Inkqubela Ekulweni NoGawulayo

“Kwimbali yoluntu zange abantu bakhe bafunde lukhulu kangaka ngesifo esintsonkothileyo kwixeshana nje elingephi,” utsho uGqr. Gerald J. Stine kwincwadi yakhe ethi AIDS Update 2003. Uthi “uphando olwenziweyo ngentsholongwane iHIV noGawulayo yimpumelelo ephawulekayo yenzululwazi.” Yintoni ephunyeziweyo?

NGENXA yolwazi nobugcisa bezamayeza bezi mini abaphandi baye bavelisa iintlobo ezahlukahlukeneyo zamachiza abangela ithemba kubantu abaneHIV. Ukongezelela koko, iinkqubo zokufundisa abantu ngoGawulayo zibe nemiphumo emihle kumazwe aliqela. Noko ke, ngaba loo mpumelelo ibonisa ithemba lokuphela kwalo bhubhani? Ngaba imigudu eyenziwayo yenzululwazi nemfundo iyakunqanda ukusasazeka kukaGawulayo? Khawuqwalasele oku kulandelayo.

Unyango Lwamachiza

“Ithemba Kumlo NoGawulayo,” utsho umxholo wephephancwadi iTime kwinkupho kaSeptemba 29, 1986. Eli “themba” labangelwa ziziphumo zovavanyo lwamayeza kusetyenziswa iazidothymidine (AZT), ichiza eliyiantiretroviral lokulwa neHIV. Izigulana ezineHIV ezisebenzisa iAZT zaziphila ixesha elide. Ukususela ngelo xesha, iiantiretroviral ziye zanceda amakhulu amawaka abantu baphila ixesha elide. (Bona ibhokisi ethi “Ziintoni Iiantiretroviral?” kwiphepha 7.) Ziye zaphumelela kangakanani ukulwa neHIV?

Phezu kwalo nje ihlombe elabangelwa kukufumaneka kweAZT, iphephancwadi iTime lanikela ingxelo yokuba abaphandi ngoGawulayo “baqinisekile ukuba iAZT ayililo ichiza lokunyanga uGawulayo.” Babechan’ ucwethe. Ezinye izigulana zazingaphathwa kakuhle yiAZT, ngoko kwaveliswa ezinye iintlobo zeeantiretroviral. Kamva, iU.S. Food and Drugs Administration yancomela ukuba kusetyenziswe iintlobo ezahlukeneyo zeeantiretroviral kwizigulana esele zihlaselwe ngamandla yiHIV. Ukusetyenziswa kweentlobo ezahlukeneyo zamachiza ukunyanga esi sifo, okuthetha ukusebenzisa iintlobo ezintathu nangaphezulu zeeantiretroviral, kwaqhwatyelw’ izandla ngabo banyamekela abantu abanoGawulayo. Enyanisweni, kwinkomfa yezizwe ngezizwe kaGawulayo ngowe-1996, omnye ugqirha wada wathi la machiza anokude ayinyange ngokupheleleyo iHIV!

Okubuhlungu kukuba, kungaphelanga nonyaka kwacaca ukuba nokubambelela ngokungqongqo kumthetho wokusebenzisa ezi ntlobo zintathu zamachiza akunakuze kuyiphelise iHIV. Nakuba kunjalo, ingxelo yeUNAIDS ithi “ukusebenzisa iintlobo ezahlukeneyo zeeantiretroviral kuye kwanceda abantu abaneHIV baphila ixesha elide, yaye besempilweni.” Ngokomzekelo, ukusetyenziswa kweeantiretroviral eUnited States naseYurophu, kuye kwalinciphisa ngama-70 ekhulwini inani labantu ababulawa nguGawulayo. Ukongezelela koko, izifundo eziliqela zibonisa ukuba ukusetyenziswa kweeantiretroviral ezithile kunokuwanciphisa gqitha amathuba okuba amabhinqa akhulelweyo asulele abantwana ngeHIV.

Sekunjalo, kukho izigidi zabantu abaneHIV abangakwaziyo ukufumana iiantiretroviral. Kubangelwa yintoni oko?

