kwami ngase ngimlinda ngesineke<br />

ukuthi aqede umhlangano wakhe.<br />

Emuva kwemizuzu emihlanu wangibiza wathi angingene.<br />

Ihhovisi likaSisi Mpumie ligcwele izithombe zemiklomelo<br />

yakhe nokuphumelela, eceleni kwesithombe sakhe<br />

egqoke i-T-shethi ethi HIV positive ewuphawu lokuthi<br />

akasiyena umphathi nje kuphela wale ndawo kodwa<br />

futhi uyilungu elikhuthele le-<strong>Treatment</strong> <strong>Action</strong> <strong>Campaign</strong><br />

(TAC). Ngabona ukuthi amehlo akhe ayekhathele lapho<br />

ngimbuza wangitshela ukuthi akazizwa kahle. Ngakhoke<br />

ngaphandle kokuchitha isikhathi saqala i-inthaviyu<br />

yethu.<br />

Umbuzo. Kungani abazali bekuthola<br />

kunzima ukudalula ezinganeni zabo<br />

ezitheleleke nge-HIV ukuthi imithi<br />

eziyiphuzayo ngama-ARV?<br />

Impendulo. Abazali bayehlukahlukana. Kunalabo bazali<br />

abanezinkinga ngokudalula isimo sabo se-HIV kwabanye<br />

futhi ngokujwayelekile lolu hlobo lwabazali lizokuthola<br />

kunzima ukutshela ingane ngesimo sayo. Abanye<br />

abakakwemukeli ngokwabo.<br />

Esinye isizathu ukuthi [ngezinye izikhathi]<br />

akunabudlelwano phakathi kwabazali nezingane zabo,<br />

akunakuxhumana phakathi [kwabo okuzosiza] ingane<br />

ukuthi izizwe ikhululekile ukuthi ikhulume.<br />

Futhi, i-HIV iza nehlazo elikhulu elinanyathiselwe<br />

kuyo kanti abazali bangafuna ukuvikela izingane zabo<br />

emhlabeni ongaphandle.<br />

Umbuzo. Sinini isikhathi esilungile<br />

sokutshela ingane ukuthi<br />

isekwelashweni ngama-ARV<br />

kwempilo yonke?<br />

Impendulo. Ayikho impendulo ecacile kulokhu, kodwa<br />

okubalulekile yindlela [otshela ngayo ingane]. Abazali<br />

belulekwa ukuthi baqale ukwazisa izingane zabo<br />

ukusuka eminyakeni eyisithupha nangaphezulu.<br />

Umbuzo. Kufanele umzali<br />

ayazise kanjani ingane yakhe<br />

ngokuxilongelwa i-HIV?<br />

Impendulo. Kubalulekile ukuthi umuntu otshela<br />

ingane ngesimo sayo se-HIV kube umuntu osondelene<br />

kakhulu nengane yabo. [Kungaba] umama, ugogo noma<br />

umnakekeli, yilowo muntu okudingeka ukuthi ethule<br />

lezi zindaba enganeni. Abazali akufanele banikeze<br />

ulwazi oludukisa ingane. Isibonelo, ukukhuthaza<br />

ingane ukuthi ikholwe ukuthi umuthi ewuphuzayo<br />

umuthi womkhuhlane [...] kungaholela ekutheni ingane<br />

ilahlekelwe ukumthemba umzali wayo.<br />

Ukudalula kudingeka ukuthi kwenzenke ngezinyathelo.<br />

Isinyathelo sokuqala kufanele kutholwe ukuthi<br />

lungakanani ulwazi, uma lukhona, ingane esivele ilwazi<br />

[ngesifo]. Uma ingane ingazi lutho nge-HIV/AIDS<br />

kudingeka ukhulume ngayo futhi ukhave yonke into<br />

ukusuka ekuthelelekeni uze ufinke ekwelashweni[…].<br />

Uma ingane isicacelwe [yilezi zinto] kungalandela<br />

ukudalula emva kwesikhathi—ngaphandle uma ingane<br />

ihlangane nolwazi ngaphambi kwesikhathi, lapho umzali<br />

kungadingeka ukuthi alungise umonakalo.<br />

Umbuzo. Inkulu kangakanani inkinga<br />

yokuthi abazali bakuthole kunzima<br />

ukudalula ukuxilongwa kwe-HIV<br />

ezinganeni zabo ezithelelekile?<br />

Isithombe ngu-Maureen Sill<br />

Impendulo. Okwamanje asinazibalo ezikhombisa<br />

ubungako benkinga, kodwa inkinga ikhona. Okwamanje<br />

sisafuna ukuthola ithimba lodokotela bezingane<br />

NAMA-ARV<br />

ezindaweni zethu abazosebenzisa uhlu lokuhlola<br />

noma amathuluzi okubhala nje ukuthi izingane zazi<br />

NE-HIV<br />

kangakanani nge-HIV/AIDS. Sikuqaphelile ukuthi<br />

isigaba esiyingozi ezinganeni sokutheleleka siphakathi<br />

kobudala beminyaka eyi-7 – 14, isigaba sokuqala<br />

ukungena ebudaleni. UKUPHILA<br />

11


UKUPHILA NE-HIV NAMA-ARV<br />

12<br />

amathiphu kubanakekeli<br />

Ukungani, nini nokanjani wokutshela ingane ukuthi ine-HIV<br />

UNokuphumelela<br />

Zwane usebenzela<br />

i- Reproductive<br />

Health and HIV<br />

Research Unit<br />

(RHRU), eNyuvesi<br />

yase-Witwatersrand.<br />

Iphothifoliyo<br />

ye-RHRU<br />

ibandakanya<br />

impilo yokuzalana,<br />

ucwaningo lwe-HIV<br />

kanye nokungenelela<br />

kwemisebenzi<br />

yezempilo. Ngo-<br />

Okthoba ka-2010,<br />

i-RHRU yahlangana<br />

ne-ECHO<br />

(Enhancing<br />

Children’s HIV<br />

Outcomes), olunye<br />

uphiko locwaningo<br />

lwe-Nyuvesi<br />

yase-Witwatersrand<br />

olubhekene ne-HIV<br />

ezinganeni. I-ECHO<br />

iphethe imisebenzi<br />

ehlukahlukene<br />

enikezela usizo,<br />

ulwazi kanye<br />

nokumelelwa<br />

kwezingane<br />

ezisandakuzalwa,<br />

izingane kanye<br />

nentsha engena<br />

ebudaleni etheleleke<br />

noma ethintwe<br />

yi-HIV.<br />

Kungani kufanele ngiyitshele ingane<br />

yami?<br />

• Ingane yakho inelungelo lokwazi isimo sayo se-HIV.<br />

• Ingane kufanele yazi ukuthi izivikela kanjani yona<br />

nabanye, ikakhulukazi uma seziya ocansini.<br />

• Ingane yakho kungenzeka ukuthi isiqalile ukubuza<br />

imibuzo ngokuthi kungani iphuza imithi.<br />

• Ingane kungenzeka idideke noma iphatheke kabi<br />

ngenxa yokuthi ayiqondi ukuthi yini engalungile<br />

ngayo.<br />

• Ukutshela ingane yakho ngesimo sayo se-HIV<br />

kuyivumela ukuthi ikwazi ukuyenza eyayo.<br />

Kufanele ngiyitshele nini ingane yami?<br />

• Ngenxa yokuthi isimo ngasinye sihlukile, akukho<br />

budala obuthize ngqo obungcono kakhulu. Kufanele<br />

uholwe imibuzo ingane yakho eyibuzayo.<br />

• Kudingeka uzilungiselele ingxoxo. Bonana<br />

nomeluleki ngokwengqondo uma uzizwa<br />

ungaqinisekile.<br />

• Uma ingane yakho yala ukuphuza umuthi<br />

ngoba ayizizwa igula, lesi isikhathi esibalulekile<br />

sokuqala ukukhuluma nayo nge-HIV nokuthi<br />

izidambisigciwane (ama-ARV) asebenza ukuyigcina<br />

iphilile.<br />

Ngikhuluma kanjani enganeni yami<br />

nge-HIV?<br />

• Kufanele ingane yakho uyitshele wena uqobo, kodwa<br />

ungasebenzisa usizo lwabasebenzi basemtholampilo,<br />

abanye abanakekeli, abangane noma umndeni.<br />

• Ukudalula enganeni yakho kufanele kwenzeke<br />

ngezigaba, kuqala kulokhu ingane yakho eseyivele<br />

ikwazi uhanbe kancane uye kulokhu engakwazi.<br />

• Unganikeza isibonelo somuntu ophila kahle nesifo<br />

esingapheli. Lokhu kuzobakhombisa ukuthi impilo<br />

enhle inokwenzeka kubantu abaphila ne-HIV.<br />

• Ichazele ingane yakho ukuthi yayithola kanjani i-HIV.<br />

• Chaza ukuthi i-HIV iqhubeka kanjani, iqhaza<br />

lokwelashwa ngezidambisigciwane (ART) kanye<br />

nezinzuzo zokubambelela ku-ART.<br />

• Zama ukulisho uma usuyela ngasemaphethelweni<br />

engxoxo yenu igama elithi ‘HIV’. Izingane<br />

zinemiqondo yazo nge-HIV evela esikoleni,<br />

kwabezindaba nakubangane bazo. Kubalulekile<br />

ukuchaza ukuthi igciwane lisebenza kanjani<br />

kuqala, uma ingane ivulelekile ekulaleleni futhi<br />

ingaphazanyisiwe yihlazo kanye nemiqondo<br />

engaguquki okungenzeka ukuthi yayizwa .<br />

• Buza ingane yakho ukuthi ubani omunye okufanele<br />

azi ngesimo sayo. Kufanele sihlonishwe isifiso<br />

sengane yakho<br />

• Ingane yakho idlulisele kumeluleki ngokwengqondo<br />

ukuze baxoxe baqhubeke.<br />

Amathiphu asheshayo:<br />

• Njalo imibuzo ingane yakho eyibuzayo ixoxe<br />

nomeluleki ngokwengqondo.<br />

Ngu-UNokuphumelela Zwane<br />

• Uma une-HIV, ikakhulukazi uma i-HIV yedluliseka<br />

isuka kuwe yaya enganeni yakho, kufanele<br />

ukulungele ukudalulwa kwesimo sakho se-HIV<br />

okungafuneki.<br />

• Uma i-HIV yedluliseka isuka kuwe yaya<br />

enganeni yakho, ingane yakho kungenzeka<br />

ikusole ngokuyithelela nge-HIV. Lokhu kungaba<br />

okwesikhashana, kodwa kufanele uzilungiselele<br />

ukubhekana nakho.<br />

• Kufanele uqaphele ukuthi ukwesaba kwakho<br />

ngalokho ingane yakho engahle ikwenze noma<br />

okungahle kwenziwe ngabanye, akukuyekisi<br />

ukutshela ingane yakho ngesimo sayo se-HIV noma<br />

ukunikeza usizo .<br />

• Kufanele ube yisibonelo ngokubambelela okuhle<br />

emuthini futhi uchithe insomi yokuthi i-HIV isigwebo<br />

sokufa.


