Magazine of the Treatment Action Campaign
treatment
Ukumelana Nemithi
Umzabalazo wami wokumelana nomuthi:
Indaba kaMzi
Ukumelana nemithi ye-HIV: Isayensi
eyenziwe lula
Izimpi zamalungelo: Ukulwela ama-ARV
esikhathi esizayo
June 2011
i
Umhleli: Marcus Low
Umhleli Wezithombe: Andrea Zeelie
Umhleli Wekhophi: Cathy Goudie
Abafake isandla: Nathan Geffen, Mara Kardas-Nelson,
Thandeka Vinjwa, Adam Malapa, Elizabeth Mills,
Nondumiso Hlwele, Mary-Jane Matsolo, Nokuphumelela
Zwane, Elizabeth Nosizwe Vale, Elsa Oliveira, Catherine
Tomlinson, Luckyboy Mkhondwane.
Isithombe sekhava: Phiwokuhle Budaza we-Iliso Labantu
Izithombe: Phiwokuhle Budaza, Marius Potgieter,
Maureen Sill, Samantha Reinders, Richard Heaven,
Luckyboy Mkhondwane, Market Photo Workshop,
Thandeka Vinjwa, Adam Malapa, Faizel Slamang.
Imifanekiso esekhasini 6-9 nguBrice Reignier. Umfanekiso
osekhasini 23 nguSizwe Nguqe.
Sibonga ngokukhethekile kuMziwethu Faku,
Nokuphumelela Zwane we-The Reproductive Health
and HIV Research Unit eNyuvesi yase-Witwatersrand,
umculi nesishoshovu uNondumiso Hlwele, Elsa Oliveira
we-African Centre for Migration and Society, naku Simon
Collins we-HIV i-Base..
Ukuhambisa: Market Insertion Bureau.
Ukuhlelwa kwebhuku: Designs 4development,
info@d4d.co.za
Ukuphrinta: CTP Book Printers
Ukuhumusha: Bohle Conference and Language Services
I-TAC izinikele ekuhlinzekeni abantu abane-HIV,
imindeni yabo kanye nabanikezeli bokunakekela ulwazi
olungenaphutha ngemithi esindisa impilo kanye
nokwelashwa. I-TAC kanye nabaholi bayo bazimele abekho
embonini eyenza imithi yezokwelapha kanjalo nezimboni
zemithi yemvelo kanye nehlukile futhi ayinantshisekelo
yemali kuzo.
Leli hlelo le-Equal Treatment lixhaswe ngezimali yi-Global
Fund to Fight AIDS, Tuberculosis and Malaria, kanye ne-
Oxfam Australia.
Leli phephabhuku liyatholakala futhi ngesiTsonga,
isiXhosa nesiNgisi.
Ungakhiphela la mahlelo e-Equal Treatment kanye
nelangaphambilini kuleli kheli: www.tac.org.za/
community/equaltreatment/
Ikheli Leposi: PO Box 2069, Cape Town 8001
Ikheli Lendawo: Westminster House, 122 Longmarket
Street, 3rd Floor, Cape Town 8000
Ucingo: 0861 END HIV
Ifeksi: +27 21 422 1720
Iwebhusayithi: www.tac.org.za
Amahhovisi Esifunda e-TAC
Khayelitsha District: 021 364 5489
Ekurhuleni District: 011 873 4130
Lusikisiki District: 039 253 1951
Pietermaritzburg District: 033 394 0845
Gert Sibande District: 017 811 5085
Mopani District: 015 307 3381
ii
I-Equal Treatment
ishicilelwa yi-Treatment
Action Campaign.
Okuqukethwe
amakhasi 1–9
amakhasi 10–19
amakhasi 20–28
Ihlelo 38 – Juni 2011
isisZulu
Ukumelana nemithi ye-HIV
Kungaba isikhathi esikhathaza kakhulu uma
ama-ARV akho eyeka ukusebenza. U-Mara
Kardas-Nelson ukhuluma noMziwethu Faku
ngolwazi lwakhe ngokumelana nemithi
ye-HIV. Emva kwendaba kaMzi, sikulethela
incazelo enemininingwane nokulula
ukuyilandela yesayensi yokumelana nomuthi
we-HIV.
Ukuphila ne-HIV nama-ARV
Ukubambelela ekwelashweni okuhle
kungaba nzima kakhulu ezinganeni -
ikakhulukazi uma zingaqondi ukuthi
kungani zidinga amaphilisi zonke izinsuku.
U-Mary-Jane Matsolo ubuza ukuthi ingane
uyitshela nini futhi kanjani ukuthi ine-HIV.
Sizwa kumsebenzi wocansi ngempilo yakhe
ne-HIV kanye nama-ARV. Futhi, ungeqi
ikhalenda yakho yokubambelela ekhasini 13
kanye nephakathi nendawo lencwadi elazisa
ngama-ARV.
Ukubambelela, ilungelo lobunikazi kanye
nesayensi entsha
Emva kwe-athikili ehlola izizathu zokuthi
kungani abantu benza amaphutha
ngokuphuza imithi, u-Catherine Tomlison
wasitshela ngomthetho wezohwebo
wamazwe omhlaba ongasho ukuphela
kwama-ARV athengekayo. Okokugcina,
sikulethela isifingqo socwaningo
oluthokozisayo olusha olwabikwa
kuNgqungquthela yeZidambisigciwane
Nezifo Ezibona Intuba (Conference on
Retroviruses and Opportunistic Infections)
Photo by Faizel Slamang.
Imithi yenzelwe ukuhlasela izinhlobo ezithize
zamagciwane. Kodwa ngokuhamba kwesikhathi
amagciwane ayashintsha; ayakhula; aguquke. Ngezinye
izikhathi ashintsha ngokwanele ukuze imithi efanele
ukuthi isebenze ngempumelelo ukulwa nawo iyeke
ukusebenza. Lokhu kujwayelekile, iyindlela amagciwane
asebenza ngayo. Kuyiqiniso ngebhaktheriya ye-TB;
yiqiniso ngegciwane leNgculazi futhi kuyiqiniso ngawo
wonke amagciwane kanye namabhaktheriya athelele
abantu nezilwane.
Ngakho-ke asikho isizathu sokuthi abantu abane-TB
ne-HIV emelana nemithi babe yihlazo. Banokugula
nje futhi kufanele senze konke okusemandleni ethu
ukwelapha isifo sabo ngalokho okunomkhawulo okukhona
okukhethayo. Kodwa-ke, uma iziguli zibambelela
ezinhlotsheni zemithi yazo futhi izinhlelo zezempilo
zisebenza kahle ngaphandle kokuphela kwesitokwe kanye
nemisebenzi yokunikezela ngemithi okubi, kuthatha
isikhathi eside ukuthi ukumelana nemithi kwenzeke.
Abanye abantu ababambelela kakhulu banokuphuza
uhlobo lwezidambisigciwane ezifanayo amashumi
eminyaka, mhlawumbe impilo yabo yonke ngaphandle
kokushintsha ngenxa yokumelana nemithi. Kodwa
ngezinye izikhathi ngisho bona abantu ababambelelayo
bazoba nokumelana nemithi. Kubantu abaningi kakhulu
ababambelela ekwelashweni zonke izinsuku zokuphila
impilo ibanzima nje.
I-HIV
Umbiko Womhleli
ENingizimu Afrika, ngeshwa sinabantu abaningi kakhulu
abaphila ne-HIV emhlabeni, kodwa ngenhlanhla, uma
kuqhathaniswa neMelika neYurophu, bambalwa kakhulu
abantu abangazweli emthini ye-HIV. Ngonyaka ka-2010
abantu abangama-3% kuphela abantu abasohlelweni
lwezibhedlela zikahulumeni bashintshela emugqeni
wesibili wezidambisigciwane ngenxa yokuthi babene-HIV
emelana nemithi. Kodwa-ke ngokuhamba kwesikhathi,
abantu abaningi bazomelana nemithi. Inkinga ukuthi uma
umelana nemithi eminingi, ukhetho lwakho lube selubiza
kakhulu.
Isibonelo, uhulumeni waseNingizimu Afrika uthenga
uhlobo lomugqa wokuqala elisezingeni lwe-tenofovir,
emitricitabine kanye ne-efavirenz oluwu-R150 isiguli
ngasinye ngenyanga. Kodwa uma ushintshela ohlotsheni
lomugqa wesibili olune-lopinavir (ebhustwe nge-ritonavir
ephawulwe njenge-Kaletra) inani lentengo lalo mkhiqizo
lingaphezu kwe-R300, noma ngaphezu kwezindleko
eziphindwe kabili zohlobo lomugqa wokuqala lonke.
Kodwa kuba kubi kakhulu. Inkampani eyenza imithi
i-Roche yenza umuthi obizwa ngokuthi i-raltegravir,
engakatholakali engxenyeni kahulumeni. Lona ngumuthi
obaluleke kakhulu onemiphumela emibi embalwa
kakhulu uma iqhathaniswa nezidambisigciwane eziningi
ezindala. Ibizwa ngokuthi i-integrase inhibitor ngenxa
yokuthi iyekisa iphrotheyini ebizwa ngokuthi i-integrase
efaka ikhodi yofuzo ye-HIV ku-DNA yomuntu. Isebenza
ngokuhlukile kwezinye izidambisigciwane ezisetshenziswa
engxenyeni kahulumeni, ngakho-ke abantu abamelana
nemithi etholakala engxenyeni kahulumeni njengamanje
bazosizakala ku-raltegravir. Engxenyeni ezimele ibiza u-R2
400 wonke ngenyanga! Ababaningi abantu abadinga lo
muthi eNingizimu Afrika okwamanje, kodwa bazowudinga
abaningi esikhathini esizayo.
I-TB
Ngonyaka ngamunye abantu abayizinkulungwane eziningi
batholakala bene-TB emelana nomuthi eNingizimu
Afrika. Nakuba kuyifashini ukuphakamisa ukuthi abantu
abathola i-TB emelana nomuthi ababambeleli, abaningi
kulabo abayitholayo batholakala bene-TB okokuqala
ngqa. Ngakho-ke angeke kube ngenxa yokungabambeleli
esimeni sabo! Ukuzama ukusola abantu ngegciwane
elimelana nomuthi akusisizi nje.
Esimeni sabantu abane-TB emelana nomuthi kuyinkinga
kakhulu kunabantu abane-HIV emelana nomuthi.
Kunemithi eminingi emihle ye-HIV manje, kodwa imbalwa
kuphela emihle eye-TB. Abantu abane-TB emelana
nomuthi banethuba eliphezulu lokufa. Izindaba ezinhle
ukuthi imithi emisha ye-TB iyenziwa. Owodwa kulena
ubizwa ngokuthi i-TMC207 kanti wenziwa yi-Tibotec,
inkampani engaphansi kwe-Johnson & Johnson. Umuthi
usadinga ukuthi uhlolwe kakhulu kodwa imiphumela
ezinhlolweni zokwelapha zokuqala zakhombisa ukuthi
kungenzeka isebenze ngempumelelo ukulwa ne-TB
emelana nemithi eminingi.
Umsebenzi we-TAC eminyakeni embalwa ezayo ucacile-ke:
kufanele sisize ngokuthola imithi efana ne-raltegravir
kanye ne-TMC207 kubantu abane-HIV kanye ne-TB.
Ukwenza ukuthi le mithi itholakale, kuzosindisa izimpilo
eziningi.
ngu-Nathan Geffen, Usikhwama we-TAC
1
UKUMELANA NEMITHI
2
Umfanekiso oncike esithombeni esithathwe ngu- Marius Potgieter
nokumelana
Ngu-Mara Kardas-Nelson
Uma uMziwethu Faku engasebenzi, usejimini noma uchitha isikhathi nonkosikazi wakhe
omusha. Uyaphumula kusheduli yomsebenzi wakhe emenza abe matasatasa wokusitshela
ngempilo yakhe ne-HIV nempi yokulwa nokumelana nemithi eyizidambisigciwane .
UMzi wazalelwa e-Cathcart, eMpumalanga Kapa
ngonyaka ka-1977. Ephakathi neminyaka engama-20
wayesesukile edolabhaneni langakubo elandela
impilo edolobheni elikhulu i-Jo’burg. Nangale
kokuthi uMzi wagula kakhulu ngonyaka ka-2001,
odokotela bendawo akaya kubo azange bazi
ukuthi kwakonakalephi. Uthi, “Akukho kodokotela
owacabanga ukuthi kahle hle nganginani ngaze
ngafika ekhaya.” “ Udokotela [e-Cathcart]
wangeluleka ukuthi ngihlolelwe i-HIV. Imiphumela
yabuya iphozithivu.
“Ngahlala ekhaya ngizama ukubhekana nesimo,
futhi ngicabanga nokuzibulala, zonke izinto ezinjalo,
he? Ngangizibuza ukuthi kwakuzokwenzekani
enganeni yami. Nganquma ukuthi mangiphilele
yona. Ngempela ngangingenalo elinye ithemba.
Ngangingazi lutho ngegciwane futhi ngangicabanga
ukuthi ngangizofa nje - angazanga ukuthi kufanele
ngenzeni.”
“Ngakho-ke nganquma ukufunda nge-HIV.
Ngajoyina inhlangano edolobheni, senza
imihlangano yokufundisana yokuqwashisa, kodwa
azange sikhulume kakhulu ngezidambisigciwane
(ama-ARV) ngoba sasingazi ngawo kabanzi ngaleso
sikhathi . Ngonyaka ka-2003, kwafika owesifazane
evela ku-Treatment Action Campaign (TAC) evela
eKapa, wangishelela ukuthi ngijoyine i-TAC.
Ngokuhamba kwesikhathi ngaya emhlanganweni
wokufundiswa ngokwelashwa lapho engafunda
khona ngezidambisigciwane. Ngamangala kakhulu
ukubona amadoda kanye nabesifazane betoyitoya
bethi kunethemba. Ngaqala ukusebenza ne-TAC
ngokushesha.”
