Ingculaza Iyasakazeka E-Afrika

“Sibhekene nohlobo lukakhukhulela-ngoqo losuku lwethu.”

LAWO mazwi kaStephen Lewis, inxusa elikhethekile legciwane lesandulela-ngculaza nengculaza e-Afrika, ananela ukukhathazeka kwabantu abaningi ngesimo sengculaza e-Afrika eseningizimu yeSahara.

Kunezici eziningana ezihilelekile ekusakazekeni kwesandulela-ngculaza. Ingculaza nayo iye yashubisa ezinye izinkinga. Izimo ezikhona kwamanye amazwe ase-Afrika nakwezinye izingxenye zomhlaba lapho ingculaza yande khona ngokuvamile zihlobene nalezi zici ezilandelayo.

Ukuziphatha. Njengoba ucansi luyindlela eyinhloko igciwane lesandulela-ngculaza elisakazeka ngayo, kusobala ukuthi ukuntuleka kwezindinganiso zokuziphatha ezicacile kubhebhethekisa lesi sifo. Nokho, abaningi banomuzwa wokuthi akunangqondo ukukhuthaza abantu abangashadile ukuba bagweme ucansi. “Ngeke kusebenze ukumane uxwayise intsha ngokuthi igweme ucansi,” kubhala uFrancois Dufour kuyi-Star, iphephandaba laseGoli, eNingizimu Afrika. “Nsuku zonke ibona imifanekiso ekhangayo ngokobulili eyitshela ukuthi kufanele ibukeke kanjani nokuthi kufanele iziphathe kanjani.”

Kubonakala lesi simo siqinisekiswa ukuziphatha kwentsha. Ngokwesibonelo, ucwaningo kwelinye izwe lwabonisa ukuthi cishe ingxenye yesithathu yabasha bakulelo zwe abaneminyaka engu-12 kuya kwengu-17 ubudala sebake baya ocansini.

Ukudlwengulwa kwabantu kuye kwachazwa njengesimo esibucayi ezweni laseNingizimu Afrika. Umbiko wezindaba ephephandabeni laseGoli i-Citizen wathi “kwande kangangokuba kwedlula zonke ezinye izici ezifaka impilo yabesifazane engozini, ikakhulukazi neyezingane kuleli zwe.” Sona leso sihloko saphawula: “Amanani ezingane ezidlwengulwayo asephindeke kabili muva nje . . . Kubonakala sengathi kubangelwa yinsumansumane yokuthi umuntu onegciwane lesandulela-ngculaza uyelapheka uma edlwengula intombazane eseyintombi nto.”

Izifo ezithathelwana ngobulili. Liphakeme inani lezifo ezithathelwana ngobulili kuleli zwe. I-South African Medical Journal yathi: “Ukuba nesifo esithathelwana ngobulili kwandisa amathuba okungenwa yigciwane lesandulela-ngculaza ngezikhathi eziphindwe kabili kuya kweziphindwe kahlanu.”

Ubumpofu. Amazwe amaningi e-Afrika adonsa kanzima ngenxa yobumpofu, futhi lokhu kwenza isimo sivune ukubhebhetheka kwengculaza. Izinto ezingase zibhekwe njengezidingo eziyisisekelo emazweni acebile azitholakali emazweni amaningi asathuthuka. Imiphakathi eminingi ayinawo ugesi futhi ayinawo namanzi ahlanzekile okuphuza. Emaphandleni imigwaqo mibi noma imane nje ayikho. Izakhamuzi eziningi azondlekile, kanti nezikhungo zezempilo zimbalwa futhi ziyantula.

Ingculaza inomphumela omubi kwezamabhizinisi nezezimboni. Njengoba ingena abantu abaningi, kuyezwela ezimayini lapho zikhiqiza ngaphansi kokuvamile. Ezinye zicabangela izindlela zokusebenzisa imishini ekwenzeni imisebenzi ethile ukuze kuvalwe lesi sikhala. Kulinganiselwa ukuthi emayini ethile ye-platinum ngonyaka ka-2000, inani lezisebenzi ezinengculaza lacishe laphindeka kabili, futhi izisebenzi ezingaba amaphesenti angu-26 zazinayo.

