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