Isonto le<br />

Umuthi<br />

Isikhathi<br />

uMsombuluko<br />

uLwesibili<br />

uLwesithathu<br />

uLwesine<br />

uLwesihlanu<br />

uMgqibelo<br />

iSonto<br />

Idayari Yokwelashwa<br />

Le dayari izokusiza ukuthi ukhumbule ukuphuza imithi yakho ngesikhathi esifanele usuku ngalunye.<br />

Ungatshela udokotela wakho-ke ukuthi ubambelele kahle kangakanani emithini yakho. Bhala<br />

igama lomuthi ngamunye emabhokisini afanele emugqeni ongaphezulu. Bhala isikhathi okudingeka<br />

ukuthi uphuze ngaso umuthi emugqeni wesibili. Yenza noma udwebe ikhophi yedayari ukuze ulokhu<br />

uyisebenzisa. Sebenzisa idayari zonke izinsuku - maka ibhokisi bese ubhala isikhathi emva komthamo<br />

ngamunye.<br />

AM PM<br />

UKUPHILA NE-HIV NAMA-ARV<br />

13


UKUPHILA NE-HIV NAMA-ARV<br />

14<br />

Yazi ama-ARV<br />

Funda ngezinhlobo ezahlukene zezidambisigciwane nokuthi<br />

zisebenza kanjani. Ungasebenzisa futhi leli shadi ukubheka<br />

ukutholakala ngokusebenzisa ikhodi yombala<br />

Ukutholakala ezingxenyeni zikahulumeni nezizimele<br />

Ukutholakala engxenyeni ezimele kuphela<br />

Awubhalisiwe eNingizimu Afrika kodwa ubhalisiwe<br />

e-United States<br />

Ukuhlola kokulinga<br />

Amanani entengo yemithi aseNingizimu Afrika njengoba eshiwo<br />

ngoMeyi 2011. Amanani amele izindleko zenyanga zomuntu<br />

omdala ngamunye.<br />

I-Non-nucleoside Reverse Transcriptase<br />

Inhibitors (NNRTI) – ‘Non-Nukes’<br />

Ukuze amaseli atheleleke nge-HIV enze amakhophi amasha<br />

e-HIV, i-HIV kufanele ikopishele ikhodi yayo yokuzalana<br />

ku-DNA yamaseli. I-HIV isebenzisa i-enzayimu ebizwa ngokuthi<br />

i- reverse transcriptase ukukwenza lokhu.<br />

Njengama-‘nukes’, ama-non-nukes (NNRTI) nawo ayekisa<br />

amaseli ukukhiqiza amakhophi amasha e-HIV. Kodwa<br />

esikhundleni sokuphazamisa i-enzayimu i- reverse<br />

transcriptase ye-HIV, azifaka ngokwawo ku-enzayimu i-reverse<br />

transcriptase futhi ivimbela ekuguquleni ikhodi yokuzalana<br />

ye-HIV ukuthi ibe yi-DNA.<br />

Efavirenz (EFV)<br />

amaphilisi angu-30 x 600mg: R40.11 (Uhulumeni) R134 (Abazimele)<br />

Nevirapine (NVP)<br />

amaphilisi angu-60 x 200mg: R23.42 (Uhulumeni) R62.07 (Abazimele)<br />

Etravirine<br />

120 x 200mg: R1005.48 (Abazimele)<br />

Delavirdine (DLV)<br />

Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.<br />

Lersivirine<br />

Ukuhlola kokulinga<br />

Rilpivirine<br />

Ukuhlola kokulinga<br />

I-Nucleoside Reverse Transcriptase<br />

Inhibitors (NRTI) – ‘Nukes’<br />

I-NRTIs noma i-‘nukes’ ivimbela iseli etheleleke nge-HIV<br />

ekukhiqizeni amagciwane amasha.<br />

Ukuze amaseli atheleleke nge-HIV enze amakhophi e-HIV,<br />

i-HIV kufanele ikopishele ikhodi yayo yokuzalana ku-DNA<br />

yamaseli. I-HIV isebenzisa i-enzayimu i-reverse transcriptase<br />

ukwenza lokhu. I-‘nukes’ isiza ukuvimbela igciwane le-HI<br />

ekuphindeni lizikhiqize ngokuphambanisela i-enzayimu<br />

i-reverse transcriptase ukuthi isebenzise amabhlokwe okwakha<br />

anephutha ukwakha i-DNA.<br />

Zidovudine (AZT/ZDV/Retrovir)<br />

amaphilisi angu-60 x 300mg: R62.07 (Uhulumeni) R228 (Abazimele)<br />

Didanosine (DDI)<br />

amaphilisi angu-60 x 50mg: R108.29 (Uhulumeni) R222.30 (Abazimele)<br />

Lamivudine (3TC/Epivir)<br />

Umbhubhudlo womlomo (240ml ibhodlela): R15.79 R15.79 (Uhulumeni)<br />

amaphilisi angu-60 x 150 mg: R20.49 (Uhulumeni) R44.40 (Abazimele)<br />

Stavudine (d4T)<br />

200ml ibhodlela: R19.36 (Uhulumeni)<br />

amakhebsuli angu-60 x 30mg: R12.84 (Uhulumeni) R34.18 (Abazimele)<br />

Emtricitabine (FTC)<br />

amaphilisi angu-30 x Emtricitabine 200mg namaphilisi angu-Tenofovir<br />

300mg: R104.95 (Uhulumeni) R483.78 (Abazimele)<br />

Tenofovir (TDF)<br />

amakhebsuli angu-30 x 300mg: R54.82 (Uhulumeni) R204.06 (Abazimele)<br />

Abacavir (ABC)<br />

240ml ibhodlela: R71.12 (Uhulumeni)<br />

amaphilisi angu-60 x 300mg: R128.14 (Uhulumeni) R531.24 (Abazimele)<br />

Amdoxovir (AMDX)<br />

Ukuhlola kokulinga<br />

Apricitabine (ATC)<br />

Ukuhlola kokulinga<br />

Apricitabine (Beta-L-Fd4c)<br />

Ukuhlola kokulinga


akho<br />

Ama-Protease Inhibitor (PIs)<br />

Uma i-HIV ithelela -iCD4 seli (T seli emzimbeni womuntu,<br />

ikopisha ikhodi yayo yokuzalana ku-DNA yamaseli. I-CD4<br />

seli-ke ehlelelwe ukuthi yenze izinto ezintsha zofuzo lwe-HIV<br />

kanye namaphrotheyini e-HIV. Amaphrotheyini kufanele<br />

asetshenziswe yi-HIV protease – i-enzayimu esebenzisa<br />

amaphrotheyini – ukwenza amaphathikili e-HIV amasha.<br />

Ama-PI abhloka i-enzayimu i-proteae bese ivimbela iseli<br />

ekukhiqizeni amagciwane amasha.<br />

Ritonavir/Lopinavir<br />

Amaphilisi i-Lopinavir 200mg ne-Ritonavir 50mg x 120: R308.27<br />

(Uhulumeni)<br />

Umbhubhudlo womlomo we-Lopinavir 80mg ne-Ritonavir 20mg/<br />

ml, 5 x 60ml ibhodlela: R285.47 (Uhulumeni) R308.27 (Abazimele)<br />

Darunavir<br />

amaphilisi angu-120 x 300mg : R977.72 (Abazimele)<br />

Saquinavir<br />

amaphilisi angu-270 x 200mg: R797.18 (Abazimele)<br />

Atazanavir<br />

amaphilisi angu-60 x 200mg: R434.72 (Abazimele)<br />

Indinavir (IDV)<br />

Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.<br />

Fosamprenavir (FPV)<br />

Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.<br />

Atazanavir (ATV)<br />

Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.<br />

Nelfinavir (NFV)<br />

Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.<br />

Ama-Integrase inhibitors (IIs)<br />

Ukuze i-HIV ithathe ngempumelelo ukukhiqizwa kwamaseli<br />

i-CD4 ukuze ikhiqize amagciwane amasha, i-RNA ye-HIV<br />

iguqulelwa ku-DNA yi-enzayimu i- reverse transcriptase (ama-<br />

‘nukes’ angalubhloka lolu hlelo).<br />

Emva kwe-‘reverse transcription’ye-RNA iba yi- DNA<br />

sekuphelile, I-DNA ye-HIV kufanele ifakwe ku-DNA ye-CD 4 seli.<br />

Lokhu kwaziwa ngokuhlanganiswa. Ama-integrase inhibitor<br />

asebenza ngokubhloka lolu hlelo. Ngakho-ke ama-integrase<br />

inhibitor amisa i-DNA ye-HIV ekutheni ifakwe ku-DNA ye-T seli.<br />

Raltegravir<br />

amaphilisi angu-60 x 400mg: R2,396.44 (Abazimele<br />

Elvitegravir<br />

Ukuhlola kokulinga<br />

Dolutegravir<br />

Ukuhlola kokulinga<br />

Ama-Entry Inhibitors (abandakanya<br />

ama- fusion inhibitor)<br />

Ama-entry inhibitors asebenza ngokuvimbela i-HIV ekungeneni<br />

amaseli e-CD 4 aphilile emzimbeni. Asebenza ngezindlela<br />

ezahlukene emuthin i eminingi evunyiwe elwa ne-HIV, esebenza<br />

ngokukhuthala ukulwa ne-HIV emva kokuba seyithelele i-CD4<br />

seli.<br />

Ama-entry inhibitor asebenza ngokuzifaka kumaphrotheyini<br />

aphezulu kumaseli e-CD 4 noma kumaphrotheyini aphezulu<br />

ku-HIV. Ukuze i-HIV izihlangansie namaseli e-CD4,<br />

amaphrotheyini asekhaveni engaphandle ye-HIV kufanele<br />

izihlanganise namaphrotheytini aphezulu kumaseli e-CD4.<br />

Ama-entry inhibitor avimbela ukuthi kungenzeki lokhu.<br />

Abantu abane-HIV asebemelene nama-PI, NRTI kanye<br />

nama-NNRTI kungenzeka basizakale kuma-entry inhibitor<br />

ngenxa yokuthi iyikilasi elehlukile lemithi. Lokhu kuyizindaba<br />

ezimnandi kubantu abane-HIV asebezame behluleka emithini<br />

eminigni evunyiwe njengamanje elwa ne-HIV.<br />

Maraviroc<br />

Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.<br />

