NeuroAIDS in Africa

In July 2009, the Center for Mental Health Research on AIDS at the National Institute of Mental Health organized and supported the meeting “NeuroAIDS in Africa.” This meeting was held in Cape Town, South Africa, and was affiliated with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Presentations began with an overview of the epidemiology of HIV in sub-Saharan Africa, the molecular epidemiology of HIV, HIV-associated neurocognitive disorders (HANDs), and HAND treatment. These introductory talks were followed by presentations on HAND research and clinical care in Botswana, Cameroon, Ethiopia, The Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, and Zambia. Topics discussed included best practices for assessing neurocognitive disorders, patterns of central nervous system (CNS) involvement in the region, subtype-associated risk for HAND, pediatric HIV assessments and neurodevelopment, HIV-associated CNS opportunistic infections and immune reconstitution syndrome, the evolving changes in treatment implementation, and various opportunities and strategies for NeuroAIDS research and capacity building in the region.     

Patterns of neuroAIDS in Africa

According to UNAIDS, the African population accounts for greater than half of persons infected with HIV. Nevertheless, little information exists characterizing HIV in this population. Thus, the natural history and progression of HIV in the African population is virtually undocumented and therefore, poorly understood. Information regarding virtually every aspect of the disease including microbiology, pathogenicity, virulence, and clinical manifestation is based largely on data from select and limited populations. During the HAART-era, we have seen dramatic and significant changes in patterns of NeuroAIDS in patients in clinical cohorts from the United States and Western Europe. These observations have led to increased understanding of the progression of NeuroAIDS and have improved our ability to design treatment regimens to combat CNS complications resulting from HIV. Despite the existence of antiretroviral therapy for HIV, its absence in Africa along with poor treatments for opportunistic infections associated with HIV have become the main sources of neurological morbidity and mortality. In this context, we are presented with a unique opportunity to cultivate and enhance our understanding of the natural history and progression of NeuroAIDS in the African population thereby, better equipping healthcare providers, patients and their families in addressing this epidemic. This concept is particularly important as rapidly improving and more accessible anti-HIV medications and medications for the treatment of opportunistic infections become available to third world countries such as Africa. We believe that it is imperative to foster research, education and training between institutions in the industrialized world and Africa to close the gap in understanding patterns of NeuroAIDS in Africa.     

Suicide in South Africa

Nationally registered suicide mortality data for South Africa (1984–1986) were analysed. There were 5448 deaths (1.3%) due to suicide in this period. Proportional mortality and mean annual suicide mortality rates were highest for whites, followed by Asians and then coloureds. The proportional mortality for blacks was similar to that of coloureds. Suicide was relatively prominent as a cause of death for Asian females (15–24 years). For whites, the most commonly used method of suicide was firearms. Except for coloured females, hanging was the most common method used for the other population groups. Political, economic, and religious factors may account for some of the differences. Cultural factors may explain the findings for young Asian females. There is a need for strict gun control legislation.     

Epilepsy in South Africa

Since its first democratic elections in 1994, South Africa has undertaken a massive social reconstruction program that has included major healthcare reform. The state healthcare system aims to provide a unitary service, based on a primary healthcare approach, to the 85% of the population who depend on it. Although the burden of epilepsy is largely unknown, it is likely to be large, with a study of children in a large rural community, for example, demonstrating an active prevalence of 6.7/1000. Common causes of epilepsy are likely to include infectious diseases, such as neurocysticercosis and HIV/AIDS, trauma and alcohol consumption. Limited evidence suggests the existence of a large treatment gap in some areas. The management and treatment of epilepsy are also greatly influenced by cultural attitudes and beliefs, which vary widely. South Africa thus provides a microcosm of issues affecting the management of epilepsy worldwide.     

Beggary in West Africa

Westerners visiting Africa for the first time are often surprized --if not shocked--at the large number of beggars in the streets and the relative ease with which people solicit or give help although pure adherents of Islam are in favour of restricting beggary . A first reason for this is that most West African societies are deeply Islamized and that begging is a characteristic feature of Islamic societies. But a closer look at the traditional structures shows that the ancestral principle of mutual solidarity is also at the basis of most people's attitude. However, the increasing number of beggars and forms of begging have turned the phenomenon into a national concern. Senegalese novelists and film-makers, even Senegalese members of the Parliament often engage in debates about that national plague and what to do about it. This paper analyzes the various motives for begging and giving alms and discusses youth's attitude towards the issue. Its tentative conclusion is that despite the overall acceptance of the phenomenon for religious reasons--a position of principle--there are clear indications of an increasingly critical attitude towards begging .     

History of psychiatry in West Africa

This paper explores the social context of the development of mental asylums in colonial Nigeria. The characteristics of the medical leadership is described, as is the environmental condition of the asylums. The colonial period produced conceptualizations of the African mind and of the pattern and distribution of mental illness in Africans. These conceptualizations are critically examined.     

Second assessment of NeuroAIDS in Africa

In July of 2006, the National Institute of Mental Health (NIMH) Center for Mental Health Research on AIDS (CMHRA) sponsored the second conference on the Assessment of NeuroAIDS in Africa, which was held in Arusha, Tanzania. The conference mission was to address the regional variations in epidemiology of HIV-related neurological disorders as well as the assessment and diagnosis of these disorders. Participants discussed and presented data regarding the relevance and translation of neuroAIDS assessment measures developed in resource intensive settings and the challenges of neuro-assessment in Africa, including the applicability of current tools, higher prevalence of confounding diseases, and the complexity of diverse cultural settings. The conference presentations summarized here highlight the need for further research on neuroAIDS in Africa and methods for assessing HIV-related neurological disorders.     

The spread of HIV in Africa

A significant effort has been put into identifying the origin of HIV, tracking its spread, and mapping its distribution. This effort is of particular importance in Africa, where the AIDS epidemic is genetically most diverse, where prevalence reaches its highest levels, and where HIV had its origins in cross-species transmission from non-human primates to man. In this article, we summarize the molecular epidemiology of HIV in Africa, from both a historical and modern perspective. There are marked differences in the local diversity and in the rate of epidemic expansion in different regions of Africa. Understanding the distribution of genetic forms of HIV can be used to tailor vaccine strategies to specific regions and nations. Finally, we review the relationship of HIV lineages to related simian retroviruses and the evolutionary history and the origins of the HIV epidemic.     

Child neurology services in Africa

The first African Child Neurology Association meeting identified key challenges that the continent faces to improve the health of children with neurology disorders. The capacity to diagnose common neurologic conditions and rare disorders is lacking. The burden of neurologic disease on the continent is not known, and this lack of knowledge limits the ability to lobby for better health care provision. Inability to practice in resource-limited settings has led to the migration of skilled professionals away from Africa. Referral systems from primary to tertiary are often unpredictable and chaotic. There is a lack of access to reliable supplies of basic neurology treatments such as antiepileptic drugs. Few countries have nationally accepted guidelines either for the management of epilepsy or status epilepticus. There is a great need to develop better training capacity across Africa in the recognition and management of neurologic conditions in children, from primary health care to the subspecialist level.