Medical, legal and financial aspects of rape in South Africa

Rape is an emotive topic, about which has been generated much heat but little light. Some cynics (usually male) believe that there is no such thing as rape. At the other extreme are those (usually female) who believe that every woman who alleges rape has been raped, and that many more rapes go unreported. The truth obviously lies somewhere in between. This paper examines the practical and financial difficulties involved in the medico-legal management of complainants and of their accused.     

The participation of minors in preventive HIV research trials in South Africa: legal and human rights considerations

The constitutional prohibition of experimentation/research without the individual subject's (own) consent is investigated. A distinction is drawn between therapeutic and non-therapeutic research. A minor of 14 is competent to consent independently to medical treatment (which would include therapeutic research), but not to non-therapeutic research. A minor must be at least 18 years to be able to do so. Proxy consent can be secured for the participation of minors under 18 in non-therapeutic research only if they assent, if their participation in the research is indispensable and the research carries no more than negligible risk. Since the risks inherent in HIV preventive vaccine trials may carry more than negligible risk, these trials may not be carried out on children under 18. The limitation of rights and the consideration of foreign and international law in the interpretation of the South African Bill of Rights are investigated.     

The registration and control of medicines in South Africa: legal issues.

In the provision of health care medicines occupy a central position, both at primary and more advanced levels. Sound medicines have the capability to control and prevent common diseases, and to alleviate suffering. People's confidence in the health services that are provided by the state and by the private sector (as the case may be) is influenced by their knowledge that the medicines that they receive are of good quality and proven efficacy and safety, and that they are continuously available at reasonable cost. A sound national policy for the provision of safe and cost-effective medicines needs to be based on several elements. The most important are: A sound pharmaceutical industry that is able to function in an atmosphere of confidence, with the knowledge that its efforts in support of the public health are understood and respected; and a drug regulatory authority that is trusted for its expertise, independence and integrity. This is as true for a country such as South Africa as it is for a fully industrialised country such as the United States. The regulation and control of medicines in South Africa falls under the aegis of the Medicines Control Council, a statutory body established in accordance with the Medicines and Related Substances Act. In terms of the Act, the council has the mandate to ensure that the medicines available to the South African public are safe, effective, and of high quality, and that their availability is in the public interest. In considering this, the council may take into account only the scientific data available.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mining disasters in South Africa: the Rovic Diamond Mine disaster and the criminal liability of the mine authorities

The South African economy depends heavily on the mining industry. Deep level mining--which is a very common occurrence in the South African Mining Industry, is fraught with dangers. It is therefore inevitable that these dangers will be a constant source of medico-legal involvement. At the end of November 1996, a mining disaster occurred at the Rovic Diamond Mine between Boshof and Dealsville. At about 1000 metres underground, a mudslide occurred and trapped 20 miners. Rescue workers could only retrieve four bodies. Due to the dangers of additional mudslides and collapse of the entire slope, the rescue workers were withdrawn. The 16 miners were later declared dead by a Court Order after a full investigation into the disaster was completed. In this discussion focus will be placed on the Rovic Mine Disaster Investigation, the post mortem examination of the four victims, the legal declaration of death of the other victims not found and the legal accountability of the mine authority.     

HIV/AIDS, peacekeeping and conflict crises in Africa

This article investigates the impact of the spread of HIV/AIDS on the African military and its ability to act as an effective instrument of conflict resolution in the continent. The capacity of African militaries is particularly important at a time when major powers are reluctant to engage in greater peacekeeping operations in the region. The widespread prevalence of HIV among military personnel threatens political and social stability more generally, and this study focuses on the link between peacekeeping and the disease. It considers how HIV-positive soldiers act as a vector in communities where they are deployed, and how soldiers deployed in locations with a high prevalence rate of HIV/AIDS may spread the disease in their home communities upon return. Possible recommendations on how to tackle HIV/AIDS prevention efforts with the aid of peacekeepers are offered.     

HIV/AIDS post-exposure prophylaxis (PEP) for victims of sexual assault in South Africa

An earlier study (Meel, 2003) showed that more than 90% of victims of sexual assault in Transkei region, South Africa, were HIV-seronegative at the time of the incident. This was despite the fact that the community had a high prevalence of HIV. In sexual assault cases post-exposure prophylaxis (PEP) is recommended to prevent HIV transmission. Therefore, therapy with zidovudine (AZT) and lamivudine (3TC) is justified. The purpose of this study is to describe the demographic characteristics of the victims, to assess the outcome of HIV transmission and to evaluate the success of PEP after its implementation in Transkei. There were 594 victims of sexual assault during the study period at Sinawe Centre from 2000-2003. Of these, 346 (58.2%) were children under the age of 15 years. Seventeen children (2.9%) were found to be HIV positive at the first test. Among the adults, 58(9.8%) tested HIV positive. Of the 225 who attended after PEP was introduced, only two were found to be HIV seropositive at the time of the incident. A second test was recommended after four weeks and a third after 12 weeks. The majority of the victims did not report for the second test, but all 35 who did come to be tested were seronegative. who did come to be tested were seronegative. Seventeen of those were between 11-15 years of age. Only seven victims came for the third test, and they, too, were negative. Nausea and vomiting were the commonest side effects of PEP treatment in four patients and one developed a generalized rash. Only one victim seroconverted.     

