Guest Editorial

Adolescent healt

Guest Editorial: Colliding epidemics of communicable and non-communicable diseases during adolescence in South Africa

No Abstract

HIV treatment in South Africa: overcoming impediments to get started.

No abstract available

AIDS research must link to local policy

HIV research in South Africa is world class. To halt the country's epidemic, scientists need to shift focus from global problems to priorities at home

Adolescent health

The period of adolescence is associated withcomplex psychological, physical and cognitivechanges as children transition to adulthood. In morerecent times this transition has taken on addedcomplexities, particularly in developing countriesundergoing social and political changes, in an era of increasingglobalisation and access to information through new technologies

Colliding epidemics of communicable and non-communicable diseases during adolescence in South Africa

Over the past 50 years, the improvement of health outcomes ininfants and young children has received more attention than that inadolescents, primarily because adolescence is not typically associatedwith ill health. However, this picture is rapidly changing, with thepresent generation of adolescents already encountering diversechallenges, with different biosocial and neurocognitive responsescompared with their parents and grandparents. These transitions areinfluenced by geographical, cultural, economic and genetic contexts.This issue of CME includes the final two articles on the topic ofadolescent health

Antiretroviral prophylaxis: a defining moment in HIV control

A defining moment in the global AIDS response has been reached. The discourse is no longer about HIV prevention or HIV treatment; it is now about HIV control through the implementation of antiretrovirals as key components of combination interventions. Barely a year ago, visions of HIV control would have been considered far-fetched. The impetus for this change in mindset, which has been building since the XVIII International AIDS Conference in Vienna last year, emanates from the compelling evidence that antiretroviral drugs prevent HIV infection in the general heterosexual population, which is released this week and presented at the 6th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Rome by the Partners PrEP and Botswana TDF2 trials

Contraceptive Choices, Pregnancy Rates, and Outcomes in a Microbicide Trial

OBJECTIVE: Women who become pregnant during the conduct of biomedical human immunodeficiency virus prevention trials are taken off the study product for safety reasons. High pregnancy rates can compromise statistical integrity in these trials. The comprehensive contraceptive curriculum developed for the Centre for the AIDS Programme of Research in South Africa (CAPRISA) 004 trial was evaluated for its ability to enhance contraceptive uptake, reduce pregnancy rates, and preserve statistical integrity. METHODS: Contraceptive- and pregnancy-related eligibility criteria were specified in the protocol. We enrolled women who opted for a nonbarrier method of contraceptive and provided hormonal contraceptives onsite at no cost. At each monthly study visit, we provided pregnancy prevention counseling and performed pregnancy testing. Study product was withheld on pregnancy diagnosis, but women continued with monthly follow-up. RESULTS: Contraceptive use was high throughout the study with 100% uptake at baseline and 94.71% use after a mean of 18 months follow-up at exit. Injectable progestins, particularly medroxyprogesterone acetate, remained the preferred choice of contraceptive. After 30 months of follow-up, 54 pregnancies were reported out of 889 participants, giving a pregnancy incidence rate of 3.95 per 100 woman-years (95% confidence interval 2.96-5.17). Of all pregnancies, two thirds (64.81%) resulted in a full-term live birth, whereas 18.52% and 11.11% pregnancies culminated as miscarriage and terminated pregnancies, respectively. There were no congenital anomalies in the early neonatal period. Pregnancies resulted in 1.56% of woman-years of study follow-up lost as a result of temporary product withdrawal. CONCLUSION: The CAPRISA 004 contraceptive curriculum was an effective strategy for maintaining low pregnancy rates, thereby minimizing product withdrawal and loss of follow-up time

HIV epidemic types and customized prevention responses.

Since the first reported case of AIDS 27 years ago, more than 70 million people have been infected with HIV worldwide, and 25 million have died of AIDS. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 33 million people are currently living with HIV. The global prevalence of HIV has leveled off, but the total number of people living with HIV continues to grow.1 This article briefly discusses the roles that different HIV transmission modes play in the worldwide pandemic, and explains how the global pandemic is actually a complex mosaic of dynamic epidemics within and between countries.2 Further, it discusses matching appropriate prevention responses to two different types of epidemics: generalized and concentrated