IsiXhosa - Treatment Action Campaign

tac.org.za

IsiXhosa - Treatment Action Campaign

Magazine of the Treatment Action Campaign

treatment

UMzabalazo wonyango

usaqhubekeka

Ufikelelo kunyango: Bona ukuba

amanye amazwe agcina njani

Kutheni ipilisi enye kuphela, kanye

ngemini sele iza kuba yinyani

Into ekufuneka uyazile nge-tenofovir

kunye nezikhokelo ezintsha zonyango

June 2010

1


Umhleli: Marcus Low

Usekela Mhleli: Mara Kardas-Nelson

Umhleli Wekopi: Cathy Goudie

Abafake isandla: Lihle Dlamini, Catherine Tomlinson,

Mary-Jane Matsolo, Ntombizonke Ndlovu, Andrea

Zeelie, Adam Malapa, Catherine Karlsson, Malusi

Mbatha, Lamya Moosa, Nathan Geffen

Uqweqwe lwangaphambili: Photo by Brendan

Bannon/International Federation of the Red Cross.

Iifoto: Brendan Bannon/International Federation of

the Red Cross, Mara Kardas-Nelson, Zethu Mlobeli,

Damien Schumann, Roulé le Roux, Eric Miller, Oupa

Nkosi/Mail & Guardian, David Harrison, Delwyn

Verasamy/Mail & Guardian, Ntombizonke Ndlovu,

David Chancellor/International Federation of the Red

Cross, Adam Malapa, Malusi Mbatha, Gallo Images/

Getty Images, Roger Segelken/Cornell University

News Service, Mike Blyth, Paul Bettings, Suraj

Mishra, Mary-Jane Matsolo, Talia Frenkel/American

Red Cross, International Federation of the Red Cross,

Emily Chastain, blog.dragonballyee.com, Paymon

Ebrahimzedah. Illustration on page 12 by Brice Reignier

Imibulelo ekhethekileyo ku-Simon Collins of

HIV i-Base, Professor Mark Cotton, director of the

Children’s Infectious Disease Clinical Research Unit

at the University of Stellenbosch, and to the Médicins

Sans Frontières – Campaign for Access to Essential

Medicines and MSF South Africa office

Usasazo: Kagiso Seleka

Uyilo: Designs4development, www.d4d.co.za

Ushicilelo: CTP Book Printers

Iguqulwe yi-Bohle Conference and Language Services

I-TAC izibophelele ekuboneleleni abantu abane-

HIV, iintsapho zabo kunye nabakhathaleli ulwazi

oluchanekileyo olumalunga namayeza asindisa

ubomi kunye nonyango. I-TAC kunye neenkokheli

zayo bazimele kwishishini loxubo-mayeza ngokunjalo

nakumashini amayeza endalo kunye namayeza

angamanye kwaye ayinamdla wezemali kuwo.

Olu hlelo lwe-Equal Treatment luxhaswe Global Fund

to Fight AIDS, Tuburculosis and Malaria and by Oxfam

Australia.

Le magazini ifumaneka ngeXitsonga, isiXhosa

nesiZulu.

Ungalufumana olu hlelo kunye nezinye iintlelo

ze-Equal Treatment ku- www.tac.org.za/community/

equaltreatment/

Equal Treatment is

published by the Treatment

Action Campaign

Idilesi yePosi: PO Box 2069, Cape Town 8001

Idilesiye Sitalato: Westminster House,

122 Longmarket Street, 3rd Floor, Cape Town 8000

Inombolo yomNxeba: 0861 END HIV

Ifeksi: +27 21 422 1720

I-Website: www.tac.org.za

II-Ofisi zesSithili ze-TAC

ISithili sesa-Khayelitsha: 021 364 5489

ISithili sase-Ekurhuleni: 011 873 4130

ISithili saseLusikisiki: 039 253 1951

ISithili saseMgungundlovu: 033 394 0845

ISithili i-Gert Sibande: 017 811 5085

2

ISithili saseMopani: 015 307 3381

IzIqulatho

amaphepha

2 –15

amaphepha

16–21

amaphepha

6 –7 kunye

namaphepha

14–15

uhlelo 33 – Juni 2010

IsiXhosa

Izikhokelo ezintsha nethenda ye-ARV

Emva kokulinda ixesha elide izikhokelo

zonyango lwe-antiretroviral zoMzantsi

Afrika zide zahlaziywa ekugqibeleni.

Make sijongeni olunye lolu tshintsho

lubalulekileyo kwizikhokelo,

siphonononge ukuba kungenzeka

umntu athathe ipilisi enye kanye

ngemini, kunye nokumisela okufunwayo

kwithenda ye-antiretroviral ka-2010.

Imfuno yamachiza angcono

Unyango lwabantwana abane-HIV

lunokwenziwa ukuba lube lula kakhulu

ngeendibaniselwano zamachiza.

Siphonononga ukuba yintoni engenziwa

ukuqinisekisa amayeza alungele

abantwana ayafumaneka. Sikwaxoxa

noxhathiso kumachiza kunye nokuba

kungenzeka ukuba abantu abaninzi

kungafuneka ukuba batshintshele

kunyango lwesibini olubizayo

nolukuluhlu olulandelayo.

Ufikelelo: Ngoko nangoku, apha

naphaya

Ngexa wonke umntu ethetha ngokuba

iza kuba njani iNdebe yeHlabathi, sikala

ukuba athelekisa njani na amazwe xa

kuza ekujonganeni ne-HIV – kwaye

abase-Brazil baqhuba kakuhle.

Sikwakuzisa la nexesha lokwenzeka

kweziganeko elibonisa ukuba ufikelelo

kunyango lutshintshe njani na

ngokuhamba kweminyaka.


Ifoto ngu-Mara Kardas-Nelson

Ndaba ngomnye wabantu bokuqala owaba nethamsanqa

ukuba afumane unyango lwe-I antiretroviral (ART) oko

kusenzeka ngeProjekithi yoNyango le-Treatment Action

Campaign (Iphulo eliZabalazela uNyango) ngo-2003,

xa isibalo sam se-CD4 sasingama- 91. Ngelo xesha

urhulumente wethu waye wathandabuza ukunika abantu

abane-HIV ii-antiretrovirals (ARVs) ngenxa yezimvo

zokungafuni ukukholwa koosopolitiki abaphezulu.

Abantu abaninzi baya basweleka, kodwa ngaphandle

koko saye salulwela ufikelo kwi-ART.

Wathi urhulumente akubhengeza ukukhutshwa

kwe-antiretroviral ngasekupheleni kuka- 2003, aye

akhula amathemba ethu. Emva kwetyala le-PMTCT

(usulelo olusuka kumama lusiya emntwaneni), saye

sanemvakalelo yokuba siphumelele elinye idabi

kwakhona. Saye sakhankasela ama-200,000 abantu

ukuba bafumane ii-ARVs ngo-2006. saye safuna inkxaso.

Saye salwela ukwehliswa kwamaxabiso amachiza,

kwaye ngamanye amaxesha sasityholwa kakubi

kusithiwa sisebenzela iinkampani zoXubo-mayeza.

Sicela umngeni kwibala elinxulunyaniswa ne-HIV, saye

saqhuba iphulo lokungena umnyango nomnyango

sifundisa abantu ngokusazi isimo sabo se-HIV, ukuthatha

ii-ARVs nokubambelela kunyango.

Abantu baye baqala ukutyelela izibhedlele zabo

beyokufumana i-ART. Kodwa sisajongene nemiqobo

emininzi. Nangoko, zange silahle ithemba. Endaweni

yoko, saye salwa ngamandla saqhuba nomsebenzi

wethu kwinqanaba lasekuhlaleni. Kwathi kwakusebenza

ukukhutshwa kwe-ARV, kwakho imiceli mngeni emisha:

ukungabikho kwamachiza, kunye nemfuno yokuzisa

amachiza asebenza ngamandla.

Ndisakhumbula siqhankqalaza sisiya kwii-ofisi ze-

ASPEN ekumNtla waseThekwini ngexesha lephulo lethu

le-tenofovir. Yayiyimini eyayishushu kakhulu, kodwa

kwakungekho namnye owayebonisa ukulikhathalela

elo langa laligqatse ubhobhoyi okanye indlela ende

eyayinyuka endulini. Ndisakhumbula xa sasiqhankqalaza

ngaphandle kwesibhedlele i-Mahatma Gandhi, sibuza

sifuna ukwazi ukuba kutheni kukho i-1,300 yabantu

Inqaku loMhleli

abasekuluhlu lokulindela lwesibhedlele. Enye indoda

yasibuza ukuba ibizakuba isaphila na ngeKrisimesi

ukuba ibingafakwanga kwi-ARVs. Ndisakhumbula xa

endisebenza nabo u-Promise, Ralph no-Sindi baye

baleqiswa ngezinja kwintolongo yase-Westville, kuba

babexhasa amabanjwa ukuba afumane unyango, nawo.

Yayingamaxesha anzima lawo. Kodwa okungenani

sinokujonga emva sithi iinzame zethu azihambanga nje.

Ubunkokheli bezopolitiko bangoku luzibophelele

ekuthembiseni ekulweni iHIV/AIDS- kwinkqubo yempilo

karhulumente. SinoYilo lweSicwangciso seSizwe

olujoliswe kuwo wonke umntu Izigulane zinofikelelo

kunyango kwiikliniki zazo zengingqi, kwaye iPhulo

lukuCetyiswa nokuVavanyelwa i-HIV lizakusebenza

ngokubhekisele kuzo zonke ikliniki ezinika unyango

olusisiseko ukuba zibe ziindawo ze-ART. Kwakuthi

kusakwenzeka oku, ibe ngabantu abambalwa

abazakuhamba imigama emide beyokuvavanywa

beyokufuna nonyango.

Eskugqibeleni sinezikhokelo ezitsha neziphuculiweyo

ze-HIV kwaye kuqikelelwe ukuba ngoJuni 2011 malunga

nesigidi esinye sabantu siyakuba nofikelelo kwii-ARVs.

Le yenye yempumelelo ekufuneka siyibhiyozele!

Koko imiceli mngeni emininzi isasele. Abantu

basajikiswa ezikliniki kuba abekho oogqirha

okanye oosokhemisti bokukhupha amayeza. Abanye

bayivavanyelwa emva kwexesha kakhulu i-HIV, usulelo

oluhamba ne-TB/HIV isulelo olubanga ukusweleka

kwabantu abaninzi eMzantsi Afrika.

Ibala elinxulunyaniswa ne-HIV lisekhona, kodwa

abantu abaninzi basaqhuba bezithatha ii-ARVs zabo

ngaphandle kobunzima obubehlelayo. Aba bantu baphila

ubomi obunempilo – kwaye ndingomnye wabo mna.

Sibubungqina bokuba ii-ARVs ziyasebenza. Isende

indlela ekusafuneka siyihambe, kodwa ke yindlela

esingayihamba sonke. Njengabantu abane-HIV, kufuneka

siqhube sixhasana kwaye sibambelele kunyango ukuze

siphile ubomi obude, nobugqibeleleyo.

Lihle Dlamini, Usekela Sosiba Jikelele we-TAC

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IZIKHOKELO EZINTSHA

NETHENDA

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Ichiza elitsha

ekliniki

Ifoto ngu-Mara Kardas-Nelson

Ngu-Catherine Tomlinson no-Marcus Low

Ukuba ngaba ukwirejimeni equlethe

i-d4T kwaye uphethwe yi-lactic acidosis,

lipodystrophy, peripheral neuropathy okanye

i-pancreatitis, kufuneka ubuze ugqirha wakho

ngoko nangoko malunga ngokutshintshela

kwi-tenofovir. Ukutshintshela kwi- tenofovir

kunokususa iziphumo ebezingalindelekanga

ezininzi ezinxulunyaniswa ne- d4T.

Ekugqibeleni iSebe lezeMpilo sele liqalile

ukutshintsha i-stavudine (d4T) nge-tenofovir (TDF).

Eli linyathelo elikhulu eliya phambili kunyango

lwe-HIV eMzantsi Afrika. Nantsi into ekufuneka

siyazi.

Kutheni i-tenofovir ingcono kuned4T

I-Stavudine (d4T) ibiyinxenye yerejimeni yamachiza

okuqala eNkqubo yeMpilo kaRhulumente eMzantsi

Afrika iminyaka emininzi. Ukuba ngaba ubufumana

ii- antiretrovirals (ARVs) kwiikliniki zikarhulumenete,

amathuba ngawokuba enye kwezintathu ii-ARVs oye

wayifumana yi-d4T. I-D4T iye yanceda ukusindisa

amawaka obomi kummandla. Koko, yiyo ebangele

iziphumo ebezingalindelekanga ezimandundu

eziye zehlela abanye abantu abakunyango lweantiretroviral

(ART).

Iminyaka emininzi i-Treatment Action Campaign

(TAC) ibikhankasela ukuba endaweni ye-d4T

kufakwe i-tenofovir (TDF). Isizathu esingundoqo soku

kukuba i-tenofovir ineziphumo ebezingalindelekanga

ezimbalwa kune-d4T. Kumazwe atyebileyo amaninzi


kwaye kwangena i-tenofovir endaeni ye-d4T

kwiminyaka emininzi eyadlulayo.

Amalingo ezonyango abonise okuhle nge-tenofovir

ukodlula i-d4T. Uphononongo obeluthiwe thaca

kwiNkonfa yoMbutho wamaZwe ngamaZwe we-

AIDSA (International AIDS Society Conference)

ngo-2009 eKapa lwabonisa ukuba iirejimeni

eziqulethe i-d4T zineziphumo ebezingalindelekanga

ezimandundu ezininzi kwaye zifune utshintsho

lwamachiza rhoqo kuneerejimeni eziqulethe

i-tenofovir. Uphononongo lwaluthelekisa izigulane

ezili-1000 ezazikwirejimeni equlethe i-tenofovir

kwi-1000 yezigulane ngenye indlela ezazikwirejimeni

efanayo kodwa yona equlethe i-d4T. I-50.5%

oyezigulane ezithatha i-d4T yehlelwa ziziphumo

ebezingalindelekanga ezinxulumene ne-d4T yaze

i-16.2% yathsintshelwa kwichiza elitsha ekupheleni

kweminyaka emibini. Kwiqela le-tenofovir

yi-2.5% kuphela yezigulane eyehlelwa sisiphumo

esinxulumene ne- tenofovir.

Ezinye zeziphumo ebezingalindelekanga

ezinxulunyaniswa ne-d4T ziquka i-lactic acidosis

(imelo apho i-lactic acid yakheka ngokukhawuleza

egazini kunokuba umzimba uyisuse), i-lipodystrophy

(utshintsho kumafutha omzimba kunye nemilo

yomzimba), i-peripheral neuropathy (umonakalo

kumxokomezelo wemithambo-luvo ye-peripheral)

kunye ne-pancreatitis (ukukrala kwe-pancreas,

ilungu elikhupha iihomoni eziyimfuneko).