西宁地区库存血HCV RNA、HIV RNA核酸扩增技术(NAT)的检测与分析

目的:调查库存血感染HCV、HIV的危险度,正确评估西宁地区目前酶免抗体筛检方法的血液安全性.方法:使用ProcleixTM TMAHIV-1/HCV检测方法对10 086份库存血进行检测.结果:发现3份NAT检测HCV RNA和EIISA检测抗-HCV均阳性的标本,未发现NAT检测阳性,但EIA检测抗-HCV、抗-HIV阴性的标本.未发现血清抗体转换窗口期标本.结论:西宁地区目前HCV、HIV的感染危险度小于1:10 000,说明本地区目前血液检测质量是可信的,临床使用血液是相对安全的.     

西宁地区库存血HCV RNA、HIV RNA核酸扩增技术(NAT)的检测与分析

目的：调查库存血感染HCV、HIV的危险度，正确评估西宁地区目前酶免抗体筛检方法的血液安全性。方法：使用Procleix^TM TMAHIV-1/HCV检测方法对10086份库存血进行检测。结果：发现3份NAT检测HCV RNA和EIISA检测抗-HCV均阳性的标本，未发现NAT检测阳性．但EIA检测抗-HCV、抗-HIV阴性的标本。未发现血清抗体转换窗口期标本。结论：西宁地区目前HCV、HIV的感染危险度小于1:10000，说明本地区目前血液检测质量是可信的，临床使用血液是相对安全的。     

Economics of health in South Africa: past, present and future

Some of the background to the present structure of medicine in South Africa, an outline of some economic aspects of our current (inadequate) health care service and tentative suggestions regarding the directions in which our health services should be moving to facilitate the legitimization (political) and accumulation (economic) processes required to meet the needs and demands of all the people of an internationally recognized, just and free South Africa are presented.     

Radioactivity standardization in South Africa.

South Africa's national radioactivity measurement standard is maintained at a satellite laboratory in Cape Town by the National Metrology Laboratory (NML) of the Council for Scientific and Industrial Research. Standardizations are undertaken by a number of direct methods utilizing liquid scintillation counting (LSC). The successful application of LSC to the 4pi beta-gamma coincidence method is reviewed. The activity unit is maintained through radionuclide specific calibration factors relating to a pressurized re-entrant well type ionization chamber. A comparison is made between normalized factors given by the manufacturer and deduced factors obtained by a method used to transfer calibration factors from the International Reference System of the International Bureau of Weights and Measures based on the NML's own absolute standardizations.     

Criminal abortion and concealment of birth in Transkei region, South Africa

The objective was to estimate the incidence of criminal abortions and concealment of births in Transkei. This paper presents a review of the records of the medico-legal register at Umtata General Hospital from 1993-2003. There were 37 cases of premature concealed births and conceptus material brought to the attention of medico-legal investigators between 1993 and 2003. Of these, 26 (70.3%) were concealed births, and 11 (29.7%) were abortion products. There is great variability in the incidence of abortion and concealment of births during this period. There were nine cases in 1993 and three in 2003. No case was reported in 1994. There was only a single case reported in each of the years 1995, 1997 and 2001, and four cases in each of the years 1996, 1998 and 2002. In 1998 there were eight cases, the highest for any year after promulgation of the Abortion Act. There is no significant difference in the number of cases reported for medico-legal investigation of criminal abortion and concealment of births before and after the Abortion Act which came into effect in 1997.     

Doctors can kill--active euthanasia in South Africa

Medical practitioners in South Africa will be given the legal right to end the lives of terminally ill patients. This is the practice of active euthanasia, the procedure whereby a medical doctor or a professional nurse can end the life of a terminally ill patient at the patient's request, by providing or administering a lethal dosage of a drug. Voluntary active euthanasia is included in a Draft Bill--The End of Life Decisions Act--which form part of a report of the South African Law Commission, wherein regulations regarding the end-of-life decisions are formulated. Specifically, it provides that a medical practitioner may under certain conditions stop the treatment of a patient whose life functions are being maintained artificially. Further, that a competent person may refuse life-sustaining treatment if he chooses to die. A medical practitioner may also give effect to a patient's living will in which the patient has requested the cessation of treatment. The Act also provides for the options of active voluntary euthanasia or physician-assisted suicide.     

Paget's disease of bone in South Africa

A survey of Paget's disease of bone in Johannesburg South Africa, has revealed a prevalence of 2.4% in whites aged 55 years and over, which is similar to some centres in Europe; it has also revealed an unexpectedly high prevalence of 1.3% among blacks. These findings are discussed in relation to recent concepts of the pathogenesis of Paget's disease.