Enfuviritide<br />

Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika<br />

Vicriviroc<br />

Ukuhlola kokulinga<br />

Ibalizumab<br />

Ukuhlola kokulinga<br />

UKUPHILA NE-HIV NAMA-ARV<br />

15


UKUPHILA NE-HIV NAMA-ARV<br />

16<br />

Umsebenzi<br />

Wocansi<br />

ne-HIV<br />

Photo by Market Photo Workshop/ Working the City 2010.<br />

U-Diputo Lety , umsebenzi osebenza<br />

ngocansi ovela e-Hillbrow, utshela<br />

u-Elsa Oliveira ngendaba yakhe<br />

yokuphila ne- HIV nokuhlala ephilile.<br />

Ngatheleleka nge-HIV ngenxa yokudlwengulwa.<br />

Ngonyaka ka-2004 ngangikhwehlela futhi ngincipha<br />

kakhulu emzimbeni ngase ngiya kuPhrojekthi<br />

Yabasebenza Ngocansi e-Hillbrow ngayohlolwa<br />

izifo ezithathelwana ngocansi (ama-STI). Selokhu<br />

lo mtholampilo wavulwa ngonyaka ka-1997,<br />

abasebenza ngocansi sebaba nendawo ephephile<br />

yokuyokwelashelwa impilo nokunakekela kokuvimbela.<br />

Ngesikhathi ngivakashile ngathola ukuthi ngangine-HIV.<br />

Ngesikhathi unesi engitshela ngesimo sami se-HIV<br />

wamemezela ephaseji lasemtholampilo, phambi kwawo<br />

wonke umuntu. Ngathukuthela ngaphoxeka, kodwa<br />

azange ngazi ngaleso sikhathi ukuthi ngangingambika<br />

ngokungabi naluzwelo. Ngenhlanhla, ulwazi lwami<br />

lokunakekelwa kwezempilo selwaba ngcono<br />

kunangaleso sikhathi.<br />

Ngalesi sikhathi, ngangingazi lutho ngokuthi kwakusho<br />

ukuthini ukuba ne-HIV. Ngangingazi ukuthi kwakufanele<br />

ngenzeni ukuze ngizinakekele. Konke engikukhumbulayo<br />

ukuthi ngangesaba kakhulu, futhi ngangingabaza<br />

nokuqala ukwelashwa ngezidambisigciwane. Uma<br />

sengibheka emuva, kuyacaca ukuthi ukuphoxwa<br />

phambi kwabantu emtholampilo azange kungikhuthaze<br />

ukuthi ngazi kabanzi ngokhetho lokwelashwa kwami.<br />

Ngangingakulungele ukuqala ama-ARV, esikhundleni<br />

salokho ngaphuza amavithamini ngazama nokudla<br />

izithelo eziningi kanye nemifino.<br />

Ngonyaka ka- 2008, ngaba umfundisi wontanga e-RHRU<br />

(Reproductive Health & HIV Research Unit, ephethe<br />

Phrojekthi Yabasebenzi Bocansi). Njengomfundisi<br />

wontanga, ngafundisa abanye abasebenzi bocansi<br />

ngokuvimbela kanye nama-STI, futhi ngabancenga<br />

ukuthi basebenzise i- Sisonke Sex Worker Movement*<br />

ukuze bathole izinsizakalo zosizo. Ngalesi sikhathi,<br />

ngaqala ukufunda kabanzi nge-HIV futhi ngazi<br />

nokuthi yayingakapheli impilo yami. Ngathola nokuthi<br />

kungenzeka ukuthi ngphile futhi ngiphile impilo ende.<br />

Ngonyaka ka-2009, ngaqala ukwelashwa ngama-ARV,<br />

ngase ngikulungele. Ngibonga usizo lweSisonke, onesi<br />

abanakekelayo kuPhrojekthi Yabasebenzi Bocansi<br />

kanye nomsebenzi wami njengomfundisi wontanga,<br />

ukwesaba kwami ngehlazo lokuba ne-HIV kwangena<br />

isifiso sokuphila impilo enempilo esikhundleni sakho.<br />

Nakuba umndeni wami ungazi ukuthi ngingumsebenzi<br />

wocansi, nokuthi ngayithola kanjani i-HIV, bayengeseka<br />

kakhulu. Bobabili abazali bami abasebenzi basehosiphisi<br />

abanakekela iziguli ezine-HIV, ngakho-ke baqonda<br />

kangcono kunabantu abaningi ukuthi kusho ukuthini<br />

ukuba ne-HIV. Bayangikhuthaza kakhulu ukuthi ngihlale


ngiphilile futhi ngiphuze imithi nyami. Empeleni,<br />

bangishayela ucingo zonke izinsuku bengikhumbuza<br />

ukuthi ngiphuze ama-ARV ami. Lolu hlobo lokwesekwa<br />

luyisimanga futhi ngizizwa ngibusisekile ngokuba nabo<br />

empilweni yami. Bekuzoba nzinyana ukuba umndeni<br />

wami ubungangeseki. Uma ngizizwa ngingaphilile<br />

ngiyahamba ngiye ekhaya ngiyophumula ngibe ngcono,<br />

okwenza umehluko omkhulu. Umoya wami uphezulu<br />

ngenxa yothando lwabo nokungikhuthaza.<br />

Njengomsebenzi wocansi, ngiyaqiniseka ukuthi<br />

amaklayenti ami ngiyawavikela kanye nami ngokugqoka<br />

amakhondomu. Kahle hle, umzimba wami umsebenzi<br />

wami! Uma amaklayenti engafuni ukugqoka ikhondomu,<br />

ngisebenzisa ikhondomu yabesifazane. Abaningi babo<br />

abazi ngama-STI ngakho uma ngibona ukuthi omunye<br />

wawo une-STI, ngiyamkhuthaza ukuthi ayohlolwa<br />

emtholampilo. Amanye amaklayenti angitshela ukuthi<br />

ayesaba ukuya, abanye bathi abanendaba ngempilo<br />

yabo. Ngezinye izikhathi ngike ngahamba namaklayenti<br />

ukuya emtholampilo ukuze bahlolelwe i-HIV.<br />

Ngiyabeseka ngale ndlela ngoba ngiyazi ukuthi akulula<br />

ukuhamba wedwa .<br />

Ama-ARV sengiwaphuze iminyaka emibili manje.<br />

Nakuba ngezinye izikhathi kunzima ukubhekana<br />

nemiphumela emibi, ngiyawaphuza amaphilisi<br />

kodwa, ngoba ngiyazi ukuthi angisiza ukuthi ngihlale<br />

ngiphilile futhi nginamandla. Ngiyaqhubeka nokudla<br />

kahle futhi ngiphumule ngokwanele ngoba yonke le<br />

mizamo isiza umzimba wami nemithi yami ukuthi<br />

kusebenze ndawonye ngempumelelo. Ngisebenza futhi<br />

njengomfundisi wontanga eSisonke, ngifundisa abanye<br />

abasebenza ngocansi ngempilo nangamalungelo abantu<br />

nokuthi kubaluleke ngani ukuthi umsebenzi wocansi<br />

ungabi icala. Abasebenzi bocansi abaningi bayesaba<br />

ukuhlolelwa i-HIV ngenxa yenhlamba ehambisana<br />

nomsebenzi wabo. Bayesaba ukuthi abasebenzi<br />

bezempilo bangahle bababandlulule. njengomfundisi<br />

wontanga, umsebenzi wocansi kanye nowesifazane<br />

one-HIV nginethuba lokuphonsela izinsumo inselele<br />

ngegciwane ngokushiyelana ngolwazi lwami uqobo<br />

nokutshela abanye ikakhulukazi abasebenzi bocansi<br />

ngqo ukuthi akufanele besabe ukuhlolelwa i-HIV<br />

nokufuna ukwelashwa.<br />

Indaba yami isibonelo nje, kodwa ngiyethemba ukuthi<br />

isebenza ukukhombisa ukuthi abasebenzi bocansi<br />

bahlanganyela kanjani ukusizana. Kuyisifiso sami<br />

ukuthi le ndaba ifake isandla ekuguquleni umphakathi<br />

nepolitiki ukuze kusizakale abasebenzi bocansi,<br />

nokuthi iNingizimu Afrika ikhiphe imisebenzi yezempilo<br />

enozwelo ngokuthe xaxa nengahluleli.<br />

*I- Sisonke Sex Worker Movement inhlangano ese- Hillbrow, eyasungulwa<br />

ngonyaka ka-2003 kanti iholwa ngabasebenzi abasebenza ngocansi.<br />

Inhlangano ihlose ukuhlanganisa abasebenzi abasebenza ngocansi, yenze<br />

ngcono izimo zabo zokuphila nokusebenza, futhi ikhankasele amalungelo<br />

alinganayo.<br />

Isithombe yi-Market Photo Workshop/ Working the City 2010.<br />

“Abazali bami bobabili<br />

Isu<br />

bangabasebenzi bendawo<br />

Lokubambelela<br />

yokunakekela abagulayo<br />

(ihosiphisi)abaphila ne-HIV.<br />

Bangitshela ukuthi kulungile<br />

nokuthi kufanele nje ngiphuze<br />

umuthi wami. Uma ngisekhaya, indodakazi<br />

yami iyazi njalo uma sekuyisikhathi sokuthi<br />

ngiphuze imithi yami ama-ARV. Uma<br />

sekuwu-8pm iyamemeza, “Mama! Phuza<br />

umuthi wakho! Ngiyabonga ngalokhu<br />

ngoba bayangeseka futhi abangiphathi<br />

ngokwehlukile ngenxa yesimo sami.”<br />

U-Diputo Lety, umsebenzi osebenza ngocansi<br />

ovela e-Hillbrow<br />

UKUPHILA NE-HIV NAMA-ARV<br />

17


Isithombe ngu Thandeka Vinjwa.<br />

Isithombe ngu Thandeka Vinjwa.<br />

UKUPHILA NE-HIV NAMA-ARV<br />

18<br />

Ungayeki manje<br />

Kungani abantu bephazamisa ukwelashwa kwabo ngama-ARV<br />

Nakuba ama-ARV esindisa izimpilo eziningi ningi, abanye abantu bayehluleka<br />

ukuwaphuza njengoba beyalelwe. UThandeka Vinjwa eLusikisiki, uNondumiso Hlwele<br />