Ngokuchaseneyo, izigulane ezikwi-tenofovir

zehlelwa ziziphumo ebezingalindelekanga

ezimandundu ezimbalwa kakhulu. Koko i-tenofovir

iye yanxulunyaniswa nomonakalo wezintso kwaye

izigulane ezithatha ichiza kufuneka zihlolelwe

iingxaki zezintso.

Izikhokelo ezitsha

Iindaba ezimnandi kukuba ukusukela ngomhla

woku-1 Aprili 2010 iSebe lezeMpilo liqalile

ukutshintsha i-d4T nge-tenofovir njengenxenye

yonyango lomgca wokuqala kwiNkqubo yezeMpilo

yoMzntsi Afrika.

Oku akuthethi ukuba wonke umntu okwi-d4T

uyakutshintshela kwi-tenofovir ngoko nangoko.

Kuphela ngabantu abaqala unyango okokuqala

emva komhla we-1 Aprili kunye nabantu abehlelwa

ziziphumo ebezingalindelekanga ezimandundu

kwi- d4T abaza kufumana i-tenofovir. Ukuba

ngaba ukwirejimeni yonyango oluqulethe i-d4T

kwaye awehlelwa zizo naziphi na iziphumo

ebezingalindelekaga, akuyi kubakho mfuneko

yokutshintshela kwi-tenofovir.

Esinye isizathu sokungatshintsheli zonke izigulane

kwi-tenofovir ngexesha elinye, kukuba urhulumente

usenokungakwazi ukufumana i-tenofovir eyoneleyo

yomntu wonke. Kwakhona, ukuba ngaba abantu

baqhuba kakuhle kwi-d4T, asikho isizathu sokuba

bayitshintshe irejimeni yabo.

Imithombo: S. Rosen et al.,

‘Net cost of switching from

stavudine to tenofovir in first

line antiretroviral therapy in

Zambia’, IAS 2009. Available at

http://www.ias2009.org/abstract.

aspx?elementId=200721757.

I-TAC imele ukukhutshwa kwe-tenofovir njengenxenye yeMithombo yephulo leMpilo. Ifoto ngu-Zethu

Mlobeli, courtesy MSF.

I-Tenofovir nethenda ka-2010

ISebe lezeMpilo liwathenga amachiza e-antiretroviral (ARV) ngethenda ye-ARV

ekhethekileyo. Ithenda ye-ARV eyanikwayo ngo-2008 iyaphela kulo nyaka

kwaye urhulumente uzakunika ithenda entsha msinyane nje.

Ukufumana ilungelo lethenda kubalulekile ekuhlangabezaneni nokujoliswe

kuko kwe- NSP, ekuphumezeni izikhokelo ezintsha zonyango kunye nokwehlisa

amaxabiso amachiza. Ngexesha lonke lethenda yonyaka ophelileyo kuphela

yinguqulelo enye kuphela kasinga chiza (generic) tenofovir eyabhaliswayo yaze

yathengiswa. Oku kwathetha ukuba i-tenofovir yahlala ibiza imali eninzi.

Iinguqulelo zoosinga tenofovir ezisalindele ukuba zibhaliswe kwiBhunga

eliLawula amaYeza loMzantsi Afrika (Medicines Control Council) (MCC)

kufuneka zibhaliswe ukonyusa ukhuphiswano kunye nokwehlisa amaxabiso.

Ukuphucula kunye nowenza lula iirejimeni zamachiza i-MCC kufuneka

ikhawulezise ubhaliso lwazo zonke iindibaniselwano ze-tenofovir ezisekelwe

kwidosi esisigxiba.

Jonga kwiphepha le-12 ngokuthe vetshe ngethenda ka-2010 ye-ARV kunye

nemiqobo kwi-MCC.

IZIKHOKELO EZINTSHA

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IZIKHOKELO EZINTSHA

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Ibali lika-

Eunice

U-Mary-Jane Matsolo

wenza udliwano-ndlebe

no-Eunice Lindiso

malunga namava akhe

ngokutshintsha kwistavudine

(d4T) waya

kwi-tenofovir (TDF).

U-Eunice Lindiso ngowasetyhini oneminyaka engama-33 ohlala eKhayelitsha unonyana

one-14 leminyaka. U-Eunice kwafunyaniswa ngovavanyo ngo-2007 ukuba une-HIV,

emva kokufumanisa ukuba isithandwa sakhe awayethandana naso iminyaka emininzi

sasinganyanisekanga kuye sithandana nowasetyhini owayesaziwa ekuhlaleni ukuba une-

HIV. Ukufunyaniswa kwakhe ngoxilongo u-Eunice isibalo sakhe se-CD4 sasingama-192,

kodwa ke ngelo xesha wayengabonisi mpawu ezimandundu zosulelo lwe-HIV.

Ngo-2007 waqalisa unyango lwe-antiretroviral (ART) esebenzisa i-stavudine (d4T),

lamivudine (3TC) ne-nevirapine (NVP). Emalunga neenyanga ezine kolu nyango u-

Eunice waqalisa ukuphawula iziphumo ebezingalindelekanga. Waba nobucaphu-caphu

obukhulu wagabha rhoqo ngenxa yesiphimo ebesingalindelekanga esixhaphakileyo

se- d4t esaziwa ngokuba yi-lactic acidosis (imeko apho i-lactic acid yakheka egazini

ngokukhawuleza kunokuba unokukwazi ukuyisusa umzimba). Oku kwenza kwanzima

kakhulu kuye ukuba akhathalele unyana wakhe kuba ixesha elininzi wayengaphilanga

ngokwaneleyo ukuba akwenze oko.

Wathi akukhalaza malunga noku, ugqirha wakhe watshintshela u-Eunice kwirejimeni

ene-Zidovudine (AZT), 3TC ne-nevirapine. Kule rejimeni waye waqala ukwehlelwa

bubunzima kodwa kwangaxesha nye amabele akhe akhula ukusuka kwisayizi 32B ukuya

ku-36D. Le yindibaniselwano yokwehlelwa ngamafutha kunye nokufumana amafutha

sesinye isiphumo ebesingalindelekanga se- d4t esaziwa angokuba yi-lipodystrophy.

Nge-3 ka Febuwari 2010 unyango luka-Eunice lwaye lwatshintshwa kwakhona. Kweli

tyeli waye waqala irejimeni ye-tenofovir (TDF), 3TC ne-nevirapine. Ugqirha wakhe

wamcacisela ukuba olu unyango luneziphumo ebezingalindelekanga ezimbalwa kunye

nokuba angaphathwa yintloko kunye nobucaphucaphu. Koko, akukhange kwenzeke oku.

Endaweni yoko, u-Eunice ufumanise ukuba unyango olutsha luye lwaziguqula ezinye

iziphumo ebezingalindelekanga ezimbalwa ezamehlela kwi-d4t. Isayizi yakhe yebhodi

yabuyela ku-32B kwaye uphila ubomi obunempilo. Enkosi kwi-tenofovir akasaziva egula

ngalo lonke ixesha ngoku kwaye unobudlelwane obuhle nonyana wakhe.


Izikhokelo ezintsha zonyango lwe-antiretroviral

NgoMatshi ka-2010 izikhokelo zonyango zoMzantsi Afrika – ezazigqityelwe ukuhlaziywa ngo- 2004 –

ekugqibeleni zaye zahlaziywa emva kweminyaka emininzi yolibaziseko olungeyomfuneko. Itheyibhule

engasezantsi ibonisa ukuba ngubani oyakufanela awaphi na amachiza, phantsi kwezikhokelo ezitsha eziqale

ukusebenza ngowo-1 Aprili 2010.

Abantu abadala kunye nabantwana abafikisayo

Umgca wokuqala

Zonke izigulane ezintsha ezifuna unyango TDF + 3TC/FTC +EFV/NVP

Abo bakwi-d4T ngoku bengenazo iziphumo ebezingalindelekanga Hlala kwi-d4T

Uphawu lokungaqhubi ngeyeza kwi-TDF: isifo sezintso AZT+ 3TC +EFV/NVP

Umgca wesibini

Ukungaphathwa kakuhle yirejimeni ye-first line esekelwe kwi-AZT TDF + 3TC/FTC + LPV/r

Ukungaphathwa kakuhle yirejimeni yomgca wokuqala esekekwe kwi-TDF AZT + 3TC + LPV/r

Ukungaphathwa kakuhle yirejimeni yomgca wesibini – thumela kwingcali

Iimveku nabantwana

Umgca wokuqala

Zonke iimveku ezingaphantsi kweminyaka emi-3 ABC + 3TC + LPV/r

Abantwana abaneminyaka em i-3 nangaphezulu ABC + 3TC + EFV

Abo okwangoku bakwi-d4T bengenazo iziphumo ebezingalindelekanga Remain on d4T

Umngca wesibini

Ifoto ngu-Damien Schumann

Abantwana abangaphezulu kweminyaka emi-3 abangaphathwanga kakuhle yi-ABC ABC + ddl +LPV/r

+ 3TC + EFV

Abangaphathwanga kakuhle yirejimeni ye-AZT okanye ye-d4T ABC + 3TC + LPV/r

Irejimeni engaphathanga kakuhle ye-LPV/, iimveku ezingaphantsi kweminyaka emi-3 ezingaphathwanga

kakuhle ngumgca wokuqala okanye umgca wesibini – thumela kwingcali

Undoqo: abacavir (ABC), zidovudine (AZT), didanosine (ddI), stavudine (d4T), efavirenz (EFV), emtricitabine (FTC),

lopinavir/ritonavir (LPV/r), nevirapine (NVP), tenofovir (TDF), lamivudine (3TC)

IZIKHOKELO EZINTSHA

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IZIKHOKELO EZINTSHA

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Ipilisi enye, kanye ngemini

Ngu-Catherine Tomlinson no-Marcus Low

Iindibaniselwano zedosi emiselweyo

kwenziwa isincomo sayo ngabasebenzi

bezempilo kunye nombutho wezoNyango

lwe-HIV kumaZantsi e-Afrika. Umthwalo

wepilisi osezantsi unxulunyaniswa

nobambelelo oluphucukileyo.

Ifoto ngu-Roulé le Roux


I-TAC iyakuqhuba ikhankasela ukuba kwenziwe iindibaniselwano zedosi emiselweyo eziqulethe i-tenofovir into

enokufezekiswa kwinkqubo yempilo karhulumente. Ipilisi enye kanye ngemini iyafikeleleka, inokwenzeka, kunye

nasemdleni womntu ngamnye.

Uninzi lwabantu eMzantsi Afrika abathatha unyango

lwe-antiretroviral (ART) kufuneka bathathe amachiza

amathathu awohlukeneyo yonke imihla. Amanye

kufuneka athathwe ngamaxesha athile amanye

kufuneka athathwe ngaphambi okanye emva kokutya.

Ukuthatha iipilisi ezininzi kangako kunye nokuzithatha

ngokwemiyalelo kunganzima kwaye kufuna

ukuziqeqesha okukhulu. Esi sesinye isizathu sokuba

kutheni ukubambelela kakuhle kunyango kunokuba

nzima.

Kwiminyaka yakutsha nje oosonzululwazi baye

bakwazi ukudibanisa ii-antiretrovirals (ARVs) ezintathu

ezohlukeneyo zaba yipilisi enye ekufuneka uyithathe

kanye kuphela okanye kabini yonke imihla. Olu hlobo

lwendibaniselwano ‘lweepilisi ezintathu kwenye’

kuthiwa yindibaniselwano yedosi emiselweyo (fixed-dose

combinations) equka i-tenofovir.

Iindaba ezimnandi zezokuba iindibaniselwano zedosi

emiselweyo eziqulethe i-tenofovir ziyafikeleleka

kwaye azibanjwa yimida ebekwa kwilungelo lomenzi.

Kukho imiqobo ngokuphathelene nokubhaliswa

kwezi ndibaniselwano zedosi emiselweyo kwiBhunga

eliLawula amaYeza (jonga kwiphepha le-12), kodwa

ukuba urhulumente uyafuna, unokunika i-FDCs

equlethe i-tenofovir kwinkqubo yempilo karhulumente

ngasekupheleni kuka-2010.

Ubambelelo kunyango oluphuculiweyo

olunxulunyaniswa nokuba kufuneke uthathe

iipilisi ezimbalwa lusekiwe ngokwenziwa kwenani

lamaphononongo. Uhlalutyo lwamaphononongo

alithoba luye lwalandelela ubambelelo kunyango

kwizigulane ezingama-20,242 – i-11,925 yezigulane

ezikwiindibaniselwano zedosi emiselweyo nama- 8,317

ezigulane ezikwiirejimeni zendibaniselwano enechiza

– ngaphezulu kwe-avareji yeenyanga ezi-8.6. Uhlalutyo

lufumanise ukuba ingozi yobambelelo kunyango

olulambathayo yehliswa ngama-26% kwizigulane ezikwi-

FDCs.

Ubambelo kunyango olulambathayo lukhokelela

kuxhathiso kwichiza olunyukayo. Ngenye indlela,

uxhathiso olukhulu luthetha ukuba abantu

abaninzi kufuneka batshintshele kumgca wesibini

nowesithathu wonyango olubiza kakhulu. Ngoko ke,

ukwazisa iindibaniselwano zedosi emiselweyo kunye

nokwehlisa imfuno yamachiza abizayo omgca wesibini

nowesithathu.

Ukuthatha ipilisi enye kuphela ngosuku nako kwenza

lula ukuba uthathe amayeza akho bucala. Oku

kunokufaka isandla ngokungaphaya kubambelelo

olulungileyo kunyango kwizimo apho kunzima kuzo

ukuxela isimo sakho ngenxa yebala okanye uloyiko

lwebala.

De zibe iindibaniselwano zedosi emiselelweyo zilungela ukufumaneka, ukusebenzisa

iblista yamayeza ukulungisa amayeza akho kuyakunceda ukuqinisekisa ukuba

uthatha umthamo owaneleyo suku ngalunye. Ifoto ngu-Eric Miller, courtesy MSF.

Ii-FDCs kunye nethenda ye-ARV ka-2010

Ithenda ye-ARV ka-2010 lithiuba elichanekileyo lokuba urhulumenteaveze

iindidaniselwanozedosi emiselweyo (fixed-dose combinations) (FDCs).

Njengomthengi wamazwe ngamazwe omkhulu wonyango lwe-antiretroviral,

uMzantsi Afrika kufuneka usebenzise amandla awo okuthenga ngokufuna ukuba

iirejimeni zenziwe zifumaneke ngee-FDCs apho kwenzekayo, okanye ngenye

indlela zifakwe kwipakethe zeeblista ekulula ukuziseebznisa.

Ukufaka kunye kudibanisa onke amachiza kwirejimeni kwipakethe yeblista

enye. Iirejimeni kufuneka zipakishwe kwiipakethe zekhalenda eziphakamisa

ubambelelo, ezifanayo nezo zisetyenziswa kwizicwangcisi ezithathwa ngomlomo.

