AIDS spread most rapid in South Africa

Between the end of 1993 and the end of 1994, the prevalence of HIV infection increased 70% (4.3-7.6%) in South Africa, the largest increase of HIV in Africa and perhaps even the world. HIV seroprevalence is highest in Kwa/Zulu (20%). Complacency is more common place in South Africa than in other African countries. In a survey, 75% of Black women in Johannesburg wanted to use condoms, but only 2% used them. People in South Africa have a higher standard of living and are healthier so they may remain healthy longer after HIV infection than those in other African countries. UNAIDS is focusing its attention on sub-Saharan Africa, largely because Africa does not have its own financial resources to fight against AIDS. Physicians in developing countries tend to not know that they can use locally-made drugs to treat opportunistic infections. Some recent beneficial publications on AIDS are the new issue of The AIDS Handbook, the latest booklet in ActionAid's Strategies for Hope series, and the Cote d'Ivoire's Filling the Gaps. The handbook presents information on transmission and symptoms of AIDS and prevention as well as advice on counseling.     

The high burden of injuries in South Africa

OBJECTIVE: To estimate the magnitude and characteristics of the injury burden in South Africa within a global context. METHODS: The Actuarial Society of South Africa demographic and AIDS model (ASSA 2002) - calibrated to survey, census and adjusted vital registration data - was used to calculate the total number of deaths in 2000. Causes of death were determined from the National Injury Mortality Surveillance System profile. Injury death rates and years of life lost (YLL) were estimated using the Global Burden of Disease methodology. National years lived with disability (YLDs) were calculated by applying a ratio between YLLs and YLDs found in a local injury data source, the Cape Metropole Study. Mortality and disability-adjusted life years' (DALYs) rates were compared with African and global estimates. FINDINGS: Interpersonal violence dominated the South African injury profile with age-standardized mortality rates at seven times the global rate. Injuries were the second-leading cause of loss of healthy life, accounting for 14.3% of all DALYs in South Africa in 2000. Road traffic injuries (RTIs) are the leading cause of injury in most regions of the world but South Africa has exceedingly high numbers - double the global rate. CONCLUSION: Injuries are an important public health issue in South Africa. Social and economic determinants of violence, many a legacy of apartheid policies, must be addressed to reduce inequalities in society and build community cohesion. Multisectoral interventions to reduce traffic injuries are also needed. We highlight this heavy burden to stress the need for effective prevention programmes.     

AIDS spread most rapid in South Africa [letter

Between the end of 1993 and the end of 1994, the prevalence of HIV infection increased 70% (4.3-7.6%) in South Africa, the largest increase of HIV in Africa and perhaps even the world. HIV seroprevalence is highest in Kwa/Zulu (20%). Complacency is more common place in South Africa than in other African countries. In a survey, 75% of Black women in Johannesburg wanted to use condoms, but only 2% used them. People in South Africa have a higher standard of living and are healthier so they may remain healthy longer after HIV infection than those in other African countries. UNAIDS is focusing its attention on sub-Saharan Africa, largely because Africa does not have its own financial resources to fight against AIDS. Physicians in developing countries tend to not know that they can use locally-made drugs to treat opportunistic infections. Some recent beneficial publications on AIDS are the new issue of The AIDS Handbook, the latest booklet in ActionAid's Strategies for Hope series, and the Cote d'Ivoire's Filling the Gaps. The handbook presents information on transmission and symptoms of AIDS and prevention as well as advice on counseling.     

Eliminating mother-to-child HIV transmission in South Africa

Problem

The World Health Organization has produced clear guidelines for the prevention of mother-to-child transmission (PMTCT) of the human immunodeficiency virus (HIV). However, ensuring that all PMTCT programme components are implemented to a high quality in all facilities presents challenges.

Approach

Although South Africa initiated its PMTCT programme in 2002, later than most other countries, political support has increased since 2008. Operational research has received more attention and objective data have been used more effectively.

Local setting

In 2010, around 30% of all pregnant women in South Africa were HIV-positive and half of all deaths in children younger than 5 years were associated with the virus.

Relevant changes

Between 2008 and 2011, the estimated proportion of HIV-exposed infants younger than 2 months who underwent routine polymerase chain reaction (PCR) tests to detect early HIV transmission increased from 36.6% to 70.4%. The estimated HIV transmission rate decreased from 9.6% to 2.8%. Population-based surveys in 2010 and 2011 reported transmission rates of 3.5% and 2.7%, respectively.

Lessons learnt

Critical actions for improving programme outcomes included: ensuring rapid implementation of changes in PMTCT policy at the field level through training and guideline dissemination; ensuring good coordination with technical partners, such as international health agencies and international and local nongovernmental organizations; and making use of data and indicators on all aspects of the PMTCT programme. Enabling health-care staff at primary care facilities to initiate antiretroviral therapy and expanding laboratory services for measuring CD4+ T-cell counts and for PCR testing were also helpful.     

The circumstances surrounding the outbreak and spread of equine influenza in South Africa

Equine-2 influenza A virus (H3N8) infection first occurred among na?ve horses in South Africa in December 1986. The virus was introduced following the importation of six horses from the United States of America. While the release of in-contact horses from quarantine three days after the arrival of these six horses played a role in the rapid spread of the disease in South Africa, other outbreaks of disease were associated with viral introduction by personnel or contaminated instruments. The control measures and implications of the introduction of equine influenza to South Africa are also discussed.     

