Intuthuko Ekulweni Nengculaza

“Akukaze kwenzeke emlandweni wesintu ukuba kufundwe okuningi kangaka ngesifo esiyinkimbinkimbi kangaka ngesikhathi esifushane kangaka,” kubhala uDkt. Gerald J. Stine encwadini yakhe ethi AIDS Update 2003. Uthi “umlando we-ngculaza nesandulela sayo ungenye intuthuko enkulu kakhulu kwezesayensi.” Yini eye yafinyelelwa?

ULWAZI nobuchwepheshe besimanje bezokwelapha kuye kwasiza abacwaningi ukuba bakwazi ukuthaka inhlanganisela yemithi ebanika ithemba elisha abantu abanesandulela-ngculaza. Ngaphezu kwalokho, izinhlelo zokufundisa ngengculaza ziye zaba nemiphumela emihle emazweni amaningana. Kodwa ingabe ukuphumelela kwemizamo enjalo kubonisa ukuthi usuzoqedwa lo mqedazwe obulalayo? Ingabe imizamo yamanje yesayensi neyokufundisa abantu ingakunqanda ukusakazeka kwengculaza? Cabangela okulandelayo.

Ukwelapha Ngemithi

Isihloko esikhulu sikamagazini i-Time ka-September 29, 1986 sathi “Inhlansi Yethemba Ekulweni Nengculaza.” Le ‘nhlansi yethemba’ yayokhelwe yimiphumela yokuzanywa kwe-azidothymidine (AZT), umshanguzo wokulwa nesandulela-ngculaza. Ngokuphawulekayo, abantu abanaleli gciwane ababephuza i-AZT babephila isikhathi esijana. Kusukela ngaleso sikhathi, imishanguzo (ama-ARV) iye yanweba ukuphila kwamakhulu ezinkulungwane zabantu. (Bheka ibhokisi elithi “Ayini Ama-ARV?” ekhasini 7.) Iye yaphumelela kangakanani ekulweni negciwane lesandulela-ngculaza?

Nakuba kwakunesasasa elikhulu lapho kuvela i-AZT, umagazini i-Time wabika ukuthi abacwaninga ngengculaza “babeqiniseka ngokuthi i-AZT yayingelona ikhambi eliwujuqu lokulwa nengculaza.” Babeqinisile. Imizimba yezinye iziguli yayingezwani ne-AZT, ngakho kwathakwa eminye imishanguzo. Kamuva, i-U.S. Food and Drug Administration yagunyaza inhlanganisela yemishanguzo ezonikwa abantu abanegciwane lesandulela-ngculaza eseliqhubeke kakhulu. Izisebenzi zezengculaza zakujabulela ukusetshenziswa kwenhlanganisela yemithi, okwakuhilela ukuphuza imishanguzo emithathu noma ngaphezulu. Empeleni, engqungqutheleni yamazwe ngamazwe yengculaza ngo-1996, udokotela othile waze wamemezela ngisho nokuthi le mishanguzo ingase ikwazi ukulibulala nya igciwane lesandulela-ngculaza emzimbeni!

Ngokudabukisayo, ungakapheli nonyaka kwahlaluka ukuthi ngisho nokuyiphuza ngokwethembeka le mishanguzo emithathu eyinhlanganisela kwakungeke kuliqede igciwane lesandulela-ngculaza. Noma kunjalo, umbiko we-UNAIDS uthi “ukwelapha ngenhlanganisela yama-ARV kuye kwasiza abantu abanegciwane lesandulela-ngculaza ukuba baphile isikhathi eside, bezisebenzela, futhi beyimiqemane.” Ngokwesibonelo, e-United States naseYurophu, ukusetshenziswa kwemishanguzo kuye kwanciphisa inani lababulawa yingculaza ngamaphesenti angaphezu kwangu-70. Ngaphezu kwalokho, ucwaningo oluningana luye lwabonisa ukuthi ukwelashwa ngemishanguzo ekhethwe ngokucophelela kungawanciphisa kakhulu amathuba okuba umama okhulelwe adlulisele igciwane lesandulela-ngculaza kumntanakhe.