Umugqa wokuqala nomugqa wesibili
Umuthi womugqa wokuqala inhlanganisela (uhlobo lwemithi) yemithi
abantu abayithola uma beqala ukwelashwa ngezidambisigciwane ohlelweni
lwezempilo lukahulumeni. Le mithi yakhethelwa umugqa wokuqala ngenxa
yokuthi isebenza ngempumelelo, iphephile futhi iyathengeka.
Uma imithi yomuthi wokuqala iyeka ukusebenza, iziguli zishintshelwa
ekwelashweni ngomugqa wesibili. Imithi yomugqa wesibili nayo iphephile
futhi isebenza ngempumelelo, kodwa ihlasela i-HIV ngendlela ehlukile
emithini yomugqa wokuqala futhi kaningi ibiza kakhudlwana.
Uhlelo lwezempilo lukahulumeni namhlanje alunikezeli ngohlobo lwemithi
yomugqa wesithathu futhi kunethemba elincane ezigulini ezimelana
nokwelashwa komugqa wesibili. Lezi ziguli kaningi kufanele zihlale ziphuza
imithi ezinokumelana nayo okuncane noma kufanele zikhokhe amanani
aphezulu emithi yomugqa wesithathu engxenyeni kahulumeni. Imithi
engasetshenziswa njengemithi yokwelapha yomugqa wesithathu iyabiza
ngokuthe xaxa. kunemithi yomugqa wokuqala nowesibili. (Bheka amakhasi
22-25 ukuthi singawehlisa kanjani la manani entengo.)
“Ngonyaka ka-2004 isibalo se-CD4 yami sehla
[saya ku-17] ngase ngiqala ukwelashwa
ngezidambisigciwane.[…] Iphrojekthi Yokwelapha
ye-TAC […] yangitholela umuthi, okwakuyi-
Triomune, iphilisi elilodwa ngelanga,ene-nevirapine,
lamivudine (3TC), ne-stavudine (d4T). I-TAC yalithola
eNdiya yaliletha e-East London.
“Ngonyaka ka-2008 ngaphawula [izimpawu]
zokumelana, engingazange ngempal ngikuqonde
ngoba ngangisebenzisa ikhondomu futhi imithi
ngiyiphuza njengoba ngitsheliwe. Kodwa [ngibonga]
ukufundiswa ngokwelashwa ngangazi ukuthi
ngezinye izikhathi ngisho uyiphuza imithi yakho
UKUMELANA NEMITHI
3
Isithombe ngu-Marius Potgieter.
Isu
Lokubambelela
“Ibhokisi lami lamaphilisi ngilibeka phezu kwe-TV futhi
ngisebenzisa imibukiso ye-TV njengezikhumbuzi. Imithi yami
ngiyiphuza ngo-21:00 kanti leso yisikhathi okungena ngaso
uMuvhango. Uma umbukiso ungadlali, isb. ngoLwesihlanu
nangempelasonto, ngingakwazi ukuthembela ku-alamu yefoni
yami ekhala ngesikhathi esifanayo ngqo.”
4
ayihlali isebenza njalo. Emva kwezinyanga eziyisithupha
ngayokwenza ukuhlolwa okuyisisekelo udokotela wathi
isibalo samaseli e-CD 4 yami sasehle saya ku-180 sisuka
kuma-300. Savuma ukuthi kwakunokumelana nemithi
nokuthi kwakudingeka ukuthi ngishintshe imithi.
“Ngaqala ngaphuza i-Alluvia (lopinavir/ritonavir) ne-
Inverase (saquinavir), yomibili okungama- protease
inhibitors* ngokujwayelekile engeke inikezelwe
[ndawonye]. Kodwa udokotela wami wathi ayikho into
engingayenza ngoba ngangingazweli kuyona yonke
imithi ekhona ezweni lethu ngaphandle kwale emibili.
“[…] Ekuhambeni kwezinyanga eziyisithupha ubuningi
begciwane emzimbeni babungasatholakali kanti
nesibalo se-CD4 yami sase siphezulu. Ngonyaka
olandelayo, ngeshwa, ngadilizwa kwa-TAC usizo lwami
lokwelashwa lwamiswa. Nganquma ukuqhubeka
nomuthi. Nakuba i-Alluvia yayitholakala ezingxenyeni
zikahulumeni, i-Inverase yayingekho, futhi [yayibiza]
R820-R850 ngokunikezelwa kwangenyanga. Kwafika
lapho engingakwazanga ukuyikhokhela khona.
Ngangikhokha irenti, nganginemoto, kwakufanele
ngidle, kwakufanele ngondle umndeni wami kanti
umsebenzi wawungangikhokheli kahle ngokwanele
ukukwazi ukukhokhela konke lokhu.
“Okokugcina, ngosizo luka-Dkt. Francois Venter
owayevela eNyuvesi yase-Witwatersrand, ngathola
[uhlobo lwemithi olusha ] Alluvia, lamivudine (3TC)
ne-tenofovir (TDF), konke okutholakalayo engxenyeni
kahulumeni. Ngayiqala ngoJanuwari 2011 ngase
ngithola imiphumela yokuhlolwa kwami. Izinga
legciwane egazini alitholakali kanti i-CD4 yami
ikhuphuke yafika ku-461.”
UMzi manje usehlala e-East London, indawo akayibiza
ngekhaya kusukela eqala ukusebenzela i-South Africa
Partners ngonyaka ka-2009. Uyivakashela kaningi
i-Cathcart ukuzobona indodakazi yakhe endala
eneminyaka eyishumi, ehlala nogogo wayo. Yena
nonkosikazi yakhe banethemba lokuba nengane.
“Ngiphilile”, uMzi engitshela. “Ngiphilile ngempela
impela.”
Ukwesekwa umndeni wakhe bekubalulekile
ekuqinisekiseni ukuthi uMzi uyabambelela emithini
yakhe yokwelashwa.” Ekugcineni ngasemukela isimo
sami se-HIV ngonyaka ka-2003, kanti umuntu wokuqala
engakhuluma naye kwakungumfowethu omdala. Ngeza
e-East London emhlanganweni wokufundisana ngase
ngimcela ukuthi eze kimi ehhotela ngase ngimtshela,
wathi ‘Mfowethu akusikhona ukuphela komhlaba.
Awuwedwa.’ Wanganga futhi wajabula ukuthi wayazi
ekugcineni ukuthi kwakwenzekani.
“Labo abasondelene nami bayazi ukuthi ngiphila
ne-HIV, futhi lokhu kuyangisiza ukuthi ngibambelele.
Abantu abangizungezile bayazi ukuthi kufanele
ngiphuze umuthi wami ngehora lesi-9 ekhanda.
Uma ngingekho ekhaya ngo-9 unkosikazi wami
uyangikhumbuza ukuthi kufanele ngithathe ama-ARV
ami.”
UMzi uyabonga ngempilo akanayo manje, kodwa
ucela ukuthi umphakathi wabantu kanye nohulumeni
bandise ukufinyelela kuma-ARV amasha nasekhona.
Uthi, “Ngikhathazekile ngoba uma ubheka ezweni
lethu uhlobo lwemithi engikulo ngolokugcina okwazi
ukuluthola. Umngane wami unesibalo se-CD4 esiwu-4
kanti usohlotsheni lwemithi lomugqa wesibili.
Wayohlolwa [wathola ukuthi] akaphenduli emthini.
Kodwa-ke unenhlanhla ngoba unosizo lokwelashwa.
Kwenzekani ngathi esingenalo usizo lokwelashwa
esimelana nohlobo lwemithi lomugqa wesibili?
Sikuhlolelwa kanjani ukumelana nomuthi [ngaphandle]
kosizo lwezokwelashwa. Uma sikwazile ukuyohlolwa,
imithi yomugqa wesithathu esiyidingayo angeke ibe
khona engxenyeni kahulumeni.”
* I-Protease inhibitor: Uhlobo lwesidambisigciwane olubhloka umnyakazo
we- protease, i-enzayimu edingekayo ukwenza amakhophi egciwane.
UKelebokgile Kabanyane, Treatment Action Campaign, Ekurhuleni
Isithombe
nguLuckyboy
Mkhonwane.
Photo by Marius Potgieter.
Ama-ARV atholakala engxenyeni kahulumeni
Umugqa wokuqala
Zonke iziguli ezintsha,
kubandakanya abesifazane
abakhulelwe, kufanele bathole
i-tenofovir + lamivudine/
emtricitabine + efavirenz/
nevirapine
Iziguli njengamanje
ezisohlotsheni
oluncike ku-stavudine,
abangenamiphumela emibi
kufanele zithole
i-stavudine +
lamivudine + efavirenz
Labo ababa nemiphumela
emibi i- d4T bangashintshela
okhethweni olukwesokunxele.
Umugqa wesibili
Iziguli ezehlulekayo ohlotsheni lwemithi yomugqa
wokuqala encike ku-tenofovir kufanele zithole
i-zidovudine + lamivudine + lopinavir/
ritonavir
Iziguli ezinezinkinga zezinso
(ezingafanelwe yi-tenofovir)
kufanele zithole
i-zidovudine +
lamivudine + efavirenz/
nevirapine
Iziguli ezehlukelayo ohlotsheni lomugqa
wokuqala oncike ku-stavudine noma kuzidovudine
kufanele zithole
i-tenofovir + lamivudine/
emtricitabine + lopinavir/ritonavir
UKUMELANA NEMITHI
5
UKUMELANA NEMITHI
6
isayensi
Yokumelana Nemithi
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
CD4
Cell
CD4
Cell
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
CD4
Cell
HIV
Cell
Uma umuthi uyeka ukusebenza kaningi sithi isifo (kungaba igciwane,
ibhaktheriya noma ifangasi) asisezweli kulowo muthi. Ngale ndlela i-HIV
ngezinye izikhathi ayibe isezwela emithini yomugqa wokuqala. Abantu
kube sekufanele bashintshele emithini yomugqa wesibili njengamanje nje
ebiza kakhulu. Kodwa kungani i-HIV imelana nomuthi kwasekuqaleni?
CD4
Cell
HIV
Cell
HIV
Cell
HIV
Cell
CD4
Cell
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell HIV
Cell
Umfanekiso ngu-Brice Reignier. Uma ungawasebenzisi ama-ARV, i-HIV ikwazi
ukuhlasela izivikeli mzimba ingaphazanyiswa
yilutho.
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
HIV
Cell
Isiphindaphindi esisheshayo
• I-human immunodeficiency virus (HIV) ingena
kumaseli egazi amhlophe bese iwathumba.
• Isebenzisa la maseli ukwenza enye i- HIV –
mhlawumbe engaphezu kwama-300 kuseli ngayinye.
• La makhophi amasha e-HIV abe esethelela amanye
amaseli egazi amhlophe bese luyaqala futhi uhlelo
phansi.
• I-HIV ikwazi kahle kakhulu ukuziphindaphinda yona
ngokwayo. Yingakho nje abantu abangelashwa
kaningi benamashumi ezinkulungwane zamakhophi
kumililitha elilodwa legazi labo.
I-T-seli etheleleke nge-HIV esebenzayo iphila
kuphela usuku nesigamu. Ngalesi sikhathi yenza
amakhophi amasha angamakhulu amaningana
egciwane ngaphambi kokuba life.
Hhayi nje ohlobo olulodwa
lwamagciwane oluvela egciwaneni
lokuqala
Uma i-HIV yenza amakhophi ayo ngaphakathi
kuseli, kaningi yenza amaphutha amancane abizwa
ngezinguquko. Lezi zinguquko zisho ukuthi amanye
ama-HIV amasha ahlukile kancane egciwaneni
eliqale kuqala ukuthelela iseli. Eziningi kakhulu kulezi
zinguquko zenza ukuthi igciwane libe buthakathaka
lingaphili isikhathi eside.
Uhlobo lwamagciwane oluvela egciwaneni lokuqala
abantu abaningi kakhulu abatheleleke ngalo lubizwa
ngokuthi igciwane oluwuhlobo lwasendle. Igciwane
oluwuhlobo lwasendle likwazi ngempela ukulimaza
izivikeli mzimba zakho uma ungayiphuzi imithi . Kodwake,
uma sewuphuza izidambisigciwane ngokuvamile,
igciwane lohlobo lwasendle liba nobunzima obukhulu
bokuphila emzimbeni wakho.
Kodwa-ke, noma umuntu ewaphuza ama-ARV
igciwane lilokhu liguquguquka ngezinga elincane
kakhulu. Okubalulekile, igciwane liyaqhubeka
nokuziguqula ngezindlela ezahlukene lize lizishayise
ngengozi oguqukweni olulisiza ukuthi lengamele
izidambisigciwane. Ngesikhathi olulodwa lwalezi
zinguquko lwenzeka, uhlobo oluguqukile olusha
luzophindaphindeka ngokushesha kunezinye izinhlobo
ngoba lingcono ekwengameleni ama-ARV athize ngqo
aphuzwa ngumuntu.
Amandla okwelashwa ngokuphindwe
kathathu
Ukwelashwa ngezidambisigciwane yiyona ndlela
kuphela efakazisiwe yokucindezela i-HIV (ukwehlisa
inani legciwane egazini) nokusiza ukubhusta izivikeli
mzimba (kwandiswe isibalo se-CD4). Izidambisigciwane
zenza lokhu ngokungenelela ukuyekisa i-HIV ukuthumba
Izidambisigciwane zicindezela i-HIV bese
ziyivimbela ukuthi ingalimazi izivikeli
mzimba zakho.
amaseli. Njengoba uzobona ekhasini 16-17, amakilasi
ahlukene emithi ye-HIV angenelela ezigabeni ezahlukene
zohlelo lokutheleleka (ukuthumba).
