A Human Rights Case Study on Access to Pre-exposure Prophylaxis for Female Sex Workers in South Africa

This paper examines the extent to which access to HIV preventive medicines such as pre-exposure prophylaxis (PrEP) are ensured under the International Covenant on Economic, Social and Cultural Rights. There is a lack of human rights-focused research on access to HIV preventive medicines for vulnerable populations such as female sex workers in HIV-endemic countries. To help fill this gap, I utilized a case study approach to critically examine the rollout of PrEP for female sex workers in South Africa, drawing on the country’s Bill of Rights, health care policies, and PrEP implementation. My analysis found that (1) PrEP rollout was largely physically and economically inaccessible for female sex workers outside of urban centers; (2) the dissemination of PrEP information specific to female sex workers was limited both virtually and in clinics, reducing the medicine’s acceptability; and (3) South Africa’s overburdened public health care system and continued criminalization of sex work limited the accessibility and quality of HIV prevention services, contributing to weak uptake of PrEP among female sex workers. To remedy these issues, state leaders should prioritize PrEP counseling and socially acceptable information dissemination; expand comprehensive, coherent, and coordinated sexual health services for female sex workers; increase the financial resources available for programs specific to female sex workers; and decriminalize sex work.     

A matrix technic for comprehensive methods documentation

This article presents an approach to total documentation of clinical laboratory methods that is practical and comprehensive. Primary reference documents including the bench method, all aspects of instrumentation, calibration, quality control, safety, results, and reporting conventions and back-up research data are entered into a matrix by section. This system has proved to be of great utility particularly in meeting regulatory demands and for the use and orientation of staff technologists.     

Activity in the chronically critically ill.

Although therapeutic activity prevents functional decline and reduces mortality, little is known about typical levels of activity among intensive care unit (ICU) patients. This report of a preliminary study describes typical therapeutic activity and compares the use of two measures of activity in a small sample of chronically critically ill adults. Type, frequency, and duration of therapeutic activity were measured simultaneously with direct observation and actigraphy. The only consistent activity documented was turning (frequency: 3 turns/8 hours; duration: mean average of 11 minutes). Analysis demonstrated acceptable agreement between the two measures of activity for both frequency and duration of therapeutic but not for type of activity. Congruence between measures for duration of activity was also supported. This study provides information for investigators and practitioners who are interested in measuring or implementing therapeutic activity in selected critically ill adults.     

Use of "average of normals" quality control procedure in the detection and resolution of assay discrepancies

Improved computer technology and imperatives for cost control have made the use of "average of normals" (AVON) procedure an attractive alternative to the more expensive standard quality control programs for clinical laboratory assay monitoring. The authors report the use of a version of the AVON procedure to resolve assay discrepancies with CO2 determination that the traditional quality control program appeared incapable of detecting. Their study suggests that the mean of patients within the reference interval (RI) is a sensitive indicator of accuracy, whereas the percentage of patients within RI is a good indicator of random imprecision.