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- Volume 11, Issue 1, 2010
Southern African Journal of HIV Medicine - Volume 11, Issue 1, 2010
Volumes & issues
Volume 11, Issue 1, 2010
Author Linda-Gail BekkerSource: Southern African Journal of HIV Medicine 11 (2010)More Less
It is an interesting time in South Africa ... with public debate on education, the judicial system, and whether or not politicians should be allowed to say and sing what they like in public, to name just a few issues. The journal also takes on controversy this quarter, and I hope will elicit some debate. I remind you that the opinions expressed in its pages are not necessarily supported by the editorial committee or the Clinicians Society!
Stigma, human rights, testing and treatment - time for action : Ruben Sher Memorial Lecture, 26 November 2009 : forumAuthor Edwin CameronSource: Southern African Journal of HIV Medicine 11, pp 6 –18 (2010)More Less
Ruben Sher came into my life at perhaps its darkest moment. I was diagnosed with HIV on a rainstorm-filled Friday afternoon in the second half of December 1986. My well-meaning doctor, who had not obtained my consent, phoned me with the bad news and left me in anguish, not only for the weekend but for the ensuing years. His one act of solicitude in telling me that I was infected with HIV was to suggest that I contact Professor Ruben Sher at the South African Institute of Medical Research (SAIMR).
Innovative responses for preventing HIV transmission : the protective value of population-wide interruptions of risk activity : forumSource: Southern African Journal of HIV Medicine 11, pp 19 –21 (2010)More Less
Concurrent partnering contributes to high HIV prevalence. This is in part due to the natural history of the virus. After transmission, an individual's viral load spikes in a period of 'acute infection' during which they are highly infectious. Models estimate that around 10 - 45% of HIV acquisition arises from sex with an individual in the acute infection period. If everyone in a population abstained from high-risk sex for a given period of time, in theory the viral loads of all recent seroconverters should pass through the acute infection period. When risk behaviour resumed there would be almost no individuals in the high-viraemic phase, thereby reducing infectivity, and HIV incidence would fall. Recurring population-wide shifts in risk behaviour are not unheard of. Many, in fact, occur as part of existing religious observances. The month of Ramadan in Muslim communities is perhaps one of the most obvious cases. Ramadan sees significant behaviour changes. In addition to fasting from sunrise to sunset, observant individuals abstain from coitus during daylight hours. There is anecdotal evidence that risky sexual behaviours are also significantly reduced over this period. In Indonesia, for instance, it was reported that research with sex workers was not possible during Ramadan because people 'abstained from sex from one end of the month to the other ... Many sex workers returned to home villages during this time'.
'Differential poverty rates are responsible for the racial differentials in HIV prevalence South Africa' : an enduring epidemiological urban legend? : opinionAuthor Chris KenyonSource: Southern African Journal of HIV Medicine 11, pp 22 –27 (2010)More Less
It is widely held to be axiomatic in South African epidemiological and social science circles that it is not worth comparing the risk factors underpinning the dramatic differences in HIV spread in South Africa's racial groups, as these are all explained by corresponding differences in socio-economic status. The available evidence, however, suggests that HIV is not simply contoured along lines of socio-economic deprivation; rather, other - largely culturally determined - factors such as the practice and acceptance of multiple concurrent sexual partnerships play a key role. Comparison of sexual behaviours between South Africa's different races supports the likelihood that cultural and not socio-economic factors are the mediators of differential racial HIV spread. Finally, it is argued that the failure of many South African experts in the study of HIV to consider race as a valid variable for analysis, and allied to this their continued exaggeration of the importance of socio-economic rather than cultural factors, has contributed to the relative failure of our national AIDS strategy.
Author Celicia SerenataSource: Southern African Journal of HIV Medicine 11, pp 28 –30 (2010)More Less
In 2009 the South African National AIDS Council (SANAC) Treatment Technical Task Team (TTT) finalised recommendations for changes to the national standard treatment guidelines for adult and paediatric management and treatment, as well as changes in the prevention of mother-to-child transmission of HIV (PMTCT) guidelines, moving away from monotherapy to dual therapy. President Zuma announced changes in the national antiretroviral therapy (ART) programme on World AIDS Day 2009. Subsequently additional changes were made to the treatment guidelines to be in line with these new Presidential mandates, which came into effect on 1 April 2010.
Source: Southern African Journal of HIV Medicine 11, pp 31 –34 (2010)More Less
Cytomegalovirus is a multi-systemic infection reactivated in the immunocompromised. Diagnosis and treatment are prohibitively costly in sub-Saharan Africa, and efforts need to be made for their price reduction to support the expanding highly active antiretroviral treatment programme in the region.