Uma usebenzisa umuthi owodwa kuphela ukuhlasela
igciwane, kungaba lula kakhulu egciwaneni ukuguquka
nokuzisindisa kulowo muthi. Kodwa, uma uhlasela
igciwane ezimeni ezintathu ezahlukene, kuba nzinyana
ukuthi igciwane liguquke. Lokhu kungenxa yokuthi
igciwane lenza uguquko elingakuhlula ukuhlasela
okukodwa, okunye ukuhlasela kuzobe kusalilawula.
Yingakho nje ukwelashwa ngezidambisigciwane
ezisebenza kakhulu (active antiretroviral therapy
(HAART)) zivamise ukuba nemithi eyizidakamizwa
emithathu.
Uma ucabanga ngokucindezela igciwane
njengasemdlalweni webhola lezinyawo, ungathi
kungenzeka ulimise igciwane uma izivikeli zakho
zinamandla ahlukene. Kungenzeka udinge ovimbayo
osheshayo ukuze kubhekwe emaceleni, umvimbi omude
ukuthi ahede ibhola lize liyofika emapalini, kanye
nomvimbi ohlakaniphile ukucabangela ukuthi abahlaseli
bacabangani .
Kwenzeka kanjani ukungazweli emthini
Uma iphuzwa kahle, imithi yokwelapha emithathu
isebenza kahle kakhulu ekulawuleni i-HIV. Ukwelashwa
kusiza isiguli ukuthi inani legciwane egazini lehle
ezinkulungwaneni eziningi zegciwane zamakhophi
egciwane ngemililitha legazi ngalinye libe ngaphansi
kwama-20.
Ngeshwa, asikazi ukuthi singayiqeda kanjani ikhophi
ngayinye yegciwane ukuze selaphe umuntu i-HIV. Ngisho
nangemithi emihle kakhulu yokwelapha ekhona iphuzwa
ngqo njengoba kufanele iphuzwe, enye i-HIV ihlala isele
emzimbeni, ikakhulu ngokucasha kumaseli e-CD4 alele.
Lokhu kuthiwa
Igciwane le-HIV liguquka kungahleliwe lize
libe noguquko oluyenza ukuthi ingazweli
kuma-ARV athize.
7
UKUMELANA NEMITHI
8
njengezingodla zamaselula. I-HIV kungenzeka ukuthi ibe
kwamanye amathishu kodwa ukukhathazeka okukhulu
kubantu abenza ucwaningo ngokwelapha, amaseli alele.
Ngokushesha lapho kuyekwa ukwelapha, i-HIV
ingaphuma ezingodleni ze-gciwane lapho kade
icashe khona bese iqala ukuziphindaphinda futhi
ngokukhululeka . Yingakho nje okwamanje ukwelashwa
kwe-HIV kungokokuphila konke.
Uma uyeka ukuphuza imithi igciwane lizosebenzisa
leso sikhala ukuziphindaphinda ngokuguquka kakhulu
ngokukhululeka. Ezinsukwini ezimbalwa inani lakho
legciwane lizobe selitholakala futhi nasemasontweni
ambalwa lingabuya ngezinkulungwane. Yingakho
nje ukuphela kwesitokwe kubanga ukukhathazeka
okungaka. Eminyakeni embalwa eyadlula
kwakucatshangwa ukuthi kungenzeka ukuthi kuthathwe
ikhefu ekuphuzeni imithi, kodwa uhlolo olukhulu
lwathola ukuthi abantu abathatha ikhefu emithini bagula
kakhulu kunabantu abangazange balithathe. Isizathu
esisodwa salokhu ukuthi amakhefu ekwelashweni
avumela igciwane ukuthi liguquke ngokukhululeka.
Isibonelo, isimo esincane soguquko lwegciwane
singalawuleka kodwa ngenxa yokuthi isiguli siyeke
imithi lolu hlobo oluguqukile lungaba isimo se-HIV
esingazweli nhlobo ekwelashweni. Uma isiguli sesiqala
futhi siphuza umuthi ofanayo nangaphambilini,
kungenzeka ukuthi ungasasebenzi. Izinhlobo ezindala
zisazobe lokhu zicindezelwa yimithi, kodwa izinhlobo
Uma ngabe uguquko selwenzekile
olumelana nama-ARV athize, lolo guquko
luphindaphindana ngesivinini.
ezintsha eziguqukile angeke zilawulwe futhi zizozalana
zande, zibe uhlobo olukhulu emzimbeni walowo
muntu. Esimeni esinjalo isiguli kufanele sishintshele
enhlanganiseleni yama-ARV entsha uhlobo lwe-HIV
olungakamelani nalo.
Kungadluliseleka yini ukumelana
nemithi?
Uma umuntu otheleleke ngohlobo lwe-HIV olumelana
nomuthi edlulisela igciwane komunye umuntu, umuntu
osanda kutheleleka uzoba nokumelana nomuthi
okufanayo. Ngale ndlela umuntu osandakutheleleka
angangazweli emithini ethize kusukela ngosuku
lokutheleleka. Ngeshwa asinawo umqondo ocacile
wokuthi inkinga yokumelana nomuthi inkulu
kangakanani eNingizimu Afrika. Ngokuhlambekisela
okuwuhlaka, kungaphansi kwama-5% ukutheleleka
okusha kwe-HIV okubandakanya izinhlobo ezimelene
nemithi.
Kwamanye amazwe acebile ukuhlolwa kokungazweli
kuyatholakala ezigulini ezisandakuxilongwa. Lokhu
kuhlola kusiza ukucabangela ukuthi yimuphi umuthi
ozosebenza ngempumelelo nokungenzeka ungasebenzi
ngempumelelo. Kodwa-ke, ukuhlolwa kokungazweli
akukabi bikho njengamanje ohlelweni lwezempilo
lukahulumeni eNingizimu Afrika ngenxa yokubiza
kwalo kakhulu nokuthi uhlelo lwezempilo lukahulumeni
lusebenzisa izinhlobo zemithi ezisezingeni kunemithi
eyenzelwe umuntu ngamunye.
Uma i-HIV ingasezweli emithini yomugqa wokuqala,
imithi yomugqa wesibili isuke isasebenza
ngempumelelo ngokuvamile.
Igrafu A: Amazinga emithi kanye nokumelana nayo
Izinga lomuthi elihlosiwe lidinga ukuthi libe ngaphezu kwe-MEC ukugwema
ukumelana kodwa lingabi phezulu lize libange imiphumela emibi
i-MEC
Igrafu B: Amazinga omuthi kanye nokumelana nawo
Uma weqe umthamo noma wephuze ukuwuphuza, amazinga omuthi
angehla ukufika ezingeni lapho kungenzeka khona ukumelana nawo.
i-MEC
Ingozi ekhulile yemiphumela emibi
Ingozi ekhulile yokumelana nemithi
umthamo umthamo umthamo umthamo
i-MEC = Minimum Effective Concentration (Ukujiya Okusebenza
Ngempumelelo Okuphansi)
Ingozi ekhulile yokumelana nemithi
umthamo umthamo
Umthamo
oweqiwe
Umthamo
ophuzwe
ngemuva
kwesikhathi
umthamo
Imifanekiso incike kumagrafu avela ku-HIV i-Base.
“Imithi yakho
ungayibeka endaweni
lapho okuzokwenzeka
khona ukuthi uma
sekuyisikhathi
sokuyiphuza
uyithathe. Isibonelo,
uma ukuxubha
amazinyo kuyinto
yokuqala neyokugcina
ekuseni, ukubeka
imithi yakho
eduze kwesixubho
kusebenza
njengesikhumbuzi.”
U-Stephen Ngcobo,
Treatment Action
Campaign, Ekurhuleni
Ngeshwa i-HIV angeke icindezelwe ngokuphelele ngama-ARV amanje. Enye
i-HIV iyacasha ezingodleni zamagciwane ilindele ukusebenza futhi uma
sekuyekwa ukwelashwa noma kwenzeka ukungezweli.
Isu
Lokubambelela
Isithombe ngu Luckyboy Mkhonwane.
UKUMELANA NEMITHI
9
UKUPHILA NE-HIV NAMA-ARV
10
Photo by Richard Heaven.
obala
Ngu-Mary-Jane Matsolo
Uyitshela kanjani ingane
ukuthi ine-HIV?
Ngibheka isikhathi ewashini lami. 15:30. Ulwesihlanu
ntambama olushisayo. Ngingena emtholampilo i-Ubuntu
eKhayelitsha ngethemba lokuthi umphathi wezindawo
zokusiza – uSisi Mpumie, njengoba aziwa kanjalo –
akakakhohlwa ngomhlangano wethu. .
Emtholampilo manje kunabantu abaningi abasale
endaweni yokulinda kodwa indlu isenomuzwa wokuthi
ngelinye lamalanga amatasatasa emtholampilo. USisi
Mpumie ungaphakathi ehhovisi lakhe nomunye unesi.
Ngamazisa ngokufika kwami ngase ngimlinda ngesineke
ukuthi aqede umhlangano wakhe.
Emuva kwemizuzu emihlanu wangibiza wathi angingene.
Ihhovisi likaSisi Mpumie ligcwele izithombe zemiklomelo
yakhe nokuphumelela, eceleni kwesithombe sakhe
egqoke i-T-shethi ethi HIV positive ewuphawu lokuthi
akasiyena umphathi nje kuphela wale ndawo kodwa
futhi uyilungu elikhuthele le-Treatment Action Campaign
(TAC). Ngabona ukuthi amehlo akhe ayekhathele lapho
ngimbuza wangitshela ukuthi akazizwa kahle. Ngakhoke
ngaphandle kokuchitha isikhathi saqala i-inthaviyu
yethu.
Umbuzo. Kungani abazali bekuthola
kunzima ukudalula ezinganeni zabo
ezitheleleke nge-HIV ukuthi imithi
eziyiphuzayo ngama-ARV?
Impendulo. Abazali bayehlukahlukana. Kunalabo bazali
abanezinkinga ngokudalula isimo sabo se-HIV kwabanye
futhi ngokujwayelekile lolu hlobo lwabazali lizokuthola
kunzima ukutshela ingane ngesimo sayo. Abanye
abakakwemukeli ngokwabo.
Esinye isizathu ukuthi [ngezinye izikhathi]
akunabudlelwano phakathi kwabazali nezingane zabo,
akunakuxhumana phakathi [kwabo okuzosiza] ingane
ukuthi izizwe ikhululekile ukuthi ikhulume.
Futhi, i-HIV iza nehlazo elikhulu elinanyathiselwe
kuyo kanti abazali bangafuna ukuvikela izingane zabo
emhlabeni ongaphandle.
Umbuzo. Sinini isikhathi esilungile
sokutshela ingane ukuthi
isekwelashweni ngama-ARV
kwempilo yonke?
Impendulo. Ayikho impendulo ecacile kulokhu, kodwa
okubalulekile yindlela [otshela ngayo ingane]. Abazali
belulekwa ukuthi baqale ukwazisa izingane zabo
ukusuka eminyakeni eyisithupha nangaphezulu.
Umbuzo. Kufanele umzali
ayazise kanjani ingane yakhe
ngokuxilongelwa i-HIV?
Impendulo. Kubalulekile ukuthi umuntu otshela
ingane ngesimo sayo se-HIV kube umuntu osondelene
kakhulu nengane yabo. [Kungaba] umama, ugogo noma
umnakekeli, yilowo muntu okudingeka ukuthi ethule
lezi zindaba enganeni. Abazali akufanele banikeze
ulwazi oludukisa ingane. Isibonelo, ukukhuthaza
ingane ukuthi ikholwe ukuthi umuthi ewuphuzayo
umuthi womkhuhlane [...] kungaholela ekutheni ingane
ilahlekelwe ukumthemba umzali wayo.
Ukudalula kudingeka ukuthi kwenzenke ngezinyathelo.
Isinyathelo sokuqala kufanele kutholwe ukuthi
lungakanani ulwazi, uma lukhona, ingane esivele ilwazi
[ngesifo]. Uma ingane ingazi lutho nge-HIV/AIDS
kudingeka ukhulume ngayo futhi ukhave yonke into
ukusuka ekuthelelekeni uze ufinke ekwelashweni[…].
Uma ingane isicacelwe [yilezi zinto] kungalandela
ukudalula emva kwesikhathi—ngaphandle uma ingane
ihlangane nolwazi ngaphambi kwesikhathi, lapho umzali
kungadingeka ukuthi alungise umonakalo.
Umbuzo. Inkulu kangakanani inkinga
yokuthi abazali bakuthole kunzima
ukudalula ukuxilongwa kwe-HIV
ezinganeni zabo ezithelelekile?
Isithombe ngu-Maureen Sill
Impendulo. Okwamanje asinazibalo ezikhombisa
ubungako benkinga, kodwa inkinga ikhona. Okwamanje
sisafuna ukuthola ithimba lodokotela bezingane
NAMA-ARV
ezindaweni zethu abazosebenzisa uhlu lokuhlola
noma amathuluzi okubhala nje ukuthi izingane zazi
NE-HIV
kangakanani nge-HIV/AIDS. Sikuqaphelile ukuthi
isigaba esiyingozi ezinganeni sokutheleleka siphakathi
kobudala beminyaka eyi-7 – 14, isigaba sokuqala
ukungena ebudaleni. UKUPHILA
11
UKUPHILA NE-HIV NAMA-ARV
12
amathiphu kubanakekeli
Ukungani, nini nokanjani wokutshela ingane ukuthi ine-HIV
UNokuphumelela
Zwane usebenzela
i- Reproductive
Health and HIV
Research Unit
(RHRU), eNyuvesi
yase-Witwatersrand.
