Cutaneous manifestations of HIV/AIDS: Part I

Human immunodeficiency virus (HIV) infection can lead to a variety of clinical cutaneous manifestations. These cutaneous disorders occur universally during the course of HIV infection. Cutaneous manifestations of HIV are very diverse. The course and clinical presentation of HIV in individuals who have access to highly active antiretroviral therapy (HAART) is completely different from that in those who do not. Many of the HIV cutaneous presentations seen in South Africa become chronic and progressive. There is a marked reduction in the incidence of opportunistic infections and neoplasms in North America, Western Europe and Australia, where there is access to HAART. Approximately 90% of patients will develop one or more skin diseases during the course of their illness. It is therefore crucial that health professionals become familiar with and are able to recognise the various skin manifestations of HIV Southern African Journal of HIV Medicine Vol. 5 (4) 2004: 12-1

Small, micro and medium enterprises access to credit in the Eastern Cape, South Africa

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, Wits Business School, 2017.The study is aimed at empirically investigating the dynamic interaction between the demand and supply factors affecting SMME access to credit in the Eastern Cape. The study is also aimed at conducting a comparative evaluation of lending criteria used by development finance institutions (DFIs) and commercial banks in evaluating SMME funding applications. The study is geared towards proposing a funding framework aligned to the characteristics of SMMEs which can be used by both DFIs and commercial banks to assess applications for SMME funding. In order to meet the objectives of the study, a sample of 80 SMMEs from the manufacturing, construction, services, agriculture, automotive, mining, security, merchandising and retail sectors was, through proportionate stratified sampling, selected from the population of all the SMMEs from the eight metropolitan and district municipalities (Nelson Mandela, Buffalo City, Joe Gqabi, Chris Hani, OR Tambo, Cacadu, Alfred Nzo and Amathole) constituting the Eastern Cape Province. Three separate structured open and closed-ended questionnaires were used to collect data from the 80 SMMEs owner/managers, 8 DFIs’ regional/branch managers and 5 major commercial banks branch managers in the province. The design of both questionnaires was underpinned by the credit rationing theoretical framework as well as the 5C’s of credit (capacity, collateral, capital, condition and character). A response rate of 100% was achieved. Content analysis and Relative Importance Index (RII) were used to analyse data. The results of the dynamic interaction between the supply and demand factors affecting SMME access to credit show that generally, there is an alignment between the SMME and the funding institutions survey results. This shows that the lending criteria of funding institutions are transparent. On the other hand, it is evident that there is poor awareness of the funding institutions criteria by SMMEs. SMMEs seem not to know what funding institutions are looking for when they evaluate funding applications. The results also pointed out that the characteristics of SMMEs in the study are representative of those of SMMEs countrywide. SMMEs in the study are characterised by poor/no business plans, lack of financial statements, lack of collateral, tax clearance certificates, poor cash flow, lack of owners’ contribution and lack of previous industry experience. The results also indicate that funding institutions’ lending criteria do not take into account the unique characteristics of SMMEs in the Eastern Cape. The results of the comparative evaluation of the lending criteria of DFIs and commercial banks show that there are no substantive differences between how commercial banks and DFIs evaluate the credit applications made by SMMEs. Both groups of lenders place significance on the business plans, financial statements, cash flows, owners’ contribution, collateral and experience of owner/managers. Moreover, the study also found that there is significant discrepancy between what the lending documentation of DFIs and commercial banks indicates as key requirements and what the survey results indicate. This means that what funding institutions practice is not congruent with what is enshrined in their lending criteria/policy. If we proxy lend in practice with what the key informants indicated as critical variables, the results show that both groups are more stringent in practice in key areas of their lending criteria. The review of the characteristics of SMMEs in South Africa showed that they lack collateral, are low on savings and experience. Furthermore, they have little capacity for writing business plans and cash flow management. The results here indicate that these are the very same areas which the financial institutions place significant importance on. The findings indicate that the lending criteria used by both groups tend to favour large and well established firms which have the required capacities. Based on the above findings, it is evident that in order to address the SMME access to credit constraint, a new framework that can be used by DFIs to lend to SMMEs needs to be developed. The framework must take into account the peculiar nature of SMME characteristics. Without such an approach, the funding gap for SMMEs in SA will continue. In response to the above findings, the study proposes that government must incentivise funding institutions to innovatively provide capacity building and training programmes targeted at improving the skills and expertise of their staff. It is proposed that DFIs should simplify their loan application forms to cater for the historically low literacy levels of SMMEs in the Eastern Cape. In addition, DFIs should adopt a more streamlined loan application process as well as a shared due diligence process. Credit application forms as well as key lending documents should be standardised. DFIs should conduct road shows to take their potential SMME customers through their application form, how they must be completed and the documents to accompany the form. SMMEs must be personally involved in the gathering of the relevant business plan information as well as in the writing up of their business plans. DFIs must organise quarterly workshops aimed at taking their potential clients through their lending criteria. The SEFA Credit Guarantee Scheme must be reviewed. Government must provide support to its venture capital industry by creating a good investment climate. The study proposes that a knowledge portal that will enable the sharing of knowledge and learning among SMMEs in the Eastern Cape be established. DFIs must set up SMME divisions or units to provide specialised credit services to their SMME customers. DFIs should evaluate SMME credit applications based on alternative risk evaluation methodologies such as the psychometric screening developed by the Harvard University’s Entrepreneurial Finance Laboratory. DFIs should explore alternative means of financing that do not require collateral. To increase SMME access to credit, government should establish specialised banks that can exclusively cater for the needs of the SMME sector. Government could consider granting certain incentives to funding institutions that actively promote SMME financing and have achieved a sizeable SMME loan book.MT 201

