Early evidence of San material culture represented by organic artifacts from Border Cave, South Africa

Recent archaeological discoveries have revealed that pigment use, beads, engravings, and sophisticated stone and bone tools were already present in southern Africa 75,000 y ago. Many of these artifacts disappeared by 60,000 y ago, suggesting that modern behavior appeared in the past and was subsequently lost before becoming firmly established. Most archaeologists think that San hunter-gatherer cultural adaptation emerged 20,000 y ago. However, reanalysis of organic artifacts from Border Cave, South Africa, shows that the Early Later Stone Age inhabitants of this cave used notched bones for notational purposes, wooden digging sticks, bone awls, and bone points similar to those used by San as arrowheads. A point is decorated with a spiral groove filled with red ochre, which closely parallels similar marks that San make to identify their arrowheads when hunting. A mixture of beeswax, Euphorbia resin, and possibly egg, wrapped in vegetal fibers, dated to ～40,000 BP, may have been used for hafting. Ornaments include marine shell beads and ostrich eggshell beads, directly dated to ～42,000 BP. A digging stick, dated to ～39,000 BP, is made of Flueggea virosa. A wooden poison applicator, dated to ～24,000 BP, retains residues with ricinoleic acid, derived from poisonous castor beans. Reappraisal of radiocarbon age estimates through Bayesian modeling, and the identification of key elements of San material culture at Border Cave, places the emergence of modern hunter-gatherer adaptation, as we know it, to ～44,000 y ago.     

From the Cover: Implications for complex cognition from the hafting of tools with compound adhesives in the Middle Stone Age,South Africa

Compound adhesives made from red ochre mixed with plant gum were used in the Middle Stone Age (MSA), South Africa. Replications reported here suggest that early artisans did not merely color their glues red; they deliberately effected physical transformations involving chemical changes from acidic to less acidic pH, dehydration of the adhesive near wood fires, and changes to mechanical workability and electrostatic forces. Some of the steps required for making compound adhesive seem impossible without multitasking and abstract thought. This ability suggests overlap between the cognitive abilities of modern people and people in the MSA. Our multidisciplinary analysis provides a new way to recognize complex cognition in the MSA without necessarily invoking the concept of symbolism.     

On the earliest evidence for habitual use of fire in Europe

The timing of the human control of fire is a hotly debated issue, with claims for regular fire use by early hominins in Africa at ～ 1.6 million y ago. These claims are not uncontested, but most archaeologists would agree that the colonization of areas outside Africa, especially of regions such as Europe where temperatures at time dropped below freezing, was indeed tied to the use of fire. Our review of the European evidence suggests that early hominins moved into northern latitudes without the habitual use of fire. It was only much later, from ～ 300,000 to 400,000 y ago onward, that fire became a significant part of the hominin technological repertoire. It is also from the second half of the Middle Pleistocene onward that we can observe spectacular cases of Neandertal pyrotechnological knowledge in the production of hafting materials. The increase in the number of sites with good evidence of fire throughout the Late Pleistocene shows that European Neandertals had fire management not unlike that documented for Upper Paleolithic groups.     

The Ysterfontein 1 Middle Stone Age site, South Africa, and early human exploitation of coastal resources

Human fossils and the genetics of extant human populations indicate that living people derive primarily from an African population that lived within the last 200,000 years. Yet it was only approximately 50,000 years ago that the descendants of this population spread to Eurasia, where they swamped or replaced the Neanderthals and other nonmodern Eurasians. Based on archaeological observations, the most plausible hypothesis for the delay is that Africans and Eurasians were behaviorally similar until 50,000 years ago, and it was only at this time that Africans developed a behavioral advantage. The archaeological findings come primarily from South Africa, where they suggest that the advantage involved much more effective use of coastal resources. Until now, the evidence has come mostly from deeply stratified caves on the south (Indian Ocean) coast. Here, we summarize results from recent excavations at Ysterfontein 1, a deeply stratified shelter in a contrasting environment on the west (Atlantic) coast. The Ysterfontein 1 samples of human food debris must be enlarged for a full comparison to samples from other relevant sites, but they already corroborate two inferences drawn from south coast sites: (i) coastal foragers before 50,000 years ago did not fish routinely, probably for lack of appropriate technology, and (ii) they collected tortoises and shellfish less intensively than later people, probably because their populations were smaller.     