Children's care and living arrangements in a high HIV prevalence area in rural South Africa

Abstract

The objectives of this study were to describe the care and living arrangements of children in rural South Africa, focusing on differences between maternal, paternal and double orphans and non-orphans and to assess the prevalence and characteristics of ‘child-only’ households and ‘child- and elderly-only’ households in this setting. We analysed data from a longitudinal demographic information system using Mantel–Haenszel adjusted odds ratios and logistic regression. The prevalence of orphanhood almost doubled over the period 2000–2005. Maternal and double orphanhood prevalence increased more rapidly than paternal orphanhood, although most orphans are paternal orphans. Responsibility for paternal orphans' school fees and households is taken disproportionately by mothers. There is no evidence that it falls disproportionately to the young or elderly. Responsibility for maternal and double orphans' care is spread between different individuals with different ages, although the elderly have increased odds and fathers have decreased odds compared to non-orphans. Sixteen per cent of double orphans live in sibling-headed households, and most of these heads are over 18 years old. A high proportion of all children are responsible for their own day-to-day care and maternal orphans are more likely than non-orphans to care for themselves (age-adjusted). Seven per cent of maternal and double orphans and 2% of non- and paternal orphans live in ‘child- and elderly-only’ households. Two per cent of maternal and paternal orphans live in ‘child-only’ households, compared to 1% of non-orphans. Most of these children's school fees are the responsibility of non-resident parents. Understanding the reality of care and living arrangements is important to ensure that the needs of all children are met.     

Population and antenatal-based HIV prevalence estimates in a high contracepting female population in rural South Africa

Background  

To present and compare population-based and antenatal-care (ANC) sentinel surveillance HIV prevalence estimates among women in a rural South African population where both provision of ANC services and family planning is prevalent and fertility is declining. With a need, in such settings, to understand how to appropriately adjust ANC sentinel surveillance estimates to represent HIV prevalence in general populations, and with evidence of possible biases inherent to both surveillance systems, we explore differences between the two systems. There is particular emphasis on unrepresentative selection of ANC clinics and unrepresentative testing in the population.     

Exposing misclassified HIV/AIDS deaths in South Africa

Objective

To quantify the deaths from human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) that are misattributed to other causes in South Africa’s death registration data and to adjust for this bias.

Methods

Deaths in the World Health Organization’s mortality database were distributed among 48 mutually exclusive causes. For each cause, age- and sex-specific global death rates were compared with the average rate among people aged 65–69, 70–74 and 75–79 years to generate “relative” global death rates. Relative rates were also computed for South Africa alone. Differences between global and South African relative death rates were used to identify the causes to which deaths from HIV/AIDS were misattributed in South Africa and quantify the HIV/AIDS deaths misattributed to each. These deaths were then reattributed to HIV/AIDS.

Findings

In South Africa, deaths from HIV/AIDS are often misclassified as being caused by 14 other conditions. Whereas in 1996–2006 deaths attributed to HIV/AIDS accounted for 2.0–2.5% of all registered deaths in South Africa, our analysis shows that the true cause-specific mortality fraction rose from 19% (uncertainty range: 7–28%) to 48% (uncertainty range: 38–50%) over that period. More than 90% of HIV/AIDS deaths were found to have been misattributed to other causes during 1996–2006.

Conclusion

Adjusting for cause of death misclassification, a simple procedure that can be carried out in any country, can improve death registration data and provide empirical estimates of HIV/AIDS deaths that may be useful in assessing estimates from demographic models.     

Family systems and HIV/AIDS in South Africa

This study examines the role of family in the care and support of people living with HIV/AIDS (PLWHA) as a way of reducing the burden of stigma in the family. The PEN-3 model provided the cultural framework for this study. Data were drawn from participants' responses in 27 focus groups interviews conducted in South Africa. Participants were asked to discuss experiences of people living with HIV and AIDS in the family. The results highlight the positive and supportive aspects of the family, acknowledge the existential and unique aspects, and discuss the negative experiences shared by participants. This study's findings stress the need to take into account families' experiences with HIV and AIDS in the development of interventions aimed at reducing the burden of the disease on family systems and improving care and support for PLWHA.     

HIV/AIDS in South Africa: an overview

This paper presents an overview of the development of HIV/AIDS in South Africa, taking into consideration the social context and analyzing the factors most likely to have influenced its spread as well as the societal response to it. The authors argue that macro factors such as social and political structures, in addition to behavioral ones, have combined to shape the course of the epidemic. Since various factors linked to social inequalities have combined to shape the pattern and growth of the HIV/AIDS epidemic in South Africa, it is inappropriate to focus on only one dimension in an attempt to combat the epidemic. Following the psycho-socio- environmental model, all potential contributing elements need to be addressed simultaneously. This calls for a true interdisciplinary and multi-sectorial approach. It also requires great commitment as well as strong political will.     

International spread of MDR TB from Tugela Ferry, South Africa

We describe a death associated with multidrug-resistant tuberculosis and HIV infection outside Africa that can be linked to Tugela Ferry (KwaZulu-Natal, South Africa), the town most closely associated with the regional epidemic of drug-resistant tuberculosis. This case underscores the international relevance of this regional epidemic, particularly among health care workers.     

Sexual power and HIV risk, South Africa

Gender power inequities are believed to play a key role in the HIV epidemic through their effects on women's power in sexual relationships. We hypothesized that lack of sexual power, measured with a four-point relationship control scale and by a woman's experience of forced sex with her most recent partner, would decrease the likelihood of consistent condom use and increase the risk for HIV infection among sexually experienced, 15- to 24-year-old women in South Africa. While limited sexual power was not directly associated with HIV, it was associated with inconsistent condom use: women with low relationship control were 2.10 times more likely to use condoms inconsistently (95% confidence interval [CI] 1.17-3.78), and women experiencing forced sex were 5.77 times more likely to use condoms inconsistently (95% CI 1.86-17.91). Inconsistent condom use was, in turn, significantly associated with HIV infection (adjusted odds ratio 1.58, 95% CI 1.10-2.27).