Nokho, izigidi zabantu abanaleli gciwane zincishwa imishanguzo. Ngani?

“Isifo Esibulala Abampofu”

Imishanguzo isatshalaliswa kakhulu emazweni anabantu abaholelwa kahle. Nokho, i-World Health Organization (WHO) ilinganisela ukuthi kwamanye amazwe asathuthuka, bangamaphesenti amahlanu kuphela labo abadinga imishanguzo abayitholayo. Amanxusa eZizwe Ezihlangene aze achaza lesi simo sokungalingani ngokuthi “ukuntula ubulungisa okukhulu” nangokuthi “ihlazo elibi kakhulu lezwe lanamuhla.”

Ukungatholakali kwemithi ngokulinganayo kungaba khona nasezakhamuzini zezwe elifanayo. I-Globe and Mail ibika ukuthi umuntu waseCanada oyedwa kwabathathu obulawa yingculaza akakaze elashwe ngemishanguzo. Nakuba le mithi itholakala mahhala eCanada, amaqembu athile aye ashalazelwa. I-Globe ithi: “Labo abangakutholi ukwelashwa okufanele yilabo abakudinga kakhulu: abomdabu, abesifazane nabampofu.” I-Guardian yacaphuna umama othile ongumAfrika onegciwane lesandulela-ngculaza ethi: “Angiyiqondi le nto. Kungani la madoda amhlophe alala namadoda ethola ithuba lokuphila kodwa mina ngiyekwa ngife?” Impendulo yombuzo wakhe isekukhiqizweni nasekusatshalalisweni kwemithi.

Intengo evamile yenhlanganisela yemishanguzo emithathu e-United States naseYurophu iphakathi kuka-R63 000 no-R94 000 ngonyaka. Yize imikhiqizo eyimifuziselo yale mithi isitholakala emazweni athile asathuthuka ngentengo engu-R1 400 noma ngaphansi ngonyaka, lokhu kusengaphezu kwamandla eningi labantu abanesandulela-ngculaza abahlala lapho imishanguzo idingeka kakhulu khona. UDkt. Stine ufingqa lesi simo ngale ndlela: “Ingculaza iyisifo esibulala abampofu.”

Ibhizinisi Lokukhiqiza Imithi

Ukukhiqiza imifuziselo yale mithi nokuyidayisa ngentengo ephansi akulula. Imithetho eqinile enqanda umgunyathi emazweni amaningi iyakwenqabela ukukhiqizwa okungagunyaziwe kwemithi efuze eminye. “Lena yimpi yezomnotho,” kusho umphathi wenkampani ethile enkulu ethaka imithi. Uthi ukukhiqiza imithi eyimifuziselo nokuyidayisela amazwe asathuthuka ngenzuzo “kuyabakhinyabeza abantu abaye bathaka leyo mithi kuqala.” Izinkampani ezingabakhiqizi bale mithi bokuqala zikhala nangokuthi ukuncipha kwenzuzo kungaphumela ekuncipheni kwemali yokuxhasa izinhlelo zocwaningo lwezokwelapha. Ezinye zikhathazeka ngokuthi imishanguzo eshibhile ethunyelwa emazweni asathuthuka ingase igcine isidayiswa ngomgunyathi emazweni asethuthukile.

Abasekela ukukhiqizwa kwemishanguzo eshibhile bathi izindleko zokukhiqiza imithi emisha zingaba amaphesenti amahlanu kuya kwayishumi entengo esikiselwa yimboni ethaka imithi. Futhi bathi ucwaningo nentuthuko eyenziwa yizinkampani ezizimele ezithaka imithi iye yazishalazela izifo ezithinta amazwe ampofu. Ngakho, uDaniel Berman, umxhumanisi wohlelo lwe-Access to Essential Medicines, uthi: “Ngokuphathelene nemithi emisha, kudingeka isimiso esisebenza emhlabeni wonke esinciphisa intengo ibe sezingeni amazwe asathuthuka angalifinyelela.”