Umphumela odabukisayo wengculaza inani lezingane ezisala ziyizintandane lapho abazali bazo bebulawa yilesi sifo. Ngaphezu kokushonelwa abazali nokuphelelwa ukulondeka ngokwezimali, lezi zingane kumelwe zibekezelele isigcwagcwa esihambisana nesifo sengculaza. Izihlobo noma imiphakathi ngokuvamile impofu kakhulu ukuba ilekelele noma ayifuni ukwenza kanjalo. Izintandane eziningi ziyasiyeka isikole. Ezinye ziqala ukudayisa ngemizimba kanjalo zandise ukubhebhetheka kwalesi sifo. Amazwe amaningana anezinhlelo ezimiswe uhulumeni noma ngabantu abathile zokulekelela lezi zintandane.

Ukungazi. Inani elikhulu lalabo abanegciwane lesandulela-ngculaza alikwazi lokhu. Abaningi abafuni ukuyohlolwa ngoba besaba isigcwagcwa esihambisana nalesi sifo. “Abantu abanegciwane lesandulela-ngculaza noma okucatshangwa ukuthi banalo, bangase baxoshwe ezikhungweni zezempilo, benqatshelwe ukuthola izindlu nokuqashwa emisebenzini, bagwenywe ngabangane nabantu abasebenza nabo, benqatshelwe ukubhalisa umshuwalense noma benqatshelwe nokungena kwamanye amazwe,” kuphawula umbiko wezindaba okhishwe yi-Joint United Nations Programme on HIV/AIDS (UNAIDS). Abanye baye babulawa ngisho nokubulawa lapho kutholakala ukuthi banegciwane lesandulela-ngculaza.

Isiko. Emiphakathini eminingi yase-Afrika, akuvumelekile ukuba abesifazane baqhwande abayeni babo ngamashende abo, ukuba benqabe ukulala nabo noma ukuba basikisele izindlela eziphephile zocansi. Indlela yabo yokuphila ngokuvamile ibonisa ukuthi abazi lutho ngengculaza futhi bayaphika ukuthi ikhona. Ngokwesibonelo, kungase kuthiwe lesi sifo sibangelwa ubuthakathi, futhi kungase kufunwe usizo ezinyangeni.

Izikhungo zezempilo ezinganele. Izikhungo zezempilo ezinganele kwazona zithwele kanzima nakakhulu ngenxa yengculaza. Izibhedlela ezimbili ezinkulu zibika ukuthi iziguli zazo ezingaphezu kwesigamu zinesandulela-ngculaza. Isikhulu sezokwelapha esiphethe kwesinye sezibhedlela KwaZulu-Natal sathi amagumbi aso agcwele ayachichima ngamaphesenti angu-140. Ngezinye izikhathi kuye kudingeke ukuba iziguli ezimbili zilaliswe embhedeni owodwa, bese esesithathu silaliswa ngaphansi kwalowo mbhede!—South African Medical Journal.

Yize sidabukisa ngaleyo ndlela isimo e-Afrika, izinkomba zibonisa ukuthi singaba sibi nakakhulu. “Kuseyisiqalo salolu bhadane,” kuphawula uPeter Piot we-UNAIDS.

Kusobala ukuthi ikhona imizamo eyenziwayo kwamanye amazwe yokulwa nalesi sifo. Futhi ngokokuqala ngqá, ngo-June 2001 uMkhandlu-jikelele Wezizwe Ezihlangene waba nengqungquthela ekhethekile ukuze udingide udaba lwesandulela-ngculaza nengculaza. Ingabe imizamo yabantu iyophumelela? Ukuqothula kwengculaza kuyogcina kunqandwé nini?

[Ibhokisi/Isithombe ekhasini 5]

UMSHANGUZO WENGCULAZA I-NEVIRAPINE NENKINGA YENINGIZIMU AFRIKA

Iyini i-Nevirapine? Ngokwentatheli uNicole Itano, “iwumshanguzo olwa negciwane lengculaza ukuhlola okuye kwabonisa ukuthi ungawanciphisa ngesigamu amathuba okuba umama adlulisele ingculaza enganeni yakhe.” Inkampane ethile yaseJalimane ekhiqiza imithi yathembisa ukuthumela leli khambi mahhala eNingizimu Afrika eminyakeni emihlanu eyayizolandela. Kodwa, kuze kwaba ngu-August 2001, uhulumeni engakalwamukeli lolo sizo. Inkinga ikuphi?