Ancient DNA, Strontium isotopes, and osteological analyses shed light on social and kinship organization of the Later Stone Age

In 2005 four outstanding multiple burials were discovered near Eulau, Germany. The 4,600-year-old graves contained groups of adults and children buried facing each other. Skeletal and artifactual evidence and the simultaneous interment of the individuals suggest the supposed families fell victim to a violent event. In a multidisciplinary approach, archaeological, anthropological, geochemical (radiogenic isotopes), and molecular genetic (ancient DNA) methods were applied to these unique burials. Using autosomal, mitochondrial, and Y-chromosomal markers, we identified genetic kinship among the individuals. A direct child-parent relationship was detected in one burial, providing the oldest molecular genetic evidence of a nuclear family. Strontium isotope analyses point to different origins for males and children versus females. By this approach, we gain insight into a Late Stone Age society, which appears to have been exogamous and patrilocal, and in which genetic kinship seems to be a focal point of social organization.     

Behavior and psychological functioning of young children of HIV-positive mothers in South Africa

Adults with HIV are living longer due to earlier diagnosis and increased access to antiretroviral medications. Therefore, fewer young children are being orphaned and instead, are being cared for by parents who know they are HIV positive, although they may be asymptomatic. Presently, it is unclear whether the psychological functioning of these young children is likely to be affected or, alternatively, whether it is only when a mother is ill, that children suffer adverse effects. We, thus, aimed to compare the behavior and psychological functioning of young children (aged 6–10 years) of HIV-positive and HIV-negative mothers. We also aimed to examine the association between HIV status disclosure and child outcomes. This study uses cross-sectional data from the baseline assessment of a randomized controlled trial conducted in Tshwane, South Africa. Participants (n=509) and their children were recruited from area health clinics. Among the 395 mothers with HIV, 42% reported symptoms of HIV disease. Multivariate linear regression models suggested that after adjusting for socio-demographic characteristics, children of HIV-positive mothers had significantly greater externalizing behaviors than children of HIV-negative mothers. Importantly, children whose mothers were symptomatic had greater internalizing and externalizing behaviors compared with children of HIV-negative mothers, but this was not true for children of asymptomatic mothers. Additionally, among children of HIV-positive mothers, those who had been told their mothers were sick compared with children who had been told nothing had less internalizing and externalizing behaviors and improved daily living skills. This study, therefore, provides evidence that maternal HIV disease can affect the behaviors of young children in South Africa but, importantly, only when the mothers are symptomatic from their disease. Furthermore, results suggest that disclosure of maternal illness but not HIV status was associated with improved behavior and psychological functioning among young children.     

Microstratigraphic evidence of in situ fire in the Acheulean strata of Wonderwerk Cave, Northern Cape province, South Africa

The ability to control fire was a crucial turning point in human evolution, but the question when hominins first developed this ability still remains. Here we show that micromorphological and Fourier transform infrared microspectroscopy (mFTIR) analyses of intact sediments at the site of Wonderwerk Cave, Northern Cape province, South Africa, provide unambiguous evidence--in the form of burned bone and ashed plant remains--that burning took place in the cave during the early Acheulean occupation, approximately 1.0 Ma. To the best of our knowledge, this is the earliest secure evidence for burning in an archaeological context.     

Sexual behavior and HIV risk across the life course in rural South Africa: trends and comparisons

There is limited information about sexual behavior among older Africans, which is problematic given high HIV rates among older adults. We use a population-based survey among people aged 15–80+ to examine the prevalence of sexual risk and protective behaviors in the context of a severe HIV epidemic. We focus on variation across the life course, gender and HIV serostatus to compare the similarities and differences of young, middle aged, and older adults. Younger adults continue to be at risk of HIV, with potential partners being more likely to have been diagnosed with an STI and more likely to have HIV, partner change is high, and condom use is low. Middle aged and older adults engage in sexual behavior that makes them vulnerable at older ages, including extramarital sex, low condom use, and cross-generational sex with people in age groups with the highest rates of HIV. We find insignificant differences between HIV positive and negative adults’ reports of recent sexual activity. This study provides new information on sexual behavior and HIV risk across the life course in rural South Africa to inform HIV prevention and treatment programing.     