Oku kunokufuna ukuba iinkampani zoosinga machiza zisebenzisane ekupakisheni

amachiza azo.

Indibaniselwano yedosi emiselweyo neerejimeni ezifakiweyo ziyakwehlsia

umthwalo kubasebenzi bokhathalelo lwempilo. Ziyakwenza lula ulawulo lonikezo

kunye namakhonco okufumana kwiSebe lezeMpilo, ngokunjalo. Ukufaka kunye

kwakhona kunokwehlisa imiqobo, ingakumbi kwizibonelelo zasemaphandleni,

okubangwa kukunqongophala kweekhemisti. UmThetho neMimiselo yeeKhemisti

uvumela ukuba umncedisi kaSokhemisti odlulileyo kwisiseko kwisibonelo sempilo

esisiseko sikarhulumente okanye nasiphi na isibonelelo esivunywe liBhunga

leeKhemisti, akhuphe amayeza phantsi kokonganyelwa okungangqalanga. Oku

kunokwenzeka ngaphandle kokuba amayeza akwiipakete zesigulane esele zilungile

apakishiwe kwakhona kulungiselelwa le njongo esibhedlele okanye kwindawo

yephondo ehlala amayeza.

Jonga kwiphepha le-10 ngokungaphaya ngethenda ye-ARV ka-2010.

Umthombo: SANAC Technical Task Team on Treatment, Care and Support, ‘Building the Capacity of

the Primary Health Care System for HIV/AIDS Diagnosis, Care and Treatment in EMzantsi Afrika’,

May 2009; S. Bangalore et al., ‘Fixed-Dose Combinations Improve Medication Compliance: A Meta-

Analysis’, The American Journal of Medicine (2007) 120, 713-719

IZIKHOKELO EZINTSHA

NETHENDA

7


UFIKELELO

8

Sithelekiswa njani

kwihlabathi xa lilonke?

E-Brazil

Abemi: 198,739,269 (2009)

I-avareji yeminyaka ekulindeleke

ukuba umntu ayiphile ukusukela

ekuzalweni: Amadoda 68,

AbaseTyhini 76 (2009)

Inani labantu abaphila ne- HIV/AIDS:

730 000 (2007)

Qaphela: Ixabiso lolu thelekiso

lunyiniwe ngenxa yokuba

ayololonyaka omnye lonke

kunye nakumthombo omnye.

Kuzo zonke izehlo sisebenzise

iingqikelelo zakutsha nje

esizifumene kwimithombo

ethembekileyo.

Brazil

Botswana

EBotswana

Abemi: 1,990,876 (2009)

I-avareji yeminyaka ekulindeleke

ukuba umntu ayiphile ukusukela

ekuzalweni: Amadoda 62,

AbaseTyhini 62 (2009)

Inani labantu abaphila ne-HIV/AIDS:

300,000 (2007)

Ingqikelelo yobukho jikelele be-HIV kubantu abadala:

South Africa

India

Russia

EMzantsi Afrika

Abemi: 49,052,489 (2009)

I-avareji yeminyaka ekulindeleke

ukuba umntu ayiphile ukusukela

ekuzalweni: Amadoda 50,

AbaseTyhini 48 (2009)

Inani labantu abaphila ne-HIV/AIDS:

5.2 Million (2008)

E-Russia

Abemi: 140,041,247 (2009)

I-avareji yeminyaka ekulindeleke

ukuba umntu ayiphile ukusukela

ekuzalweni: Amadoda 59, AbaseTyhini

73 (2009)

Inani labantu abaphila ne-HIV/AIDS:

940,000 (2009)

E-Indiya

Abemi: 1,156,897,766 (2009)

I-avareji yeminyaka ekulindeleke ukuba

umntu ayiphile ukusukela ekuzalweni:

Amadoda 65, AbaseTyhini 67 (2009)

Inani labantu abaphila ne-HIV/AIDS: 2.4

Million (2007)

0.6% (2007)

23.9% (2007)

18.1% (2009)

0.3% (2007)

1.1% (2009)


Ufikelelo kwi-ART (ipesenti yabo bafuna i-ART kwaye beyifumana):

Brazil

Botswana

South Africa

India

Russia

Inani labantu abafuna i-ART:

80% (2007)

79% (2007)

28% (2007)

Insufficient data

16% (2007)

Ufikelelo kwi-PMTCT (uthintelo losulelo olusuka kumama lusiya emntwaneni):

Brazil

Botswana

South Africa

India

Russia

Brazil

Siphi ngoku

Botswana

South Africa

India

Russia

230,000 (2007)

120,000 (2007)

1.7 million (2007)

Insufficient data

190,000 (2007)

UMzantsi Afrika uneyona nkqubo yecandelo likarhulumente ye-ART enkulu ehlabathini

kodwa okwangoku unceda kuphela isiqingatha sabantu abafuna unyango. Okwangoku

bamalunga nama-900,000 abantu abakwi-ART leyo urhulumente aneenjongo zokuyonysa

iye kwisigidi esi-1 ngasekupheleni kukaJuni. Kuqikelelwa ukuba ngabantu abazizigidi ezi-2

okwangoku abafuna unyango. Urhulumente ujolise ekubeni aliphinde kabini inani labantu

abafumana unyango kulo nyaka uzayo oko kusenziwa ngokuphunyezwa kwezikhokelo

zonyango ezihlaziyiweyo kunye nephulu lokuCetyiswa nokuVavanyelwa i- HIV.

Inani labantu abanofikelelo kwi-ART:

Brazil

Botswana

South Africa

India

Russia

181,000 (2007)

93,000 (2007)

460,000 (2007)

158,000 (2007)

31,000 (2007)

72% (2007)

95% (2008)

76% (2007)

10% (2006)

87% (2006)

Imithombo: UNAIDS/WHO Global

HIV/AIDS online database – Country

Epidemiological Fact Sheets on HIV/

AIDS and Sexually Transmitted

Infections; World Health Statistics 2009

report; avert.org; World Bank. Statistics

compiled by Catherine Karlsson.

UFIKELELO

9


IZIKHOKELO EZINTSHA

NETHENDA

10

Ingaba siyakuwafumana amayeza esiwafunayo?

ITHENDA:

Imiqobo ephakathi kwakho nonyango olungcono

UMzantsi Afrika unangaphezulu kwezigidi ezihlanu zabantu

abaphila ne-HIV kwaye kuqikelelwa ukuba izigidi ezibinoi

zabantu okwangoku zifuna unyango.

Ilizwe lineyona nkqubo inkulu ye-antiretroviral (ARV)

ehlabathini - malunga nama-900 000 abantu abafumana

unyango kwicandelo likarhulumente. Eli nani kufuneka

liphindeke kabini uke lihlangabezane nama-80% ekujolise

Ifoto ngu-Oupa Nkosi/Mail & Guardian

Ngu-Catherine Tomlinson

kuwo onyango lwe-HIV & AIDS kunye noYkilo

weSizcwangciso loMzantsi Afrika (2007-2011).

Xa kunikwa isikeyile senkqubo yonyango, ngokunjalo

nemfuno engxamisekileyo yokonyusa inani labantu abafumana

unyango, uMzantsi Afrika kufuneka wenze konke onako

ukuyenza ukukhusela ufikelelo kumachiza afikelelekayo.

Kufuneka kwakhona siphucule ubulunga bamachiza ethu

ukuze kwehle iziphumo ebezingalindelekanga kunye nemfuno

yokutshintsha unyango. Njengomthengi omkhulu kumazwe

ngamazwe wonyango lwe-antiretroviral (ART), uMzantsi


Afrika kufuneka usebenzise amandla awo okuthenga ukuba

ufumane amaxabiso asezantsi ngokunjalo nokuphucula

iirejimeni nokufuma iindibaniselwano ekulula ukuzisebenzisa

kunye neerejimeni ezifakwe kunye.

Ithenda yangoku yonyango lwe-HIV yayikhutshwe ngo-2008

kwaye izakuphelelwa ngoMeyi 2010. Inkqubo yethenda

yangaphambili yaye yagxekwa ngenxa yokuswela kwayo

ukuvuleleka yaziwe kunye nothabatho nxaxheba. Imibutho

yasekuhlaleni izibandakanya nethenda ezayo oko ikwenza

ngeQumrhu eliHlola uHlahlo lwaBiwo-Mali neNkcitho

(Budget and Expenditure Monitoring Forum) (BEMF)

ohlangansia kunye abo basebenzisanayo kuqukwa neengcali

zomthetho, abezonyango, abezoqoqosho, abo baphanda

ngeziso kunye nemanyano yabasebenzi namatsha-ntliziyo

asekuhlaleni. Amaxwebhu avela kwi-BEMF ayafumaneka kuhttp://www.tac.org.za/community/BEMF

ISebe lezeMpilo leSizwe liphuhlisa ithenda ye-antiretroviral

ezayo lidibene ne-Clinton Foundation HIV/AIDS

Initiative (CHAI). I-CHAI isebenza noorhulumente kunye

neenkampani zoxubo-mayeza nezoosinga machiza zamazwe

ngamazwe zisenza uthethathethwano lokuba kwehliswe

amaxabiso ee-ART.

I-CHAI yenze inani lezindululo kwiSebe lezeMpilo leSizwe

ngeendlela zokuphucula iirejimeni zonyango kunye neendleko

zolawulo kwithenda ezayo. Ithenda ye-antiretroviral kufuneka

ingeniswe kwaye ivunywe nguNondyebo weSizwe phambi

kokuba yaziswe uwonke-wonke ukuba abhide.

Inqaku ekungavisiswana ngalo lelokuba ingaba ubhido

kufuneka luvulelwe iinkampani zoMzantsi Afrika

kuphela na ukuba ubhido lwazo luyafikeleleka. Kujongwa

impucuko yezityalo eziveliswa ekhaya kunye nesabelo sazo

esinokuthelekelelwa kwimarike, ezi nkampani kufuneka

zikwazi ukukhuphisana kumazwe ngamazwe.

Ngexa uninzi lwamachiza e-antiretroviral ithengwa ngethenda

karhulumente eyenziwa apha ekhaya, ixabiso loosinga machiza

kakhulu lingenxa yexabiso lawo lezithako zoxubo mayeza

ezisebenzayo (APIs), jikelele ezivela phesheya. Ukuqinisekisa

ukuba uMzantsi Afrika ungazisebenzisela ithuba lamaxabiso

amazwe ngamazwe elinokufikeleleka ngexesha lonke lethenda,

ithenda kufuneka ifune iinkampani ezithengisa imveliso

egqityiweyo ukuba zehlise amaxabiso azo zokwenza oko

zisabela kutshintsho lwemarike olwehlisa iindleko zee-APIs.

Kulandela izibhengezo zikaMongameli Jacob Zuma zoSuku

lwe-AIDS lweHlabathi luka – 2009, iSebe lezeMpilo leSizwe

liye lahlaziya izikhokelo zalo zonyango lwe-HIV/AIDS. Oku

bekuyimfuneko ekufumaneni iirejimeni ezintsha nezingcono

oko kusenziwa ngethenda ezayo. Imiqobo emininzi yokufuma

ezi rejimeni koko isahleli (jonga kwibhokisi esekunene).

Imiba engundoqo yethenda

Iindibaniselwano zedosi emiselweyo (Fixed-dose

combinations) (FDCs) kunye nokufakwe kuzo

Urhulumente kufuneka asebenzise ithenda ezayo ukuphucula kunye

nokwenza lula iirejimeni zonyango. Ukwenza oku kubalulekile ukuba

urhulumente athenge ii-FDCs nanini na xa ziofumaneka. Xa zingafumaneki

ii-FDCs urhulumente makathenge iipakethe ezidibanisa onke amachiza

erejimeni zibe yiblista enye ekulula ukuyisebenzisa (Jonga kwiphepha

lesi-7 ngokungaphaya.)

Tenofovir (TDF)

Inani leenguqulelo zoosinga tenofovir, kuquka neendibaniselwano zedosi

emiselweyo esekelwe kwi-tenofovir zisalindele ukubhaliswa liBhunga

eliLawula amaYeza (Medicines Control Council) (MCC). I-MCC kufuneka

ikhawulezise ukubhaliswa kwala machiza. (Jonga kwiphepha lesi-2

ngokungaphaya.)

Abacavir (ABC)

Iinguqulelo ezingosinga abacavir, kuqukwa neendibaniselwano

zabantwana ze-ABC/lamivudine, zisalindele ukubhaliswa yi-MCC. I-MCC

kufuneka ikhawulezise ukubhaliswa kwala machiza.

Lopinovir/Ritonavir (LPV/r)

Iipilisi ze-heat stable paediatric LPV/r zisalindele ukubhaliswa yi-MCC.

Ubukho bechiza buyimfuneko ekuphunyezweni kwezikhokelo zonyango

ezihlaziyiweyo. I-MCC kufuneka ikhawulezise ukubhaliswa kweli chiza.

(Jonga kwiphepha lama-20 ngokuthe vetshe kwi-ABC ne-LPV/r.)

Kule minyaka idlulileyo sibone ukuzibophelela

ngokwezopolitiko okunyukayo ekuphuculweni

konyango olusekelwe kubungqina, uthintelo

nokhathalelo lwe-HIV. Urhulumente uphinde

wazibophelela kwakhona ekuhlangabezaneni nojoliso

loYilo weSicwangciso seSizwe (National Strategic

Plan) (NSP), wolula uhlahlo lwabiwo-mali lwe-HIV

kwaye uhlaziya ekwaphucula izizikhokelo zonyango.

Ukufumana ilungelo lethenda ye-ARV kuyimfuneko

ukuba olu tshintsho kufuneka luphunyezwe

ngokufanelekileyo. Urhulumente makasebenzise

eli thuba aphucule izibonelelo enze lula unyango

nokhathalelo lwezigulane kunye nabasebenzi

bokhathalelo lwempilo.

Ifoto ngu-David Harrison

Ifoto ngu-Delwyn Verasamy/

Mail & Guardian

Umntu osayina amaxwebhu ambalwa angenza

umahluko wokuba ingaba kufanele uhlale

uhlutshwa sisiphumo ebesingalindelekanga

na okanye hayi, okanye mhlawumbi uthatha

iipilisi ezintathu ngemini okanye enye.

11


12

Umqobo we-MCC

UMzantsi Afrika ujongene nomqobo ongundoqo

ekuphuculeni iirejimeni zonyango – ubhaliso olusezantsi

lwamachiza olwenziwa liBhunga eliLawula amaYeza

(Medicines Control Council) (MCC). Amachiza

amaninzi ayimfuneko kwizikhokelo esitsha zonyango

awakavunywa yi-MCC, ingakumbi indibaniselwano

yedosi emiselweyo ( fixed-dose combinations) (FDCs)

kunye nemixube yabantwana.