no-Elizabeth Mills eKapa baphenya ngokuthi yini abantu ngezinye izikhathi behluleka<br />

ukuphuza imithi yabo.<br />

Isithombe ngu-Samantha Reinders.<br />

Izithuthi<br />

Kaningi abantu kufanele bahambe<br />

amabanga amade ukuya ezindaweni<br />

zosizo lwezempilo eziseduze nabo,<br />

emigwaqeni emibi enemigodi<br />

eminingi. Abanye bahamba la<br />

mabanga amade kakhulu ngoba<br />

akunazithuthi noma zibiza kakhulu.<br />

Imigqa emide<br />

Uma iziguli sezifike ezindaweni zosizo<br />

lwezempilo kaningi babhekana nemigqa<br />

emide. Lokhu kungaqeda amandla<br />

futhi kwenzeka ukuthi kungasebenzeki<br />

ngezinsuku abavakashela ngazo<br />

emtholampilo. Ukuthatha usuku<br />

emsebenzini ukuze uyothola<br />

izidambisigciwane (ARV) nakho<br />

kungaphoqa abantu ukuthi badalule<br />

isimo sabo se-HIV kubaqashi babo.<br />

Ukuphela kwesitoko sama-ARV<br />

Ngezinye izikhathi ukushoda kwemithi<br />

ezindaweni zezempilo kusho ukuthi iziguli<br />

zivele zijikiswe nje. I-<strong>Treatment</strong> <strong>Action</strong><br />

<strong>Campaign</strong> (TAC) ivamise ukuqapha<br />

ukuphela kwezitokwe endaweni<br />

yaseLusikisiki.<br />

“Manje imithi yami angisayiphuzi<br />

kahle ngoba azange ngiwathole<br />

[amaphilisi] enyanga . Ngizowathola<br />

nini futhi? Kuzokwenzekani<br />

ngezinsuku engingezuwaphuza<br />

ngazo?”<br />

(owesifazane one-HIV, eLusikisiki)<br />

Imiphumela emibi<br />

Abanye abantu baba nemiphumela emibi ebangwa ngama-<br />

ARV, ikakhulukza i- stavudine (d4T). Khuluma nodokotela<br />

wakho ngokushintsha uhlobo lwakho lwemithi yokwelashwa,<br />

njengoba imiphumela emibi kaningi ingancishiswa.<br />

“…kimi imiphumela emibi… bekunzima<br />

kimi ngoba kube noshintsho olusheshayo<br />

esimeni sokwakheka komzimba wami,<br />

kanti ngezinye izikhathi bengingawuphuzi<br />

umuthi wami.” (owesifazane one-HIV, eKapa)<br />

Photo by Maureen Sill.<br />

Indlala notshwala<br />

Uma ungakwazi ukukhokhela ukudla noma<br />

isithuthi kunzima kakhulu ukunakekela<br />

ukwelashwa. Lesi ngesinye sezizathu i-TAC<br />

yeseka umqondo weSibonelelo Semali<br />

Esiyisisekelo - imali encane njalo ngenyanga -<br />

kuwo wonke umuntu eNingizimu Afrika.<br />

“Ngezinye izikhathi umuntu akanakho<br />

ukudla okuningi lapho kudingeka ukuthi<br />

aphuze ama-ARV ngoba akwenza ukuthi<br />

ulambe. Nalabo abaphuza utshwala<br />

bavele bakhohlwe.”<br />

(owesifazane one-HIV, eKapa).<br />

Izinsumo kanye nokuba nolwazi olungesilo iqiniso<br />

Kwezinye izindawo abantu bakholwa ukuthi izinyanga zingayelapha<br />

i-HIV. Bayayeka ukuphuza ama-ARV esikhundleni sawo basebenzise<br />

imithi yendabuko, engayicindezeli i-HIV. Abanye bakholwa yizindaba<br />

ezibadukisayo zokuthi ama-ARV akwenza ukuthi usheshe ufe, noma<br />

ukuthi kungenzeka ukuthi yelapheke i-HIV ngenkolo.


Ukudalula kanye nenhlamba<br />

Ukwesaba inhlamba kaningi kubanga abantu<br />

abanokuzethemba okungekukhulu bazizwe<br />

bephoxekile ngokusebenzisa ama-ARV. Ukujoyina<br />

amaqembu okubambelela noma okusiza kusiza<br />

ukubhekana nalobu bunzima.<br />

“Uma ungakadaluli [kubantu]<br />

abasondelene nawe kakhulu kuzoba<br />

nzima ukuphuza imithi. Kufanele<br />

uchaze ukuthi kungani uyiphuza<br />

bese ugcina ungasayiphuzi.”<br />

(owesifazane one-HIV, eKapa)<br />

Ukukhumbula ukuphuza ama-ARV<br />

Izikhumbuzi, njengokusetha i-alamu yefoni noma<br />

ukusebenzisa ukuqala kohlelo lwe-TV ukucabanga,<br />

kungakusiza ukukhumbula ukuphuza ama-ARV akho.<br />

Uma udalula kubantu ophila nabo bangakukhumbuza<br />

nabo.<br />

“Ukuba ngumuntu omatasatasa<br />

ngezinye izikhathi oya emihlanganweni,<br />

inselele yami ukuthi ngiwafaka<br />

esikhwameni sami bese ngiyawakhohlwa<br />

ukuwaphuza, ngoba azange<br />

ngisethe isikhumbuzi efonini yami….”<br />

(owesifazane one-HIV, eKapa)<br />

‘Ukuphumula’<br />

Uma abantu abelashwa ngezidambisigciwane<br />

sebeqala ukuba ngcono ngezinye izikhathi bayayeka<br />

ukuphuza umuthi. Lokhu kuvumela igciwane ukuthi<br />

liphindaphindeke ngokukhululeka. Uma labo bantu<br />

sebegula futhi ama-ARV afanayo kungenzeka<br />

angasasebenzi ngenxa yokumelana nomuthi. Ngakho<br />

kokubili i-HIV ne-TB kubaluleke kakhulu ukuphuza<br />

imithi yakho - ngisho ngabe uzizwa uphilile impela.<br />

“Abanye abantu banquma<br />

ukuphumula [kuma-ARV] bese kuthi<br />

uma sebegula banqume ukuphindela<br />

kuwo futhi. [Kodwa-ke] umuthi<br />

awusebenzeli ngenxa yokumelana<br />

kwegciwane nawo.”<br />

(owesifazane one-HIV, eKapa)<br />

Isithombe ngu-Adam Malapa.<br />

Ukutreyisa abantu abenza<br />

amaphutha<br />

Ngu-Adam Malapa<br />

UFrancinah Chauke ngomunye wabangama-20 wama-<br />

Prevention <strong>Treatment</strong> Literacy Practitioners (PTLPs) asebenzela<br />

i-TAC eSigodini saseMopani, eLimpopo. I-PTLP umfundisi<br />

osemphakathini endaweni yezempilo ofundisa iziguli<br />

ngokwelashwa nokuvimbela.<br />

Elinye lamaqhaza ama-PTLP ukutreyisa abantu abenza amaphutha<br />

ngokuthatha imithi - abantu abasandakuhluleka ukulanda imithi<br />

yabo. UChauke udinga ukuqonda ukuthi kungani umuntu enze<br />

iphutha, nokumenza ukuthi aqale imithi yakhe futhi. Ngeshwa,<br />

olunye lwalolu hlelo lwenzeka emva kwendaba njengoba i-HIV<br />

noma i-TB kungenzeka ukuthi kusuke sekwenze umonakalo<br />

omkhulu kakhulu ngalesi sikhathi kade beyeke umuthi.<br />

“[Isizathu esikhulu sokwenza iphutha] imali yesibonelelo<br />

somphakathi”, kusho uChauke. “Abantu abaningi [...] bangitshela<br />

ukuthi bacabanga ukuthi isibonelelo sabo sizomiswa uma impilo<br />

yabo iba ngcono, ngakho-ke [bangamane] bahlale bengenamandla<br />

ukuze bagcine isibonelelo sabo somphakathi.”<br />

U-Oscar Mabela uyi-PTLP ye-TAC e-Dr C N Phatudi Hospital,<br />

eLimpopo. Uthi, “Inkinga enkulu endaweni yangakithi izithuthi”.<br />

“[…]Abantu […] kufanele basebenzise izithuthi ukuze bafinyelele<br />

ezindaweni zosizo bebe belokhu bengenakho ukudla kokudla<br />

emizini yabo.” Le nkinga ixhumana nobunzima uFrancinah<br />

abubona: uma abantu bengenakudla namali yokugibela, abaningi<br />

bangamane bahlale emakhaya baze bagule bese befaka isicelo<br />

sesibonelelo semali yomphakathi.<br />

“Abantu abasebenza emapulazini kaningi abanaso isikhathi<br />

esikhululekile [...] sokulanda imithi yabo,” kusho uMasingita<br />

Mavodze ovela eRotterdam. “Kungcono ukuthi bavele bengayiceli<br />

nemvume kubaqashi babo [...] ngoba bafuna ukuvikela imisebenzi<br />

yabo.” Abanye abantu abasuka kwenye indawo beye kwenye<br />

ngomsebenzi abakucabangi ukuthola izincwadi zokudluliselwa<br />

ezizobavumela ukuthi bathole imithi eduze nemisebenzi yabo<br />

elandelayo.<br />

Ngokwalokhu okutholakele, i-TAC Mopani yanikeza u-Chauke<br />

umsebenzi wokusebenza emapulazini asendaweni, afundise<br />

abantu ngokubaluleka kokuphuza imithi ngendlela elungile<br />

nangesikhathi.<br />

UKUPHILA NE-HIV NAMA-ARV<br />

19


20<br />

Umtholampilo<br />

Kuthengiswe kwaphela<br />

Ikhaya<br />

Imithi yokwelashwa kungenzeka ukuthi idide futhi ibe<br />

nzima, ikakhulukazi uma kungenakwesekwa. Ngezinye<br />

izikhathi imiphumela embi ingangabi mihle ngempela, futhi<br />

kungangcono ukuyigwema.<br />

R10<br />

Indawo yosizo<br />

Isixazululo: Thola umngane wokwelashwa<br />

noma ikilabhu. Wena nenisizana nabo<br />

ngokwelashwa ningakhumbuzana ukuphuza<br />

umuthi futhi nixoxe ngezinto ezinhle<br />

nezimbi ngemithi. Mazise umsebenzi<br />

wezempilo wakho uma unemiphumela<br />

emibi kakhulu ukuze uhlobo lwakho<br />

lwemithi luzoshintshwa .<br />

Impahla Ebhaliwe<br />

Umtholampilo wangakini kungenzeka ungakwazi<br />

ukuphinde u-ode imithi ngesikhathi bese uphelelwa<br />

yisitokwe. Umtholampilo kungenzeka ungakwazi<br />

ukuphatha abasebenzi bawo kanye nezinsizasidingo kahle,<br />

noma kungenzeka ube nabasebenzi abancane.<br />

Amalungelo eMpahla Ebhaliwe kaningi abeka inzalo ngaphezu kwelungelo leziguli<br />

