Ukumelana Nemithi - Treatment Action Campaign

tac.org.za

Ukumelana Nemithi - Treatment Action Campaign

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

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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

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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

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UKUMELANA NEMITHI

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isayensi

Yokumelana Nemithi

HIV

Cell

HIV

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HIV

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HIV

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CD4

Cell

CD4

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HIV

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HIV

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HIV

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HIV

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HIV

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HIV

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CD4

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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

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HIV

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CD4

Cell

HIV

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HIV

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HIV

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HIV

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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

18

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,

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and social

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