UMbutho wabezoNyango we-HIV wamaZantsi

e-Afrika (HIV Clinicians Society of Southern Africa)

uye wacela i-MCC ukuba ikhawulezise ukubhaliswa

kwenani lamachiza e-antiretroviral phambi kokuba ibe

iyagqitywa ithenda, ingakumbi iindibaniselwano zedosi

ezimiselweyo ezisekelwe kwi-tenofovir (TDF) (-based

fixed-dose combinations) ngokunjalo neendibaniselwano

ze-abacavir/lamivudine (ABC/3TC) kunye ne-lopinavir/

ritonavir (LPV/r) engumxube wabantwana.

Ukuba ngaba imiqobo ye-MCC ayisonjululwa

kwangexesha, ithenda kufuneka ivumele ukuthengwa

kwamayeza angekabhaliswa yi-MCC okwangoku. La

machiza kufanele ukuba sele ebhalisiweyo yimibutho

elawulayo yamazwe ngamazwe efana noLawulo lokuTya

namaChiza (Food and Drug Administration) (FDA)

eMelila. La machiza kufuneka ubhaliso lwawo kwanoba

lukhawuleziswe eMzantsi Afrika.

Umfanekiso ngu-

Brice Reignier


Intlekele yase-Edendale

NgoMeyi 2009 isibhedlele sase-Edendale eMgungundlovu saye

sayeka ukuqalisa izigulane ezitsha ezine-HIV kunyango lweantiretroviral.

NgoJulayi kwakusele kukhona abantu abaninzi

abamalunga nama-2,000 ababesekuluhlu lokulindela unyango.

Oogqirha nabongikazi baxelela abeendaba ukuba kusweleka

izigulane veki nganye.

Esinye isizathu sokungaqalisi ezinye izigulane kunyango

yayiyikukunqongophala koogqirha kunye noosokhemisti

esibhedlele. Oogqirha baxelela abeendaba ukuba bazise

amagosa empilo esithili ngeengxaki ezo ukusukela

ngoNovemba 2008.

Ngowe-16 Julayi 2009 i-TAC eMgungundlovu kunye

nemibutho ebambisene nayo baye balungiselela uqhankqalazo

ekwakuze kulo ngaphezulu kwama-700 abantu. Isiqulo

soqhankqalazo sasi sesi ‘ULUHLU LOKULINDELA =

UKUFA’. Ujoliso yayisisimo sesiBhedlele sase-Edendale,

ukunqongophala kwendawo yokuqhubela inkqubo ye-ARV

ngokusebenzayo kunye nokunqongophala kwabasebenzi

kwizibonelelo zikarhulumente. Uqhankqalazo lwenzeka

emva kosuku ekwakubanjwe ngawo umthandazo ubanjelwa

abo baswelekileyo ngenxa yokunqongophala konyango.

Asazi ukuba ngabantu abangaphi ngqo

abasweleka ngenxa yonqongophalo

e-Edendale.

Ngu-Ntombizonke Ndlovu

Ekugqibeleni, ngenxa yemisebenzi

ye-TAC, eminye imibutho eyahlukeneyo

kunye nabeendaba, saye sasonjululwa

isimo. NgoJulayo ka-2009 i-MEC

yezeMpilo yaKwazulu-Natal, uGqirha

Sibongiseni Dhlomo,waye wasusa

uMphathi wezeMpilo weSithili , u-May

Zuma-Mkhonza owayesohluleka

kukulawula ukukhutshwa kwee-ARV

kwisibhedlele sase-Edendale. Kwaye

kwavakala kwakhona ukuba uZuma-

Ifoto ngu-Ntombizonke Ndlovu

Mkhonza waye wala isithembiso esivela

kubanikeli bamazwe ngamazwe sokuncedisa ekuhlawuleni

oogqirha kunye noosokhemisti abangaphaya esibhedlele.

“Ingaba kwakufanele ukuba ide iyokufikelela apho? Ngubani

ekufuneka athathe uxanduva lwako konke oko kusweleka

koobhuthi noosisi bethu, oomama nootata bethu kunye

nabantwana bethu abaswelekayo?” – incwadana yamalungu

ye-TAC eMgungundlovu ka-2009.

Ifoto ngu-Ntombizonke Ndlovu

UFIKELELO

13


UFIKELELO

14

Ifoto ngu-Eric Miller, courtesy MSF

ufikelelo kumayeza ayim

1959

Kwi-

Democratic

Republic of

Congo

Isehlo sokuqala

esaziwa njenge-

HIV siyehla.

2002

EMzantsi Afrika

i-TAC ne-MSF babhengeza

ukuba bangenisa elizweni

oosinga machiza abavela e-Brazil

kwinkqubo yabo ye-ARV. Oku

kungathobeli

kuvumela

iprojekithi

elingwayo

ye-ARV

eKhayelitsha.

2002

EMzantsi Afrika

Amatsha-ntliziyo abeka ityala

uMphathiswa wezeMpilo uManto

Tshabalala-Msimang kunye

noMphathiswa wezoRhwebo

noShishino u-Alec Erwin ngokubulala

ngaphandle kokufuna ukwenza njalo

ngama-600 abeMi boMzantsi Afrika

abasweleka yonke imihla ngnxa

yokunqongophala kufikelo

lonyango. Oku kwenza

inxenye yephulo le-TAC’s

‘lokuSwelekela

unyango.

1986

Kwihlabathi

Jikelele

I-retrovirus

ngaphambili

ebisaziwa

njengonobangela

we-AIDS

ngokusemthethweni

ibizwa njenge-HIV.

2002

EBotswana

Inkqubo

yokuqala

yonyango

lwe-HIV

e-Afrika

iyaziswa.

1987

EMelika

I-Zidovudine (AZT)

iba lichiza lokuqala

elivunywayo

kunyengo lwe-HIV

ngexabiso lama-

R30,000 ngomntu

ngonyaka. I-AZT

ayiyi kufumaneka

eMzantsi Afrika de

ibe ngu- 1999.

1987

EMelika

I-AIDS Coalition to

Unleash Power (ACT UP)

iyasekwa ukuba ixhase

unyango olungcono kunye

nemigaqo-nkqubo yabantu

abaphila ne-HIV.

Photo from blog.dragonballyee.com

2001

E-Qatar

IsiBhengezo sase-Doha (Doha

Declaration is) siyaziswa. Esi

sivumelwano sitsha kwi- TRIPS

sicacisa ukuba oorhulumente

bayakungawathathi njani nanini

amalungelo omenzi. Ukungenisa

elizweni okunxuseneyo (ukungenisa

oosinga machiza abavela kwamanye

amazwe elizweni) kunika amazwe

anengeniso encinane ulawulo

olukhulu lwemiqathango yonyango

kubemi balo. UMphathiswa

wezeMpilo waseMzantsi Afrika u

Manto Tshabalala- Msimang, uyala

ukusebenzisa i-Doha ukuze afumane

unyango olufikelelakayo olungaphaya.

2002

EMzantsi Afrika

Ngenxa yoxinzelelo

loluntu kunye

nolwamazwe

ngamazwe,

urhulumente uveza

inkqubo yakhe

yonyango lwe-ARV

phantsi koYilo

lokuSebenza loNyango

oluBanzi kunye

noKhathalelo lwe-HIV/

AIDS.

1989

KwiHlabathi Jikelele

Ixabiso le-AZT lehla

ngama-20%, kulandela

iminyaka emibini

yoqhankqalazo lwe- ACT

UP. Unyango luxabisa

ama-R24,000 ngomntu

ngamnye ngonyaka —

lusabiza kakhulu kuninzi

lwabo baphila ne-HIV.

2001

EMzantsi Afrika

Inkundla igweba

ngecala le-Treatment

Action Campaign

kwi-TAC vs

uRhulumente, iyalela

urhulumente ukuba

enze kufumaneke

i-nevirapine

kwabasetyhini

abakhulelweyo abane-

HIV njengenxenye

yenkqqubo yosulelo

olusuka kumama lusiya

emntwaneni (prevention

of mother-to-child

transmission) (PMTCT).

Ifoto ngu-Eric M

2004

e-Indiya

Umbutho woLawulo lwe-AIDS

weSizwe (National AIDS Control

Organization) (NACO), ebambisene

norhulumente, uyaqala ukubonelela

ngee-ARVs simahla.

Ifoto yi-International Federation of the Red Cross


funeko kwixesha le-hIV

1994

E-Uruguay

Isivumelwano samazwe ngamazwe ekuthiwa yi-Trade

Related Aspects of Intellectual Property Rights

(TRIPS) siyayilwa, esichaphazela onke amazwe

angamalungu oMbutho woRhwebo weHlabathi.

Esi sivumelwano sifuna ukuba amazwe athobele

umthetho welungelo lomenzi – oko kumisela umda

kwinani lamachiza akhuphisanayo emarikeni, loo nto

ke igcine amaxabiso wephezulu. Ukusukela ekubeni

unyango lomgca wokuqala nolomgca wesibini

lusabonelelwa ngamalungelo abenzi, luhlala lubiza

kakhulu kwaye lufumaneka kakhulu kumazwe

anengeniso ephezulu. Amazwe anengeniso

ephakathi kunye nesezantsi aye anyanzeleke ukuba

alinde kude kuphelelwe imihla yamalungelo abenzi,

okanye ade amachiza anebrendi ehlise amaxabiso

ngokuhamba kwexesha.

iller, courtesy MSF

1998

EMzantsi Afrika

I-Treatment Action

Campaign (TAC)

iyasekwa ukuze ifune

inkxaso yofikelelo

olukhulu kunyango

lwe-HIV lwabo bonke

abantu baseMzantsi

Afrika.

2005

Kwihlabathi jikelele

Ilungelo lomenzi

le-AZT’liyaphelelwa,

okokuvunyelwa

iinguqulelo ezininzi

zoosinga machiza.

Ichiza liyafumaneka

ngama-R670 ngomntu

ngamnye ngonyaka,

libiza ngaphantsi ngama-

20% kunenguqulelo

enelungelo lomenzi

kunye nasezantsi

ngama-87% kunexabiso

lakuqala.

2006

EMelika (United

States)

I-Atripla, ipilisi

yokuqala enye,

indibaniselwano

yedosi emiselweyo

yakanye ngemini

kusetyenziswa

unyango

lwendibaniselwano

yamachiza

amathathu,

ivunyiwe.

1997

E-Brazil

I-Brazil iphumeza ukunikwa

kwemvume yamachiza

okunyanzelekileyo, oko

okuvumela abenzi ukuba

bavelise iinguqulelo

ezingoosinga machiza

zamachiza anamalungelo

abenzi. Ngokungawahoyi

amalungelo omenzi,

amaxabiso ehla kakhulu

kwaye ufikelelo kunyango

lwenyuke. UMzantsi Afrika

zange uke unyanzelise

imvume enyanzelekileyo.

1994

EMelika

I-AZT esetyenziswa ngabasetyhini

abakhulelwe kufumaniseka

ukuba ilwehlisa ngama-70%

usulelo olusuka kumama lusiya

emntwaneni.

Ifoto ngu-Talia Frenkel/American Red Cross 1994

EMelika

Unyango oluSebenza ngamandla

kaKhulu lwe-Antiretroviral (Highly

Active Antiretroviral Therapy)

(HAART), olunendibaniselwano

yee-ARVs ezininzi luyayilwa. Le

indlela yonyango olunamandla ibiza

ama-R36,000-R55,000 ngomntu

ngamnye ngonyaka. I-HAART

ayiyikufumaneka eMzantsi Afrika de

ibe ngu-2004.

2007

E-Thailand

Urthulumente

wase-Thai

ukhupha iimvume

ezinqumamisa

amalungelo abenzi

kumayeza abizayo

nayimfuneko,

evumela

ukungeniswa

elizweni koosinga

machiza be-ARVs.

1996

EMelika

I-Post-exposure prophylaxis

(PEP), ikhosi emfutshane

yamachiza e-ARV, kwenziwa

isincomo sayo ekwehliseni

ingozi yosulelo lweHIV emva

kokungakhuseleki okunengozi

kakhulu kwizibonelelo

zokhathalelo lwempilo, oko

kusehlisa usulelo ngama-79%.

I-PEP ayiyikufumaneka eMzantsi

Afrika de ibe ngu-2002.

Ifoto nguMalusi Mbatha

2007

EMzantsi Afrika

Uyilo lweSicwangciso

seSizwe se-HIV/AIDS and

STIs (NSP) iyaziswa, lujolise

ukubeka ama-80% abantu

abafuna unyango kwii-ARVs

ngo-2011.

1996

E-Brazil

Inkqubo yokuqala

yesizwe esimahla ye-ARV

iyaziswa ngurhulumente

onengeniso esezantsi.

2010

EMzantsi Afrika

Ngaphandle kwenkqubela

enkulu eyenziwe

kwiminyaka engama-20

edlulileyo, ngaphantsi

kwesiqingatha sabo baphila

ne-HIV bafuna unyango

abanofikelelo kulo.

15


IMFUNO YAMACHIZA

AMATSHA

uxhathiso

kwichiza

16

Ngu-Marcus Low

kunye nawe

Ifoto ngu-David Chancellor/International Federation of the Red Cross

Yintoni uxhathiso?

Uxhathiso kwichiza kwenzeka xa iyeza elithile,okanye

indibaniselwano yamayeza, engasenako ukucinezela

okanye ukuphilisa isifo. Kuthetha ukuba isifo

sitshintshile emzimbeni wakho ngendlela yokuba lide

liyeke ukusebenza iyeza. Le yinto eyenzekayo xa abantu

bane-HIV betshintsha kunyango lwe- antiretroviral

therapy (ART) lomgca wokuqala besiya kunyango

lwe-ART lomgca wesibini kuba unyango lwe-ART

yomgca wokuqala lungasasebenzi.

Njegokuba i-HIV isosulela iiseli ezintsha iphinde iziveze

kwakhona emizimbeni yethu, iyaguquka (iyatshintsha).

I-HIV iguquka ngokukhawuleza kuba inezinga eliphezulu

lokuziphinda (yenza iikopi zayo ngokukhawuleza) kwaye

ayinayo indlela ‘yokujonga kwakhona’ – oku kuthetha

ukuba xa iikopi ezintsha ze-HIV zisenziwa emzimbeni

wakho, akukho ukukhangela ukuba ingaba i-HIV entsha

ifana ngqo neyangaphambili. Ngenxa yoku ukuziguqula

kwenzeka ngokupheleleyo ngethuba – okunye kuhle,

okunye kubi, kwaye okunye akwenzi mahluko.

Ukuba, ngethuba okunye ukuziguqula kuyaxhathisa

kumayeza akho, uhlobo loxhathiso lwe-HIV

luyakuphindaphindeka kuba lungcono ekulweni

unyango kunezinye iintlobo ze-HIV emzimbeni wakho

olungenako oko kuziguqula. Njengoko oku kuziguqula

kuvela ngobuninzi, amayeza ngqo owathathayo aye

angasasebenza kakhulu.