“Isifo Samahlwempu”

Unyango lweeantiretroviral lusetyenziswa gqitha kumazwe afumileyo. Noko ke, iWorld Health Organization (WHO) iqikelela ukuba kumazwe athile asakhulayo, ngabantu aba-5 ekhulwini abakwaziyo ukufumana la machiza kwabo bafuna unyango lweeantiretroviral. Abathunywa beZizwe Ezimanyeneyo baye bathetha gqitha bechaza oku kungalingani “njengokungabikho sikweni okugqithiseleyo” “nokucalucalulwa kwabantu namhlanje.”

Ingxaki yokungakwazi kwabantu ukufumana unyango ngokulinganayo inokwenzeka nakwilizwe elinye. IThe Globe and Mail, ithi ngumntu om-1 kwaba-3 eKhanada obulawa nguGawulayo engazange anyangwe ngeeantiretroviral. Nangona la machiza efumaneka simahla eKhanada, kukho amaqela athile angakhathalelwayo. IGlobe ithi: “Abo bangafumani nyango lufanelekileyo, ngabo kanye baluswele gqitha: abemi bomthonyama, amabhinqa namahlwempu.” IThe Guardian yacaphula omnye umama Ontsundu oneHIV esithi: “Andazi ukuba kuqhubeka ntoni. Kutheni amadoda abelungu abelana ngesondo namanye amadoda ekwazi ukufumana unyango ze aphile ixesha elide ndibe mna ndiza kufa?” Impendulo yalo mbuzo ixhomekeke kuqoqosho lokuveliswa nokuthengiswa kwamayeza.

Umlinganiselo wexabiso lokunyanga umntu ngeentlobo ezintathu zamachiza eeantiretroviral eUnited States naseYurophu uphakathi kwee-R63 000 nee-R94 000 ngonyaka. Nakuba oozenzele bala machiza ahlukahlukeneyo befumaneka kwamanye amazwe asakhulayo ngomlinganiselo wee-R1 400 nangaphantsi, le mali iseninzi gqitha kubantu abaninzi abaneHIV abahlala apho zifuneka ngamandla khona ezi antiretroviral. Eshwankathela le meko uGqr. Stine uthi: “UGawulayo sisifo samahlwempu.”

Ishishini Lokwenza Amachiza

Ukwenza amachiza angoozenzele uze uwathengise ngexabiso eliphantsi bekungasoloko kulula. Imithetho engqongqo yokwenziwa kwamayeza kumazwe amaninzi iyakwalela ukuveliswa kwechiza elenziwe yenye inkampani ngaphandle kwemvume. Umphathi wenye inkampani enkulu yamayeza uthi “yimfazwe yezoqoqosho.” Uthi, ukuvelisa amachiza angoozenzele uze uwathengise kumazwe asakhulayo ufuna inzuzo, “yinkohlakalo kubantu abavelise loo machiza.” Kwakhona iinkampani ezivelisa amachiza zimi ngelithi ukunciphisa ingeniso kunokwenza ingabikho imali yokuxhasa iinkqubo zokuphanda nokuphucula amayeza. Ezinye zinexhala lokuba iiantiretroviral zexabiso eliphantsi ezithunyelwa kumazwe akhulayo zinokugqibela zithengiswa ngondlela mnyama kwakuloo mazwe afumileyo.

Abo balwela ukuba amachiza eeantiretroviral athengiswe ngexabiso eliphantsi bathi amachiza amatsha anokuveliswa ngexabiso eliphakathi kwesi-5 ne-10 ekhulwini kwixabiso athengiswa ngalo ziinkampani zamayeza. Kwakhona bathi uphando nokuphuculwa kwamayeza okwenziwa ziinkampani zamayeza zabucala kubonisa ukuba azizikhathazi ngezifo ezithwaxa amazwe ahlwempuzekileyo. Ngenxa yoko, uDaniel Berman, umalathisi kwiphulo iAccess to Essential Medicines uthi: “Kumachiza amatsha, kufuneka kubekho umthetho wezizwe ngezizwe oza kunyanzelisa ukuthotywa kwamaxabiso ukuze afikeleleke kumazwe akhulayo.”