ENingizimu Afrika kunabantu abayizigidi ezingu-4,7 abanegciwane lesandulela-ngculaza, inani elingaphezu kwanoma iliphi elinye izwe emhlabeni. Ngo-February 2002, i-Economist yaseLondon yabika ukuthi uMongameli waseNingizimu Afrika uThabo Mbeki “uyawungabaza umbono owandile wokuthi igciwane lesandulela-ngculaza libangela ingculaza” futhi “unezinsolo ngezindleko, ukuphepha nokusebenza kwemishanguzo elwa nengculaza. Akazange ayivimbele ngokomthetho, kodwa odokotela baseNingizimu Afrika abakhuthazwa ukuba bayisebenzise.” Kungani lokhu kuyimbangela enkulu yokukhathazeka? Ngenxa yokuthi eNingizimu Afrika kuzalwa izingane eziyizinkulungwane unyaka ngamunye zinegciwane lengculaza kanti amaphesenti angu-25 abesifazane abakhulelwe analeli gciwane.

Ngenxa yalokhu kungaboni ngaso linye, uhulumeni wamangalelwa ezinkantolo ukuze aphoqwe ukuba avumele ukukhishwa kwe-nevirapine. INkantolo Yomthetho-sisekelo yaseNingizimu Afrika yakhipha isinqumo sayo ngo-April 2002. Ngokwalokho uRavi Nessman akubhala kuyi-Washington Post, le nkantolo yanquma ukuthi “uhulumeni kumelwe enze lo mshanguzo utholakale ezikhungweni zezempilo ezizokwazi ukuwusebenzisa.” Nakuba uhulumeni waseNingizimu Afrika ebelokhu enikeza abantu lo mshanguzo ezikhungweni ezingu-18 okuhlolwa ngazo ezweni kabanzi, lesi sinqumo esisha kuthiwa sibanikeza ithemba bonke abesifazane abakhulelwe abanesandulela-ngculaza kuleli zwe.

[Ibhokisi/Isithombe ekhasini 6]

IGCIWANE ELINOBUQILI LIPHAMBA INGQAMUZANA

Ake sithi ukuhlola ukuphila kwegciwane elincane lesandulela-ngculaza [i-human immunodeficiency virus (HIV)]. Usosayensi othile waphawula: “Ngemva kweminyaka eminingi ngihlola izinhlayiya zamagciwane ngesibonakhulu, kusangimangalisa futhi kungihlaba umxhwele ukubona umklamo onembile noyinkimbinkimbi entweni encane kangaka.”

Igciwane eliyi-virus lincane kune-bacterium, kanti nayo incane kunengqamuzana elivamile lomuntu. Incwadi ethile ithi igciwane lesandulela-ngculaza lincane kangangokuthi “[izinhlayiya zesandulela-ngculaza] eziyizigidi ezingu-230 zingenela kungqi osekugcineni kwalo musho.” Igciwane eliyi-virus alikwazi ukuzandisa ngaphandle kokuba lingene engqamuzaneni lesisulu bese lilawula ukusebenza kwalo.

Lapho igciwane lesandulela-ngculaza lihlasela umzimba womuntu, kumelwe lilwe namasosha anamandla esimiso somzimba sokuzivikela ezifweni.a Umnkantsha ukhiqiza amasosha okuzivikela akhiwa amangqamuzana amhlophe egazi. Amangqamuzana amhlophe egazi anezigaba ezimbili eziyinhloko zama-lymphocyte, ezaziwa ngokuthi ama-T cell nama-B cell. Amanye amangqamuzana amhlophe egazi kuthiwa ama-phagocyte, noma “izidla-mangqamuzana.”

