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- Southern African Journal of HIV Medicine
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- Volume 12, Issue 3, 2011
Southern African Journal of HIV Medicine - Volume 12, Issue 3, 2011
Volumes & issues
Volume 12, Issue 3, 2011
Author Francois VenterSource: Southern African Journal of HIV Medicine 12 (2011)More Less
The National Strategic Plan for 2011 - 2016 is being written as you read this issue of the Journal. Through its members, the Society has contributed a lot to the draft that it is hoped will be out in the next few weeks. The previous Plan was constructed in extremely difficult political circumstances (the then Minister of Health and senior Department of Health officials were still part of the old Mbeki era of HIV denial), and involved long meetings arguing over the most ridiculous points of science. This Plan is a completely different beast - broadly consulted in multiple meetings with every corner of society, with the DoH leading from the front. The writing team is reviewing a huge number of submissions, and integrating the suggestions into a strategic plan.
Author Landon MyerSource: Southern African Journal of HIV Medicine 12 (2011)More Less
As some readers of the South African Journal of HIV Medicine will know, Professor Linda-Gail Bekker has elected to step down as editor, and I am moving into this position beginning with the September issue. Under Linda-Gail's leadership the journal has grown considerably, and we are indebted to her for her contribution over the past years. On a personal note Linda-Gail has been immensely helpful during the handover of the editorship, and I am happy to report that she will continue to provide guidance while serving on the journal's editorial board.
Source: Southern African Journal of HIV Medicine 12, pp 6 –8 (2011)More Less
To determine how a program for learning immunology could be most useful for clinicians in South Africa, we consulted with the country's 20 leading HIV specialist pediatricians. They told us that immunology and its underlying concepts were perceived to be complex and arcane and that there was a need for immunology to be better integrated into "real-life" clinical practice. Most saw immunology as predominantly a laboratory science with little application to clinical practice; this highlighted a gap between clinical management of patients and theoretical understanding of the etiology and immunopathogenesis of disease. We speculated that one of the possible reasons for this perception and knowledge gap is that immunology is not an independent discipline within the South African medical curriculum. Instead, it is diffusely integrated into disciplines such as pathology or internal medicine and is not specifically provided for during post-degree training.
When to start antiretroviral therapy in adults : the results of HPTN 052 move us closer to a 'test-and-treat' policy : opinionAuthor Nathan GeffenSource: Southern African Journal of HIV Medicine 12, pp 9 –11 (2011)More Less
When is the best time to initiate antiretroviral therapy (ART) in adults? This is a vital question in HIV treatment and prevention services. More specifically, is the 350 cells/µl CD4 count threshold recommended by current World Health Organization (WHO) guidelines sufficient, or should we move to a 'test-and-treat' approach in which anyone who tests HIV-positive is offered ART, irrespective of their CD4 count? The recently announced results of the HPTN 052 trial take us closer, but not all the way, to a test-and-treat approach.
How can we reduce the risk of mother-to-child transmission of HIV during invasive obstetric procedures? : opinionSource: Southern African Journal of HIV Medicine 12, pp 12 –13 (2011)More Less
Antenatal invasive obstetric procedures may be diagnostic or therapeutic, and are performed at different stages of pregnancy for various indications. The most common indication for an invasive procedure during pregnancy is for fetal karyotyping when a chromosomal abnormality or a genetic defect is suspected, either from the couple's history or from ultrasound assessment of the fetus. Other less common but equally important indications may be diagnostic (fetoscopy, fetal tissue sampling, estimation of fetal haemoglobin) or therapeutic (aspiration of various fetal cavities, fetal blood transfusion and embryo reductions). In a high HIV prevalence setting like South Africa, a significant proportion of pregnant women in need of invasive procedures will be HIV-infected.
Knowledge, attitudes and personal beliefs about HIV and aids among mentally ill patients in Soweto, Johannesburg : original articleSource: Southern African Journal of HIV Medicine 12, pp 14 –20 (2011)More Less
Aim. The aim of the study was to determine knowledge, attitudes and personal beliefs regarding HIV and AIDS in a group of mentally ill patients attending outpatient clinics in Soweto, Johannesburg.