Ukuze ihlangabezane noku kufuneka kwamachiza eeantiretroviral ehlabathini lonke, iWHO iye yaqulunqa iqhinga lokuba uthi uphela unyaka wama-2005 ibe sele incede abantu abazizigidi ezithathu abanentsholongwane iHIV noGawulayo ngeeantiretroviral. UNathan Ford weMédecins Sans Frontières walumkisa wathi: “Eli phulo lowama-2005 limele lingabi sesinye isiganeko sokusilela kweZizwe Ezimanyeneyo kusukelo lwazo. Izigidi ezithathu sisiqingatha nje sabantu ekuqikelelwa ukuba bafuna unyango lwentsholongwane iHIV noGawulayo namhlanje yaye eli nani liya kube selande gqitha ngowama-2005.”

Eminye Imiqobo

Nokuba amazwe akhasayo ebekwazi ukufumana iiantiretroviral ezaneleyo, kukho omnye umqobo ebekuya kufuneka ajamelane nawo. Amanye kula machiza, kufuneka utye ngaphambi kokuba uwasele uze usele namanzi acocekileyo, ngoxa kwamanye amazwe kukho amakhulu amawaka abantu abalala bengatyanga. Iiantiretroviral (ekudla ngokufuneka umntu asele iipilisi ezingama-20 okanye ngaphezulu mihla le) kufuneka zityiwe ngokungqalileyo ngamaxesha athile suku ngalunye, kodwa izigulana ezininzi azinayo kwawotshi leyo. Iintlobo zala machiza kufuneka ziselwe ngokwemeko yomguli lowo. Kodwa oogqirha banqongophele gqitha kumazwe amaninzi. Kucacile ukuba, ukunyanga abantu ngeeantiretroviral kumazwe akhulayo kuza kuba ngumqobo onzima.

Nezigulana ezikumazwe ami kakuhle zinazo iingxaki zokusebenzisa iintlobo ezahlukeneyo zala machiza. Uphando lubonisa ukuba yanda ngokothusayo ingxaki yokusilela kwabantu ukusebenzisa onke amachiza abo ngexesha elimisiweyo. Oku kunokubangela ukuba la machiza angasebenzi. Umntu unokubasulela abanye ngeHIV esele ikwazi ukwenza la machiza angasebenzi.

UGqr. Stine usichazela ngenye ingxaki abajamelene nayo abantu abaneHIV. Uthi: “Umnqa ekunyangeni iHIV kukuba, maxa wambi unyango lubangela iintlungu ezingakumbi kunezo umntu ebekade enazo, ngokukhethekileyo ukuba olo nyango luqaliswe ngaphambi kokuba zivele iimpawu zeHIV.” Abantu abaneHIV abasebenzisa iiantiretroviral badla ngokukhathazwa zizifo ezifana nesifo seswekile, ukubakho kwamanqatha kwiindawo angamele kubakho kuzo, icholesterol nokuba buthathaka kwamathambo. Ezinye zazo ziyabulala.

Imigudu Yokuthintela Esi Sifo

Ingakanani inkqubela esele yenziwe kwimigudu yokuthintela ukwanda kukaGawulayo nokuphucula indlela abantu abaziphatha ngayo ebabeka esichengeni sokwasulelwa sesi sifo? Ukuqinisa kumaphulo okufundisa abantu ngoGawulayo eUganda kwiminyaka yee-1990 kwanciphisa inani labantu abasulelwa yiHIV kwelo lizwe lisusela kubantu abali-14 ekhulwini laya kutsho phantse kwaba-8 ekhulwini ngowama-2000. Ngokufanayo, imigudu eyenziwa eSenegal yokufundisa abantu balapho ngeengozi zokwasulelwa yiHIV iye yanceda elo lizwe lakwazi ukugcina umlinganiselo wokwanda kweso sifo kubantu abadala ungaphantsi komntu omnye ekhulwini. Ikhuthaza gqitha imiphumo enjalo.