kuBanikazi bezempilo, uhlobo lwe-IP engahlala amashumi, ivumela izinkampani<br />

zemithi ukuthi zishintshe amanani entengo abanye ohulumeni abangeke bakwazi<br />

ukuwakhokhela. Lokhu kusho ukuthi ngisho ngabe umuthi onoguquko, osindisa impilo<br />

uyethulwa, kungenzeka kube yiminyaka ngaphambi kokuba abantu abawudingayo<br />

bakwazi ukuwuthola. Izinkampani ezejwayelekile kungenzeka zingakwazi ukukhiqiza<br />

imithi kuze abanikazi bawo bokuqala baphelelwe yisikhathi.<br />

Isixazululo: Thola ezinye izindawo zosizo<br />

lwezempilo eziseduze nawe, njengokokusiza.<br />

Ngisho ngabe le mitholampilo ikude,<br />

kungenzeka ukuthi ikwazi ukukusiza ezimeni<br />

eziphuthumayo<br />

Umgwaqo ophokophele ekubambeleleni okuhle<br />

!<br />

R80<br />

Umphakathi<br />

Ukubandlulula kukhona ngoba<br />

kunokushoda kwemfundo nokuqonda<br />

ngokwelashwa kwe-HIV.<br />

Isixazululo: Buza ngokuqeqeshelwa ukuzwela<br />

kwabalingani bakho nezidingongqangi<br />

zokwelulekwa ngokwengqondo emsebenzini<br />

wakho. Ukudalulela umndeni nabangane nakho<br />

kuzokusiza ukwakha umphambo wokukusiza.<br />

Zama ukujoyina iqembu losizo noma ikilabhu<br />

yokubambelela.<br />

Ishibhi<br />

Isixazululo: Funda ngomthetho wempahla ebhaliwe.<br />

Umsebenzi we- <strong>Treatment</strong> <strong>Action</strong> <strong>Campaign</strong><br />

((TAC) emthethweni wempahla ebhaliwe udlale<br />

indima ebalulekile ekunciphiseni amanani entengo<br />

ezidambisigciwane eNingizimu Afrika. I-TAC<br />

nohulumeni waseNingizimu Afrika kufanele<br />

baqinise ingcindezi yabo ukuthola ama-ARV<br />

amasha asindisa impilo. (Funda kabanzi ngalokhu<br />

ku-athikili elandelayo.)


Wena uqobo<br />

Kungenzeka ukhohlwe ukuphuza<br />

umuthi wakho ngoba umatasatasa<br />

kakhulu noma uphuze utshwala.<br />

Isixazululo: Setha i-alamu yewashi lakho uqobo efonini<br />

yakho ukwelashwa ukwenze ingxenye yenjwayelo<br />

yempilo yakho. Umuthi wakho uphathe kuwe ukuze<br />

ukwazi ukunakekela ukwelahwa kwakho ngisho ungekho<br />

ekhaya. Ukuphuza kwakho utshwala kukale kube kahle.<br />

Izinto eziningi ezingakusiza ekukhumbuleni ukuphuza<br />

izidambisigciwane zakho, bheka amathiphu okubambelela<br />

agcwele leli phephabhuku.<br />

Inqubomgomo<br />

Nangale kwenqubekela phambili enkulu,<br />

uhulumeni wethu akazange atshale imali eyanele<br />

kuzidambisigciwane noma enze okwanele<br />

ukuqinisekisa ukuthi ama-ARV esikhathi esizayo<br />

ayathengeka. INingizimu Afrika isengakahlanganyeli<br />

i-TRIPS (Agreement on Trade Related Aspects<br />

of Intellectual Property Rights) izinguqunguquko<br />

emthethweni kazwelonke noma kusetshenziswe<br />

ngaphansi kwelayisense eyimpoqo. Ilayisense eyimpoqo<br />

isho ukuthi uhulumeni angaphoqa umuntu ophethe<br />

ubunikazi bomuthi ukuthi avumele ukwakhiwa<br />

komuthi ojwayelekile.<br />

petroStation<br />

Ezokuthutha<br />

Usuhambe amabanga amade, emigwaqeni<br />

emibi, noma ukhokha izimali zamatekisi<br />

abizayo kungakuyekisa ukuya emtholampilo.<br />

Awukho uphethiloli<br />

Isixazululo: Thola ukuthi akhona yini amavawusha<br />

amatekisi okukulanda emzini wakho akuse<br />

emtholampilo noma eqenjini lokwesekwa<br />

umphakathi. Bheka ukuthi umtholampilo<br />

wakho unawo yini amabhasi ahambisa abantu<br />

noma bathumela abasebenzi bezokwelashwa<br />

emphakathini. Shayela uhulumeni weseke indlela<br />

eyaba amandla okunakekela lapho imitholampilo<br />

yakhiwe futhi yesekwa ezingeni lasekhaya.<br />

Ukunikezela<br />

Ukuphathwa okubi kwezezimali, ukuhlela okungenele<br />

kanye nomkhawulo wesabiwo mali sezempilo kusho<br />

ukuthi amadepho emithi yesifundazwe kungenzeka iphele.<br />

Isixazululo: Qapha ukunikezelwa kwemithi<br />

nokuphela kwesitokwe emiphakathini<br />

yethu. Uma ukuphela kwesitokwe<br />

nokushoda kwenzeka, kubike ngokushesha<br />

ezinhlanganweni ezisekwa umphakathi,<br />

kubasebenzi bezempilo, kuhulumeni<br />

wasekhaya, wesifundazwe nakokazwelonke.<br />

Funa uhlelo lwethenda olusobala ngokuthe xaxa, futhi funa<br />

uhulumeni ukuthi asebenzise amandla akhe okuthenga<br />

aqinile ukuthenga ama-ARV ngamanani entengo<br />

angcono. Phikisana nezivumelwano zokuhweba ezintsha<br />

ezinemingcele njenge-EU-India Fair Trade Agreement<br />

(bona ikhasi 23).<br />

Emizini yethu, emsebenzini nasemiphakathini yethu singasiza ngokunconzulula<br />

izithiyo ezivimba endleleni yokuphuza imithi njengoba kuyalelwe.<br />

ADHERENCE<br />

21


UKUBAMBELELA<br />

22<br />

Izimpi<br />

Zelungelo<br />

Lobunikazi<br />

Ngu-Catherine Tomlinson<br />

Lapho abantu abaningi beba nokumelana nemithi ye-HIV eminyakeni ezayo,<br />

sizodinga imithi emisha ukusiza ukugcina labo bantu bephila futhi benempilo.<br />

Kodwa izivumelwano zohwebo ezintsha zesabisa ngokubulala izindlela zokwenza<br />