Method. All patients attending four randomly chosen clinics in Soweto were invited to complete a self-administered questionnaire after obtaining informed written consent. The 63-item questionnaire, developed from others specifically for this study, included questions on socio-demographic and clinical characteristics; knowledge on how HIV is acquired and spread; attitudes and beliefs regarding HIV and AIDS; and condom usage. The statements in the knowledge sections were used to calculate a composite score, which if greater than or equal to 75% was defined as 'adequate knowledge'.
Results. A total of 1 151 patients with mental illness participated in the study. The mean age was 41.9 years (standard deviation 11.6) and the majority were males (50%); single (55%), and had achieved only a secondary level of education (53.3%). Overall, most of the study population did not believe in the myths surrounding the spread and acquisition of HIV and AIDS. There were however, significant associations between a low level of education and the belief that HIV is acquired from mosquito bites (odds ratio (OR) 1.61; 95% CI 1.19 - 2.18; p=0.002) and through masturbation or body rubbing (OR 1.76; 95% CI 1.34 - 2.33; p=0.000). Although more than 90% of the patients were aware of the facts regarding the spread of HIV, approximately 40% did not believe that one could acquire HIV through a single sexual encounter. The composite scoring for knowledge showed that less than half the patients had adequate knowledge of HIV/AIDS. This was significantly associated with gender and level of education: females were 1.6 times (p<0.0004) and patients with Grade 8 or higher education 1.5 times more knowledgeable (p=0.002).
Conclusion. Among mentally ill patients there is both a lack of knowledge about most aspects of HIV and AIDS and a belief in some of the myths associated with the acquisition and spread of the disease, especially among older, less educated patients. It is imperative that a targeted strategy be developed for this vulnerable group, taking into cognisance their inherent lower level of education and the cognitive impairment associated with mental illness, to educate them on all aspects of HIV and AIDS and to improve access to services.
Source: Southern African Journal of HIV Medicine 12, pp 21 –22 (2011)More Less
Primary extranodal lymphoma of the breast is rare and accounts for 0.04 - 0.53% of all malignant tumours, less than 1% of non-Hodgkin's lymphomas (NHLs) and 1.7% of extranodal NHLs. Extranodal lymphoma arises from tissue other than lymph nodes and sites that normally contain no lymphoid tissue. This case describes the clinical and treatment dilemma posed by extranodal presentation in an AIDS-NHL patient.
Source: Southern African Journal of HIV Medicine 12, pp 23 –24 (2011)More Less
A 5-month-old South African girl presented to a casualty department with a short history of fever. General examination did not reveal organomegaly or neck stiffness. In keeping with local guidelines, malaria was excluded on antigen testing and microscopy (thick and thin smear with Giemsa stain). Rickettsia typhi, R. conorii and Coxiella burnetti were also excluded on the basis of serological testing.
Source: Southern African Journal of HIV Medicine 12, pp 26 –30 (2011)More Less
Men who have sex with men (MSM) are at high risk of HIV acquisition and transmission, and country-specific HIV prevalence rates are always higher in MSM than among heterosexual men. South African data confirm this, with reported HIV prevalences of 10.4 - 33.9% across various studies. Donors and government health planners have recognised the need for targeted programmes that address the high burden of HIV transmission and disease in stigmatised populations such as MSM, as well as other 'most at risk populations' (MARPS) such as commercial sex workers, drug users and displaced refugees. Specific programmes targeting MSM and other MARPS have been included in the South African government's current National Strategic Plan for health care and will feature in the new plan under development.
A Clinical Atlas of Skin Conditions in HIV/AIDS : An Illustrated Management Guide for Health Care Professionals, Ncoza Dlova and Anisa Mosam : book reviewAuthor Dirk HagemeisterSource: Southern African Journal of HIV Medicine 12 (2011)More Less
Written by two dermatologists from the University of KwaZulu-Natal's Nelson R Mandela School of Medicine, the much-needed 2nd edition of the Atlas of Skin Conditions in HIV/AIDS is now available. Immunocompromise in HIV cases results in a large variety of skin findings that significantly differ in quality and extent from those in immunocompetent people.