Kwelinye icala, ukufundisa abantu ngoGawulayo akukhange kuphumelele kwamanye amazwe. Uhlolisiso olwenziwa ngowama-2002 kwabaselula abali-11 000 baseKhanada lwabonisa ukuba isiqingatha sabantwana abakunyaka wokuqala esinaleni sikholelwa ukuba uGawulayo unokunyangwa. Ngokutsho kohlolisiso olwenziwa eBritani kwakuloo nyaka, amakhwenkwe angama-42 ekhulwini aphakathi kweminyaka eli-10 neli-11 leminyaka ubudala akazange ave kwanto ngeHIV okanye uGawulayo. Ukanti nolutsha olwaziyo ngeHIV noGawulayo nokunganyangeki kwesi sifo luya lungakukhathaleli ngakumbi oko. Omnye ugqirha uthi: “Kubantu abaselula abaninzi, iHIV sele ifana nje neengxaki ezininzi zemihla ngemihla, ezifana nokuba baza kukufumana kusini na ukutya okumnandi, baza kuhlala nabani, baza kuya na esikolweni.”

Akumangalisi ke, ukuba iWHO isithi “ukunikela ingqalelo kwabaselula kubonakala ngathi yeyona ndlela inokuphumelela gqitha ekulweni nalo bhubhani, ngakumbi kumazwe ogqugqisileyo kuwo.” Ulutsha lunokuncedwa njani ukuze lunikele ingqalelo kwizilumkiso eziphathelele uGawulayo? Khona, ngaba kusengqiqweni ukuba nethemba lokuba uya kunyangeka?

[Amagama acatshulweyo akwiphepha 6]

Nyakenye, eAfrika ngabantu aba-2 ekhulwini kuphela abaye bakwazi ukufumana iiantiretroviral kwabo bazifunayo, xa kuthelekiswa nabangama-84 ekhulwini kumazwe aseMerika

[Ibhokisi/Imifanekiso ekwiphepha 7]

Ziintoni Iiantiretroviral?a

Kumntu ophile qete, iihelper T cells zivuselela okanye zinceda inkqubo yokuzikhusela yomzimba ikwazi ukuhlasela izifo ezingena emzimbeni. Ngokukhethekileyo iHIV ihlasela ezi helper T cells. Isebenzisa iiseli zomzimba ukuze iphindaphindeke, ngoxa isenza buthathaka yaye itshabalalisa iihelper T cells de inkqubo yokuzikhusela yomzimba ingakwazi kusebenza. Amachiza iiantiretroviral alwa nale nkqubo yokuziphindaphinda kwale ntsholongwane.

Okwangoku zine iintlobo zeeantiretroviral ezisetyenziswayo. Iinucleoside analogues nenon-nucleoside analogues zithintela ukuba iHIV ingakwazi ukuzijika ifane neDNA yomntu lowo imhlaselayo. Zona iiprotease inhibitors zithintela iiprotease enzyme ezikwezo seli sele zichaphazelekile ukuba zingakwazi ukuvelisa ezinye iintsholongwane ukuze kwande iHIV. Iifusion inhibitors zenzelwa ukunqanda iHIV ingakwazi ukungena kwiiseli. Ngokuthintela iHIV ukuba ingakwazi ukuziphindaphinda, iiantiretroviral zinokwenza iHIV ingakhawulezi ivuthwe ibe nguGawulayo, esona sifo sibuhlungu sibangelwa yiHIV.

[Umbhalo osemazantsi]

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EKENYA—Ugqirha ufundisa isigulana esinoGawulayo ngonyango lweeantiretroviral

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KENYA—Isigulana esinoGawulayo sifumana amayeza eeantiretroviral esibhedlele

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© Sven Torfinn/Panos Pictures

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Amabhinqa NoGawulayo

Kubantu abadala abaneHIV noGawulayo ngoku, abangama-50 ekhulwini ngamabhinqa

Ngowe-1982 xa kwafunyaniswa amabhinqa anoGawulayo, kwacingwa ukuba asulelwe xa ezitofela iziyobisi. Kungekudala, kwaqondwa ukuba amabhinqa anokwasulelwa nje ngokuba neentlobano zesini okuqhelekileyo yaye ngawona asesichengeni sokwasulelwa yiHIV. Ehlabathini lonke, ngoku ama-50 ekhulwini kubantu abadala abaneHIV noGawulayo ngamabhinqa. “Esi sifo sihlasela ngendlela engathethekiyo amabhinqa namantombazana afikisayo abantu abahleli besesichengeni entlalweni, kwinkcubeko, ngokwemvelo nakwezoqoqosho, nabona bathwele uxanduva lokunyamekela abantu abagulayo nabafayo,” itsho ingxelo yeUNAIDS.