Perceived neighborhood safety and exercise behavior among community dwellers in Gauteng,South Africa

Maintaining a physically active life is an important determinant of overall health and psychosocial wellbeing among adults. Physical exercise behavior can be influenced by various social and environmental circumstances including neighborhood safety. Using data from South Africa Quality of life Survey 2015/16, this study aimed to assess the hypothesis that lack of perceived neighborhood safety (PNS) can reduce the likelihood of engaging in physical exercise (PE). The participants were 30,002 men and women aged 18 years and above. The association between self-reported PE behavior and neighborhood safety were assessed by multivariable regression method while adjusting for potentially confounding factors. Less than a quarter (23.41%) of the participants reported taking exercise on daily basis whereas 27.90% reported never taking any. Respectively 6.0% and 38.1% of the participants reported feeling very unsafe walking in the neighborhood during day and night. In regression analysis, both the pooled and stratified models indicated that lack of PNS was inversely associated with regular PE. Lack of PNS (bit unsafe) during day was associated with lower odds of PE both among men (OR = 0.776, P < .001) and women (OR = 0.874, P < .001). The negative association between lack of PNS and PE during day was significant among those living with disability (OR = 0.758, P < .001). Further analysis showed that the negative association between lack of PNS with regular PE during day was significant in Johannesburg (OR = 0.800, P < .001), Tshwane (OR = 0.735, P < .001) and Emfuleni (OR = 0.619, P < .001) only, while that during night was significant in Johannesburg (OR = 0.737, P < .001), Ekurhuleni (OR = 0.673, P < .001), Emfuleni (OR = 0.418, P < .001), Lesedi (OR = 0.385, P < .001), Mogale City (OR = 0.693, P < .001), and Randfontein (OR = 0.565, P < .001). Overall, the findings highlight a significantly inverse association between lack of PNS and PE behavior. In light of the current findings, it is recommended that PE promotion programs pay special attention on population living in the neighborhoods fraught with crime concerns.     

Distribution of Human Papillomavirus (HPV) Genotypes in HIV-Negative and HIV-Positive Women with Cervical Intraepithelial Lesions in the Eastern Cape Province,South Africa

South African women have a high rate of cervical cancer cases, but there are limited data on human papillomavirus (HPV) genotypes in cervical intraepithelial neoplasia (CIN) in the Eastern Cape province, South Africa. A total of 193 cervical specimens with confirmed CIN from women aged 18 years or older, recruited from a referral hospital, were tested for HPV infection. The cervical specimens, smeared onto FTA cards, were screened for 36 HPV types using an HPV direct flow kit. HPV prevalence was 93.5% (43/46) in CIN2 and 96.6% (142/147) in CIN3. HIV-positive women had a significantly higher HPV prevalence than HIV-negative women (98.0% vs. 89.1%, p = 0.012). The prevalence of multiple types was significantly higher in HIV-positive than HIV-negative women (p = 0.034). The frequently detected genotypes were HPV35 (23.9%), HPV58 (23.9%), HPV45 (19.6%), and HPV16 (17.3%) in CIN2 cases, while in CIN3, HPV35 (22.5%), HPV16 (21.8%), HPV33 (15.6%), and HPV58 (14.3%) were the most common identified HPV types, independent of HIV status. The prevalence of HPV types targeted by the nonavalent HPV vaccine was 60.9% and 68.7% among women with CIN2 and CIN3, respectively, indicating that vaccination would have an impact both in HIV-negative and HIV-positive South African women, although it will not provide full protection in preventing HPV infection and cervical cancer lesions.     