Yiloo nto ke kufuneka sithathe indibaniselwano

yee-antiretrovirals ezintathu ezohlukeneyo ukugcina

intsholongwane iphantsi kolawulo. Ukuba ngaba

iyaziguqula intsholongwane ukuze icinezele elinye

lamachiza, amanye amabini asenokuyithintela ukuba

izitshintshe kwaye iphindaphindeke.


Igrafu A:Amanqanaba echiza

noxhathiso

Inqanaba ekujoliswe kulo lechiza kufuneka

libengaphezulu kwe-MEC ukuphepha uxhathiso

kwaye lingabi phezulu kakhulu ukude libange

iziphumo ebezingalindelekanga.

MEC

Idosi

Ingozi enyukileyo yeziphumo ebezingalindelekanga

Idosi

Idosi

MEC = Minimum Effective Concentration

(UbuNcinane beNgxinano eSebenzayo)

Idosi

Igrafu B: Amanqanaba echiza

noxhathiso

Ukuba ngaba uphosa idosi okanye ushiywe lixesha

amanqanaba echiza anokwehla aye kwinqanaba

apho kungenzeka khona uxhathiso

MEC

Ingozi enyukileyo yoxhathiso Ingozi enyukileyo yoxhathiso

luvela njani uxhathiso

Ukuze ucinezele i-HIV, umthamo wee-antiretrovirals

emzimbeni wakho kufuneka ugcinwe kwinqanaba

elichanekileyo. Ukuba ngaba amanqanaba aphezulu

kakhulu, kuvulwa iingcango zokuba kuvele uxhathiso.

Igrafu A ibonisa amanqanaba echiza emzimbeni

wakho ukuba ngaba uthtaha iyeza ngqo qho kwiiyure

ezingama-24. Qaphela ukuba lihala lisendaweni

echanekileyo njani inqanaba lechiza.

Igrafu B ibonisa ukuba ukuba kwenzeka ntoni ukuba

ngaba uphosa idosi enye yechiza ebekufanele ukuba

uyithathe qho kwiiyure ezingama-24. Qaphela ukuba

inqanaba lexchiza lehla kanjani kwindawo apho

usengozini yokuvela uxhathiso.

oonobangela basekuhaleni boxhathiso

Xa iikliniki ziphelelwa ngamayeza kwaye abantu

abane-HIV- bejikiswa, bonke abo bantu basengozini

yokuvela uxhathiso. Ngoko ke, unikezo lwamayeza

oluthembekileyo lubaluleke kakhulu ekugcineni

uxhathiso luphantsi kuluntu lwethu.

Koko, ukulawula uxhathiso akukho malunga nokuba

kufumaneke amachiza kwiikliniki kuphela. Kumalunga

nokuba abantu abane-HIV bathathe ii-ART xa kufuneka

bekwenzile oko. Xa kuziwa kwiinkqubo zonyango

ezinempumelelo, ufikelelo kunyango kuphela

sisiqingatha sebali – ubambelelo oluchanekileyo

kunyango sesinye.

Idosi Idosi Idosi Idosi Idosi

ephosiweyo ethathwe

emva

kwexesha

Imifanekiso isekelwe kwiigrafu ezivela kwi-iBase

Ivela njani i-TB exhathisayo kumachiza

Uxhathisa kumachiza yingxaki enzima kakhulu ingakumbi xa kuziwa kwi-TB.

Iintlobo ezigqithisileyo ze-TB exhathisayo kumachiza kunzima ukuzinyanga.

Njengonyango lwe-HIV, uxhathiso kunyango lwe-TB kuye kuvele ngenxa

yokuphazamiseka konyango. Ngamachiza e-TB oku kuhlala kusenzeka ngenxa

yokuba abantu bayayeka ukuthatha amayeza abo xa beziva bengcono. Nangona

beziva bengcono, i-TB mycobacterium kusenokwenzeka ukuba isasebenza

emizimbeni yabo ize iziguqule ibe luhlobo oluxhathisayo.

Zimbini iindlela zokufumana i-TB exhathisayo kumachiza: 1.Ukuba ngaba

uyifumana komnye umntu kunye nokuba 2.Ukuba ngaba ivela emzimbeni

wakho. Uhlobo lokuqala singazama ukululawula sisebenzisa amanyathelo

okulawula usulelo njengokuqinisekisa ukuba sinendawo engena umoya

kakuhle nokuba siphi na. Olwesibini uhlobo sinokuluphepha ngokuthatha

amayeza ethu e- TB njengoko emiselwe, nokuba sele siziva ngcono.

Ungacinga nge-HIV njengenyoka. Kufuneka

ube namatye anzima amathathu okuyicinezela

phantsi le nyoka. Uxhathiso luyavela kufana

nokube ingathi unamatye amabini lilitye

elinye nenyoka ke ezinokuphuncuka. Ukuba

ngaba uthatha ii- antiretrovirals zakho emva

kwexesah kufana nokungathi uwaphakamisa

kancinane la matye. Uxhathiso lufana nenyoka

efunda ukuba ingazikhulula njani na.

IMFUNO YAMACHIZA

AMATSHA

17


IMFUNO YAMACHIZA

AMATSHA

18

Ingxaki ngonyango lomgca

wesibini nomgca wesithathu

Njengoko abantu abaninzi bechitha ixesha elininzi kunyango

lwe-antiretroviral, sinokulindela ukuba unyango lomgca

wesibini nomgca wesithathu luyakunyuka kwiminyaka ezayo.

Kuba unyango lomgca wesibini nomgca wesithathu lubiza

kakhulu kunonyango lomgca wokuqala, oku kungenzeka

ukuba kukhokelele kwiingxaki ezinzima zenkxaso.

Kubalulekile ke ngoko ukuba sikhankase kwangaphambili

siqinisekise ukuba unyango olunobulunga lomgca wesibini,

nomgca wesithathu nolulandelayo luyafikeleleka kwaye

luyafumaneka kwinkqubo yempilo karhulumente.

Alpha Mlondobozi

Ifoto ngu-Adam Malapa

Ukuhlala ngoloyiko

U-Adam Malapa uye wadlana indlebe no-Alpha

Mlondobozi oxhathisayo kunyango lwe-antiretroviral

yomgca wokuqala kwaye okwangoku ekwirejimeni

omgca wesibini.

U-Alpha Mlondobozi uneminyaka engama-43

yobudala. Uhlala e-Bridgeway, ngaphandle nje

kwedolophu yase-Tzaneen kwiPhondo laseLimpopo.

Unonyana oneminyaka engama-24 kwaye ube ne-HIV

ukusukela ngo-2000.

Wathi akufumanisa isimo sakhe se-HIV u-Alpha

woya kakhulu. Awayekwazi nje yayikukuba i-HIV

ayinayngeki kwaye wayecinga ukuba umntu

uyafa msinyane nje awukwazi ngesimo sakhe.

Ngecandelo labucala waye waqala ngoko nangoko

unyango lwe-antiretroviral (ART). U-Alpha

zange afumane kucetyiswa ngendela ezisebezna

ngayo ii-antiretrovirals (ARVs), okanye nakuphi

na ukucetyiselwa ukubambelela kumachiza.

Ngamanye amaxesha unyango lwakhe wayeluthatha

emva kwexesha ngeeyure ezimbalwa kuze okuke

kumtatazelise kuba ugqirha wamxelela ukuba

kufuneka awathathe ngexesha amayeza akhe.

U-Alpha swaqala ngerejimeni ye-stavudine (d4t),

lamivudine (3TC) ne-efivarenz (EFV). Wayephathwa

lurhudo olungamandla rhoqo kwaye egabha.

Indlela ekukuphela kwayo yokulawula ezi ziphumo

bezingalindelekanga yaba kukuba angeniswe

esibhedlele iintsuku ezimbalwa. Wayehlala ephethwe

bubucaphucaphu kwaye eziva ebuthathaka.

Emva kokungaboni bungcono kolu nyango waye

watshintsela kwirejimeni yomgca wesibini. Kweli

tyeli u-Alpha waye wabhalisa kwisibonelelo sempilo

sikarhulumente. Waya kwizifundo zonyango

kunye nakwiiseshoni zokubamabelela kunyango

kwiSibhedlele iLetaba apho waye wazuza ulwazi

oluninzi malunga ne-HIV kunye nokuba kubaluleke

kanjani na ukuthatha unyango lwakho. Emva

kweenyanga ezimbalwa ekunyango lomgca wesibini

kwaye kwabakhona utshintsho olungundoqo

empilweni yakhe. Waye waqala ukufumana amandla

akhe kwakhona waze wazimanya namaqela enkxaso

esibhedlele, apho waye wabelana namava akhe

kunye nezinye izigulane ezine-HIV.

Ku-Alpha, unyango lomgca wesibini lelona

themba lakhe lokugqibela kwicandelo lempilo

likarhulumente. Nangona unyango lunceda,

akakwazi ukukuqhela ukukrakra kwamanye

amachiza, umzekelo i-didanosine (ddI), ethathwa

kanye ngemini ungekatyi. Iyipilisi enzima ukuba

uyiginye kuba inkulu kakhulu. Mhlawumbi

ungayinyibilikisa okanye uyihlafune ukuze ukwazi

ukuyiginya. “Andikwazi ukuyichaza ukuba

ingcamleka njani kodwa imbi,” utshilo u-Alpha.

“Omnye umceli mngeni kum yi-lopinavir/ritonavir

(LPV/r). Kufuneka ndithathe ama-100mg amane

[iipilisi] ukwenza ama- 400mg [engumthamo

olungileyo] obunzima bam. Kum [ezo] ziipilisi

ezininzi kakhulu ngexesha elinye,” uphawule.

“Ngaphambili kwakungcono kuba ndandizithatha

njengeekhapsule, kodwa ngoku ndizithatha

njengeepilisi ekufuneka ndizingcamle, eyinto embi

kakhulu ke leyo kum.”

U-Alpha woyika kwakhona into enokwenzeka kwixa

elizayo ukuba ngaba uvela uxhathiso kwirejimeni

ayesebenzisa ngoku. “Andazi ngenene ukuba yintoni

eza kwenzeka. Ndicinga ukuba umntu uyakuvela

alindele ukusweleka.”


Abantwana

Nee-antiretrovirals

Ngu-Catherine Karlsson

Eyona ndlela isebenzayo yokuthintela usulelo lwe-HIV

ebantwaneni lunyango lwe-PMTCT (prevention of mother-

to-child transmission) (uthintelo losulelo olusuka kumama

luye emntwaneni), kodwa ke kwiimeko apho umntwana

aye wosuleleka ngaphandel kwale mizamo kukho imfuno

emandla yokumnika i-ART. Njengoko iimveki ezine-HIV ziye

zibonakalise iimpawu zezonyango kunyaka wokuqala wobomi

babo uMbutho wezeMpilo weHlabathi wenze isindululo

sokubekwa kunyango kwee-mveku ezinjalo ngoko nangoko

emva kokuzalwa. NgoSuku lwe-AIDS leHlabathi kunyaka

ophelileyo, umongameli Jacob Zuma waye wabhengeza ukuba

uMzantsi Afrika uyakuzilandela ezi zindululo uqala ngo-Aprili

2010.

U-Mark Cotton, umlawuli weYunithi yoPhando

lwezoNyango ngeziFo zabaNtwana ezoSulelayo ( Children’s

Infectious Disease Clinical Research Unit) kwiYunivesiti

yase- Stellenbosch, uthi zimvuyisa kakhulu izikhokelo ezitsha

kuba yinto iingcali zoMzantsi Afrika ebeziyixhasa kule

minyaka mithathu idlulileyo. Isibhengezo sikamongameli

yaba linyathelo eliya kwicala elichanekileyo, kodwa ke imiceli

mngeni isasele xa kuziwa ekinikeni usana kunye nabantwana

i-ART.

U-Cotton uthi ukunqongophala kweendibaniselwano

zamachiza akhethekileyo abantwana kusahleli kungumqobo

ongundoqo.

Ifoto ngu-David Chancellor/International Federation of the Red Cross

Ngaphandle konyango lwe-antiretroviral (ART), ngaphezulu

kwama-30% abantwana abosulelwe yi-HIV abaya kusweleka

phambikokuab bafike kunyaka wabo wokuzalwa wokuqala

kunye namalunga nama-50% phambi kokuba badibanise

iminyaka emibini. Ngonayngo ke, malunga nama-75% ezi

ntsana anokusindiswa.

Njengabantu abadala, intsana nabantwana kufuneka

banyangwe okungenani ngamachiza amathathu awohlukeneyo

ukunyina ingozi yokuvela koxhathiso. Koko, amachiza

kufuneka anikwe ngeedosi ezincinane. Ngaphaya koko,

iinxenye kunye neendibaniselwano zezi dosi kufuneka

zitshintshwe rhoqo njengoko umntwana ekhula. Ukuze

ulinganise iidosi ngokuchanekileyo, ubalo olunononophelo

kufuneka lwenziwe, usebenzisa indlela enzima esekelwe kubude

nakubunzima bomntwana.

Ezi zibalo akulula ukuba zenziwe kwiikliniki zempilo

kwimimandla esemaphandleni kuba zisoloko zingenazo

izixhobo eziyimfuneko, njengezibali, Endaweni yoko

abasebenzi ngezempilo kufuneka bazenze lula izibalo baze

bohluke ii-antiretrovirals (ARVs) zabantu abadala bezohlulela

abantwana. Le ndlela inyusa ingozi yokudosa ngaphezulu

okanye ngaphantsi (Jonga kwiphepha le-17 ngokungaphaya

ngokuba ukudosa ngokungaphantsi kungakhokelela njani

kuxhathiso.) Ukwenza lula ukudosa kunokuba neziphumo

IMFUNO YAMACHIZA

AMATSHA

19


IMFUNO YAMACHIZA

AMATSHA

Sources: Newell, M. et al,

‘Mortality of infected and

uninfected infants born to HIVinfected

mothers in Africa: a

pooled analysis’, The Lancet

364:9441 (2004).

20

ezibi emntwaneni.

Ukudosa ngokungaphezulu

kunokunyusa iziphumo

ebezingalindelekanga

emntwaneni, ngexa ukudosa

ngaphantsi kunokukhokelela

kuxhathiso kwichiza.

Ukudosa kwenziwa nzima

Ifoto ngu-Emily Chastain nangakumbi yinto yokuba

iintsana azikwazi ukuginya

iipilisi. Kuye kufuneka ke ngoko ukuba zilithathe ichiza

ngokohlobo lwesiraphu okanye imigubo. Oku kubanga

iingxaki kuba akwenzeki ukuba bonke abazali bayigcine

efrijini isiraphu okanye ukufumana amanzi okusela okuxuba

umgubo ngawo. Kwakhona, ungcamlo olubi lunokwenza

ukuba umntwana angafuni ukuginya..