ukuthi ama-ARV athengeke. Uma singaziqedi lezi zivumelwano manje, izimpilo<br />

eziningi zizolahleka kungenasidingo.<br />

Kungani imithi ejwayelekile ishibhile<br />

kunemithi enelungelo lobunikazi?<br />

Ilayisensi yobunikazi (indlela yempahla ebhaliwe) ilungelo elihlukile<br />

elinikezwa umsunguli isikhathi esithize esimvumela ukuthi umsunguli<br />

anqume ukuthi ukusungula kwabo kuzosetshenziswa kanjani. Ngalesi<br />

sikhathi umsunguli angabiza ngokujwayelekile noma yini ayifunayo<br />

ngomkhiqizo. Yingakho imithi enelungelo lobunikazi ibiza kakhulu<br />

kunemithi ejwayelekile.<br />

Imithi ejwayelekile inezithako ezifanayo zokwenza umuthi<br />

ezisebenzayo, eyenza ukuthi ifane noma ilingane ngokwempilo<br />

(ukuba nezithako nemiphumela efanayo), nemithi enelungelo<br />

lobunikazi. Umehluko ukuthi imithi ejwayelekile ayenziwa futhi<br />

ithengiswe umuntu onelungelo lobunikazi, kodwa ngenye inkampani.<br />

Le nkampani kungenzeka ukuthi inikwe ilayisense yokuthengisa<br />

umuthi ngumnikazi welungelo lobunikazi noma ezweni lapho ilungelo<br />

lobunikazi lingavikelwe khona.<br />

Ukhetho olujwayelekile lwehlisa inani lentengo yemithi ngoba bathula<br />

umncintiswano emakethe eyehlisa amanani entengo. Uma ziningi<br />

izinkampani ezithengisa umuthi, inani lentengo yomuthi lizokwehla<br />

kakhulu. Uma kuvunyelwa umuntu oyedwa kuphela endaweni yakini<br />

ukuthi athengise ubisi, lowo muntu angabiza amanani entengo<br />

aphezulu kakhulu ngoba uyazi ukuthi angeke ubisi uluthenge noma<br />

kuphi. kodwa-ke, uma abantu abahlukene abayishumi bethengisa<br />

ubisi emphakathini wakini, inani lentengo yobisi lizoba phansi<br />

kakhulu.<br />

* Impahla ebhaliwe ingachazwa njengemiqondo yomuntu inenani<br />

lezowhebo futhi kungenzeka ivikelwe umthetho.<br />

Ngaphambi kuka-2005 amazwe anemali ephakathi<br />

nendawo njengeNingizimu Afrika ayekwazi<br />

ukuzikhiqizela amahlelo ajwayelekile emithi<br />

eyayingaphansi kwelungelo lobunikazi emazweni<br />

acebile. Lokhu kungenxa yewmithetho yamazwe<br />

omhlaba ethinta ukuhweba ngemithi yayingadingi<br />

ukuthi amazwe anemali engenayo ephakathi nendawo<br />

avikele la malungelo obunikazi.<br />

Le mithi ejwayelekile yehlisa amanani entengo<br />

yezidambisigciwane, azenza ukuthi zithengeke<br />

ezindaweni zezempilo zikahulumeni e-Afrika yonkana.<br />

Kodwa-ke ngonyaka ka-2005, amazwe anemali<br />

ephakathi nendawo kwadingeka ukuthi ethule<br />

imithetho ezonikezela ngokuvikeleka okufanayo<br />

kwamalungelo obunikazi njengamazwe acebile. Ngenxa<br />

yalokhu, namhlanje kunzima kakhulu ukuthi amazwe<br />

afana neNdiya, iNingizimu Afrika kanye neBrazil<br />

akhiqize imithi emisha.<br />

Ukungabi bikho okulandelayo kwamahlelo ajwayelekile<br />

emithi emisha kuyisizathu sokuthi imithi yomugqa<br />

wesithathu ihlale ingathengeki futhi ingabi bikho<br />

ohlelweni lukahulumeni wethu lwezempilo. Eminyakeni<br />

ezayo lokhu kungenzeka kubange ukufa okuningi<br />

okugwemekayo futhi kwandise izindleko kuhulumeni<br />

wethu nabanye.<br />

Nangale kwezinselele ezinkulu amazwe ezibhekene<br />

namazwe ampofu ekutholeni amahlelo athengekayo<br />

emithi emisha, amazwe acebile manje asephushela<br />

ukuthi imithetho emisha yokuqhubeka nokuvikela<br />

impahla ebhaliwe ngale kwemikahwulo ye-TRPS<br />

((Trade-Related Aspects of Intellectual Property<br />

Rights). Lokhu okubizwa nge-TRIPS kuhlanganiswe<br />

nezindlela kwesabisa ukunikezela okuqhubekayo<br />

kwemithi esesivele sethembele kuyo. Futhi bacindezela<br />

izinguquko emithini esindisa impilo njengemithi<br />

ye-TB, ukwenziwa kwama-ARV ezingane, kanye<br />

nezinhlangansiela zomthamo wama-ARV ongaguquki.