Isabela kulesi sidingo sembulunga yonke semishanguzo yengculaza, i-WHO iye yasungula uhlelo oluzokwenza ukuba imishanguzo ibe isitholwa abantu abayizigidi ezintathu abanengculaza noma isandulela sayo ngonyaka ka-2005. UNathan Ford we-Médecins Sans Frontières waxwayisa ngokuthi “lo mgomo akumelwe ube omunye wemigomo ebhuntshayo ye-UN. Lesi yisigamu nje sabantu abanengculaza noma isandulela sayo okulinganiselwa ukuthi badinga ukwelashwa namuhla futhi leli nani liyobe selilikhulu [ngo-2005].”

Ezinye Izithiyo

Ngisho noma amazwe asathuthuka abenganikezwa imishanguzo eyanele, kunezinye izithiyo obekuyofanele zinqotshwe. Imithi ethile kufanele iphuzwe kanye nokudla namanzi ahlanzekile, kodwa amakhulu ezinkulungwane zabantu kwamanye amazwe adla kanye ngemva kwezinsuku ezimbili. Imishanguzo (ngokuvamile engamaphilisi angu-20 noma ngaphezulu ngosuku) kufanele iphuzwe ngesikhathi esithile usuku ngalunye, kodwa iziguli eziningi azinalo iwashi. Inhlanganisela yemithi kufanele ivunyelaniswe nesimo sesiguli. Kodwa kunokuntuleka okukhulu kodokotela emazweni amaningi. Ngokusobala, ukutholela amazwe asathuthuka imishanguzo kuyinkinga okuyoba nzima ukuyinqoba.

Ngisho neziguli ezisemazweni asethuthukile zinezinselele ekuphuzeni imithi eyinhlanganisela. Ucwaningo lwembula ukuthi ukungayiphuzi yonke imithi ngezikhathi ezimisiwe kuvame kakhulu. Lokhu kungase kwenze amagciwane amelane nemithi. Amagciwane anjalo esandulela-ngculaza amelana nemithi angadluliselwa kwabanye.

UDkt. Stine uveza enye inselele abantu abanegciwane lesandulela-ngculaza ababhekene nayo. Uthi: “Indida ngokwelashelwa igciwane lesandulela-ngculaza ukuthi ngezinye izikhathi ukwelashwa kubuhlungu ngaphezu kwesifo, ikakhulukazi uma kuqalwa ngaphambi kokuba kubonakale izimpawu.” Abantu abanegciwane lesandulela-ngculaza abaphuza imishanguzo bavame ukubhekana nemiphumela engemihle ehlanganisa isifo sikashukela, ukuphazamiseka kwamangqamuzana amafutha emzimbeni, amafutha amaningi egazini, nokuwohloka kwamathambo. Eminye yale miphumela isongela ukuphila.

Imizamo Yokugoma

Imizamo yokugoma iye yaphumelela kangakanani ekunqandeni ukusakazeka kwengculaza nokushintsha ukuziphatha okuyingozi? Imikhankaso emikhulu yokufundisa ngengculaza e-Uganda ngawo-1990 yanciphisa ukusakazeka kwegciwane lesandulela-ngculaza kulelo zwe kwasuka cishe kumaphesenti angu-14 kwaya cishe kwangu-8 ngo-2000. Ngokufanayo, imizamo yezwe laseSenegal yokuqaphelisa izakhamuzi ngezingozi zaleli gciwane iye yenza izinga lokusakazeka kwaleli gciwane kulelo zwe lihlale lingaphansi kwephesenti elilodwa phakathi kwabantu abadala. Imiphumela enjalo iyakhuthaza.