Oko kuthiwa yindibaniselwano yedosi emiselweyo ( fixeddose

combinations) (FDCs) oko kuhlanganisa ii-ARVs

eziphindiweyo zibe yipilisi enye kubantwana isanda

Ithenda ye-ARV ka-2010 ARV neeRejimeni

zabaNtwana

Nanjeko uMzantsi Afrika ulungisa i-ART yentsana kunye

nabantwana, kufuneka uqinisekise ufikelelo kunikezo

lwarhoqo lwamachiza abantwana akhuselekileyo, anobulunga

obuphezulu.

Abacavir (ABC)

Umbutho weMpilo weHlabathi unduluile ukusetyenzisa

kwe-ABC kweerejimeni zabantwana zomgca wokuqala.

Amaphononongo abonise ukuba inokusetyenziswa

ngokusebenzayo kwiindawo ezinemithombo enyiniweyo.

Kulandela isikhalazo sokhuphiswano lwekomishini i-TAC

kunye namaqabane, kunye nenani labavelsii boosinga

machiza ngoku banokuthengsia i-ABC. Ufikelo kwi-ABC

onokukwazi ukuyithenga lulityaziswa lubhaliso oluhamba

kancinane lwemveliso ezintsha ze-ABC liBhunga eliLawula

amaYea loMzantsi Afrika (Medicines Control Council) (MCC).

Umbutho wabezamaYeza e- HIV umeme i-MCC ukuba

ikhawulezise ukubhalisa zonke iimveliso ze- ABC kwaye

ingakumbi iindibaniselwano zabantwana ze-ABC/lamivudine.

kuphuhliswa kutsha nje. Kumazwe apho zifumaneka khona ezi

pilisi kulula ke ukuwagcina, ukuwathutha kunye nokuwafaka

amayeza ngoku. Iingozi ezinxulumene nabezonyango zokuba

kohlulwe iipilisi zabantu abadala zisohlulelwa abantwana sele

ziphelisiwe kwezi ndawo. Koko, imixube yabantwana ibiza

kakhulu kunonyango lwabantu abadala. Kaninzi azifikeleleki

kwimimandla efuneka kakhulu kuzo.

Ekuqaleni kulo nyaka, kwinqaku le- Plus News, uGqirha Eric

Goemaere, umlungelelanisi wezonyango waseMzantsi Afrika

kumbutho woogqirha abangamavolontiye i-Médicins Sans

Frontières, waye wavakalisa ukukhathazeka kwakhe ngabantu

abangabanyangiyo abantwana kuba besoyika ukubala iidosi

ngokungachanekanga baze babenze bagule kakhulu. Waye

wamemela unyango lwabantwana ukube lwenziwe lube lula

kubongikazi kwinqanaba lokhathalelo lwempilo elisisiseko

ukuze ukunyanga abantwana kube lula njengokunyanga

abantu abadala.

Kucacile ukuba uphuhliso olungaphaya lweendibaniselwano

zedosi emiselweyo ezingabiziyo kubantwana zifuneka kakhulu.

Lopinovir/Ritonavir (LPV/r)

Phantsi kwezikhokelo ezitsha i-LPV/r isetyenziswa kunyango

lomgca wokuqala kuzo zonke iintsana ezingaphantsi

kweminyaka emi-3. I-LPV/r iyasetyenziswa kwakhona

kwiirejimeni yomgca wesibini kubantwana abangaphezulu

kweminyaka emithathu, kubantwana abafikisayo kunye

nakubantu abadala abangaphathwa kakuhle lunyango lomgca

wokuqala.

I-LPV/r iphansti kwelungelo lomenzi eMzantsi Afrika kwaye

ithengiswa yi-Abbott Laboratories kuphela. Ukuba ngaba

amaxabiso asezantsi kasinga chiza le-LPV/r ayafumaneka

uMphathiswa ugunyaziswa ngumThetho wamaLungelo

abeNzi ukuba acele i-Abbott ikhuphele iimvume abenzi

boosinga machiza ngemiqathango efanelekileyo.

Iipilisi ezizinzileyo zabantwana i-lopinovir 100mg/ritonavor

25mg zisalindele ukubhaliswa yi-MCC. Ezi pilisi ziyimfuneko

ekuphumezeni izikhokelo ezitsha kwaye i- MCC kufuneka

ikhawulezise ubhaliso zazo.

Imithombo: www.who.org; www.avert.org; www.newsplus.org; P. Nahirya-Ntege et al, ‘Successful management of suspected abacavir hypersensitivity reactions among

African children in the ARROW’, IAS (2009); Violari, A. et al, ‘Early antiretroviral therapy and mortality among HIV-infected infants’, N Engl J Med. 359, 2233-44, 20

November 2008 (http://www.ncbi.nlm.nih.gov/ pubmed/19020325).


USphelele Yende uneminyaka emine

ukwi-ART sukusukela ngoSeptemba

2007. Ifoto ngu-Mbatha

USphelele Yende uyinkwenkwe eneminyaka emine

evela kwilali Iswepe e-Gert Sibande, kwiPhondo

laseMpumalanga. Ngumntwana odlamkileyo

ophila ngokonwaba ne-HIV. USphelelewaba

kunyango lwe-antiretroviral (ART) ukusukela

ngoSeptemba 2007 x umama wakhe wafumanisa

okokuqal ukuba une-HIV. UMalusi Mbatha uthethe

nomama kaSphelele uNomsa Nhlengethwa,

ilungu le-Treatment Action Campaign (TAC) kunye

nevolontiye kwikliniki yase-Iswepe. U Nomsa uye

wanika amagqabantshintshi ngamava omntwana

wakhe ukusukela ekufunyanisweni kwakhe ukuba

une-HIV.

NgoSeptemab ka-2007, xa uSphelele wayeneminyaka

emibini yobudala, waye wagula waze umama wakhe

wamsa ukuba ayokwenziwa uvavanyo lwe-HIV.

Wayefumansie ngesakhe isimo se-HIV kunyaka

onagphambili.

Emva kokuba efunyaniswe ene-HIV, uSphelele

iwaye waqala ngoko nangoko unayngolwerejimeni

1a kwiSibhedlele sase-Piet Retief. UNomsa kwaye

kwafuneka ukuba aziqhelanise ngokukhawuleza

nesimo se-HI sonyana wakhe, kwaye amncede

ukuba athathe i-ART ukuze akwazi ukuphila ubomi

obuqhelekileyo. Irejimeni yokuqala yonyango

awaqala wayizama uSphelele zange imsebenzele

kakuhle. Waye waqhuba egula – egabha,

ephathwa yintloko ebuhlungu rhoqo, kunzima

ukuba atye kwaye esehlelwa bubunzima obuninzi.

Ngeli xesha uSphelele waye wavela neempawu

zokurhoza zentlalo-ngqondo. Wayengasakonwabeli

ukuba phakathi kwabanye abantwana, kaninzi

Ibali

likaSphelele

ekhetha ukuhlala ekhaya nomama wakhe. Emva

kweenyanga ezintandathu, wayokukhangelwa

impilo. Ugqirha wafumanisa ukuba umthamo wakhe

wentsholongwnae egazini ungama-45,000, waze

wamtshintshela kwi-zidovudine, didanosine and

lopinovir/ritonavir ngoko nangoko.

USphelele wasabela kakuhle, kwaye akasaguli

ngoku okanye kwehle ubunzima bakhe.UNomsa

uxel ukuba ngumntwana odlamjke kakhulu

odlalayo. Uthanda yonke imidlalo edlalwa

ngamanye amakhwenkwe engqingqini, njengebhola

ekhatywayo, imidlalo yokulwa, ukudlala ngeemoto

njalo njalo. Sele elungele ukuya esikolweni sabo

bangekangeni esikolweni kulo nyaka uzayo, kwaye

ufuna ukuba lipolisa xa emdala ukuze abambe bonke

abantu abangalunganga.

Xa kubuzwa ukuba umntwana wakhe uziva njani

ngokuthatha amayeza yonke imihla, uNomsa

kuqala ubengafuni uSphelele. Ehleka, uchaza ukuba

ubeqhele ukubaleka kanjani na, kodwa ebemxelela

ukuba kufuneka athathe amayeza akhe ukuze

angaguli kwakhona. Unyango ngoku sele luyinxenye

yesiqhelo yobomi bakhe bemihla ngemihla ude

abuze nomama wakhe ukuba ingaba ulithathile na

iyeza olakhe. Xa uSphelele ebona uNomsa ethatha iiantiretrovirals

zakhe, uyakulangazelela nangakumbi

ukuthatha ezakhe. Into yokuba akazange ehlelwe

kuko nakuphio na ukuphazamiseka kunyzngo

lwakhe nayo imncede kakhulu.

UNomsa unemvakalelo yokuba kubalulekile

kubazali kunye nakubagcini babantwana abane-HIV

ukusamkela isimo somntwana kwaye bazibophelele

ekumncedeni ukuthatha unyango lwakhe-.

Umceli mngeni ngowokuba abanye

abazali baye bangakholwa okanye

boyike ukuyokuthatha iziphumo,

oko kube neziphumo ezibi kwimpilo

yomntwana.

21


ULAWULO KUNYE NOKUFUMANEKA

KWAMACHIZA/ AMAYEZA

22

Imithombo: http://

www.msfaccess.org/

main/access-patents/

make-it-happencampaign/

campaign-updates/

february-9-2010/;

http://www.unitaid.

eu/en/20091215237/

News/UNITAID-

APPROVES-

PATENT-POOL.

html

Yintoni ekufuneka uyazi

Yintoni ilungelo lomenzi?

Ilungelo lomenzi lilungelo elikhethekileyo elinikwa umenzi

ngumthetho. Lithatha ukuba umenzi eyedwa wenza isigqibo

sokuba oko akwenzileyo kufuneka kusetyenziswe njani na.

Umzekelo, ukuba ngaba wenza uhlobo olutsha lwe-oveni

olwahlukileyo kwaye olusebenzisa iindlela ezikrelekrele

zokufudumeza ukutya, ungafaka isicelo ke sokuba ufumane

ilungelo lakho lokuba ngumenzi nge-oveni leyo. Ukuba ngaba

ulinikiwe ilungelo lomenzi, abanye abantu ke bayathintelwa

ukba bathengise ii-oveni ezisebenzisa le ndlela yakho

ikrelekrele yokufudumeza ukutya – ngaphandle kokuba

bafumana imvume yakho. Indlela yelungelo lomenzi ekwanye

yiyo le isebenza kumachiza amatsha kunye nezinye izinto

ezenziwayo ezininzi.

Amalungelo omenzi ahlala inani elithile leminyaka kuphela

– emayezeni ngokuqhelekileyo iba yiminyaka eqala kweli-

10 ukuya kwengama-20. Uluvo apha kukuba, kwixesha

elinyiniweyo, ilungelo lomenzi livuza umenzi ngomsebenzi

wakhe wokwenza i-oveni entsha okanye iyeza. Ukuba ngaba

uwedwa unelungelo lokuthengisa loo mveliso yakho intsha

imangalisayo, unokuniza ixabiso eliphezulu kakhulu kwaye

wenze imali eninzi ngokukhawuleza kwinto leyo oyenzileyo.

Kumayeza ayimfuneko afana nee-antiretrovirals kuye

kubenzima kakhulu kunee-oveni. Iinkampani zinikwa

amalungelo abenzi kwaye la malungelo abenzi abavumela

ukuba bawagcine ephezulu amaxabiso. Ukwenza oku ngexa

abantu besweleka ngenxa yokuba bengakwazi ukufikelela

kumayeza athile oko akunazo iinqobo ezisesikweni.

Ngesi sizathu, sinolungiselelo olufana nee-patent pools,

iimvume ezinyanzelekileyo kunye nokungenisa elizweni

okunxuseneyo(okucaciswe kwenye indawo kweli nqaku).

Ukhuselo lelungelo lomenzi kwilizwe elithile alinabeli

kwamanye amazwe.

Ii-Patent pools

I-Patent pool yechiza le-HIV ivumela ukuba iinkampani

zamachiza zingenise ngokuzithandela amalungelo azo abenzi

kumbutho ozimeleyo ofana ne- UNITAID, ekuMbutho

weMpilo weHlabathi kwaye enjongo yawo ingundoqo

ikukunyusa ufikelelo kumachiza kwizifo ezikhoyo kwihlabathi

jikelele. I-UNITAID iye ke isasaze la malungelo abenzi

bamachzia e-HIV ukuba ziye kwiinkampani ezenza oosinga

machiza kunye nakubaphandi baze ke bona bafumane

intlawulo efunyanwa xa kuthengiswe umsebenzi wakho wena

menzi wokuqala okanye wena mnini welungelo lokwenza.

I-patent pool ke ngoko ifana nevenkile enesikhululo

esinye apho iinkampani zinokuya khona ziyokufumana

iimvume zokuba zenze amachiza athile. Kunokuba zenze

uthethathethwano nezinye iinkampani, abenzi kuphela

zisebzna ne-patent pool.

Ekujikeleziseni la malungelo abenzi, ukhuphiswano olukhulu

lwe-patent pool kukuba ivumela ukwenziwa kwamachiza

angoosinga machiza ziinkampani. Ezi nkampani zinokuvelisa

iikopi ngqo zamachiza anokufikeleleka ngakumbi kwabo

bawafunayo..

I-patent pool ye-HIV kwakhona ivumela uphuhliso olulula

lweendibaniselwano zedosi emiselweyo, kuba onke amalungelo

abenzi ayakufumaneka kubaphandi abafuna ukudibanisa iiantiretrovirals

ezithile zibe yipilisi enye.

Eyona ndlela isebenzayo yokunyusa ukusasazwa kwamachzia

e-HIV kunge-patent pool ehlolwayo nesebenzayo. Oku kuyakuvunela

usasazo olubanzi lwamachiza asindisa ubomi e-HIV

ngokuphelisa iimonopoli kunye nokwehlisa umiso olungeyomfuneko.

Iinkampani zoxubo-mayeza ngokwe-avareji zichitha ngokuphindwe kabini kwintengiso

kunye nakulawulo kunokuba besenza inkcitho kuphando nakuphuhliso. Oku kucebisa

ukuba izigidi ngezigidi ezenziwe ngenxa yokhuselo lelungelo lomenzi ziseteynziswa

kakhulu kwintengiso kunokuba zisetyenziswe kuphando.

Ngu-Lamya Moosa

no- Catherine Karlsson


Yintoni i-TRIPS?

U-TRIPS umele i-Trade-Related Aspects of Intellectual Property

Rights, isivumelwano samazwe ngamazwe esisetyenziswa nguMbutho

weMpilo weHlabathi (World Trade Organization) (WTO). I-TRIPS

yaveza imithetho yelungelo lomenzi kwinkqubo yorhwebo yamazwe

ngamazwe kwaye yabeka imida ethile kumazwe angamalungu

e- WTO ngokunxulumene namalungelo abaseki okanye abaqambi.