I- EU-India Free Trade<br />

Agreement (FTA)<br />

I- European Union (EU) okwamanje ixoxisana<br />

ngesivumelwano sohwebo neNdiya esingalimaza<br />

ukukwazi kweNdiya ukwenza nokukhiphela<br />

emazweni angapahndle imithi ejwayelekile. Lokhu<br />

kungenxa yokuthi i-EU iphusha Indiya ukuthi yenze<br />

imithetho yayo yobunikazi ithi ukuqinaqina kunaleyo<br />

edingekayo njengemanje emithethweni yamazwe<br />

omhlaba afana ne-TRIPS.<br />

Indiya ingumnikezeli omkhulu wemithi ejwayelekile<br />

nenezithako zokwenziwa kwemithi ezisebenzayo<br />

e-Afrika. Ngakho-ke uma yamukela lesi sivumelwano<br />

kuzolimaza ukutholakala kwemithi e-Afrika<br />

nasemazweni asathuthuka onkana. Futhi kungavula<br />

indlela yeminye imithetho eqinile yamazwe omhlaba<br />

ebhloka ukutholakala kwemithi futhi ilimaze<br />

nezempilo kuhulumeni.<br />

Ngalesi sivumelwano, i-EU iphushela:<br />

Izindlela zemingcele<br />

Lokhu kuzovumela i-EU ukuthi imise ukuhanjiswa<br />

kwemithi enqamula emingceleni ye-EU uma leyo<br />

mithi ingaphansi kwelungelo lobunikazi ezweni<br />

le-EU. Ngisho ngabe indawo yokugcina okuya<br />

kuyo lowo muthi izwe elifana neNingizimu Afrika<br />

lapho okungekho khona bunikazi kuleyo mithi, i-EU<br />

izokwazi ukuyithatha leyo mithwalo. Lesi sidingo<br />

sizokwenza ukuthi kuphele isitokwe<br />

Imifanekiso nguSizwe Nguqe.<br />

Isithombe ngu- Samantha Reinders.<br />

Umthetho wamazwe omhlaba olawula ukuhweba<br />

ngemithi kanye neminye imikhiqizo waziwa ngokuthi<br />

yi- Trade Related Aspect of Intellectual Property<br />

Rights, noma i-TRIPS.<br />

UKUBAMBELELA<br />

23


UKUBAMBELELA<br />

24<br />

Amazwe<br />

acebile afuma<br />

ukwandisa<br />

inzuzo yawo<br />

ngokuhlupheka<br />

kwezimpilo<br />

zethu!<br />

Yithi cha<br />

ekwandisweni<br />

kokuvikelwa<br />

kobunikazi<br />

ezivumelwneni<br />

zokuhweba!<br />

Isithombe nguLuckyboy Mkhonwane.<br />

emitholampilo yethu futhi kuphazamise<br />

ukunikezelwa kwemithi emhlabeni osathuthuka.<br />

Isahluko sokutshalwa kwezimali<br />

Umkhandlu Wongqongqoshe waseYurophu<br />

usazovotela ukuthi ingabe izingxoxo ze-EU-India<br />

zingayifaka yini impahla ebhaliwe (intellectual<br />

property-IP) kusahluko sokutshalwa kwezimali<br />

se-FTA.. Uma ifakiwe, lokhu kuzovumela izinkampani<br />

ukuthi zenze konke ukuvikela ukutshalwa<br />

kwezimali okwenziwe yi-IP yawo, kubandakanya<br />

nokukhiqizwa kwemithi . Yize okwamanje amazwe<br />

kuphela angathatha isinyathelo ukuphikisana<br />

namanye amazwe, isahluko sokutshalwa kwezimali<br />

singavumela izinkampani ukuthi zibophe ezinye<br />

izinkampani ngqo. Ukwenza kanjalo kuzodingeka<br />

ukuthi ziye enkantolo yamacala kunasenkantolo<br />

engaphakathi kuhulumeni walelo zwe. Isibonelo,<br />

uma inkampani yaseYurophu icabanga ukuthi<br />

umthetho waseNdiya wawulimaza i-IP yayo<br />

ngokuvumela izinkampani nezejwayelekile ukuthi<br />

zenze imithi inelungelo lobunikazi njengoba<br />

kuvunyiwe ngaphansi komthetho wokuhweba<br />

wamazwe omhlaba, inkampani ingabopha<br />

uhulumeni waseNdiya enkantolo yamazwe<br />

omhlaba, ivimbela isenzo sikahulumeni. Lokhu<br />

kuhlinzeka kungavimbela ohulumeni ekuvikeleni<br />

ezempilo kohulumeni uma izenzo zabo zazibonwa<br />

njengokucindezela i-IP.<br />

* I-EU futhi ixoxisana nge- Economic Partner<br />

Agreement ne-SACU (South African Customs Union<br />

“Kufanele ube nomngane wokwelashwa<br />

ozokukhumbuza ukuthi uphuze imithi<br />

yakho. Lokhu akusho ukuthi wena nomsizi<br />

wakho ngokwelashwa kufanele nihlale<br />

ndawonye ngoba kulezi zinsuku wonke<br />

umuntu unocingo ahamba nalo, ngakho-ke<br />

umsizi ngokwelashwa angathumela umyalezo<br />

noma akushayele ucingo kunemizuzwana<br />

embalwa esele ngaphambi kokuba kufike<br />

isikhathi sokuphuza imithi yakho bese<br />

ekukhumbuza.”<br />

UMaria Khambule, <strong>Treatment</strong> <strong>Action</strong><br />

<strong>Campaign</strong>, Ekurhuleni<br />

Isu<br />

Lokubambelela<br />

ebandakanya iNingizimu Afrika, Botswana, Namibia,<br />

Lesotho neSwaziland) kanjalo neMozambique<br />

ne-Angola. Kodwa-ke imininingwane yalesi<br />

sivumelwano ayikho sobala. Ngenxa yendawo<br />

yokuxoxisana enamandla ye-EU nokusetshenziswa<br />

kolimi oluqinile oluzungeze ukuvikelwa kwempahla<br />

ebhaliwe kusiphakamiso se-EU, kunokwesabela<br />

ngempela ukuthi i-EU iqonela iNingizimu Afrika<br />

ekutheni yamukele ukuvikelwa kobunikazi obuqinile.<br />

I-Anti-Counterfeiting Trade<br />

Agreement (ACTA)<br />

I-Anti-Counterfeiting Trade Agreement (ACTA)<br />

isivumelwano samazwe amaningi esiphakanyiswe<br />

amazwe angasisayina ‘ngokuzithandela’. Nakuba<br />

lesi sivumelwano kungesokuzithandela kuzoba<br />

nengcindezi enkulu evela emazweni acebile ukuthi<br />

abanye basayine isivumelwano. Kungenzeka<br />

kudingeke ngokwezivumelwano zokuhweba.<br />

Umuthi ozishaya umuthi wangempela ungesiwona<br />

yisithipha noma umuthi ongesilo iqiniso ongenazo<br />

izithako zokwenza umuthi ezifanayo ezisebenzayo<br />

njengomuthi onelungelo lobunikazi noma<br />

ojwayelekile. Umuthi oyisithipha kungenzeka<br />

ulimaze futhi ube yingozi. Kufanele kungabi<br />

semthethweni ukuwuthengisa noma ukuwuthenga.<br />

I-ACTA ithi kunendlela ezoyekisa ukuthengiswa<br />

kwemithi eyizithipha. Kodwa-ke, nalokhu<br />

kuwukuhlasela imithi ejwayelekile esithembela


kuyo. Isivumelwano siphakamisa izintshisekelo<br />

zezinkampani ezenza imithi ngokuphazamisa<br />

ukunikezelwa kwemithi ejwayelekile esemthethweni.<br />

Lokhu kungenxa yokuthi kwezinye izimo i-ACTA<br />

yandisa incazelo yesithipha ukubandakanya imithi<br />

ejwayelekile.<br />

Ngaphansi kwemithetho ye-ACTA, iziphathimandla<br />

zasemingceleni kanye nohulumeni bazovunyelwa<br />

ukuthi bathathe futhi bacekele phansi imithwalo<br />

yemithi abakholelwa ukuthi yephula ilungelo<br />

lobunikazi. Bazokwazi ukwenza lokhu ngaphandle<br />

ngisho kokuthinta umnikazi welungelo lobunikazi<br />

ukuqinisekisa ukuthi ingabe imithi yiyo ngempela<br />

yini. Lokhu kungenziwa ngaphandle kohlelo<br />

lomthetho kanti amandla okuhlukumeza<br />

nenkohlakalo makhulu.<br />

Ukuvumela iziphathimandla zesemngceleni ukuthi<br />

zithathe futhi zicekele phansi imithi kuzophazamisa<br />

ukunikezelwa kwemithi esemthethweni<br />

emitholampilo yethu, kubange ukushoda kwesitokwe<br />

futhi kuphoqe iziguli ukuthi zipahazamise<br />

izidambisigciwane noma okunye ulwelashwa.<br />

I-ACTA akusiwo kuphela umthetho olwa nezithipha<br />

okwamanje osathuthuikiswa. Kwenziwa imithetho<br />

eminingana efanayo noma eyamukelwe e-Afrika<br />

yonkana kubandakanya iKenya, Burundi, Tanzania<br />

ne-Rwanda.<br />

“Ngiphuza amaphilisi amathathu<br />

(i-nevirapine embili ne-Truvada<br />

eyodwa) into yokuqala ekuseni.<br />

Ngakho-ke uma ngivuka ekuseni<br />

ngibilisa igedlela bese ngikhipha isitsha<br />

samaphilisi ami. Sinezimbobo eziyisikhombisa,<br />

eyodwa yelangana ngalinye lesonto.<br />

Ngiwagcwalisa ngawo ngoMgqibelo. Ngakhoke<br />

ngiyakwazi njalo ukubona uma ngeqe<br />

usuku okucishe akwenzeki nhlobo, kuphela<br />

uma ngingakwazi ukuphuza amaphilisi ami<br />

khona manjalo lapho ngivuka.Ngakho-ke<br />

ngiziqeqeshile kanzima ukuthi ngiliphuze<br />

kube yinto yokuqala ekuseni [e]mpilweni yami<br />

nasemcabangweni njalo ekuseni, okuyinto<br />

elungile - ngoba ngaphandle kwamaphilisi<br />

angeke ngibe nampilo.<br />

“Futhi ngiwumgibeli bhayisiskili onothando<br />

futhi ngiqede ukubekezela okumbalwa<br />

kwemijaho yamabhayisikili njenge-Argus ne-<br />

94.7. Inhloso yami ukuqeda umjaho we-Argus<br />

ngonyaka ka-20111 ngaphansi kwamahora<br />

amane. Lokhu kusho ukuthi kufanele<br />

ngizilolonge kaningi, ngidle ngokunempilo<br />

futhi ngiphuze ama-ARV ami ngokuvamile.<br />

Nginezithombe eziningi ezahlukene<br />

zokugibela kwami ibhayisikili ezathathwa<br />

umndeni wami nabangane bami endlini<br />

yami nakukhompiyutha yami. Lezi zithombe<br />

zingikhumbuza ngezinhloso zami nokuthi<br />

umuthi wami ungigcina kanjani ngiphilile.”<br />

U-Justice Edwin Cameron<br />

Isu<br />

Lokubambelela<br />

Isithombe ngu-Edwin Cameron.<br />

UKUBAMBELELA<br />

25


UKUBAMBELELA<br />

26<br />

Iseli<br />

ye-CD4<br />

Ucwaningo olusha<br />

Amaseli e-CD4 enziwe ukuthi<br />

amelane ne-HIV<br />

Iseli<br />

ye-HIV<br />

Olunye lwezifundo ezithokozisa kakhulu ezibikwe<br />

eNgqungqutheleni esanda kuba khona i- Conference<br />

for Retroviruses and Opportunistic Infections (CROI)<br />

eBoston ibandakanya indlela entsha ewumzamo omusha<br />

wokulwa ne-HIV.<br />

Abantu abayisithupha abane-HIV babamba iqhaza kulolu<br />

hlolo lokwelapha okwamanje olubizwa ngokuthi i-SB-<br />

728. Lokhu kwelapha kubandakanya ukudonsa igazi,<br />

elibe selelashwa elabhorethri ngenhloso yokushintsha<br />

amaseli e-CD4 ukuze engezukwazi ukuthelelwa<br />

yi-HIV. Lokhu kwenziwa kusetshenziswa isimo<br />

sokwelashwa kwesakhi sofuzo okuphazamisa isakhi<br />

sofuzo i-CCR5 kumaseli e-CD4. (Ukwelashwa kwezakhi<br />

zofuzo kubandakanya ukuguqula, ukuhlanganisa<br />

noma ukususa izakhi zofuzo kumaseli emzimbeni<br />

womuntu ukuze kuliwe nokugula.) I-HIV iyazabalaza<br />

ukuhlangana namaseli e-CD4 lapho isakhi sofuzo<br />

i-CCR5 siphazamisekile. Amaseli e-CD4 alashiwe abe<br />

esephindwaphindwa elabhorethri aphinde aphindiselwe<br />

emuva esigulini.<br />

Kulandela lokhu kwelashwa abahlanganyeli abahlanu<br />

kwabayisithupha ohlolweni sakhula isibalo se-CD4<br />

saba ku-avareji engama-200. Umhlanganyeli omunye<br />

akazange azuze kulokhu kwelashwa. Azange kube<br />

nemiphumela emibi kakhulu eyabikwa kunanoma<br />

yimuphi kubahlanganyeli.<br />

Kulokhu kuhlola ukwelashwa kuphela kwenza iphesenti<br />

elincane lamaseli e-CD4 ukuthi asinde ku-HIV, kodwa<br />

kuyakhuthaza ukuthi leli phesenti elincane lihlala<br />

lisindile isikhathi eside ngangonyaka. Kunjalo, ukuba<br />

namaseli e-CD4 amelana ne-HIV akwenzi ukuthi umuntu<br />

asinde ku-HIV.<br />

Iseli<br />

ye-HIV<br />

Imibuzo eminingi isala nge-SB - 728.Asikazi ukuthi<br />

ukuphazamisa isakhi sofuzo i-CCR5 kungenzeka<br />

yini ukuthi kube nemiphumela emibi kwezempilo<br />

ekuhambeni kwesikhathi. Asazi futhi ukuthi kungenzeka<br />

yini ukuthi selaphe iphesenti eliphezulu kakhulu<br />

lamaseli ngale ndlela. Kusenomgwaqo omude okufanele<br />

siwuhambe ngaphambi kokuba sizokwazi ukuthi lokhu<br />

kwelapha kuzoke kube ngaphezulu yini komqondo<br />

othokozisayo. I-Equal Treatrment izoqinisekisa ukuthi<br />

inilethela izindaba zezinhlolo zakamuva kulo mkhakha.<br />

Umthombo: Lalezari J et al. ‘Successful and persistent engraftment of ZFN-<br />

M-R5-D autologous CD4 T Cells (SB-728-T) in aviremic HIV-infected<br />

subjects on HAART.’ 18 th Conference on Retroviruses and Opportunistic<br />

Infections (CROI), Boston, abstract 46, (2011).<br />

I-entry inhibitor entsha<br />

Ama-entry inhibitor ikilasi elisha lemithi uma<br />

kuqhathaniswa elivimbela i-HIV ekungeneni amaseli<br />

e-CD4. Sidinga imithi eminingi kuleli kilasi elisha ngoba<br />

inganikeza umugqa wempilo kubantu abamelana<br />

nemithi kwamanye amakilasi. Ama-entry inhibitor<br />

amabili (abizwa ngokuthi i- maraviroc ne-enfuvirtide)<br />

asevele asebhalisiwe e-United States.<br />

Manje abacwaningi sebebike ukuthi i-entry inhibitor<br />

entsha ebizwa ngokuthi i-BMS-883068 seyidlule<br />

eyokuqala ezinkingeni eziningi emgwaqeni wokuthola<br />

imvume yokulawulwa. Ohlolweni oluncane kakhulu<br />

olwathatha izinsuku eziyisishiyagalombili kuphela<br />

umuthi uhlanganiswe nokuncipha okukhulu enanini<br />

legciwane egazini ngaphandle kwemiphumela emibi.<br />

Izinhlolo eziqhubekayo kulo muthi zihlelelwe ukuthi<br />

ziqale ekuhambeni kwalo nyaka .<br />

Umthombo: Nettles R et al. ‘Pharmacodynamics, Safety, and<br />

Pharmacokinetics of BMS-663068: A Potentially First-in-class Oral HIV<br />

Attachment Inhibitor.’ 18 th CROI, Boston, oral abstract 49 (2011).


I-tenofovir enelungelo lobunikazi<br />

elikhulu<br />

Uhlobo olusha lwe-tenofovir olubizwa ngokuthi i-GS- 7349<br />

lwenziwe olungasebenza kahle ngokuphindwe ka-15<br />

ekuletheni inhlanganisela esebenza ngokukhuthala kumanodi<br />

omantshu futhi kuhlose amaseli kune-tenofovir esetshenziswa<br />

njengamanje. Kodwa-ke ayihambisi i-tenofovir eningi kangako<br />

ezinsweni, lapho okwenzeka khona imiphumela eminingi<br />

kakhulu emibi ye-tenofovir. Ithemba ukuthi lokhu kuzovumela<br />

iziguli ukuthi ziphuze umuthi omncane bese kugwemeka<br />

imiphumela emibi. Ucwaningo olulodwa kuphela olusheshe<br />

lwenziwa ngalo muthi kubantu futhi kuzoba iminyaka embalwa<br />

ngaphambi kokuba sazi ukuthi kuphephile futhi kusebenza<br />

ngempumelelo ngokwanele yini ukuthi ungene esikhundleni<br />

sohlobo lwamanje lwe-tenofovir.<br />

Umthombo: Markowitz M et al. ‘GS-7340 Demonstrates Greater Declines in HIV-1<br />

RNA than TDF during 14 Days of Monotherapy in HIV-1-infected Subjects.’ 18 th<br />