Iphothifoliyo
ye-RHRU
ibandakanya
impilo yokuzalana,
ucwaningo lwe-HIV
kanye nokungenelela
kwemisebenzi
yezempilo. Ngo-
Okthoba ka-2010,
i-RHRU yahlangana
ne-ECHO
(Enhancing
Children’s HIV
Outcomes), olunye
uphiko locwaningo
lwe-Nyuvesi
yase-Witwatersrand
olubhekene ne-HIV
ezinganeni. I-ECHO
iphethe imisebenzi
ehlukahlukene
enikezela usizo,
ulwazi kanye
nokumelelwa
kwezingane
ezisandakuzalwa,
izingane kanye
nentsha engena
ebudaleni etheleleke
noma ethintwe
yi-HIV.
Kungani kufanele ngiyitshele ingane
yami?
• Ingane yakho inelungelo lokwazi isimo sayo se-HIV.
• Ingane kufanele yazi ukuthi izivikela kanjani yona
nabanye, ikakhulukazi uma seziya ocansini.
• Ingane yakho kungenzeka ukuthi isiqalile ukubuza
imibuzo ngokuthi kungani iphuza imithi.
• Ingane kungenzeka idideke noma iphatheke kabi
ngenxa yokuthi ayiqondi ukuthi yini engalungile
ngayo.
• Ukutshela ingane yakho ngesimo sayo se-HIV
kuyivumela ukuthi ikwazi ukuyenza eyayo.
Kufanele ngiyitshele nini ingane yami?
• Ngenxa yokuthi isimo ngasinye sihlukile, akukho
budala obuthize ngqo obungcono kakhulu. Kufanele
uholwe imibuzo ingane yakho eyibuzayo.
• Kudingeka uzilungiselele ingxoxo. Bonana
nomeluleki ngokwengqondo uma uzizwa
ungaqinisekile.
• Uma ingane yakho yala ukuphuza umuthi
ngoba ayizizwa igula, lesi isikhathi esibalulekile
sokuqala ukukhuluma nayo nge-HIV nokuthi
izidambisigciwane (ama-ARV) asebenza ukuyigcina
iphilile.
Ngikhuluma kanjani enganeni yami
nge-HIV?
• Kufanele ingane yakho uyitshele wena uqobo, kodwa
ungasebenzisa usizo lwabasebenzi basemtholampilo,
abanye abanakekeli, abangane noma umndeni.
• Ukudalula enganeni yakho kufanele kwenzeke
ngezigaba, kuqala kulokhu ingane yakho eseyivele
ikwazi uhanbe kancane uye kulokhu engakwazi.
• Unganikeza isibonelo somuntu ophila kahle nesifo
esingapheli. Lokhu kuzobakhombisa ukuthi impilo
enhle inokwenzeka kubantu abaphila ne-HIV.
• Ichazele ingane yakho ukuthi yayithola kanjani i-HIV.
• Chaza ukuthi i-HIV iqhubeka kanjani, iqhaza
lokwelashwa ngezidambisigciwane (ART) kanye
nezinzuzo zokubambelela ku-ART.
• Zama ukulisho uma usuyela ngasemaphethelweni
engxoxo yenu igama elithi ‘HIV’. Izingane
zinemiqondo yazo nge-HIV evela esikoleni,
kwabezindaba nakubangane bazo. Kubalulekile
ukuchaza ukuthi igciwane lisebenza kanjani
kuqala, uma ingane ivulelekile ekulaleleni futhi
ingaphazanyisiwe yihlazo kanye nemiqondo
engaguquki okungenzeka ukuthi yayizwa .
• Buza ingane yakho ukuthi ubani omunye okufanele
azi ngesimo sayo. Kufanele sihlonishwe isifiso
sengane yakho
• Ingane yakho idlulisele kumeluleki ngokwengqondo
ukuze baxoxe baqhubeke.
Amathiphu asheshayo:
• Njalo imibuzo ingane yakho eyibuzayo ixoxe
nomeluleki ngokwengqondo.
Ngu-UNokuphumelela Zwane
• Uma une-HIV, ikakhulukazi uma i-HIV yedluliseka
isuka kuwe yaya enganeni yakho, kufanele
ukulungele ukudalulwa kwesimo sakho se-HIV
okungafuneki.
• Uma i-HIV yedluliseka isuka kuwe yaya
enganeni yakho, ingane yakho kungenzeka
ikusole ngokuyithelela nge-HIV. Lokhu kungaba
okwesikhashana, kodwa kufanele uzilungiselele
ukubhekana nakho.
• Kufanele uqaphele ukuthi ukwesaba kwakho
ngalokho ingane yakho engahle ikwenze noma
okungahle kwenziwe ngabanye, akukuyekisi
ukutshela ingane yakho ngesimo sayo se-HIV noma
ukunikeza usizo .
• Kufanele ube yisibonelo ngokubambelela okuhle
emuthini futhi uchithe insomi yokuthi i-HIV isigwebo
sokufa.
Isonto le
Umuthi
Isikhathi
uMsombuluko
uLwesibili
uLwesithathu
uLwesine
uLwesihlanu
uMgqibelo
iSonto
Idayari Yokwelashwa
Le dayari izokusiza ukuthi ukhumbule ukuphuza imithi yakho ngesikhathi esifanele usuku ngalunye.
Ungatshela udokotela wakho-ke ukuthi ubambelele kahle kangakanani emithini yakho. Bhala
igama lomuthi ngamunye emabhokisini afanele emugqeni ongaphezulu. Bhala isikhathi okudingeka
ukuthi uphuze ngaso umuthi emugqeni wesibili. Yenza noma udwebe ikhophi yedayari ukuze ulokhu
uyisebenzisa. Sebenzisa idayari zonke izinsuku - maka ibhokisi bese ubhala isikhathi emva komthamo
ngamunye.
AM PM
UKUPHILA NE-HIV NAMA-ARV
13
UKUPHILA NE-HIV NAMA-ARV
14
Yazi ama-ARV
Funda ngezinhlobo ezahlukene zezidambisigciwane nokuthi
zisebenza kanjani. Ungasebenzisa futhi leli shadi ukubheka
ukutholakala ngokusebenzisa ikhodi yombala
Ukutholakala ezingxenyeni zikahulumeni nezizimele
Ukutholakala engxenyeni ezimele kuphela
Awubhalisiwe eNingizimu Afrika kodwa ubhalisiwe
e-United States
Ukuhlola kokulinga
Amanani entengo yemithi aseNingizimu Afrika njengoba eshiwo
ngoMeyi 2011. Amanani amele izindleko zenyanga zomuntu
omdala ngamunye.
I-Non-nucleoside Reverse Transcriptase
Inhibitors (NNRTI) – ‘Non-Nukes’
Ukuze amaseli atheleleke nge-HIV enze amakhophi amasha
e-HIV, i-HIV kufanele ikopishele ikhodi yayo yokuzalana
ku-DNA yamaseli. I-HIV isebenzisa i-enzayimu ebizwa ngokuthi
i- reverse transcriptase ukukwenza lokhu.
Njengama-‘nukes’, ama-non-nukes (NNRTI) nawo ayekisa
amaseli ukukhiqiza amakhophi amasha e-HIV. Kodwa
esikhundleni sokuphazamisa i-enzayimu i- reverse
transcriptase ye-HIV, azifaka ngokwawo ku-enzayimu i-reverse
transcriptase futhi ivimbela ekuguquleni ikhodi yokuzalana
ye-HIV ukuthi ibe yi-DNA.
Efavirenz (EFV)
amaphilisi angu-30 x 600mg: R40.11 (Uhulumeni) R134 (Abazimele)
Nevirapine (NVP)
amaphilisi angu-60 x 200mg: R23.42 (Uhulumeni) R62.07 (Abazimele)
Etravirine
120 x 200mg: R1005.48 (Abazimele)
Delavirdine (DLV)
Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.
Lersivirine
Ukuhlola kokulinga
Rilpivirine
Ukuhlola kokulinga
I-Nucleoside Reverse Transcriptase
Inhibitors (NRTI) – ‘Nukes’
I-NRTIs noma i-‘nukes’ ivimbela iseli etheleleke nge-HIV
ekukhiqizeni amagciwane amasha.
Ukuze amaseli atheleleke nge-HIV enze amakhophi e-HIV,
i-HIV kufanele ikopishele ikhodi yayo yokuzalana ku-DNA
yamaseli. I-HIV isebenzisa i-enzayimu i-reverse transcriptase
ukwenza lokhu. I-‘nukes’ isiza ukuvimbela igciwane le-HI
ekuphindeni lizikhiqize ngokuphambanisela i-enzayimu
i-reverse transcriptase ukuthi isebenzise amabhlokwe okwakha
anephutha ukwakha i-DNA.
Zidovudine (AZT/ZDV/Retrovir)
amaphilisi angu-60 x 300mg: R62.07 (Uhulumeni) R228 (Abazimele)
Didanosine (DDI)
amaphilisi angu-60 x 50mg: R108.29 (Uhulumeni) R222.30 (Abazimele)
Lamivudine (3TC/Epivir)
Umbhubhudlo womlomo (240ml ibhodlela): R15.79 R15.79 (Uhulumeni)
amaphilisi angu-60 x 150 mg: R20.49 (Uhulumeni) R44.40 (Abazimele)
Stavudine (d4T)
200ml ibhodlela: R19.36 (Uhulumeni)
amakhebsuli angu-60 x 30mg: R12.84 (Uhulumeni) R34.18 (Abazimele)
Emtricitabine (FTC)
amaphilisi angu-30 x Emtricitabine 200mg namaphilisi angu-Tenofovir
300mg: R104.95 (Uhulumeni) R483.78 (Abazimele)
Tenofovir (TDF)
amakhebsuli angu-30 x 300mg: R54.82 (Uhulumeni) R204.06 (Abazimele)
Abacavir (ABC)
240ml ibhodlela: R71.12 (Uhulumeni)
amaphilisi angu-60 x 300mg: R128.14 (Uhulumeni) R531.24 (Abazimele)
Amdoxovir (AMDX)
Ukuhlola kokulinga
Apricitabine (ATC)
Ukuhlola kokulinga
Apricitabine (Beta-L-Fd4c)
Ukuhlola kokulinga
akho
Ama-Protease Inhibitor (PIs)
Uma i-HIV ithelela -iCD4 seli (T seli emzimbeni womuntu,
ikopisha ikhodi yayo yokuzalana ku-DNA yamaseli. I-CD4
seli-ke ehlelelwe ukuthi yenze izinto ezintsha zofuzo lwe-HIV
kanye namaphrotheyini e-HIV. Amaphrotheyini kufanele
asetshenziswe yi-HIV protease – i-enzayimu esebenzisa
amaphrotheyini – ukwenza amaphathikili e-HIV amasha.
Ama-PI abhloka i-enzayimu i-proteae bese ivimbela iseli
ekukhiqizeni amagciwane amasha.
Ritonavir/Lopinavir
Amaphilisi i-Lopinavir 200mg ne-Ritonavir 50mg x 120: R308.27
(Uhulumeni)
Umbhubhudlo womlomo we-Lopinavir 80mg ne-Ritonavir 20mg/
ml, 5 x 60ml ibhodlela: R285.47 (Uhulumeni) R308.27 (Abazimele)
Darunavir
amaphilisi angu-120 x 300mg : R977.72 (Abazimele)
Saquinavir
amaphilisi angu-270 x 200mg: R797.18 (Abazimele)
Atazanavir
amaphilisi angu-60 x 200mg: R434.72 (Abazimele)
Indinavir (IDV)
Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.
Fosamprenavir (FPV)
Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.
Atazanavir (ATV)
Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.
Nelfinavir (NFV)
Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.
Ama-Integrase inhibitors (IIs)
Ukuze i-HIV ithathe ngempumelelo ukukhiqizwa kwamaseli
i-CD4 ukuze ikhiqize amagciwane amasha, i-RNA ye-HIV
iguqulelwa ku-DNA yi-enzayimu i- reverse transcriptase (ama-
‘nukes’ angalubhloka lolu hlelo).
Emva kwe-‘reverse transcription’ye-RNA iba yi- DNA
sekuphelile, I-DNA ye-HIV kufanele ifakwe ku-DNA ye-CD 4 seli.
Lokhu kwaziwa ngokuhlanganiswa. Ama-integrase inhibitor
asebenza ngokubhloka lolu hlelo. Ngakho-ke ama-integrase
inhibitor amisa i-DNA ye-HIV ekutheni ifakwe ku-DNA ye-T seli.
Raltegravir
amaphilisi angu-60 x 400mg: R2,396.44 (Abazimele
Elvitegravir
Ukuhlola kokulinga
Dolutegravir
Ukuhlola kokulinga
Ama-Entry Inhibitors (abandakanya
ama- fusion inhibitor)
Ama-entry inhibitors asebenza ngokuvimbela i-HIV ekungeneni
amaseli e-CD 4 aphilile emzimbeni. Asebenza ngezindlela
ezahlukene emuthin i eminingi evunyiwe elwa ne-HIV, esebenza
ngokukhuthala ukulwa ne-HIV emva kokuba seyithelele i-CD4
seli.
Ama-entry inhibitor asebenza ngokuzifaka kumaphrotheyini
aphezulu kumaseli e-CD 4 noma kumaphrotheyini aphezulu
ku-HIV. Ukuze i-HIV izihlangansie namaseli e-CD4,
amaphrotheyini asekhaveni engaphandle ye-HIV kufanele
izihlanganise namaphrotheytini aphezulu kumaseli e-CD4.
Ama-entry inhibitor avimbela ukuthi kungenzeki lokhu.
Abantu abane-HIV asebemelene nama-PI, NRTI kanye
nama-NNRTI kungenzeka basizakale kuma-entry inhibitor
ngenxa yokuthi iyikilasi elehlukile lemithi. Lokhu kuyizindaba
ezimnandi kubantu abane-HIV asebezame behluleka emithini
eminigni evunyiwe njengamanje elwa ne-HIV.
Maraviroc
Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika.