Abaninzi bathi i-TRIPS yakhokelela kufikelelo olunyiniweyo

kumayeza ayimfuneko kumazwe asaphuhlayo. ISibhengezo sase-

Doha yayingumzamo wokubuyisela kwisimo sangaphambili

i- TRIPS ukuze ipahakamsie ufikekelelo kumayeza kwilizwe

elisaphuhlayo.

Yintoni imvume enyanzelekileyo?

Ukuba ngaba amachiza anelungelo lomenzi abiza kakhulu kwaye

kukho intlekele kawonke-wonke yempilo, iimvume ezinyanzelekileyo

zinokunikwa. Ezi zinika abenzi boosinga machiza basekhaya

ilungelo lokuvelisa eli chiza linelungelo lomenzi nokuba umnini

lungelo uyavuma okanye akavumi. Xa abenzi boosinga machiza

beqala ukuvelisa ichiza, ixabiso layo liye lehle ke kakhulu ngenxa

yokhuphiswano. Ngaphandle kokuba namandla omthetho

okukwenza oko uMphathiswa wezeMpilo waseMzantsi Afrika zange

ake alisebenzise eli lungelo.

Yintoni iSibhengezo sase-Doha?

ISibhengezo sase-Doha kwi-TRIPS wsaye saphunyezwa

nguMbutho weMpilo weHlabathi ngo- 2001 e-Doha, e-Qatar.

Siqiniseksia kwaye sicacisa ilungelo lamazwe aphuhluyo lokwenza

oosinga machiza, ngamaxesha entlelekele yesizwe kwezempilo,

ukungawananzi amalungelo omenzi agcinwe ziinkampani

zamachiza ezingundoqo. Ngenxa yokuba i-HIV iyingxakeko

eMzantsi Afrika, uMphathiswa wezeMpilo unokusebenzisa

iSibhengezo sase-Doha ukunika iimvume ezinyanzelekileyo

(jonga ngasezantsi) ngamachiza abiza kakhulu ngenxa yonyino

lwamalungelo abenzi. Akekho umphathiswa wezempilo

waseMzantsi Afrika owake wawasebenzisa la magunya.

Yintoni ukungenisa elizweni

okunxuseneyo?

Ukungenisa elizweni okunxuseneyo kuxa ilizwe lingenisa kwilizwe

alo oosinga machiza avela kwelinye ilizwe ngaphandle komnini

welungelo lomenzi. Oku kaninzi kwenzeka ngohlobo lokuba

amazwe aphuhlileyo angenise izinto kwilizwe lawo (njenge-Indiya)

elinabenzi boosinga machiza abanamandla. Ukungenisa elizweni

okunxuseneyo kungongela oorhulumente imali eninzi kuba kukho

umahluko omkhulu wexabiso phakathi kweemveliso zoxubo

mayeza ezithengisqa kumazwe awohlukeneyo.

INGABA INOKUSEBENZA NJANI I-PATENT POOL...

1.

Iinkampani zinikeza ngamalungelo

abenzi e-HIV abazivelisileyo

kumbutho ozimeleyo, ekuthiwa

yi-patent pool.

PATENT

PATENT

PATENT

POOL

2.

PATENT

Iinkampani zamachiza kunye

nabaphandi bangafikelela ngoku kwaye

bathenge amalungelo abenzi kwi-patent

pool. Umenzi ufumani imali efunyanwa

ngumezi kwiintengiso.

3.

Inkampani

zamachiza ezininzi

zinokwenza kwaye

zithengise kwa leli

chiza linye. Oku

kwenza ukuba

ixabiso lechiza

lehle.

Le mifanekiso isekelwe kwividiyo ye-MSF patent pool, efumaneka ku-www.youtube.com. Funda

ngokungaphaya ngephulo loFikelelo le-MSF Access campaign ku- MSFAccess.org.

PATENT

4.

20 10

25 25

Abaphandi

banokusebenzisa

amalungelo abenzi

ukuphuhlisa

amachiza ekulula

ukuba asetyenziswe

ebantwaneni kunye

neendibaniselwano

zeepilisi ezintsha

eziyimfuneko.

ULAWULO KUNYE NOKUFUMANEKA

KWAMACHIZA/ AMAYEZA

23


Ifoto yi-courtesy of Gallo Images/Getty Images

ULAWULO KUNYE NOKUFUMANEKA

KWAMACHIZA/ AMAYEZA

24

2.

Uninzi lwezinto ezidityanisiweyo

zokwenza amayeza zizinto ezivela

kwizityalo, kodwa ke ezinokusebenza

kakhulu kwaye zibe netyhefu esezantsi.

Iilebhu ezininzi zikhetha ukuvavanya izinto

ezidityanisiweyo kuba okuvela kwizityalo

akulula ukwenza amalungelo omenzi kuzo.

3.

Ipilisi inomxube wemichiza esebenzayo nengasebenziyo,

ngokuqhelekileyo ngokohlobo lomgubo, ecinezelwe

okanye efakwe kwisiqulatho yaba yinto eqinileyo.

Umatshini wokwenza iipilisi unokwenza

amakhulu amawaka eepilisi ngeyure.

4.

Umzi mveliso oonomatshini

abazisebenzelayo abaphucukileyo

uyakufaka kwiibhotile phakathi

kwama-120 nama-240 eepilisi

ngomzuzu, kwaye uyakuvelisa

phakathi kwama-2000 nama-5000

eepakethe zeblista ngomzuzu.

5. Nangona ezinye iipilisi ziveliswa eMzantsi Afrika,

izithako ezisebenzayo zoxubo-mayeza, oaknye ii-APIs,

kaninzi kuye kufuneke ukuba zingeniswe elizweni

zivela phesheya. Oku kuthetha ukuba, naphambi kokuba ilori

ithathe iipilisi kwiindawo ezigcinwa kuyo

kwiidolophu ezinkulu zizise kwikliniki yakho

yengingqi, ezinye izithako kwiipilisi zihambe

amawaka eekhilomitha zivela phesheya ukuba

zifike kwimizi mveliso yoMzantsi Afrika apho

zenziwa khona.

Ifoto ngu-Paul Bettings

ApHO AvELA KHONA

1.

AMAYEZA

Amahlathi eemvula zetropiki njengalalwo afumaneka kummandla we-

Amazon wamaZantsi eMelika alikhaya kuma-50% azo zonke iindidi

zezityalo, ngoko ke abalulekile kuphando ngamachiza. Koko, amayeza

amaninzi, kuqukwa nee- antiretrovirals, awaqulathanga mveliso

yezityalo.

Ifoto ngu-Roger Segelken, Cornell University News Service, copyright © 1997 Cornell University.

Ifoto ngu-amien Schumann

Ifoto yi-courtesy of Gallo

Images/Getty Images

6.

ISebe lezeMpilo lithenga

amayeza e-antiretroviral

ngethenda ekhethekileyo yeantiretroviral.

Ithenda ka-2008 yayixabisa

ngaphezulu kwe-R3.6 yesigidi sezigidi.

Ithenda ka-2010 ye-ARV iyakunikwa

ngasekupheleni kwalo nyanka.

Ifoto ngu-Flickr user Mike Blyth

7.

Imigca emide kunye

nokungabikho kwamayeza

kunokubangela kukungabikho

kwabasenzi aboneleyo aezikliniki

kunye nokungabikho kofikelelo

kumayeza ayimfuneko.

Ifoto ngu-Oupa Nkosi/Mail & Guardian

8.

Nasemva kohambo olude lwepilisi ukuba ifikelele kwabo

bayifunayo, abantu abaninzi abazithathi njengoko kumiselwe

iipilisi zabo. Ukuba nofikelelo kunyango sisiqingatha nje

kumceli mngeni xa kuza ekuphileni ne-HIV – ubambelelo olululo

kunyango ngomnye.

Ifoto ngu-by Oupa Nkosi/Mail & Guardian


umsebenzi ombi

Ngeenyanga nje, ngaphezulu kwesigidi sabantu abane-

HIV eMzantsi Afrika baza kube befumana unyango

lwe-antiretroviral (ARV). Esinye sezizathu ezingundoqo

sokuba kutehniukuze kwenzeke oku, kukuba amaxabiso

ee-ARVs awe kakhulu kule minyaka ilishumi idlulileyo.

Ngoo-1990s, unyango lwe-ARV lwalubiza ama-R3,000

ngenyanga. Ngoku urhulumente uthenga irejimeni

eqhelekileyo nge-R150 ngenyanga.

Amaxabiso aphantsi enze ukuba inkqubo yonyango

lwe-HIV ifikeleleke kurhulumente. Ngaphandle koku

kwehla kakhulu kumaxabiso, phantse ibe sisigidi

sabantu esongezelelekileyo engaba besiswelekile

okanye siza kusweleka eMzantsi Afrika.

ziye zifikeleleke njani ii-aRVs

Ekuqaleni koo-2000s, kuba la machiza ayenamalungelo

abenzi, kuphela yinkampani eyayinalo ilungelo lomenzi

eyayisenza isigqibo sokuba ngubani omakawathengise.

Oku kwathetha ukuba akukho lukhuphiswano kwii-ARVs

kwaye ke ngoko iinkampani zinokubiza amaxabiso

aphezulu kakhulu.

Koko zintathu izinto ezaye zenzeka ukuze kwehle

amaxabiso:

1. Abenzi kakhulu abazinze e-Indiya (kodwa kwakhona

nase-Brazil kunye nakwezinye iidawo)baye benza

iinguqulelo zoosinga machiza ezingabizi kakhulu

zee- ARVs. Babenokukwenza oko kuba amayeza

ayengenawo amalungelo abenzi e-Indiya. Koko,

ekuqaleni la machiza ayengafumaneki eMzantsi

Afrika kuba ayenamalungelo abenzi apha.

2. Amatsha ntliziyo eMzantsi Afrika, kwi-Afrika kunye

nakwihlabathi jikelele aye akwazi ukukhankasela

iimvume zabenzi booosinga machiza ukuba

bawathengise e-Afrika amayeza abo.

3. Kulandela olu xinzelelo zonke iinkampani ezenza

ii-ARVs phantsi kwelungelo lomenzi zaye zawehlisa

amaxabiso azo (umzekelo, i-fluconazole, efavirenz

ne-tenofovir) okanye zavumela ukhuphiswano

loosinga machiza (umzekelo, i-ddI, d4T, AZT,

lamivudine and nevirapine).

Ii-ARVs ezininzi ezenziwa e-Indiya ziyathengiswa ngoku

eMzantsi Afrika ngamaxabiso afikelelekayo.

umthetho wase-Indiya welungelo

lomenzi

Ngo-2005, urhulumente wase-Indiya waye wawisa

umThetho ovumela ukuba amayeza abe namalungelo

abenzi. Ngenxa yoko, amayeza enziwe ukusukela ngo-

2005 awunako ukuphinde enziwe kwakhona ziinkampani

ezenza oosinga machiza ezisebenza e-Indiya.

Okukuthetha inyathelo elinye ngaphezulu alisenzeki

kumachiza amatsha. Kunzima ke ngoko ukukhankasa

ngempumelelo ukuze kwehle amaxabiso amayeza.

Umzekelo, i-raltegravir yi-ARV entsha ebalulekileyo

ingakumbi kubantu abaxhathisayo kwezinye iirejimeni

ze-ARV. Okwangoku ibiza ama-R2,396 kuqukwa ne-VAT.

Oku kubiza kakhulu kwinkqubo yezempilo karhulumente

yoMzantsi Afrika. Ayikho inguqulelo yoosinga machiza

yayo e-Indiya okanye naphi na .

Okungenani ngamachiza esifo sephepha amabini

amatsha ekungenzeka ukuba afumaneke kule minyaka

imbalwa izayo. Afuneka ngokukhawuleza la mayeza

ngenxa yokhulua kukabhubhani we-TB exhathisayo

kumachiza. Iyahlupha into yokuba kusenokwenzeka

ukuba angafikeleleki apho afuneka khona kakhulu:

kumazwe ahluphekayo.

uthethathethwano lwe- Eu/Indiya

Ngoku, umbono wokwenza kufumaneke amachiza

ii-ARVs ezintsha eMzantsi Afrika ngamaxabiso

afikelelekayo uphantsi kwentsongelo ngenxa yezehlo

ezenzeka e-Indiya. Ingakumbi kuba, iManyano

yaseYurophu (European Union) (EU)ibeka uxinzelelo

kurhulumente wase-Indiya ukuba asayine isivumelwano

sorhwebo esiyakwenza ukhuphiswano lube yimfuneko

kumayeza ayimfuneko asengaphantsi kwelungelo

lomenzi lube nzima nangakumbi..

Uqulunqo olwathubelezayo lwemibhalo

yothethathethwano lubonisa ukuba i-EU ityhalela

unyino lweminyaka emihlanu ukuya kwelithoba kulwazi

olunokusetyenziswa ziinkampani zoosinga machiza xa

befaka isicelo sokubhalisa amayeza abo kwiqumrhu

lolawulo lwamayeza lase-Indiya. Oku kuyakwenza kube

nzima nangakumbi ukubhalisa oosinga machiza.

I- EU ikwatyhalela ubukho belungelo lomenzi

(ngokuqhelekileyo iminyaka engama-20) ukuba lihlale

ixesha elide. I-EU kwakhona ifuna ukba ikwazi ukuthatha

amayeza ophula aamlungelo abenzi be-EU pkwimida

ye-EU, nokuba la mayeza asendleleni eya kumazwe

angaphandle kwelizwe le-EU, elifana nelase-Afrika.

Ukuba ngaba ayamkelwa la manyathelo, ukhuphiswano

loosinga machiza kumalungelo abenzi bee-ARVs

kwi-sub-Saharan Africa wluyakuba nzima kakhulu.

Ngaphandle kokuba kubekho into esiyenzayo, amachiza

amatsha ayakuhlala engafikeleleki. Oku kuyakubanga

ukuhluphela nokusweleka okungeke kuphetshwe.

Ifoto ngu-Suraj

Mishra, courtesy MSF

Amaxabiso

asezantsi eeantiretroviral

asindise ubomi

obuninzi. Kodwa

ke ngoku iManyano

yeseYurophu izama

ukunyanzela

isivumelwano

sorhwebo

esiyakwenza

kubenzima

ukunyanzela

amaxabiso

asezantsi amachiza

kwixa elizayo.

ULAWULO KUNYE NOKUFUMANEKA

KWAMACHIZA/ AMAYEZA

25


I-TB Ifunyaniswa njani ngoxilongo i-TB ekhoyo

26

Kulula ukuba ikliniki ikuvavanye ukuba unayo na i-HIV.

Umthamo omncinane wegazi uthathwa kwiintupha zakho,

igazi ke lize lisetyenziswe kwiimvavanyo ezilula.