Kutheni ukwanda kwamabhinqa anesi sifo kubaxhalabisa ngokukhethekileyo abo banyamekela izigulana zikaGawulayo? Amabhinqa aneHIV adla ngokucalulwa ngakumbi kunamadoda, ngokukhethekileyo kumazwe asakhulayo. Ukuba ibhinqa likhulelwe, ubomi bomntwana walo busengozini; ukuba selinabantwana, kuba lucelomngeni ukubanyamekela, ngokukhethekileyo kumama ongenaqabane. Okuyenza mandundu ngakumbi le meko kukuba, kuncinane gqitha okwaziwayo ngeempawu ezingaqhelekanga zamabhinqa aneHIV nendlela yokuwanyamekela.

Ezinye izithethe zenza imeko yamabhinqa ibe mbi ngokukhethekileyo. Kumazwe amaninzi akulindelekanga ukuba amabhinqa axubushe ngemibandela yesini, yaye ayabethwa xa esala ukuba neentlobano zesini. Iqhelekile into yokuba amadoda abe neentlobano zesini namabhinqa amaninzi aze athi engazi awasulele ngeHIV. Amanye amadoda aseAfrika abelana ngesondo namabhinqa aselula ephepha ukwasulelwa yiHIV okanye ngenxa yenkolelo ebubuvuvu yokuba ukuba neentlobano zesini nentombi enyulu kunokusinyanga isifo sikaGawulayo. Iyaqondakala into yokuba iWHO isithi: “Ukuze kukhuselwe amabhinqa kumele kuthethwe namadoda (kwanamabhinqa).”

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EPERU—Umama oneHIV nentombazana yakhe engasulelwanga yiHIV

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ETHAILAND—Njengenxalenye yezifundo zabo, abafundi batyelela isigulana esinoGawulayo

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EKENYA—Intlanganiso yamalungu entlangano yamaBhinqa AnoGawulayo

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Iingcamango Ezingachananga NgoGawulayo

◼ Uyakwazi ukubabona abantu abaneHIV ukuba bayagula. UGqr. Gerald J. Stine uthi: “Ngokomlinganiselo, umntu oneHIV ugqiba iminyaka eli-10 ukusa kweli-12 ngaphambi kokuba abe noGawulayo. Ebudeni beli xesha, kubantu abaneHIV ziya kuba mbalwa iimpawu ezibonakalayo xa zithe zakho kwaukubakho, ngoxa benokuqhubeka besasulela abanye.”

◼ UGawulayo sisifo samafanasini kuphela. Ekuqaleni kweyee-1980, uGawulayo wayechazwa njengesifo samafanasini. Noko ke, namhlanje iintlobano zesini phakathi kwendoda nomntu obhinqileyo ngoyena thunywashe uphambili ekwasulelweni kwabantu yiHIV ehlabathini.

◼ Iintlobano zesini ezenziwa emlonyeni “yindlela ekhuselekileyo.” AmaZiko Okuthintela Nokulwa Izifo athi, “uhlolisiso oluninzi lubonisa ukuba ngeentlobano zesini ezenziwa emlonyeni abantu banokwasulelwa yiHIV nazezinye izifo ezidluliselwa ngesini.” Amathuba okwasulelwa yiHIV ngenxa yeentlobano zesini ezenziwa emlonyeni akakho maninzi njengaxa usiba neentlobano zesini ngezinye iindlela. Sekunjalo, lo mkhwa uxhaphake kangangokuba abanye oogqirha barhanela ukuba uza kuba negalelo eliphambili ekwasulelweni kwabantu yiHIV.

◼ UGawulayo uyanyangeka. Nakuba ukusebenzisa iiantiretroviral kunceda ezinye izigulana ziphile ixesha elide neHIV ngaphambi kokuba ibe nguGawulayo, okwangoku alikabikho iyeza lokuthintela okanye lokunyanga esi sifo.

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CZECH REPUBLIC—Ukuvavanywa kwegazi kuhlolwa uGawulayo, kukho amayeza anokuselwa ngabantu abanesi sifo nakuba sona singanyangeki siphele

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EZAMBIA—Amantombazana amabini aselula aneHIV alindele amayeza awo

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© Pep Bonet/Panos Pictures