Enfuviritide
Ivunywe yi-FDA. Ayibhalisiwe eNingizimu Afrika
Vicriviroc
Ukuhlola kokulinga
Ibalizumab
Ukuhlola kokulinga
UKUPHILA NE-HIV NAMA-ARV
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UKUPHILA NE-HIV NAMA-ARV
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Umsebenzi
Wocansi
ne-HIV
Photo by Market Photo Workshop/ Working the City 2010.
U-Diputo Lety , umsebenzi osebenza
ngocansi ovela e-Hillbrow, utshela
u-Elsa Oliveira ngendaba yakhe
yokuphila ne- HIV nokuhlala ephilile.
Ngatheleleka nge-HIV ngenxa yokudlwengulwa.
Ngonyaka ka-2004 ngangikhwehlela futhi ngincipha
kakhulu emzimbeni ngase ngiya kuPhrojekthi
Yabasebenza Ngocansi e-Hillbrow ngayohlolwa
izifo ezithathelwana ngocansi (ama-STI). Selokhu
lo mtholampilo wavulwa ngonyaka ka-1997,
abasebenza ngocansi sebaba nendawo ephephile
yokuyokwelashelwa impilo nokunakekela kokuvimbela.
Ngesikhathi ngivakashile ngathola ukuthi ngangine-HIV.
Ngesikhathi unesi engitshela ngesimo sami se-HIV
wamemezela ephaseji lasemtholampilo, phambi kwawo
wonke umuntu. Ngathukuthela ngaphoxeka, kodwa
azange ngazi ngaleso sikhathi ukuthi ngangingambika
ngokungabi naluzwelo. Ngenhlanhla, ulwazi lwami
lokunakekelwa kwezempilo selwaba ngcono
kunangaleso sikhathi.
Ngalesi sikhathi, ngangingazi lutho ngokuthi kwakusho
ukuthini ukuba ne-HIV. Ngangingazi ukuthi kwakufanele
ngenzeni ukuze ngizinakekele. Konke engikukhumbulayo
ukuthi ngangesaba kakhulu, futhi ngangingabaza
nokuqala ukwelashwa ngezidambisigciwane. Uma
sengibheka emuva, kuyacaca ukuthi ukuphoxwa
phambi kwabantu emtholampilo azange kungikhuthaze
ukuthi ngazi kabanzi ngokhetho lokwelashwa kwami.
Ngangingakulungele ukuqala ama-ARV, esikhundleni
salokho ngaphuza amavithamini ngazama nokudla
izithelo eziningi kanye nemifino.
Ngonyaka ka- 2008, ngaba umfundisi wontanga e-RHRU
(Reproductive Health & HIV Research Unit, ephethe
Phrojekthi Yabasebenzi Bocansi). Njengomfundisi
wontanga, ngafundisa abanye abasebenzi bocansi
ngokuvimbela kanye nama-STI, futhi ngabancenga
ukuthi basebenzise i- Sisonke Sex Worker Movement*
ukuze bathole izinsizakalo zosizo. Ngalesi sikhathi,
ngaqala ukufunda kabanzi nge-HIV futhi ngazi
nokuthi yayingakapheli impilo yami. Ngathola nokuthi
kungenzeka ukuthi ngphile futhi ngiphile impilo ende.
Ngonyaka ka-2009, ngaqala ukwelashwa ngama-ARV,
ngase ngikulungele. Ngibonga usizo lweSisonke, onesi
abanakekelayo kuPhrojekthi Yabasebenzi Bocansi
kanye nomsebenzi wami njengomfundisi wontanga,
ukwesaba kwami ngehlazo lokuba ne-HIV kwangena
isifiso sokuphila impilo enempilo esikhundleni sakho.
Nakuba umndeni wami ungazi ukuthi ngingumsebenzi
wocansi, nokuthi ngayithola kanjani i-HIV, bayengeseka
kakhulu. Bobabili abazali bami abasebenzi basehosiphisi
abanakekela iziguli ezine-HIV, ngakho-ke baqonda
kangcono kunabantu abaningi ukuthi kusho ukuthini
ukuba ne-HIV. Bayangikhuthaza kakhulu ukuthi ngihlale
ngiphilile futhi ngiphuze imithi nyami. Empeleni,
bangishayela ucingo zonke izinsuku bengikhumbuza
ukuthi ngiphuze ama-ARV ami. Lolu hlobo lokwesekwa
luyisimanga futhi ngizizwa ngibusisekile ngokuba nabo
empilweni yami. Bekuzoba nzinyana ukuba umndeni
wami ubungangeseki. Uma ngizizwa ngingaphilile
ngiyahamba ngiye ekhaya ngiyophumula ngibe ngcono,
okwenza umehluko omkhulu. Umoya wami uphezulu
ngenxa yothando lwabo nokungikhuthaza.
Njengomsebenzi wocansi, ngiyaqiniseka ukuthi
amaklayenti ami ngiyawavikela kanye nami ngokugqoka
amakhondomu. Kahle hle, umzimba wami umsebenzi
wami! Uma amaklayenti engafuni ukugqoka ikhondomu,
ngisebenzisa ikhondomu yabesifazane. Abaningi babo
abazi ngama-STI ngakho uma ngibona ukuthi omunye
wawo une-STI, ngiyamkhuthaza ukuthi ayohlolwa
emtholampilo. Amanye amaklayenti angitshela ukuthi
ayesaba ukuya, abanye bathi abanendaba ngempilo
yabo. Ngezinye izikhathi ngike ngahamba namaklayenti
ukuya emtholampilo ukuze bahlolelwe i-HIV.
Ngiyabeseka ngale ndlela ngoba ngiyazi ukuthi akulula
ukuhamba wedwa .
Ama-ARV sengiwaphuze iminyaka emibili manje.
Nakuba ngezinye izikhathi kunzima ukubhekana
nemiphumela emibi, ngiyawaphuza amaphilisi
kodwa, ngoba ngiyazi ukuthi angisiza ukuthi ngihlale
ngiphilile futhi nginamandla. Ngiyaqhubeka nokudla
kahle futhi ngiphumule ngokwanele ngoba yonke le
mizamo isiza umzimba wami nemithi yami ukuthi
kusebenze ndawonye ngempumelelo. Ngisebenza futhi
njengomfundisi wontanga eSisonke, ngifundisa abanye
abasebenza ngocansi ngempilo nangamalungelo abantu
nokuthi kubaluleke ngani ukuthi umsebenzi wocansi
ungabi icala. Abasebenzi bocansi abaningi bayesaba
ukuhlolelwa i-HIV ngenxa yenhlamba ehambisana
nomsebenzi wabo. Bayesaba ukuthi abasebenzi
bezempilo bangahle bababandlulule. njengomfundisi
wontanga, umsebenzi wocansi kanye nowesifazane
one-HIV nginethuba lokuphonsela izinsumo inselele
ngegciwane ngokushiyelana ngolwazi lwami uqobo
nokutshela abanye ikakhulukazi abasebenzi bocansi
ngqo ukuthi akufanele besabe ukuhlolelwa i-HIV
nokufuna ukwelashwa.
Indaba yami isibonelo nje, kodwa ngiyethemba ukuthi
isebenza ukukhombisa ukuthi abasebenzi bocansi
bahlanganyela kanjani ukusizana. Kuyisifiso sami
ukuthi le ndaba ifake isandla ekuguquleni umphakathi
nepolitiki ukuze kusizakale abasebenzi bocansi,
nokuthi iNingizimu Afrika ikhiphe imisebenzi yezempilo
enozwelo ngokuthe xaxa nengahluleli.
*I- Sisonke Sex Worker Movement inhlangano ese- Hillbrow, eyasungulwa
ngonyaka ka-2003 kanti iholwa ngabasebenzi abasebenza ngocansi.
Inhlangano ihlose ukuhlanganisa abasebenzi abasebenza ngocansi, yenze
ngcono izimo zabo zokuphila nokusebenza, futhi ikhankasele amalungelo
alinganayo.
Isithombe yi-Market Photo Workshop/ Working the City 2010.
“Abazali bami bobabili
Isu
bangabasebenzi bendawo
Lokubambelela
yokunakekela abagulayo
(ihosiphisi)abaphila ne-HIV.
Bangitshela ukuthi kulungile
nokuthi kufanele nje ngiphuze
umuthi wami. Uma ngisekhaya, indodakazi
yami iyazi njalo uma sekuyisikhathi sokuthi
ngiphuze imithi yami ama-ARV. Uma
sekuwu-8pm iyamemeza, “Mama! Phuza
umuthi wakho! Ngiyabonga ngalokhu
ngoba bayangeseka futhi abangiphathi
ngokwehlukile ngenxa yesimo sami.”
U-Diputo Lety, umsebenzi osebenza ngocansi
ovela e-Hillbrow
UKUPHILA NE-HIV NAMA-ARV
17
Isithombe ngu Thandeka Vinjwa.
Isithombe ngu Thandeka Vinjwa.
UKUPHILA NE-HIV NAMA-ARV
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Ungayeki manje
Kungani abantu bephazamisa ukwelashwa kwabo ngama-ARV
Nakuba ama-ARV esindisa izimpilo eziningi ningi, abanye abantu bayehluleka
ukuwaphuza njengoba beyalelwe. UThandeka Vinjwa eLusikisiki, uNondumiso Hlwele
no-Elizabeth Mills eKapa baphenya ngokuthi yini abantu ngezinye izikhathi behluleka
ukuphuza imithi yabo.
Isithombe ngu-Samantha Reinders.
Izithuthi
Kaningi abantu kufanele bahambe
amabanga amade ukuya ezindaweni
zosizo lwezempilo eziseduze nabo,
emigwaqeni emibi enemigodi
eminingi. Abanye bahamba la
mabanga amade kakhulu ngoba
akunazithuthi noma zibiza kakhulu.
Imigqa emide
Uma iziguli sezifike ezindaweni zosizo
lwezempilo kaningi babhekana nemigqa
emide. Lokhu kungaqeda amandla
futhi kwenzeka ukuthi kungasebenzeki
ngezinsuku abavakashela ngazo
emtholampilo. Ukuthatha usuku
emsebenzini ukuze uyothola
izidambisigciwane (ARV) nakho
kungaphoqa abantu ukuthi badalule
isimo sabo se-HIV kubaqashi babo.
Ukuphela kwesitoko sama-ARV
Ngezinye izikhathi ukushoda kwemithi
ezindaweni zezempilo kusho ukuthi iziguli
zivele zijikiswe nje. I-Treatment Action
Campaign (TAC) ivamise ukuqapha
ukuphela kwezitokwe endaweni
yaseLusikisiki.
“Manje imithi yami angisayiphuzi
kahle ngoba azange ngiwathole
[amaphilisi] enyanga . Ngizowathola
nini futhi? Kuzokwenzekani
ngezinsuku engingezuwaphuza
ngazo?”
(owesifazane one-HIV, eLusikisiki)
Imiphumela emibi
Abanye abantu baba nemiphumela emibi ebangwa ngama-
ARV, ikakhulukza i- stavudine (d4T). Khuluma nodokotela
wakho ngokushintsha uhlobo lwakho lwemithi yokwelashwa,
njengoba imiphumela emibi kaningi ingancishiswa.
“…kimi imiphumela emibi… bekunzima
kimi ngoba kube noshintsho olusheshayo
esimeni sokwakheka komzimba wami,
kanti ngezinye izikhathi bengingawuphuzi
umuthi wami.” (owesifazane one-HIV, eKapa)
Photo by Maureen Sill.
Indlala notshwala
Uma ungakwazi ukukhokhela ukudla noma
isithuthi kunzima kakhulu ukunakekela
ukwelashwa. Lesi ngesinye sezizathu i-TAC
yeseka umqondo weSibonelelo Semali
Esiyisisekelo - imali encane njalo ngenyanga -
kuwo wonke umuntu eNingizimu Afrika.
“Ngezinye izikhathi umuntu akanakho
ukudla okuningi lapho kudingeka ukuthi
aphuze ama-ARV ngoba akwenza ukuthi
ulambe. Nalabo abaphuza utshwala
bavele bakhohlwe.”
(owesifazane one-HIV, eKapa).
Izinsumo kanye nokuba nolwazi olungesilo iqiniso
Kwezinye izindawo abantu bakholwa ukuthi izinyanga zingayelapha
i-HIV. Bayayeka ukuphuza ama-ARV esikhundleni sawo basebenzise
imithi yendabuko, engayicindezeli i-HIV. Abanye bakholwa yizindaba
ezibadukisayo zokuthi ama-ARV akwenza ukuthi usheshe ufe, noma
ukuthi kungenzeka ukuthi yelapheke i-HIV ngenkolo.
Ukudalula kanye nenhlamba
Ukwesaba inhlamba kaningi kubanga abantu
abanokuzethemba okungekukhulu bazizwe
bephoxekile ngokusebenzisa ama-ARV. Ukujoyina
amaqembu okubambelela noma okusiza kusiza
ukubhekana nalobu bunzima.
“Uma ungakadaluli [kubantu]
abasondelene nawe kakhulu kuzoba
nzima ukuphuza imithi. Kufanele
uchaze ukuthi kungani uyiphuza
bese ugcina ungasayiphuzi.”
(owesifazane one-HIV, eKapa)
Ukukhumbula ukuphuza ama-ARV
Izikhumbuzi, njengokusetha i-alamu yefoni noma
ukusebenzisa ukuqala kohlelo lwe-TV ukucabanga,
kungakusiza ukukhumbula ukuphuza ama-ARV akho.
Uma udalula kubantu ophila nabo bangakukhumbuza
nabo.
“Ukuba ngumuntu omatasatasa
ngezinye izikhathi oya emihlanganweni,
inselele yami ukuthi ngiwafaka
esikhwameni sami bese ngiyawakhohlwa
ukuwaphuza, ngoba azange
ngisethe isikhumbuzi efonini yami….”