Kwimizuzu engama-20 ukuya kwengama-30, ungasazi

isimo sakho se- HIV. Iimvavanyo ziyakhawuleza, azibizi

kwaye zichaneke kakhulu. Ukuba ngaba inkqubo

yovavanyo lwe- HIV iqhutywa ngokufanelekileyo, ithauba

lokufunyaniswa okungachanekanga lincinane kakhulu.

Ngelishwa, akunjalo kwi-TB. Okungenani sisiqingatha

sabo bonke abantu baseMzantsi Afrika abosulele yi-TB.

Kodwa abantu abaninzi abosulelwe yi-TB ngeke baguliswe

sisifo. I-TB yabo ayisebenzi kwimiphunga yabo. Ayizivelisi

kwaye ihleli phantsi kolawulo lwezixokelelwano zabo

Ngu-Nathan Geffen

Isifo sephepha esikhoyo (Active tuberculosis) (TB) kunzima ukusifumanisa. Kuthatha ixesha elide

ukufumana iziphumo ezichanekileyo kwaye izigulane ziye zifune unyango ngokungxamisekileyo.

Yimali eninzi kakhulu ekuye kufuneke ukuba kwezinwe ngayo utyalo-mali kuphando ngovavanyo

olukhawulezayo, oluchanekileyo nolufikelelekayo lwe-TB ekhoyo.

zokugonyeka. Ngenxa yokuba abanyu abaninzi bene-TB

engabonakaliyo (engasebenziyo) kwaye kunqabile

ukuba oko kuthethe ukuba baza kugula, kaninzi

akubalulekanga kangako ukufumanisa ngoxilongo i-TB

engabonakaliyo TB. Endaweni yoko, into ekufuneka

sibe nako ukuyifumanisa ngoxilongo ngabantu abo

i-TB yabo izivelisayo. Kaninzi bayakugula okanye babe

bazakuphathwa yi-TB. Le kuthiwa yi-TB esebenzayo.

I-TB esebenzayo kusezantsi kwaye kuyabiza

ukuyifumanisa. Le yingxaki, kuba abantu abaninzi abane-

TB esebenzayo kaninzi kuye kufuneke ukuba banyangwe

ngoko nangoko. Ukuba ngaba oogqirha abanakuqiniseka

ukuba isigulane siphethwe sesiphi isifo, kuye kube nzima

ukwenza izigqibo zonyango ezichanekileyo.

Ifoto ngu-Damien Schumann


Iindlela zokufumanisa i-TB

esebenzayo

I-X-reyi

Kaninzi izigulane ezineempawu ze-TB (umzekelo,

ukukhohlela iiveki ezimbini, ukwehla kobunzima,

ukubula ebusuku) ziyakuthathwa i-x-reyi esifuba. I-x-reyi

engasekunene ibonsia isigulane esine-TB.

Oogqirha kufuneka babe namava ukuze bayifumanise

i-TB besebenzisa i-x-reyi. Kodwa nangoko ii-x-reyi kaninzi

aziniki lwazi lwaneleyo lokufumanisa i-TB. Kwakhona,

ii-x-reyi ngeke ziyibone i-TB esebenzayo engaphandle

kwemiphunga (eyaziwa ngokuba yi- extra-pulmonary TB).

Imakroskowupu yesikhohlela

Indlela engcono yokuzama ukufumanisa i-TB kukucela

isigulane ukuba sikhohlele isikhohlela (okanye sikhuphe).

Isikhohlela ke sinokuthunyelwa kwilebhu eqhelekileyo.

Apho, ichaphaza elikhethekileyo eliye liqatywe

kwisikhohlela liyakuyibonisa phantsi kwemakroskowupu

i-TB. Ngasekunene ezantsi yifoto ebonsia ukuba ibonakala

njani na i-TB phantsi kwemakroskowupu..

Kodwa ke imakroskowupu yesikhohlela nayo ineengxaki.

Ukuchaneka kwayo kuxhomekeka kwinkqubo eqhutywa

ngumsebenzi waselebhu oqeqeshiweyo kwisakhono eso.

Kwakhona, izigulane ezininzi, ingakumbi ezo zine-HIV,

azinasifo sephepha soneleyo kwizikhohlela zazo ukuba

kungade kubonakale phantsi kwemakroskowupu.

Njengee-x-reyi, imakroskowupu yesikhohlela ayinako

ukufuamnisa i-TB ngaphandle kwemiphunga.

Ukukhuliswa kweentsholongwane

(Culture)

Eyona ndlela ichanekileyo yokufumanisa i-TB

okwangoku kukuthumela isampuli yesikhohlela kwilebhu

ephucukileyo eyakuthi ibeke isikhohlela kwindawo

ekukhuliswa kuyo intsholongwane ekhethekileyo apho

iintsholongwane (microbes) (germs) ezifana neze-TB

zinokukhula khona. Ukuba akukho TB ikhulayo apho

kuloo ndawo ikhuliswa khona, isigulane ke ngoko

mhlawumbi asinayo i-TB, okungenani hayi emiphungeni.

Ukuba ngaba ngenene iyakhula i-TB, isigulane sinayo

i-TB.

Iimvavanyo zokukhuliswa kweentsholongwane

zinokusetyenziswa ukufumanisa i-TB ngaphandle

kwemiphunga. Okukwenziwa ngokuba kuthathwe

umcu kwilungu lomzimba ekukrokrelwa ukuba line-TB.

Umzekelo, ukuba ngaba kubonakala ngathi umntu

une-TB yomqolo, ulwelolomqolo lunokuthunyelwa

elebhu ukuba kuyokukhuliswa iintsolongwane.

Kodwa iimvavanyo zokukhuliswa kweentsholongwane

zineengxaki nazo. Ziyacotha kaninzi kuthatha iiveki

ezimbalwa phambi kokuba kufumaneke iziphumo.

Ziyabiza kananjalo, kwaye kufuneka zenziwe kwilebhu

ephucukileyo. Ngaphaya koko, isikhohlela okanye omnye

umcu womzimba kufuneka zithunyelwe ngononophelo xa

zisuka ekliniki ziziya elebhu.

I-PCR

Njenge-HIV, i-TB ekhoyo inokufunyaniswa kusetyenziswa

uvavanyo lwe-PCR (polymerase chain reaction).

Kodwa luyabiza, lufuna ilebhu ephucukileyo kwaye

aluchanekanga njengokukhuliswa kweentsholongwane

(culture).

Iindlela ezintsha

Iindlela ezintsha zokufumanisa i-TB ngoxilongo

kuyaphandwa ngazo. Olunye ufumaniso lwesifo

ngoxilongo olutsha olunika umdla luyaphandwa

eKhayelitsha, kodwa kusekwangoko kakhulu ukuxela

ukuba luyakusebenza kwaye lufikeleleke njani.

Kodwa yimali encinane kakhulu ekwenziwe ngayo utyalomali

kuxilongo olutsha lokufumanisa i-TB. Ekugqibeleni

kuyakufuneka uvavanyo lwe-TB ekhoyo olusebenza

njengovavanyo lwe-HIV. Kufuneka lungabizi, luchane,

kube lula ukuluqhuba kwaye lunike iziphumo ngemzuzu.

Isende indlela ekusafuneka ihanjwe phambi kokuba sifike

apho. Okwangoku, i-Treatment Action Campaign (TAC)

kufuneka ifake uxinzelelo kurhulumente waseMzantsi

Afrika, kumaZiko eMpilo eSizwe asekelwe eMelika

kunye noMbutho weMpilo weHlabathi ukuba bancede

ekuqinisekiseni ukuba imali eninzi kwenziwa ngayo

utyalo-mali kuphando lwe-TB.

Iintolo zibonisa ukungaqheleki

kule x-reyi yemiphunga oko

okubonisa i-TB. Ifoto ivela kwi-

Wikipedia.

Iityhubu ezibomvu yibhaktiriya

yesifo sephepha. Ifoto ivela kwi-

Wikipedia.

Izixhobo zokuhlola

intsolongwane ka

Gawulayo zikwenza oko

ngokukhawuleza,ziyafikeleleka

ngokwexabiso kwaye

ziyawuchana umhlola ngokuthe

ngqo. Akunjalongo ke kodwa

kwizixhobo zokuhlola i sifo

sephepha(TB). Zona zithatha

ixesha elide, kunezinto ezininzi

ezenziwayo.

Inxaso mali iyadingeka ke ukuze

sifumane izixhobo zokuhlola

isifo sephepha ezikhawulezayo

nezithe ngqo". iPhoto ithathwe

ngu Paymon Ebrahimzedah

Mabini amanyathelo okuchaneka kovavanyo lwezonyango: ubuntununtunu

nokuchana.

Uvavanyo kufuneka lube nobuNTUNUNTUNU:

Ukuba ngaba isigulane sine-TB, kufuneka uvavanyo lukhombise i-TB.

Uvavanyo olunobuntununtunu bama- 90% lukhombisa i-TB amaxesha

alithoba kwalishumi xa ikhona, kodwa lixesha elinye kwalishumi apho liye

lusilele ekukhombiseni i-TB xa ikhona.

Uvavanyo kufuneka LUCHANE:

Xa isigulane singenayo i-TB, uvavanyo kufuneka lungafumanisi i-TB.

Ukuba ngaba uvavanyo luchane ngama- 90% , oku kuthetha ukuba

ngamaxesha alithoba kwalishumi lokuba uxilongo ngokuchanekileyo

alukhombisi i-TB xa ingekho, kodwa kwixesha elinye kwalishumi

iyayikhombisa i-TB ibe ingekho.

I-TB

27


INDABA

28

IiNdaba zeSebe le-taC

IKhayelitsha condoms inika ama - 500,000 eekhondom ngenyanga

Ngu-Mary-Jane Matsolo

I-Treatment Action Campaign (TAC) eKhayelitsha yaye yawongwa ngoMatshi

liSebe lezeMpilo laseNtshona Koloni ngokuba yi-NGO esasaza iikhondom

ezininzi eNtshona Koloni. I-TAC yaye yawongwa ngesitifiketi sokugqwesa

liSebe. Iwonga laye lamkelwa ngumlungelelanisi wosasazo lweekhondo

ozinikeleyo we-TAC eKhayelitsha, uThobela Vika.

Iphulo lekhondom elaziwa ngokuba yi-‘Super Saturday’ lenzeka apho

amaqabane e- TAC afikelela kwiindawo ezininzi kangangoko anako.

Banikezela ngeekhondom ezikolweni, kwiishibhini, kwiindawo zokulungisa

iinwele nasezirenkini zeeteksi kwaye benza konke okusemandleni abo

ukuqinisekisa ukuba iikhondom zifikelela kubantu abaninzi kangangoko

kunokwenzeka.

I-TAC Khayelitsha iyodwa isasaza ama-500 000 eekhondom ngenyanga

kwiKhayelitsha xa iyonke.Oku bekungeke kuphunyezwe ukuba

bekungengokwamaqabane ethu asebenza nzima kwisithili.

I-taC ikhumbula u-andrew

Warlick

U-Andrew Warlick ngosizi usweleke ngeCawa ka-11 Aprili 2008.

Ukusweleka kwakhe kuye kwasothusa kakhulu ingakumbi kwa-TAC

apho waye wachukumisa iintliziyo zoluninzi.

U-Andrew waye wajongana nomsebenzi woLawulo nokuHlola

(Monitoring and Evaluation) (ME) ngodlamko noyilo, edibanisa kunye

inkqubo yethu ye-M&E kwaye ebeka isiseko sophuhliso olunomdla

lwexesha elizayo. Ngempumelelo nganye, wayengakwazi ukuzimba

ngomdla awayenawo – kwaye ulangazelelo lwakhe lwalusesulela.

Wayengasinguye umcinezeli wamanani nje kuphela, kodwa wayefuna

ukubona impumelelo yamaphulo awayewahlola.

I-Equal Treatment yayiyiprojekithi eyayisentliziyweni yakhe, kwaye

wayenothando lokuqinisekisa iimpembelelo zayo ezifikelela phezulu.

U-Andrew wayezikhathaza ngokumangalisayo ngokuphila kwabanye –

abaninzi bayakuwukhumbula umdla wakhe kubomi babo.

Hamba kahle, qabane nomhlobo.

Ifoto ngu-Mary-Jane Matsolo


4

6

0



x

2


7nt

f Hlth b

dn thrh

l . across

bn nbr f

nt n pll

d .

tt fr

r tht

t phttd

fr dn r

nd nttd patent ___. b

tttn, t lld

frt dr pprvd

nt

l f ntrtrvrl

rp t l,

f dvlpn .

uphold patent rights.

hldrn r lld

ntrntnl

8

1. The Department of Health buys antiretroviral

medicines through an antiretroviral ___.

4. A pill that combines a number of different pills into

one pill is called a fixed dose ___.

5. To do a culture test for tuberculosis requires that a

___ sample is sent to a sophisticated laboratory.

6. When patents for medicines are administered and

negotiated by one central institution, it is called a

7. What was the first drug approved for HIV treatment?

9. When the levels of antiretrovirals in your body drop

too low, you are in danger of developing ___.

10. Medicines for children are called ___ medicines.

11. An important international agreement that bound

World Trade Organization member countries to



We will give a R200

Pick n Pay gift

voucher for the first

crossword drawn

from a hat with all the

correct answers. The

answers can be found

in this issue of Equal

Treatment.

Last month’s winner

will be announced in

a future issue.

Fax or post your

completed crossword,

with your name,

address and contact

number.

Address: Equal

Treatment, PO Box

2069, Cape Town 8001

Fax: 021 422 1720

Dn

ht dr trtn t rpl d4T

n frt ln trtnt

2 Th Down t rt t dn

tbrl t th nt

1. What drug is starting to replace d4T in first-line

lld treatment? tt.

hn pn frd t rnt

2. The most accurate way to diagnose tuberculosis at the

ln moment is lln called a ___ test. nr

nftrr t prd

3. When a company is forced to grant licenses allowing

ptntd dr, t lld

generic manufacturers to produce a patented drug, it

lnn. is called ___ licensing.

8 ht ntr plntd

8. What country implemented compulsory licensing in

plr 1997 to ensure that lnn its citizens have access n to HIV t

nr treatment? t tzn hv t

HV trtnt.

Equal treatment’s Crossword Puzzle

29


30

Lulama James will turn 40

in April. In addition to being

HIV-positive, she has had TB

since 2005, progressing to drugresistant

TB and recently to

extensively drug-resistant TB.

In February of this year, she

stopped responding to treatment.

Lulama needs

more treatment

options NOW.

Campaign for Access to

Essential Medicines

Médecins Sans Frontières

Rue de Lausanne 78,

CP 116 CH-1211 Geneva 21,

Switzerland

Tel: +41 (0) 22 849 84 05

www.msfaccess.org

New drugs and treatment options are desperately needed.

The reason? Without it, people’s options for life-saving drugs will run out.

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