The outcomes and outpatient costs of different models of antiretroviral treatment delivery in South Africa

Objective  Estimate the average outpatient cost per patient in care and responding to treatment 1 year after initiation of antiretroviral therapy (ART) under different models of treatment delivery in South Africa.
Methods  At each site, medical records for a sample patients of were reviewed 1 year after ART initiation. Each subject was assigned to one outcome category: in care and responding (IC); in care but not responding (NR); or no longer in care at study site (NIC). Average cost per outcomes category was estimated based on resource utilisation.
Results  Site 1 was an urban public hospital; Site 2 a programme that contracts private general practitioners; Site 3 a rural non-governmental (NGO) AIDS clinic; and Site 4 a peri-urban NGO primary care clinic. At month 12, IC, NR and NIC rates were 67%, 7% and 26% (Site 1); 52%, 3%, and 45% (Site 2); 63%, 9% and 28% (Site 3); and 76%, 11%, and 13% (Site 4). The average outpatient cost per patient initiated was $756 (Site 1), $896 (Site 2), $932 (Site 3) and $1,126 (Site 4). When all costs and all outcomes were taken into account, the average cost to produce an IC patient was $1,128 (Site 1), $1,723 (Site 2), $1,480 (Site 3), and $1,482 (Site 4).
Conclusion  If all ART patients remain in care and responding, total costs will increase but the average cost to produce an IC patient will fall. The cost per ART patient treated varies moderately among sites. Cost differences increase markedly when patient outcomes are taken into account.     

Self-reported motivators for HIV testing in the treat-all era among HIV positive patients in Johannesburg,South Africa

To explore associations between self-reported ill-health as a primary motivator for HIV-testing and socio-demographic factors.Four local primary healthcare clinics in Johannesburg, South Africa.A total of 529 newly HIV diagnosed adults (≥18 years) enrolled from October 2017 to August 2018, participated in the survey on the same day of diagnosis.Testing out of own initiative or perceived HIV exposure was categorized as asymptomatic. Reporting ill-health as the main reason for testing was categorized as symptomatic. Modified Poisson regression was used to evaluate predictors of motivators for HIV testing.Overall, 327/520 (62.9%) participants reported symptoms as the main motivator for testing. Among the asymptomatic, 17.1% reported potential HIV exposure as a reason for testing, while 20.0% just wanted to know their HIV status. Baseline predictors of symptom-related motivators for HIV testing include disclosing intention to test (aPR 1.4 for family/friend/others vs partners/spouse, 95% CI: 1.1–1.8; aPR 1.4 for not disclosing vs partners/spouse, 95% CI: 1.1–1.7), and HIV testing history (aPR 1.2 for last HIV test >12-months ago vs last test 12-months prior, 95% CI: 1.0–1.5; aPR 1.3 for never tested for HIV before vs last test 12-months prior, 95%CI:1.0–1.6).Findings indicate that newly diagnosed HIV positive patients still enter care because of ill-health, not prevention purposes. Increasing early HIV testing remains essential to maximize the benefits of expanded ART access.     

Timing and dynamics of Late Pleistocene mammal extinctions in southwestern Australia

Explaining the Late Pleistocene demise of many of the world's larger terrestrial vertebrates is arguably the most enduring and debated topic in Quaternary science. Australia lost >90% of its larger species by around 40 thousand years (ka) ago, but the relative importance of human impacts and increased aridity remains unclear. Resolving the debate has been hampered by a lack of sites spanning the last glacial cycle. Here we report on an exceptional faunal succession from Tight Entrance Cave, southwestern Australia, which shows persistence of a diverse mammal community for at least 100 ka leading up to the earliest regional evidence of humans at 49 ka. Within 10 millennia, all larger mammals except the gray kangaroo and thylacine are lost from the regional record. Stable-isotope, charcoal, and small-mammal records reveal evidence of environmental change from 70 ka, but the extinctions occurred well in advance of the most extreme climatic phase. We conclude that the arrival of humans was probably decisive in the southwestern Australian extinctions, but that changes in climate and fire activity may have played facilitating roles. One-factor explanations for the Pleistocene extinctions in Australia are likely oversimplistic.     