(owesifazane one-HIV, eKapa)
‘Ukuphumula’
Uma abantu abelashwa ngezidambisigciwane
sebeqala ukuba ngcono ngezinye izikhathi bayayeka
ukuphuza umuthi. Lokhu kuvumela igciwane ukuthi
liphindaphindeke ngokukhululeka. Uma labo bantu
sebegula futhi ama-ARV afanayo kungenzeka
angasasebenzi ngenxa yokumelana nomuthi. Ngakho
kokubili i-HIV ne-TB kubaluleke kakhulu ukuphuza
imithi yakho - ngisho ngabe uzizwa uphilile impela.
“Abanye abantu banquma
ukuphumula [kuma-ARV] bese kuthi
uma sebegula banqume ukuphindela
kuwo futhi. [Kodwa-ke] umuthi
awusebenzeli ngenxa yokumelana
kwegciwane nawo.”
(owesifazane one-HIV, eKapa)
Isithombe ngu-Adam Malapa.
Ukutreyisa abantu abenza
amaphutha
Ngu-Adam Malapa
UFrancinah Chauke ngomunye wabangama-20 wama-
Prevention Treatment Literacy Practitioners (PTLPs) asebenzela
i-TAC eSigodini saseMopani, eLimpopo. I-PTLP umfundisi
osemphakathini endaweni yezempilo ofundisa iziguli
ngokwelashwa nokuvimbela.
Elinye lamaqhaza ama-PTLP ukutreyisa abantu abenza amaphutha
ngokuthatha imithi - abantu abasandakuhluleka ukulanda imithi
yabo. UChauke udinga ukuqonda ukuthi kungani umuntu enze
iphutha, nokumenza ukuthi aqale imithi yakhe futhi. Ngeshwa,
olunye lwalolu hlelo lwenzeka emva kwendaba njengoba i-HIV
noma i-TB kungenzeka ukuthi kusuke sekwenze umonakalo
omkhulu kakhulu ngalesi sikhathi kade beyeke umuthi.
“[Isizathu esikhulu sokwenza iphutha] imali yesibonelelo
somphakathi”, kusho uChauke. “Abantu abaningi [...] bangitshela
ukuthi bacabanga ukuthi isibonelelo sabo sizomiswa uma impilo
yabo iba ngcono, ngakho-ke [bangamane] bahlale bengenamandla
ukuze bagcine isibonelelo sabo somphakathi.”
U-Oscar Mabela uyi-PTLP ye-TAC e-Dr C N Phatudi Hospital,
eLimpopo. Uthi, “Inkinga enkulu endaweni yangakithi izithuthi”.
“[…]Abantu […] kufanele basebenzise izithuthi ukuze bafinyelele
ezindaweni zosizo bebe belokhu bengenakho ukudla kokudla
emizini yabo.” Le nkinga ixhumana nobunzima uFrancinah
abubona: uma abantu bengenakudla namali yokugibela, abaningi
bangamane bahlale emakhaya baze bagule bese befaka isicelo
sesibonelelo semali yomphakathi.
“Abantu abasebenza emapulazini kaningi abanaso isikhathi
esikhululekile [...] sokulanda imithi yabo,” kusho uMasingita
Mavodze ovela eRotterdam. “Kungcono ukuthi bavele bengayiceli
nemvume kubaqashi babo [...] ngoba bafuna ukuvikela imisebenzi
yabo.” Abanye abantu abasuka kwenye indawo beye kwenye
ngomsebenzi abakucabangi ukuthola izincwadi zokudluliselwa
ezizobavumela ukuthi bathole imithi eduze nemisebenzi yabo
elandelayo.
Ngokwalokhu okutholakele, i-TAC Mopani yanikeza u-Chauke
umsebenzi wokusebenza emapulazini asendaweni, afundise
abantu ngokubaluleka kokuphuza imithi ngendlela elungile
nangesikhathi.
UKUPHILA NE-HIV NAMA-ARV
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20
Umtholampilo
Kuthengiswe kwaphela
Ikhaya
Imithi yokwelashwa kungenzeka ukuthi idide futhi ibe
nzima, ikakhulukazi uma kungenakwesekwa. Ngezinye
izikhathi imiphumela embi ingangabi mihle ngempela, futhi
kungangcono ukuyigwema.
R10
Indawo yosizo
Isixazululo: Thola umngane wokwelashwa
noma ikilabhu. Wena nenisizana nabo
ngokwelashwa ningakhumbuzana ukuphuza
umuthi futhi nixoxe ngezinto ezinhle
nezimbi ngemithi. Mazise umsebenzi
wezempilo wakho uma unemiphumela
emibi kakhulu ukuze uhlobo lwakho
lwemithi luzoshintshwa .
Impahla Ebhaliwe
Umtholampilo wangakini kungenzeka ungakwazi
ukuphinde u-ode imithi ngesikhathi bese uphelelwa
yisitokwe. Umtholampilo kungenzeka ungakwazi
ukuphatha abasebenzi bawo kanye nezinsizasidingo kahle,
noma kungenzeka ube nabasebenzi abancane.
Amalungelo eMpahla Ebhaliwe kaningi abeka inzalo ngaphezu kwelungelo leziguli
kuBanikazi bezempilo, uhlobo lwe-IP engahlala amashumi, ivumela izinkampani
zemithi ukuthi zishintshe amanani entengo abanye ohulumeni abangeke bakwazi
ukuwakhokhela. Lokhu kusho ukuthi ngisho ngabe umuthi onoguquko, osindisa impilo
uyethulwa, kungenzeka kube yiminyaka ngaphambi kokuba abantu abawudingayo
bakwazi ukuwuthola. Izinkampani ezejwayelekile kungenzeka zingakwazi ukukhiqiza
imithi kuze abanikazi bawo bokuqala baphelelwe yisikhathi.
Isixazululo: Thola ezinye izindawo zosizo
lwezempilo eziseduze nawe, njengokokusiza.
Ngisho ngabe le mitholampilo ikude,
kungenzeka ukuthi ikwazi ukukusiza ezimeni
eziphuthumayo
Umgwaqo ophokophele ekubambeleleni okuhle
!
R80
Umphakathi
Ukubandlulula kukhona ngoba
kunokushoda kwemfundo nokuqonda
ngokwelashwa kwe-HIV.
Isixazululo: Buza ngokuqeqeshelwa ukuzwela
kwabalingani bakho nezidingongqangi
zokwelulekwa ngokwengqondo emsebenzini
wakho. Ukudalulela umndeni nabangane nakho
kuzokusiza ukwakha umphambo wokukusiza.
Zama ukujoyina iqembu losizo noma ikilabhu
yokubambelela.
Ishibhi
Isixazululo: Funda ngomthetho wempahla ebhaliwe.
Umsebenzi we- Treatment Action Campaign
((TAC) emthethweni wempahla ebhaliwe udlale
indima ebalulekile ekunciphiseni amanani entengo
ezidambisigciwane eNingizimu Afrika. I-TAC
nohulumeni waseNingizimu Afrika kufanele
baqinise ingcindezi yabo ukuthola ama-ARV
amasha asindisa impilo. (Funda kabanzi ngalokhu
ku-athikili elandelayo.)
Wena uqobo
Kungenzeka ukhohlwe ukuphuza
umuthi wakho ngoba umatasatasa
kakhulu noma uphuze utshwala.
Isixazululo: Setha i-alamu yewashi lakho uqobo efonini
yakho ukwelashwa ukwenze ingxenye yenjwayelo
yempilo yakho. Umuthi wakho uphathe kuwe ukuze
ukwazi ukunakekela ukwelahwa kwakho ngisho ungekho
ekhaya. Ukuphuza kwakho utshwala kukale kube kahle.
Izinto eziningi ezingakusiza ekukhumbuleni ukuphuza
izidambisigciwane zakho, bheka amathiphu okubambelela
agcwele leli phephabhuku.
Inqubomgomo
Nangale kwenqubekela phambili enkulu,
uhulumeni wethu akazange atshale imali eyanele
kuzidambisigciwane noma enze okwanele
ukuqinisekisa ukuthi ama-ARV esikhathi esizayo
ayathengeka. INingizimu Afrika isengakahlanganyeli
i-TRIPS (Agreement on Trade Related Aspects
of Intellectual Property Rights) izinguqunguquko
emthethweni kazwelonke noma kusetshenziswe
ngaphansi kwelayisense eyimpoqo. Ilayisense eyimpoqo
isho ukuthi uhulumeni angaphoqa umuntu ophethe
ubunikazi bomuthi ukuthi avumele ukwakhiwa
komuthi ojwayelekile.
petroStation
Ezokuthutha
Usuhambe amabanga amade, emigwaqeni
emibi, noma ukhokha izimali zamatekisi
abizayo kungakuyekisa ukuya emtholampilo.
Awukho uphethiloli
Isixazululo: Thola ukuthi akhona yini amavawusha
amatekisi okukulanda emzini wakho akuse
emtholampilo noma eqenjini lokwesekwa
umphakathi. Bheka ukuthi umtholampilo
wakho unawo yini amabhasi ahambisa abantu
noma bathumela abasebenzi bezokwelashwa
emphakathini. Shayela uhulumeni weseke indlela
eyaba amandla okunakekela lapho imitholampilo
yakhiwe futhi yesekwa ezingeni lasekhaya.
Ukunikezela
Ukuphathwa okubi kwezezimali, ukuhlela okungenele
kanye nomkhawulo wesabiwo mali sezempilo kusho
ukuthi amadepho emithi yesifundazwe kungenzeka iphele.
Isixazululo: Qapha ukunikezelwa kwemithi
nokuphela kwesitokwe emiphakathini
yethu. Uma ukuphela kwesitokwe
nokushoda kwenzeka, kubike ngokushesha
ezinhlanganweni ezisekwa umphakathi,
kubasebenzi bezempilo, kuhulumeni
wasekhaya, wesifundazwe nakokazwelonke.
Funa uhlelo lwethenda olusobala ngokuthe xaxa, futhi funa
uhulumeni ukuthi asebenzise amandla akhe okuthenga
aqinile ukuthenga ama-ARV ngamanani entengo
angcono. Phikisana nezivumelwano zokuhweba ezintsha
ezinemingcele njenge-EU-India Fair Trade Agreement
(bona ikhasi 23).
Emizini yethu, emsebenzini nasemiphakathini yethu singasiza ngokunconzulula
izithiyo ezivimba endleleni yokuphuza imithi njengoba kuyalelwe.
ADHERENCE
21
UKUBAMBELELA
22
Izimpi
Zelungelo
Lobunikazi
Ngu-Catherine Tomlinson
Lapho abantu abaningi beba nokumelana nemithi ye-HIV eminyakeni ezayo,
sizodinga imithi emisha ukusiza ukugcina labo bantu bephila futhi benempilo.
Kodwa izivumelwano zohwebo ezintsha zesabisa ngokubulala izindlela zokwenza
ukuthi ama-ARV athengeke. Uma singaziqedi lezi zivumelwano manje, izimpilo
eziningi zizolahleka kungenasidingo.
Kungani imithi ejwayelekile ishibhile
kunemithi enelungelo lobunikazi?
Ilayisensi yobunikazi (indlela yempahla ebhaliwe) ilungelo elihlukile
elinikezwa umsunguli isikhathi esithize esimvumela ukuthi umsunguli
anqume ukuthi ukusungula kwabo kuzosetshenziswa kanjani. Ngalesi
sikhathi umsunguli angabiza ngokujwayelekile noma yini ayifunayo
ngomkhiqizo. Yingakho imithi enelungelo lobunikazi ibiza kakhulu
kunemithi ejwayelekile.
Imithi ejwayelekile inezithako ezifanayo zokwenza umuthi
ezisebenzayo, eyenza ukuthi ifane noma ilingane ngokwempilo
(ukuba nezithako nemiphumela efanayo), nemithi enelungelo
lobunikazi. Umehluko ukuthi imithi ejwayelekile ayenziwa futhi
ithengiswe umuntu onelungelo lobunikazi, kodwa ngenye inkampani.
Le nkampani kungenzeka ukuthi inikwe ilayisense yokuthengisa
umuthi ngumnikazi welungelo lobunikazi noma ezweni lapho ilungelo
lobunikazi lingavikelwe khona.
Ukhetho olujwayelekile lwehlisa inani lentengo yemithi ngoba bathula
umncintiswano emakethe eyehlisa amanani entengo. Uma ziningi
izinkampani ezithengisa umuthi, inani lentengo yomuthi lizokwehla
kakhulu. Uma kuvunyelwa umuntu oyedwa kuphela endaweni yakini
ukuthi athengise ubisi, lowo muntu angabiza amanani entengo
aphezulu kakhulu ngoba uyazi ukuthi angeke ubisi uluthenge noma
kuphi. kodwa-ke, uma abantu abahlukene abayishumi bethengisa
ubisi emphakathini wakini, inani lentengo yobisi lizoba phansi
kakhulu.
* Impahla ebhaliwe ingachazwa njengemiqondo yomuntu inenani
lezowhebo futhi kungenzeka ivikelwe umthetho.
Ngaphambi kuka-2005 amazwe anemali ephakathi
nendawo njengeNingizimu Afrika ayekwazi
ukuzikhiqizela amahlelo ajwayelekile emithi
eyayingaphansi kwelungelo lobunikazi emazweni
acebile. Lokhu kungenxa yewmithetho yamazwe
omhlaba ethinta ukuhweba ngemithi yayingadingi
ukuthi amazwe anemali engenayo ephakathi nendawo
avikele la malungelo obunikazi.
Le mithi ejwayelekile yehlisa amanani entengo
yezidambisigciwane, azenza ukuthi zithengeke
ezindaweni zezempilo zikahulumeni e-Afrika yonkana.