CROI, Boston, oral abstract 152LB (2011).<br />

Singakwazi ukuthenga ama-ARV abantu<br />

abangathelelekile?<br />

Ezimbili zezifundo ezibaluleke kakhulu zangonyaka<br />

odlule kwakuyizinhlolo i-iPrEx ne-Caprisa 004. Olokuqala<br />

lwakhombisa ukuthi ukunikeza amadoda aya namanye<br />

amadodoa ocansini umthamo zonke izinsuku we-tenofovir<br />

kanye ne-emtricitabine kunciphisa ingozi yokuthola i-HIV.<br />

Olwesibili lwakhombisa ukuthi ijeli yesitho sowesifazane<br />

sangasese (noma i-microbicide) ene-tenofovir kunciphisa<br />

ingozi kwebesifazane yokutheleleka. Zombili lezi zindlela yizimo<br />

zokwelashwa ngaphambi kokubekeka engozini, noma i-PrEP,<br />

njengoba zibandakanya ukunikeza abantu iphilisi lokuvimbela<br />

ukutheleleka kunokwelapha isifo.<br />

Angeke kwenzeke ukuthi i-PrEP ibe yiqiniso ohlelweni<br />

lwezempilo lukahulumeni onyakeni olandelayo noma emibili.<br />

Sisalindele imiphumela kwezinye izinhlolo ngokuphepha,<br />

ukusebenza kahle nomthamo ophezulu wemithi ye-PrEP.<br />

Kodwa-ke, abacwaningi manje sebebike ukuthi isibonelo<br />

sezibalo esathola ukuthi ukunikezela nge-PrEP eNingizimu<br />

Afrika kungenzeka ukuthi kube yimpumelelo kodwa kubize<br />

- ikakhulukazi uma amanani entengo e-microbicides noma<br />

amaphilisi engancishiswa futhi uma ukusebenza kahle<br />

kwale mikhiqizo kungenziwa ngcono. Ucwaningo olukhulu<br />

kakhulu nokucabanga kuzofanele ukuthi kwenziwe nge-PrEP<br />

eminyakeni ezayo, kodwa okungenani manje sinophawu<br />

oluqinile lokuthi ukunikezela nge-PrEP kuzokwenza umqondo<br />

kwezezimali.<br />

Imithombo: Walensky R et al. ‘Cost Effectiveness of PrEP for HIV Infection in South<br />

Africa.’ 18 th CROI, Boston, abstract 37LB, (2011); Hallett T et al. ‘ART or PrEP<br />

for HIV Prevention in HIV Serodiscordant Partnerships: A Mathematical Modeling<br />

Comparison.’ 18 th CROI, Boston, abstract 99LB (2011).<br />

Ukuhlungela inani legciwane<br />

egazini akubalulekile<br />

Ukuthi impilo yabantu abane-HIV iqashwa kanjani<br />

umbuzo okudala ukhona. Njengoba uhlolo lwe-DART<br />

lusikhombisile, asikho isidingo sokulinda kuze kube<br />

ungahlinzeka i-CD4 kanye nokuqashwa kwenani<br />

legciwane egazini ngaphambi kokuthi kutholakale<br />

ama-ARV. Iziguli zingenza kahle kakhulu ngokuqashwa<br />

kokwelashwa nje kuphela, ngamanye amazwi, uma<br />

udokotela ebaxilonga ngokuvamile ngaphandle<br />

kokuthola nanoma yiziphi izibalo ze-CD4 noma<br />

ukuhlolwa kwenani legciwane egazini okwenziwe.<br />

Izifundo ezimbili ezintsha zinikeza umqondo<br />

othokozisayo.<br />

Ucwaningo olwenziwa e-Thailand kungahlelwanga<br />

lwafaka abantu abadala abangama-716 ukuthi bathole<br />

ukuqashwa kwe-CD4 kuhlanganiswa nokuqashwa<br />

kwenani legciwane egazini noma ukuqapha i-CD4 nje.<br />

Emva kweminyaka emithathu abacwaningi bathola<br />

ukuthi kwakungenamehluko omkhulu ezibalweni ze-CD<br />

4 kanye nezibalo zenani legciwane egazini emaqenjini<br />

amabili. Lokhu kukhombisa ukuthi ukungabi bikho<br />

kokuqashwa kwenani legciwane egazini akufanele kube<br />

yisithiyo sokuqalisa abantu ukwelashwa.<br />

Ucwaningo lwesibili lwase-Cameroon lungahlelwanga<br />

lwafaka abantu abangama-459 ukuthi bathole<br />

mhlawumbe ukuqashwa kwe-CD4 kuhlanganiswa<br />

nokuqashwa kwenani legciwane egazini noma kungabi<br />

bikho kubo futhi kuqashwe ukwelashwa kuphela.<br />

Emva kweminyaka emibili, abahlanganyeli abathola<br />

ukuqashwa kokwelashwa kuphela baba nokwehla<br />

okuncane kwezibalo ze-CD4. Lolu cwaningo lugqamisa<br />

umqondo wokuthi ukungabi bikho kokuhlolwa kwenani<br />

legciwane egazini kanye nokuqashwa kwe-CD4<br />

akufanele kuvimbele ukunikezelwa kokwelashwa.<br />

Kodwa-ke kuphakamisa ukuthi lokhu kuhlola kufanele<br />

ukuthi kutholakale lapho okunokwenzeka khona. Inani<br />

lokuqashwa kwenani legciwane egazini njengoba<br />

kugqanyiswe ukuhlaziya okusha okuvela ohlolweni<br />

lwe-DART, okuthola inhlanganisela phakathi kokukhula<br />

kwegciwane egazini kanye nokuba nokumelana nomuthi<br />

okuthize, izinguquko zesimo noma izinguquko ku-HIV.<br />

Lokhu kuphakamisa ukuthi ukuqashwa kwenani<br />

legciwane egazini kungaba lusizo ekunqumeni isikhathi<br />

esifanele sokushintsha izinhlobo zemithi.<br />

Imithombo: ‘Jourdain G et al. PHPT-3: a randomized clinical trial comparing<br />

CD4 vs viral load ART monitoring/switching strategies in Thailand.’ 18th CROI, Boston, abstract 44, 2011; ‘Kouanfack C et al. HIV viral load, CD4<br />

cell count, and clinical monitoring vs clinical monitoring alone for ART<br />

in rural hospitals in Cameroon: Stratall ANRS 12110 / ESTHER trial, a<br />

randomized non-inferiority trial.’ 18th CROI, Boston, abstract 45LB, (2011).<br />

Konke lokhu okutholakele kwethulwa ku-18th Conference on Retroviruses and<br />

Opportunistic Infections, held in Boston, U.S.A., ekuqaleni kwalo nyaka.<br />

UKUBAMBELELA<br />

27


I-TAC NEWS<br />

28<br />

Iqiniso<br />

Ukweba ama-ARV<br />

akunamqondo<br />

ngeWhoonga<br />

I-Whoonga isidakamuzwa sasemgwaqeni esiyingozi<br />

esithengiswa kweminye imiphakathi eNingizimu Afrika. Singaba<br />

nezinto eziningi zezithako kubandakanya iherowini nomuthi<br />

wamagundane. Eminye imibiko yabezindaba yathi i-whoonga<br />

inama-ARV, kodwa lapho kuhlolwa amasampula e-whoonga<br />

eNyuvesi yaKwaZulu-Natal yatholakala ingenawo ama-ARV.<br />

Ngisho ngabe i-whoonga ngezinye izikhathi iba nawo ama-ARV,<br />

ama-ARV angeke enze abasebenzisi bomuthi ukuthi badakwe<br />

. I-ARV njenge-efavirenz ngezinye izikhathi ayinayo imithelela<br />

emibi engqondweni uma iphuzwe ngokwejwayelekile, kodwa<br />

hhayi lapho ibhenywa. Ngakho-ke akwenzi mqondo ukufaka<br />

ama-ARV ku-whoonga.<br />

Kubalulekile ukuxazulula lensomi yokuthi i-whoonga inama-<br />

ARV noma ukuthi ama-ARV enza i-whoonga. Ulwazi olungesilo<br />

iqiniso njengalolu luhanjiswa ngabathengisa ngezidakamizwa<br />

futhi kungaholela ekwebeni noma ekuxhashazweni kwemithi<br />

esindisa izimpilo.<br />

Isithombe nguLuckyboy Mkhonwane.<br />

NgoLwesihlanu mhla ka-25 Mashi amalungu<br />

e-<strong>Treatment</strong> <strong>Action</strong> <strong>Campaign</strong> (TAC) ame<br />

nezingqwembe ngaphandle eNkantolo Kamatshi<br />

eKempton Park amadoda amathathu ayevela<br />

khona ngamacala okusolwa ukuthi antshontshe<br />

imithi eyizidambisigciwane engaba i-R200,000<br />

. Amaphoyisa kubikwe ukuthi akholwa ukuthi<br />

amadoda ayehlose ukusebenzisa ama-ARV<br />

ukukhiqiza iwhoonga, isidakamuzwa sasemgwaqeni<br />

esinobuthi<br />

Amabili kula madoda atholakala ephethe izikhwama<br />

zamapulasitiki amabili ngasinye siphethe amabheshi<br />

angama-20 omuthi wama-ARV i-tefonovir, kubika<br />

iphephandaba iCitizen. La madoda abe esekhomba<br />

indoda yesithathu njengebandakanyekayo.<br />

Ukuboshwa kokuqala kwakuwumphumela<br />

wokuvuswa ilungu lomphakathi. Amadoda avele<br />

enkantolo ngoJanuwari okokuqala. Emva kwama-25<br />

Mashi ukulalelwa kwecala kwahlehliswa kwaze<br />

kwaba umhla ka-19 Ephreli.<br />

“Abaphehli balobu bugebengu bathatha izimpilo<br />

zabantu abayidingayo le mithi ukuze banakekele<br />

impilo yabo”, kusho uLuckyboy Mkhondwane<br />

we-TAC Ekurhuleni. “Ngokwenza njalo abathathi<br />

nje iminyaka eyengeziwe engengezwa uma<br />

umuntu ophila ne-HIV ephuza imithi yakhe. Kodwa<br />

babeka izimpilo zabantu abangenacala engozini<br />

ngokubabeke ekumelelaneni nomuthi njengoba<br />

ukwenza iphutha kuma-ARV akho kwandisa<br />

amathuba okuthi igciwane liziguquguqule.”


Inkimbinkimbi<br />

yemeyizi<br />

Equal <strong>Treatment</strong> 38<br />

ARVs<br />

Umtholampilo<br />

Prescription<br />

Umtholampilo<br />

Ithengiswe yonke<br />

Ithengiswe yonke<br />

Gcwalisa iphepha lakho lokuthenga imithi ngokuqedela<br />

inkimbinkimbi yendlela ekhemesi elinesitokwe. Dweba<br />

umugqa ukutreyisa indlela yakho.<br />

Umtholampilo<br />

Ithengiswe yonke<br />

Umtholampilo<br />

Ithengiswe yonke<br />

Umtholampilo<br />

Ithengiswe yonke<br />

Umtholampilo<br />

Ithengiswe yonke<br />

Umtholampilo<br />

Ithengiswe yonke<br />

Clinic<br />

29


The ACMS is<br />

an independent,<br />

interdisciplinary<br />

and internationally<br />

engaged centre<br />

of excellence<br />

for research and<br />

teaching. Based<br />

in Africa, ACMS<br />

shapes global<br />

discourse on<br />

human mobility,<br />

development<br />

and social<br />

transformation.<br />

www.migration.org.za<br />

30

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