The Effect of Age on the Association Between Blood Pressure and Cognitive Function Later in Life

OBJECTIVES: To determine the prospective relationship between blood pressure (BP) and cognitive function across a wide age range.
DESIGN: Prospective population-based cohort study.
SETTING: The Rotterdam Study and the Leiden 85-plus Study.
PARTICIPANTS: Three thousand seventy-eight men and women, initial age 55 to 84 from the Rotterdam Study and 276 men and women, initial age 85, from the Leiden 85-plus Study.
MEASUREMENTS: Systolic BP (SBP) and diastolic BP (DBP) were measured at baseline, cognitive function was assessed at the end of follow-up using a dedicated neuropsychological test battery. The association between baseline BP levels and cognitive function later in life was assessed in 10-year age groups in the Rotterdam Study and in 85-year-olds of the Leiden 85-plus Study.
RESULTS: In the youngest participants (<65), SBP and DBP were not associated with cognitive function 11 years later. For persons aged 65 to 74, higher baseline SBP and DBP were related to worse cognitive function 11 years later. In contrast, in older age (≥75), higher SBP and DBP seemed to be related to better cognitive function at the end of follow-up. This effect appeared strongest in the highest age group (aged 85).
CONCLUSION: High BP was associated with greater risk of cognitive impairment in persons younger than 75 but with better cognitive function in older persons. Age-specific guidelines for BP management are needed, because the current directive that "lower is better" may not apply to BP levels in the very old.     

Prevalence of Knowledge and Use of the Female Condom in South Africa

Male condoms remain a key tool in preventing the spread of HIV and the female condom (FC) holds similar potential. Using data collected through a national cross-sectional population survey that was conducted in 2008, this report investigated the national prevalence of FC knowledge and use by sexually active males and females (n = 7,727) over the age of 15 years in South Africa, followed by a closer examination of the sexually active female population alone. Though knowledge of the FC among sexually active females over the age of 15 years (n = 4,551) was relatively high at 77.75 %, use was low at 7.16 %. The present study found statistically significant associations between knowledge or use of the FC and several demographic variables for females in South Africa. Having heard of the FC was consistently associated with locality, province, age, education level, marital status, and employment status. Use of the FC, however, was only associated with province and age group. Many demographic groups exhibited a high prevalence of knowledge but a low level of use; or conversely, a low prevalence of knowledge but a high level of use compared to their counterparts. Our findings support the need for a rigorous campaign to promote the use of FCs by women and also to increase their availability in public health sector facilities such as government clinics and hospitals in order to improve the chance of women using the FC, a cost-effective device that has the potential to protect both their rights and lives.     

Whoonga and the Abuse and Diversion of Antiretrovirals in Soweto,South Africa

Media reports have described recreational use of HIV antiretroviral medication in South Africa, but little has been written about this phenomenon in the scientific literature. We present original, qualitative data from eight semi-structured interviews that characterize recreational antiretroviral use in Soweto, South Africa. Participants reported that antiretrovirals, likely efavirenz, are crushed, mixed with illicit drugs (in a mixture known as whoonga), and smoked. They described medications being stolen from patients and expressed concern that antiretroviral abuse jeopardized the safety of both patients and users. Further studies are needed to understand the prevalence, patterns, and consequences of antiretroviral abuse and diversion.     

Motivational interviewing retention counseling and adherence to early infant diagnostic HIV testing schedule in South Africa: The PAEDLINK randomized trial

Introduction:We report the PAEDLINK randomized trial results on the effect of motivational interviewing (MI) retention counseling on the adherence of postpartum women to the early infant diagnostic human immunodeficiency virus (HIV) testing schedule.Methods:HIV positive women and their babies were enrolled 3 to 6 days after delivery at 4 midwife obstetric units in the Gauteng province of South Africa and randomized into (A) MI retention counseling and telephonic tracing, (B) biannual telephonic tracing, and (C) standard care. Mother–baby pairs were followed up for 18 months via medical records. The uptake of child HIV tests and maternal retention in the 0 to 6 and 7 to 18 month periods were modeled using Log-binomial regression.Results:Overall, 501/711 enrolled mother–baby pairs received a second HIV polymerase chain reaction test by 6 months (70.0%, 70.5%, and 70.0% in groups A, B, and C, respectively). A higher proportion of intervention children (60.9%) were tested at 7 to 90 days than group B (48.1%, adjusted risk ratio [aRR] 0.8 for B vs A, 95% confidence interval [CI]: 0.7–0.9) and group C children (52.7%, aRR 0.9 for C vs A, 95% CI: 0.9–1.0). Child testing between 7 and 18-months was also higher in group A than C (10.7% A, vs 5.5% C, RR 2.0, 95% CI: 1.0–3.7). However, maternal retention was similar across groups, with 41.6% and 16.3% retained during the 0 to 6 and the 7 to 18-months periods, respectively.Conclusion:MI retention counseling can reduce delays in the early infant diagnosis testing schedule for HIV-exposed infants. However, further support is necessary to maximize later HIV tests and maternal retention.     