Kodwa-ke ngonyaka ka-2005, amazwe anemali
ephakathi nendawo kwadingeka ukuthi ethule
imithetho ezonikezela ngokuvikeleka okufanayo
kwamalungelo obunikazi njengamazwe acebile. Ngenxa
yalokhu, namhlanje kunzima kakhulu ukuthi amazwe
afana neNdiya, iNingizimu Afrika kanye neBrazil
akhiqize imithi emisha.
Ukungabi bikho okulandelayo kwamahlelo ajwayelekile
emithi emisha kuyisizathu sokuthi imithi yomugqa
wesithathu ihlale ingathengeki futhi ingabi bikho
ohlelweni lukahulumeni wethu lwezempilo. Eminyakeni
ezayo lokhu kungenzeka kubange ukufa okuningi
okugwemekayo futhi kwandise izindleko kuhulumeni
wethu nabanye.
Nangale kwezinselele ezinkulu amazwe ezibhekene
namazwe ampofu ekutholeni amahlelo athengekayo
emithi emisha, amazwe acebile manje asephushela
ukuthi imithetho emisha yokuqhubeka nokuvikela
impahla ebhaliwe ngale kwemikahwulo ye-TRPS
((Trade-Related Aspects of Intellectual Property
Rights). Lokhu okubizwa nge-TRIPS kuhlanganiswe
nezindlela kwesabisa ukunikezela okuqhubekayo
kwemithi esesivele sethembele kuyo. Futhi bacindezela
izinguquko emithini esindisa impilo njengemithi
ye-TB, ukwenziwa kwama-ARV ezingane, kanye
nezinhlangansiela zomthamo wama-ARV ongaguquki.
I- EU-India Free Trade
Agreement (FTA)
I- European Union (EU) okwamanje ixoxisana
ngesivumelwano sohwebo neNdiya esingalimaza
ukukwazi kweNdiya ukwenza nokukhiphela
emazweni angapahndle imithi ejwayelekile. Lokhu
kungenxa yokuthi i-EU iphusha Indiya ukuthi yenze
imithetho yayo yobunikazi ithi ukuqinaqina kunaleyo
edingekayo njengemanje emithethweni yamazwe
omhlaba afana ne-TRIPS.
Indiya ingumnikezeli omkhulu wemithi ejwayelekile
nenezithako zokwenziwa kwemithi ezisebenzayo
e-Afrika. Ngakho-ke uma yamukela lesi sivumelwano
kuzolimaza ukutholakala kwemithi e-Afrika
nasemazweni asathuthuka onkana. Futhi kungavula
indlela yeminye imithetho eqinile yamazwe omhlaba
ebhloka ukutholakala kwemithi futhi ilimaze
nezempilo kuhulumeni.
Ngalesi sivumelwano, i-EU iphushela:
Izindlela zemingcele
Lokhu kuzovumela i-EU ukuthi imise ukuhanjiswa
kwemithi enqamula emingceleni ye-EU uma leyo
mithi ingaphansi kwelungelo lobunikazi ezweni
le-EU. Ngisho ngabe indawo yokugcina okuya
kuyo lowo muthi izwe elifana neNingizimu Afrika
lapho okungekho khona bunikazi kuleyo mithi, i-EU
izokwazi ukuyithatha leyo mithwalo. Lesi sidingo
sizokwenza ukuthi kuphele isitokwe
Imifanekiso nguSizwe Nguqe.
Isithombe ngu- Samantha Reinders.
Umthetho wamazwe omhlaba olawula ukuhweba
ngemithi kanye neminye imikhiqizo waziwa ngokuthi
yi- Trade Related Aspect of Intellectual Property
Rights, noma i-TRIPS.
UKUBAMBELELA
23
UKUBAMBELELA
24
Amazwe
acebile afuma
ukwandisa
inzuzo yawo
ngokuhlupheka
kwezimpilo
zethu!
Yithi cha
ekwandisweni
kokuvikelwa
kobunikazi
ezivumelwneni
zokuhweba!
Isithombe nguLuckyboy Mkhonwane.
emitholampilo yethu futhi kuphazamise
ukunikezelwa kwemithi emhlabeni osathuthuka.
Isahluko sokutshalwa kwezimali
Umkhandlu Wongqongqoshe waseYurophu
usazovotela ukuthi ingabe izingxoxo ze-EU-India
zingayifaka yini impahla ebhaliwe (intellectual
property-IP) kusahluko sokutshalwa kwezimali
se-FTA.. Uma ifakiwe, lokhu kuzovumela izinkampani
ukuthi zenze konke ukuvikela ukutshalwa
kwezimali okwenziwe yi-IP yawo, kubandakanya
nokukhiqizwa kwemithi . Yize okwamanje amazwe
kuphela angathatha isinyathelo ukuphikisana
namanye amazwe, isahluko sokutshalwa kwezimali
singavumela izinkampani ukuthi zibophe ezinye
izinkampani ngqo. Ukwenza kanjalo kuzodingeka
ukuthi ziye enkantolo yamacala kunasenkantolo
engaphakathi kuhulumeni walelo zwe. Isibonelo,
uma inkampani yaseYurophu icabanga ukuthi
umthetho waseNdiya wawulimaza i-IP yayo
ngokuvumela izinkampani nezejwayelekile ukuthi
zenze imithi inelungelo lobunikazi njengoba
kuvunyiwe ngaphansi komthetho wokuhweba
wamazwe omhlaba, inkampani ingabopha
uhulumeni waseNdiya enkantolo yamazwe
omhlaba, ivimbela isenzo sikahulumeni. Lokhu
kuhlinzeka kungavimbela ohulumeni ekuvikeleni
ezempilo kohulumeni uma izenzo zabo zazibonwa
njengokucindezela i-IP.
* I-EU futhi ixoxisana nge- Economic Partner
Agreement ne-SACU (South African Customs Union
“Kufanele ube nomngane wokwelashwa
ozokukhumbuza ukuthi uphuze imithi
yakho. Lokhu akusho ukuthi wena nomsizi
wakho ngokwelashwa kufanele nihlale
ndawonye ngoba kulezi zinsuku wonke
umuntu unocingo ahamba nalo, ngakho-ke
umsizi ngokwelashwa angathumela umyalezo
noma akushayele ucingo kunemizuzwana
embalwa esele ngaphambi kokuba kufike
isikhathi sokuphuza imithi yakho bese
ekukhumbuza.”
UMaria Khambule, Treatment Action
Campaign, Ekurhuleni
Isu
Lokubambelela
ebandakanya iNingizimu Afrika, Botswana, Namibia,
Lesotho neSwaziland) kanjalo neMozambique
ne-Angola. Kodwa-ke imininingwane yalesi
sivumelwano ayikho sobala. Ngenxa yendawo
yokuxoxisana enamandla ye-EU nokusetshenziswa
kolimi oluqinile oluzungeze ukuvikelwa kwempahla
ebhaliwe kusiphakamiso se-EU, kunokwesabela
ngempela ukuthi i-EU iqonela iNingizimu Afrika
ekutheni yamukele ukuvikelwa kobunikazi obuqinile.
I-Anti-Counterfeiting Trade
Agreement (ACTA)
I-Anti-Counterfeiting Trade Agreement (ACTA)
isivumelwano samazwe amaningi esiphakanyiswe
amazwe angasisayina ‘ngokuzithandela’. Nakuba
lesi sivumelwano kungesokuzithandela kuzoba
nengcindezi enkulu evela emazweni acebile ukuthi
abanye basayine isivumelwano. Kungenzeka
kudingeke ngokwezivumelwano zokuhweba.
Umuthi ozishaya umuthi wangempela ungesiwona
yisithipha noma umuthi ongesilo iqiniso ongenazo
izithako zokwenza umuthi ezifanayo ezisebenzayo
njengomuthi onelungelo lobunikazi noma
ojwayelekile. Umuthi oyisithipha kungenzeka
ulimaze futhi ube yingozi. Kufanele kungabi
semthethweni ukuwuthengisa noma ukuwuthenga.
I-ACTA ithi kunendlela ezoyekisa ukuthengiswa
kwemithi eyizithipha. Kodwa-ke, nalokhu
kuwukuhlasela imithi ejwayelekile esithembela
kuyo. Isivumelwano siphakamisa izintshisekelo
zezinkampani ezenza imithi ngokuphazamisa
ukunikezelwa kwemithi ejwayelekile esemthethweni.
Lokhu kungenxa yokuthi kwezinye izimo i-ACTA
yandisa incazelo yesithipha ukubandakanya imithi
ejwayelekile.
Ngaphansi kwemithetho ye-ACTA, iziphathimandla
zasemingceleni kanye nohulumeni bazovunyelwa
ukuthi bathathe futhi bacekele phansi imithwalo
yemithi abakholelwa ukuthi yephula ilungelo
lobunikazi. Bazokwazi ukwenza lokhu ngaphandle
ngisho kokuthinta umnikazi welungelo lobunikazi
ukuqinisekisa ukuthi ingabe imithi yiyo ngempela
yini. Lokhu kungenziwa ngaphandle kohlelo
lomthetho kanti amandla okuhlukumeza
nenkohlakalo makhulu.
Ukuvumela iziphathimandla zesemngceleni ukuthi
zithathe futhi zicekele phansi imithi kuzophazamisa
ukunikezelwa kwemithi esemthethweni
emitholampilo yethu, kubange ukushoda kwesitokwe
futhi kuphoqe iziguli ukuthi zipahazamise
izidambisigciwane noma okunye ulwelashwa.
I-ACTA akusiwo kuphela umthetho olwa nezithipha
okwamanje osathuthuikiswa. Kwenziwa imithetho
eminingana efanayo noma eyamukelwe e-Afrika
yonkana kubandakanya iKenya, Burundi, Tanzania
ne-Rwanda.
“Ngiphuza amaphilisi amathathu
(i-nevirapine embili ne-Truvada
eyodwa) into yokuqala ekuseni.
Ngakho-ke uma ngivuka ekuseni
ngibilisa igedlela bese ngikhipha isitsha
samaphilisi ami. Sinezimbobo eziyisikhombisa,
eyodwa yelangana ngalinye lesonto.
Ngiwagcwalisa ngawo ngoMgqibelo. Ngakhoke
ngiyakwazi njalo ukubona uma ngeqe
usuku okucishe akwenzeki nhlobo, kuphela
uma ngingakwazi ukuphuza amaphilisi ami
khona manjalo lapho ngivuka.Ngakho-ke
ngiziqeqeshile kanzima ukuthi ngiliphuze
kube yinto yokuqala ekuseni [e]mpilweni yami
nasemcabangweni njalo ekuseni, okuyinto
elungile - ngoba ngaphandle kwamaphilisi
angeke ngibe nampilo.
“Futhi ngiwumgibeli bhayisiskili onothando
futhi ngiqede ukubekezela okumbalwa
kwemijaho yamabhayisikili njenge-Argus ne-
94.7. Inhloso yami ukuqeda umjaho we-Argus
ngonyaka ka-20111 ngaphansi kwamahora
amane. Lokhu kusho ukuthi kufanele
ngizilolonge kaningi, ngidle ngokunempilo
futhi ngiphuze ama-ARV ami ngokuvamile.
Nginezithombe eziningi ezahlukene
zokugibela kwami ibhayisikili ezathathwa
umndeni wami nabangane bami endlini
yami nakukhompiyutha yami. Lezi zithombe
zingikhumbuza ngezinhloso zami nokuthi
umuthi wami ungigcina kanjani ngiphilile.”
U-Justice Edwin Cameron
Isu
Lokubambelela
Isithombe ngu-Edwin Cameron.
UKUBAMBELELA
25
UKUBAMBELELA
26
Iseli
ye-CD4
Ucwaningo olusha
Amaseli e-CD4 enziwe ukuthi
amelane ne-HIV
Iseli
ye-HIV
Olunye lwezifundo ezithokozisa kakhulu ezibikwe
eNgqungqutheleni esanda kuba khona i- Conference
for Retroviruses and Opportunistic Infections (CROI)
eBoston ibandakanya indlela entsha ewumzamo omusha
wokulwa ne-HIV.
Abantu abayisithupha abane-HIV babamba iqhaza kulolu
hlolo lokwelapha okwamanje olubizwa ngokuthi i-SB-
728. Lokhu kwelapha kubandakanya ukudonsa igazi,
elibe selelashwa elabhorethri ngenhloso yokushintsha
amaseli e-CD4 ukuze engezukwazi ukuthelelwa
yi-HIV. Lokhu kwenziwa kusetshenziswa isimo
sokwelashwa kwesakhi sofuzo okuphazamisa isakhi
sofuzo i-CCR5 kumaseli e-CD4. (Ukwelashwa kwezakhi
zofuzo kubandakanya ukuguqula, ukuhlanganisa
noma ukususa izakhi zofuzo kumaseli emzimbeni
womuntu ukuze kuliwe nokugula.) I-HIV iyazabalaza
ukuhlangana namaseli e-CD4 lapho isakhi sofuzo
i-CCR5 siphazamisekile. Amaseli e-CD4 alashiwe abe
esephindwaphindwa elabhorethri aphinde aphindiselwe
emuva esigulini.
Kulandela lokhu kwelashwa abahlanganyeli abahlanu
kwabayisithupha ohlolweni sakhula isibalo se-CD4
saba ku-avareji engama-200. Umhlanganyeli omunye
akazange azuze kulokhu kwelashwa. Azange kube
nemiphumela emibi kakhulu eyabikwa kunanoma
yimuphi kubahlanganyeli.
Kulokhu kuhlola ukwelashwa kuphela kwenza iphesenti
elincane lamaseli e-CD4 ukuthi asinde ku-HIV, kodwa
kuyakhuthaza ukuthi leli phesenti elincane lihlala
lisindile isikhathi eside ngangonyaka. Kunjalo, ukuba
namaseli e-CD4 amelana ne-HIV akwenzi ukuthi umuntu
asinde ku-HIV.