Author Sophia PathaiSource: Southern African Journal of HIV Medicine 11 (2010)More Less
Cytomegalovirus can cause a wide spectrum of multi-systemic disorders including pulmonary disease, gastrointestinal disorders and disabling central or peripheral neurological dysfunction, as well as other manifestations that are well described by Laher et al. in their article. However, retinal disease is by far the most common clinical manifestation of CMV for patients with HIV, and this devastating condition has rightly been termed 'the neglected disease of the AIDS pandemic'.
Analysis of trends in total and AIDS-related deaths certified at Mosvold Hospital, Ingwavuma, KwaZulu-Natal, from 2003 to 2008 : original articleAuthor C.H. (Vaughan) WilliamsSource: Southern African Journal of HIV Medicine 11, pp 36 –39 (2010)More Less
Objectives. To analyse mortality trends from deaths registered at Mosvold Hospital, Ingwavuma, KwaZulu-Natal, and possible impact of programmes to treat and prevent HIV infection.
Design. Longitudinal study of death certifications from 2003 to 2008.
Setting. Mosvold Hospital mortuary, Ingwavuma.
Subjects. Counterfoils of form 83/BI-1663, Notification/Register of Death/Stillbirths (Republic of South Africa, Department of Home Affairs), completed at Mosvold Hospital from January 2003 to December 2008.
Outcome measures. Age at death, cause of death, patterns of deaths grouped by age, gender and cause of death.
Results. AIDS-related deaths were the cause of 53% of deaths, particularly affecting the 20 - 59-year and under-5 age groups. Since 2005 there has been a decline in deaths in the 20 - 59 age group and an increase in average age at death.
Conclusions. The decrease in mortality from 2005 may be associated with antiretroviral roll-out reducing mortality from AIDS-related illnesses.
Source: Southern African Journal of HIV Medicine 11, pp 40 –44 (2010)More Less
Aim. The coping skills and styles individuals utilise to deal with the stress of HIV infection greatly influence the psychological impact of this illness and potential consequent feelings of hopelessness. The aim of this study was to describe levels of hopelessness in a group of stable, non-depressed HIV-positive patients receiving antiretroviral therapy, and factors associated with hopelessness.
Method. Thirty randomly selected non-depressed patients (according to Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria) were included in this study. Demographic and other data were obtained from all subjects, who also completed the Beck's Hopelessness Scale (BHS). The 20 true-false items of the BHS (29) measured three major aspects of hopelessness, which was interpreted on the total scale score as follows : ≤3 minimal, and >3 significant.
Results. The study population comprised 30 patients with a mean age of 37.9 years (standard error (SE) 1.18) (range 28 - 51 years). The mean BHS score was 4.03 (SE 0.55), with a range from 0 to 12. There were no statistically significant correlations between BHS scores of the study population and gender, marital status, employment status, level of education, years since the diagnosis of HIV, or number of children (p>0.05). Eighteen subjects (60%) scored 3 or less on the BHS, considered minimal levels of hopelessness. However, 12 (40%) scored more than 3, which is considered significant; of these 23% had scores of 7 or more. There was no statistically significant association between BHS scores and gender, employment status, level of education, number of children or number of years since diagnosis (p>0.05). However, patients who were married or living with partners were statistically more likely to score higher on the hopelessness scale compared with those who were single (p>0.05).
Conclusion. Hopelessness is a psychological distress reaction that is common but largely undetected in stable HIV-positive patients on antiretrovirals. Feelings of hopelessness may result in increase in risk-taking behaviour (e.g. unprotected sex, drug use, sharing needles) and attempted suicide.
Is pregnancy associated with biochemical and haematological changes in HIV-infected Nigerian women? : original articleSource: Southern African Journal of HIV Medicine 11, pp 45 –48 (2010)More Less
Background. While there is evidence that HIV affects the course and outcome of pregnancy, reports on the effects of pregnancy on HIV infection remain conflicting, especially in low-resource settings.
Methodology. A prospective study of two demographically similar cohorts of HIV-seropositive women, 154 pregnant and 151 non-pregnant, was conducted in a hospital setting in Nigeria.
Results. Cases and controls were matched for age, but parity in controls was significantly higher than in cases (p<0.0001). The time between diagnosis and treatment commencement was greater in controls compared with cases (p<0.0001). Electrolyte, urea and creatinine levels were within normal limits, with mean serum urea and potassium higher in controls compared with cases (p=0.002 and p=0.023). Aspartate aminotransferase (AAT)/ serum glutamic oxaloacetic acid transaminase (SGOT), alanine aminotransferase (ALT)/serum glutamic-pyruvic transaminase (SGPT) and amylase levels were higher in controls compared with cases (p=0.001, p=0.0001 and p=0.05), but the mean CD4 count was higher in cases compared with controls (p=0.001). The haematological parameters were within normal limits and comparable in cases and controls. A comparison of CD4 count, total white blood cell count and packed cell volume across the three trimesters in the cases did not reveal any statistically significant differences in these parameters.
Conclusion. Pregnancy did not affect biochemical and haematological parameters in HIV-infected Nigerian women.