Ngakolunye uhlangothi, ukufundisa ngengculaza akuzange kuphumelele kangako kwamanye amazwe. Inhlolo-vo ka-2002 yabasha abangu-11 000 baseCanada yembula ukuthi ingxenye yabafundi bebanga lesikhombisa ikholelwa ukuthi ingculaza iyelapheka. Ngokocwaningo olwenziwa eBrithani ngawo lowo nyaka ofanayo, amaphesenti angu-42 abafana abaneminyaka ephakathi kweshumi neshumi nanye ayengakaze ezwe ngegciwane lesandulela-ngculaza noma ngengculaza. Nokho, ngisho nentsha eyaziyo ngegciwane lesandulela-ngculaza nangengculaza nokuthi alikho ikhambi, ayisanaki. Udokotela othile uthi: “Entsheni eningi, igciwane lesandulela-ngculaza selingenye nje yezinkinga eziningi ekuphileni kwayo, enjengokuthi izokuthola yini ukudla okufanele, izohlala nobani, nokuthi izoya yini esikoleni.”

Yingakho-ke i-WHO ithi “ukugxila entsheni cishe kuyoba indlela ephumelela kangcono yokubhekana nalo mqedazwe, ikakhulukazi emazweni ovame kakhulu kuwo.” Intsha ingasizwa kanjani ukuba ilalele izixwayiso zengculaza? Futhi ingabe kunengqondo ukuthemba ukuthi lizotholakala ikhambi?

[Amazwi acashunwe esihlokweni ekhasini 6]

Ngonyaka odlule bangamaphesenti amabili abantu base-Afrika abadinga imishanguzo abayithola, uma kuqhathaniswa nabangamaphesenti angu-84 emazweni aseMelika

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Ayini Ama-ARV?a

Kumuntu ophile kahle, ama-T cell angabasizi akhuthaza noma agqugquzele isimiso sokuzivikela ezifweni ukuba silwe namagciwane ahlaselayo. Igciwane lesandulela-ngculaza lihlasela la ma-T cell angabasizi ngokukhethekile. Lisebenzisa la mangqamuzana ukuze liziphindaphinde, liwohloze futhi libhubhise ama-T cell angabasizi kuze kube yilapho isimiso sokuzivikela ezifweni sesiwohloke ngokuphelele. Imishanguzo (ama-ARV [antiretroviral drug]) anqanda le nqubo yokuziphindaphinda kwegciwane.

Okwamanje, kunezinhlobo ezine zama-ARV ezisetshenziswayo. Ama-nucleoside analogue nama-non-nucleoside analogue anqanda igciwane lesandulela-ngculaza lingangeni kuyi-DNA yomuntu. Ama-protease inhibitor anqanda iprotheni ethile ye-protease esemangqamuzaneni anegciwane ukuba ingaphindi ilakhe leli gciwane ukuze lingakhiqizi amagciwane engeziwe esandulela-ngculaza. Ama-fusion inhibitor asiza ekuvimbeni igciwane lesandulela-ngculaza lingangeni emangqamuzaneni. Ngokunqanda ukuziphindaphinda kwegciwane, imishanguzo ingalinqanda ukuba lingabi ingculaza, eyisimo esibi kakhulu enqubweni yokungenwa yileli gciwane.

[Umbhalo waphansi]

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EKENYA—Udokotela ufundisa umuntu onengculaza ngemishanguzo

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© Sven Torfinn/Panos Pictures

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EKENYA—Umuntu onengculaza uthola imishanguzo esibhedlela

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© Sven Torfinn/Panos Pictures

[Ibhokisi/Izithombe ekhasini 8]

Abesifazane Nengculaza

Manje abesifazane bakha amaphesenti angu-50 abantu abadala abanengculaza noma isandulela sayo

Ngo-1982, lapho abesifazane betholakala benengculaza, kwakucatshangwa ukuthi bayithole ngokusebenzisa imijovo yezidakamizwa enegciwane. Ngokushesha, kwacaca ukuthi abesifazane bangalithola igciwane ngobulili obuvamile nokuthi basengozini ngokukhethekile yokulithola. Emhlabeni wonke, abesifazane manje bakha amaphesenti angu-50 abantu abadala abanengculaza noma isandulela sayo. “Lo mqedazwe uhlasela kakhulu abesifazane namantombazane asakhula abasengozini ngenxa yesimo senhlalo, amasiko, impilo nezomnotho, futhi abathwele umthwalo wokunakekela abagulayo nabafayo,” kubika i-UNAIDS.