Iseli
ye-HIV
Imibuzo eminingi isala nge-SB - 728.Asikazi ukuthi
ukuphazamisa isakhi sofuzo i-CCR5 kungenzeka
yini ukuthi kube nemiphumela emibi kwezempilo
ekuhambeni kwesikhathi. Asazi futhi ukuthi kungenzeka
yini ukuthi selaphe iphesenti eliphezulu kakhulu
lamaseli ngale ndlela. Kusenomgwaqo omude okufanele
siwuhambe ngaphambi kokuba sizokwazi ukuthi lokhu
kwelapha kuzoke kube ngaphezulu yini komqondo
othokozisayo. I-Equal Treatrment izoqinisekisa ukuthi
inilethela izindaba zezinhlolo zakamuva kulo mkhakha.
Umthombo: Lalezari J et al. ‘Successful and persistent engraftment of ZFN-
M-R5-D autologous CD4 T Cells (SB-728-T) in aviremic HIV-infected
subjects on HAART.’ 18 th Conference on Retroviruses and Opportunistic
Infections (CROI), Boston, abstract 46, (2011).
I-entry inhibitor entsha
Ama-entry inhibitor ikilasi elisha lemithi uma
kuqhathaniswa elivimbela i-HIV ekungeneni amaseli
e-CD4. Sidinga imithi eminingi kuleli kilasi elisha ngoba
inganikeza umugqa wempilo kubantu abamelana
nemithi kwamanye amakilasi. Ama-entry inhibitor
amabili (abizwa ngokuthi i- maraviroc ne-enfuvirtide)
asevele asebhalisiwe e-United States.
Manje abacwaningi sebebike ukuthi i-entry inhibitor
entsha ebizwa ngokuthi i-BMS-883068 seyidlule
eyokuqala ezinkingeni eziningi emgwaqeni wokuthola
imvume yokulawulwa. Ohlolweni oluncane kakhulu
olwathatha izinsuku eziyisishiyagalombili kuphela
umuthi uhlanganiswe nokuncipha okukhulu enanini
legciwane egazini ngaphandle kwemiphumela emibi.
Izinhlolo eziqhubekayo kulo muthi zihlelelwe ukuthi
ziqale ekuhambeni kwalo nyaka .
Umthombo: Nettles R et al. ‘Pharmacodynamics, Safety, and
Pharmacokinetics of BMS-663068: A Potentially First-in-class Oral HIV
Attachment Inhibitor.’ 18 th CROI, Boston, oral abstract 49 (2011).
I-tenofovir enelungelo lobunikazi
elikhulu
Uhlobo olusha lwe-tenofovir olubizwa ngokuthi i-GS- 7349
lwenziwe olungasebenza kahle ngokuphindwe ka-15
ekuletheni inhlanganisela esebenza ngokukhuthala kumanodi
omantshu futhi kuhlose amaseli kune-tenofovir esetshenziswa
njengamanje. Kodwa-ke ayihambisi i-tenofovir eningi kangako
ezinsweni, lapho okwenzeka khona imiphumela eminingi
kakhulu emibi ye-tenofovir. Ithemba ukuthi lokhu kuzovumela
iziguli ukuthi ziphuze umuthi omncane bese kugwemeka
imiphumela emibi. Ucwaningo olulodwa kuphela olusheshe
lwenziwa ngalo muthi kubantu futhi kuzoba iminyaka embalwa
ngaphambi kokuba sazi ukuthi kuphephile futhi kusebenza
ngempumelelo ngokwanele yini ukuthi ungene esikhundleni
sohlobo lwamanje lwe-tenofovir.
Umthombo: Markowitz M et al. ‘GS-7340 Demonstrates Greater Declines in HIV-1
RNA than TDF during 14 Days of Monotherapy in HIV-1-infected Subjects.’ 18 th
CROI, Boston, oral abstract 152LB (2011).
Singakwazi ukuthenga ama-ARV abantu
abangathelelekile?
Ezimbili zezifundo ezibaluleke kakhulu zangonyaka
odlule kwakuyizinhlolo i-iPrEx ne-Caprisa 004. Olokuqala
lwakhombisa ukuthi ukunikeza amadoda aya namanye
amadodoa ocansini umthamo zonke izinsuku we-tenofovir
kanye ne-emtricitabine kunciphisa ingozi yokuthola i-HIV.
Olwesibili lwakhombisa ukuthi ijeli yesitho sowesifazane
sangasese (noma i-microbicide) ene-tenofovir kunciphisa
ingozi kwebesifazane yokutheleleka. Zombili lezi zindlela yizimo
zokwelashwa ngaphambi kokubekeka engozini, noma i-PrEP,
njengoba zibandakanya ukunikeza abantu iphilisi lokuvimbela
ukutheleleka kunokwelapha isifo.
Angeke kwenzeke ukuthi i-PrEP ibe yiqiniso ohlelweni
lwezempilo lukahulumeni onyakeni olandelayo noma emibili.
Sisalindele imiphumela kwezinye izinhlolo ngokuphepha,
ukusebenza kahle nomthamo ophezulu wemithi ye-PrEP.
Kodwa-ke, abacwaningi manje sebebike ukuthi isibonelo
sezibalo esathola ukuthi ukunikezela nge-PrEP eNingizimu
Afrika kungenzeka ukuthi kube yimpumelelo kodwa kubize
- ikakhulukazi uma amanani entengo e-microbicides noma
amaphilisi engancishiswa futhi uma ukusebenza kahle
kwale mikhiqizo kungenziwa ngcono. Ucwaningo olukhulu
kakhulu nokucabanga kuzofanele ukuthi kwenziwe nge-PrEP
eminyakeni ezayo, kodwa okungenani manje sinophawu
oluqinile lokuthi ukunikezela nge-PrEP kuzokwenza umqondo
kwezezimali.
Imithombo: Walensky R et al. ‘Cost Effectiveness of PrEP for HIV Infection in South
Africa.’ 18 th CROI, Boston, abstract 37LB, (2011); Hallett T et al. ‘ART or PrEP
for HIV Prevention in HIV Serodiscordant Partnerships: A Mathematical Modeling
Comparison.’ 18 th CROI, Boston, abstract 99LB (2011).
Ukuhlungela inani legciwane
egazini akubalulekile
Ukuthi impilo yabantu abane-HIV iqashwa kanjani
umbuzo okudala ukhona. Njengoba uhlolo lwe-DART
lusikhombisile, asikho isidingo sokulinda kuze kube
ungahlinzeka i-CD4 kanye nokuqashwa kwenani
legciwane egazini ngaphambi kokuthi kutholakale
ama-ARV. Iziguli zingenza kahle kakhulu ngokuqashwa
kokwelashwa nje kuphela, ngamanye amazwi, uma
udokotela ebaxilonga ngokuvamile ngaphandle
kokuthola nanoma yiziphi izibalo ze-CD4 noma
ukuhlolwa kwenani legciwane egazini okwenziwe.
Izifundo ezimbili ezintsha zinikeza umqondo
othokozisayo.
Ucwaningo olwenziwa e-Thailand kungahlelwanga
lwafaka abantu abadala abangama-716 ukuthi bathole
ukuqashwa kwe-CD4 kuhlanganiswa nokuqashwa
kwenani legciwane egazini noma ukuqapha i-CD4 nje.
Emva kweminyaka emithathu abacwaningi bathola
ukuthi kwakungenamehluko omkhulu ezibalweni ze-CD
4 kanye nezibalo zenani legciwane egazini emaqenjini
amabili. Lokhu kukhombisa ukuthi ukungabi bikho
kokuqashwa kwenani legciwane egazini akufanele kube
yisithiyo sokuqalisa abantu ukwelashwa.
Ucwaningo lwesibili lwase-Cameroon lungahlelwanga
lwafaka abantu abangama-459 ukuthi bathole
mhlawumbe ukuqashwa kwe-CD4 kuhlanganiswa
nokuqashwa kwenani legciwane egazini noma kungabi
bikho kubo futhi kuqashwe ukwelashwa kuphela.
Emva kweminyaka emibili, abahlanganyeli abathola
ukuqashwa kokwelashwa kuphela baba nokwehla
okuncane kwezibalo ze-CD4. Lolu cwaningo lugqamisa
umqondo wokuthi ukungabi bikho kokuhlolwa kwenani
legciwane egazini kanye nokuqashwa kwe-CD4
akufanele kuvimbele ukunikezelwa kokwelashwa.
Kodwa-ke kuphakamisa ukuthi lokhu kuhlola kufanele
ukuthi kutholakale lapho okunokwenzeka khona. Inani
lokuqashwa kwenani legciwane egazini njengoba
kugqanyiswe ukuhlaziya okusha okuvela ohlolweni
lwe-DART, okuthola inhlanganisela phakathi kokukhula
kwegciwane egazini kanye nokuba nokumelana nomuthi
okuthize, izinguquko zesimo noma izinguquko ku-HIV.
Lokhu kuphakamisa ukuthi ukuqashwa kwenani
legciwane egazini kungaba lusizo ekunqumeni isikhathi
esifanele sokushintsha izinhlobo zemithi.
Imithombo: ‘Jourdain G et al. PHPT-3: a randomized clinical trial comparing
CD4 vs viral load ART monitoring/switching strategies in Thailand.’ 18th CROI, Boston, abstract 44, 2011; ‘Kouanfack C et al. HIV viral load, CD4
cell count, and clinical monitoring vs clinical monitoring alone for ART
in rural hospitals in Cameroon: Stratall ANRS 12110 / ESTHER trial, a
randomized non-inferiority trial.’ 18th CROI, Boston, abstract 45LB, (2011).
Konke lokhu okutholakele kwethulwa ku-18th Conference on Retroviruses and
Opportunistic Infections, held in Boston, U.S.A., ekuqaleni kwalo nyaka.
UKUBAMBELELA
27
I-TAC NEWS
28
Iqiniso
Ukweba ama-ARV
akunamqondo
ngeWhoonga
I-Whoonga isidakamuzwa sasemgwaqeni esiyingozi
esithengiswa kweminye imiphakathi eNingizimu Afrika. Singaba
nezinto eziningi zezithako kubandakanya iherowini nomuthi
wamagundane. Eminye imibiko yabezindaba yathi i-whoonga
inama-ARV, kodwa lapho kuhlolwa amasampula e-whoonga
eNyuvesi yaKwaZulu-Natal yatholakala ingenawo ama-ARV.
Ngisho ngabe i-whoonga ngezinye izikhathi iba nawo ama-ARV,
ama-ARV angeke enze abasebenzisi bomuthi ukuthi badakwe
. I-ARV njenge-efavirenz ngezinye izikhathi ayinayo imithelela
emibi engqondweni uma iphuzwe ngokwejwayelekile, kodwa
hhayi lapho ibhenywa. Ngakho-ke akwenzi mqondo ukufaka
ama-ARV ku-whoonga.
Kubalulekile ukuxazulula lensomi yokuthi i-whoonga inama-
ARV noma ukuthi ama-ARV enza i-whoonga. Ulwazi olungesilo
iqiniso njengalolu luhanjiswa ngabathengisa ngezidakamizwa
futhi kungaholela ekwebeni noma ekuxhashazweni kwemithi
esindisa izimpilo.
Isithombe nguLuckyboy Mkhonwane.
NgoLwesihlanu mhla ka-25 Mashi amalungu
e-Treatment Action Campaign (TAC) ame
nezingqwembe ngaphandle eNkantolo Kamatshi
eKempton Park amadoda amathathu ayevela
khona ngamacala okusolwa ukuthi antshontshe
imithi eyizidambisigciwane engaba i-R200,000
. Amaphoyisa kubikwe ukuthi akholwa ukuthi
amadoda ayehlose ukusebenzisa ama-ARV
ukukhiqiza iwhoonga, isidakamuzwa sasemgwaqeni
esinobuthi
Amabili kula madoda atholakala ephethe izikhwama
zamapulasitiki amabili ngasinye siphethe amabheshi
angama-20 omuthi wama-ARV i-tefonovir, kubika
iphephandaba iCitizen. La madoda abe esekhomba
indoda yesithathu njengebandakanyekayo.
Ukuboshwa kokuqala kwakuwumphumela
wokuvuswa ilungu lomphakathi. Amadoda avele
enkantolo ngoJanuwari okokuqala. Emva kwama-25
Mashi ukulalelwa kwecala kwahlehliswa kwaze
kwaba umhla ka-19 Ephreli.
“Abaphehli balobu bugebengu bathatha izimpilo
zabantu abayidingayo le mithi ukuze banakekele
impilo yabo”, kusho uLuckyboy Mkhondwane
we-TAC Ekurhuleni. “Ngokwenza njalo abathathi
nje iminyaka eyengeziwe engengezwa uma
umuntu ophila ne-HIV ephuza imithi yakhe. Kodwa
babeka izimpilo zabantu abangenacala engozini
ngokubabeke ekumelelaneni nomuthi njengoba
ukwenza iphutha kuma-ARV akho kwandisa
amathuba okuthi igciwane liziguquguqule.”
Inkimbinkimbi
yemeyizi
Equal Treatment 38
ARVs
Umtholampilo
Prescription
Umtholampilo
Ithengiswe yonke
Ithengiswe yonke
Gcwalisa iphepha lakho lokuthenga imithi ngokuqedela
inkimbinkimbi yendlela ekhemesi elinesitokwe. Dweba
umugqa ukutreyisa indlela yakho.
Umtholampilo
Ithengiswe yonke
Umtholampilo
Ithengiswe yonke
Umtholampilo
Ithengiswe yonke
Umtholampilo
Ithengiswe yonke
Umtholampilo
Ithengiswe yonke
Clinic
29
The ACMS is
an independent,
interdisciplinary
and internationally
engaged centre
of excellence
for research and
teaching. Based
in Africa, ACMS
shapes global
discourse on
human mobility,
development
and social
transformation.
www.migration.org.za
30
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