Human respiratory syncytial virus diversity and epidemiology among patients hospitalized with severe respiratory illness in South Africa, 2012–2015

BackgroundWe aimed to describe the prevalence of human respiratory syncytial virus (HRSV) and evaluate associations between HRSV subgroups and/or genotypes and epidemiologic characteristics and clinical outcomes in patients hospitalized with severe respiratory illness (SRI).MethodsBetween January 2012 and December 2015, we enrolled patients of all ages admitted to two South African hospitals with SRI in prospective hospital‐based syndromic surveillance. We collected respiratory specimens and clinical and epidemiological data. Unconditional random effect multivariable logistic regression was used to assess factors associated with HRSV infection.ResultsHRSV was detected in 11.2% (772/6908) of enrolled patients of which 47.0% (363/772) were under the age of 6 months. There were no differences in clinical outcomes of HRSV subgroup A‐infected patients compared with HRSV subgroup B‐infected patients but among patients aged <5 years, children with HRSV subgroup A were more likely be coinfected with Streptococcus pneumoniae (23/208, 11.0% vs. 2/90, 2.0%; adjusted odds ratio 5.7). No significant associations of HRSV A genotypes NA1 and ON1 with specific clinical outcomes were observed.ConclusionsWhile HRSV subgroup and genotype dominance shifted between seasons, we showed similar genotype diversity as noted worldwide. We found no association between clinical outcomes and HRSV subgroups or genotypes.     

Positive parenting for positive parents: HIV/AIDS,poverty, caregiver depression,child behavior,and parenting in South Africa

Families affected by HIV/AIDS in the developing world experience higher risks of psychosocial problems than nonaffected families. Positive parenting behavior may buffer against the negative impact of child AIDS-orphanhood and caregiver AIDS-sickness on child well-being. Although there is substantial literature regarding the predictors of parenting behavior in Western populations, there is insufficient evidence on HIV/AIDS as a risk factor for poor parenting in low- and middle-income countries. This paper examines the relationship between HIV/AIDS and positive parenting by comparing HIV/AIDS-affected and nonaffected caregiver-child dyads (n=2477) from a cross-sectional survey in KwaZulu-Natal, South Africa (27.7% AIDS-ill caregivers; 7.4% child AIDS-orphanhood). Multiple mediation analyses tested an ecological model with poverty, caregiver depression, perceived social support, and child behavior problems as potential mediators of the association of HIV/AIDS with positive parenting. Results indicate that familial HIV/AIDS's association to reduced positive parenting was consistent with mediation by poverty, caregiver depression, and child behavior problems. Parenting interventions that situate positive parenting within a wider ecological framework by improving child behavior problems and caregiver depression may buffer against risks for poor child mental and physical health outcomes in families affected by HIV/AIDS and poverty.     

Women's health,HIV/AIDS and the workplace in South Africa

This work explores the connections between gender inequality, HIV/AIDS and women's health in the world of work in South Africa. These connections are located within a context of significant reversals in development, specifically declining life expectancy and premature mortality for South Africans — particularly for women. By relying on the existing literature and interviews with 33 key informants, the paper examines the extent to which South African workplaces are recognising women's social and biological vulnerability to HIV. In particular, the paper considers the potential role of the workplace in responding to growing evidence that links gender and health by establishing targeted HIV/AIDS interventions. The findings suggest that the vast majority of company representatives do not recognise women's social and biological vulnerability and related social norms vis-à-vis HIV and AIDS. Importantly, most workplaces are not initiating programmes that specifically address women's or men's health. The author briefly identifies factors that may help explain the current state of knowledge and practice in the realm of HIV and women's health in the workplace, and puts forward suggestions for future research.