Ama-T cell ezigaba ezihlukahlukene abelwe imisebenzi ehlukahlukene. Lawo okuthiwa ama-T cell angabasizi, anendima ebalulekile ekulweni namagciwane. Ama-T cell angabasizi asiza ekuboneni abahlaseli abese ekhipha iziyalezo zokuba kukhiqizwe amangqamuzana ahlasela futhi abhubhise isitha. Lapho lihlasela, igciwane lesandulela-ngculaza ligasela ngokuyinhloko la ma-T cell angabasizi. Umzimba ube usutshela ama-T cell angababulali ukuba abulale amangqamuzana omzimba ahlaselwe. Ama-B cell akhiqiza amasosha omzimba alekelelayo ekulweni namagciwane.

Isu Lobuqili

Igciwane lesandulela-ngculaza lichazwa njenge-retrovirus. Izakhi zalo ziwuhlobo lwe-RNA (ribonucleic acid) hhayi i-DNA (deoxyribonucleic acid). Leli gciwane lingena ngaphansi kweqenjana lama-retrovirus elaziwa ngokuthi ama-lentivirus ngoba liyakwazi ukuquba isikhathi eside ngaphambi kokuba kuvele izimpawu zesifo ezibonakalayo.

Lapho igciwane lesandulela-ngculaza selingene engqamuzaneni lesisulu, liyakwazi ukusebenzisa isimiso sokusebenza kwalo ukuze lifeze injongo yalo. “Lishintsha” i-DNA yengqamuzana ukuze lenze amagciwane amaningi esandulela-ngculaza. Kodwa ngaphambi kokuba lenze lokhu, leli gciwane kumelwe lisebenzise “ulimi” oluhlukile. Kumelwe lishintshe i-RNA yalo ibe yi-DNA ukuze isimiso sokusebenza kwengqamuzana lesisulu singalixwayi. Ukuze lifeze lokhu, igciwane lesandulela-ngculaza lisebenzisa iprotheni yegciwane okuthiwa i-reverse transcriptase. Ngokuhamba kwesikhathi leli ngqamuzana liyafa, kodwa ngemva kokuba selikhiqize izinkulungwane zezinhlayiya ezintsha zesandulela-ngculaza. Lezi zinhlayiya ezisanda kukhiqizwa zingena kwamanye amangqamuzana.

Lapho isibalo sama-T cell angabasizi sesinciphe kakhulu, kulula ukuba ezinye izitha zihlasele umzimba ngaphandle kokuhlaselwa. Umzimba ube usungenwa yizo zonke izinhlobo zezifo namagciwane. Umuntu onala magciwane usuke esenengculaza uqobo lwayo. Igciwane lesandulela-ngculaza lisuke seliphumelele ekukhinyabezeni sonke isimiso somzimba sokuzivikela ezifweni.

Lena incazelo eyenziwe yaba lula. Kumelwe sikhumbule ukuthi kuningi abacwaningi abangakakwazi, kokubili ngesimiso somzimba sokuzivikela ezifweni nangendlela igciwane lesandulela-ngculaza elisebenza ngayo.

Ingxenye enkulu yale minyaka engamashumi amabili edlule, abacwaningi abaphambili bezokwelapha emhlabeni wonke baye bahileleka ekucwaningeni ngaleli gciwane elincane, okuye kwahilela nezindleko ezinkulu. Ngenxa yalokho, kuningi okuye kwafundwa ngesandulela-ngculaza. UDkt. Sherwin B. Nuland, ongudokotela ohlinzayo, washo lokhu eminyakeni ethile edlule: “Ulwazi oluye . . . lwaqongelelwa ngegciwane lengculaza nentuthuko esiyenziwe ekulweni nokuhlasela kwalo kuyamangalisa.”

Noma kunjalo, ingculaza isaqhubeka iqothula ngesivinini esethusayo.

[Umbhalo waphansi]

[Isithombe]

Igciwane lesandulela-ngculaza lihlasela amangqamuzana ama-“lymphocyte” esimiso somzimba sokuzivikela ezifweni liwashintshe ukuze likhiqize amagciwane esandulela-ngculaza

[Umthombo]

CDC, Atlanta, Ga.

[Isithombe ekhasini 7]

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