Kungani izisebenzi zezengculaza zikhathazeke kakhulu ngokusakazeka kwalesi sifo phakathi kwabesifazane? Abesifazane abanegciwane ngokuvamile babandlululwa kakhulu kunamadoda, ikakhulukazi emazweni athile asathuthuka. Uma owesifazane ekhulelwe, impilo yengane yakhe isengozini; uma esenezingane kakade, ukuzinakekela kuba umthwalo, ikakhulukazi uma engumama ongayedwa. Ngaphezu kwalokho, kuncane kakhulu okwaziwayo ngezici ezingafani zabesifazane abanegciwane lesandulela-ngculaza nendlela okufanele banakekelwe ngayo.

Izici ezithile zamasiko zenza isimo sibe yingozi nakakhulu kwabesifazane. Emazweni amaningi akulindelekile ukuba abesifazane baxoxe ngezindaba zobulili, futhi baba sengozini yokuhlukunyezwa uma benqaba ukuya ocansini. Amadoda avame ukulala nabantu abaningi, abathelele ngegciwane lesandulela-ngculaza engazi. Amadoda athile ase-Afrika alala nabesifazane abasebasha ukuze agweme igciwane lesandulela-ngculaza noma ngenxa yenkolelo engamanga yokuthi ukulala nezintombi ntó kungayelapha ingculaza. Yingakho i-WHO ithi: “Kumelwe kugxilwe ekusizeni amadoda (kanye nabesifazane) ukuze kuvikelwe abesifazane.”

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EPERU—Umama onegciwane lesandulela-ngculaza nendodakazi yakhe engenalo

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© Annie Bungeroth/Panos Pictures

ETHAILAND—Njengengxenye yezifundo, abafundi bavakashela isiguli esinengculaza

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© Ian Teh/Panos Pictures

EKENYA—Umhlangano namalungu enhlangano i-Women Living With AIDS

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© Sven Torfinn/Panos Pictures

[Ibhokisi/Isithombe ekhasini 9]

Izinganekwane Ngengculaza

◼ Abantu abanegciwane lesandulela-ngculaza bayabonakala ukuthi bayagula. “Ngokuvamile, kuthatha iminyaka eyishumi kuya kwengu-12 ukuba umuntu onegciwane abe nengculaza,” kusho uDkt. Gerald J. Stine. “Phakathi nalesi sikhathi, abantu abanegciwane baba nezimpawu ezimbalwa eziqaphelekayo, uma zikhona, kodwa bayakwazi ukudlulisela igciwane kwabanye abantu.”

◼ Ingculaza iyisifo songqingili. Ekuqaleni kwawo-1980, kwaqale kwathiwa ingculaza yisifo songqingili. Nokho, namuhla ukulala kwabesilisa nabesifazane kuyindlela eyinhloko igciwane lesandulela-ngculaza elisakazeka ngayo ezingxenyeni eziningi zomhlaba.

◼ Ubulili bomlomo “buwubulili obuphephile.” Ngokwe-Centers for Disease Control and Prevention, “ucwaningo oluningana luye lwabonisa ukuthi ubulili bomlomo bungasakaza igciwane lesandulela-ngculaza nezinye izifo ezithathelwana ngobulili.” Ingozi yokusakazeka kwaleli gciwane ngobulili bomlomo ayinkulu njengakweminye imikhuba yobulili. Nokho, lo mkhuba sewande kakhulu kangangokuba abanye odokotela balindele ukuba ube yindlela eyinhloko yokusakaza igciwane lesandulela-ngculaza.

◼ Likhona ikhambi lengculaza. Nakuba kwezinye iziguli imishanguzo ingabambezela igciwane ekubeni ingculaza, okwamanje awukho umuthi wokugoma noma wokwelapha.

[Isithombe ekhasini 9]

ECZECH REPUBLIC—Ukuhlola ingculaza egazini, manje osekunendlela yokuyinqanda kodwa engelapheki

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© Liba Taylor/Panos Pictures

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EZAMBIA—Amantombazanyana amabili anegciwane lesandulela-ngculaza alinde imithi

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© Pep Bonet/Panos Pictures