Cutaneous manifestation of HIV/AIDS: Part 2

The insidious damage to the immune system by the human immunodeficiency virus results in increasing susceptibility to opportunistic viral infections. These can be localised, widespread, confined to the skin, or systemic. They can cause mild though disfiguring lesions such as molluscum contagiosum (MCV), or lead to life-threatening infections such as human papillomavirus (HPV-induced squamous cell carcinoma. Southern African Journal of HIV Medicine Vol. 6 (1) 2005: pp. 12-1

Drug reactions and the skin in HIV/AIDS

Drug reactions are common in HIV-positive individuals, approximately 100 times as common as in the general population, and they increase with increasing immunodeficiency.1 Factors associated with drug reactions in HIV disease are polypharmacy to deal with opportunistic infections, the nature of drugs prescribed for AIDS-related illnesses, slow acetylator status, relative glutathione deficiency, CD4 count 25 cells/μl,2 latent cytomegalovirus and Epstein-Barr virus infections3 and high CD8+ cell counts (> 460 cells/μl). The majority of reactions involve the following agents: ■ trimethoprim-sulfamethoxazole ■ other sulfonamide drugs, and ■ various penicillins. These drugs account for 75% of all adverse drug reactions. Trimethoprim-sulfamethoxazole adverse reactions are the commonest, the prevalence increasing from approximately 2 - 8% in the general population to 43% in HIV-positive individuals and to approximately 69% in patients with AIDS.4-6 One reason suggested for the striking incidence of reactions to trimethoprim-sulfamethoxazole is the systemic glutathione deficiency in individuals with HIV/AIDS, which increases the likelihood of accumulation of toxic intermediates such as the hydroxylamine derivatives in the circulation, hence inciting adverse drug reactions.7 Other agents implicated are antituberculosis drugs, antiretrovirals, non-steroidal anti-inflammatory drugs (NSAIDs) and anticonvulsants. Southern African Journal of HIV Medicine Vol. 7 (1) 2006: pp. 18-2

Teledermatology by Videoconference : Experience of a Pilot Project

Background: There is a shortage of medical specialists within the provincial departments of health in South Africa. Telemedicine is a potential way of providing specialist services, at a distance, to rural areas. This study assesses patient and staff satisfaction and issues, technological and operational, associated with the establishment of a videoconference-based teledermatology service. Methods: An ISDN-based videoconference link was established between Port Shepstone Hospital and the Nelson R Mandela School of Medicine in Durban. Patients with a dermatological problem that would have necessitated transfer to the academic hospital for diagnosis and/or management were entered into a prospective study which evaluated the ability to make a diagnosis and prescribe a management plan by videoconference and the patients\' and doctors\' satisfaction with the consultations. Results: A total of 69 patients were seen during 12 videoconferenced consultation sessions. Seventeen patients (24.6%) were subsequently referred to the academic hospital: nine patients were sent because a definitive diagnosis could not be made; and eight patients were transferred for specialist management based on the diagnosis made. The patients\' and referring doctors\' satisfaction with the consultation was 80.3% and 82.1% respectively, while the dermatologist was satisfied 67.6% of the time. The dermatologist was dissatisfied with ten (14.7%) of the consultations and this was related to difficulties in making a definitive diagnosis. The referring doctors found 59 (85.9%) of the consultations to be of educational value. No problems were noted in diagnosing lesions in dark-skinned patients. Conclusion: Videoconferenced teledermatology between district hospitals and regional hospitals is possible and can improve services to rural areas. Further studies on widespread implementation and sustainability are warranted. South African Family Practice Vol. 50 (3) 2008: pp. 70-70

Acneiform lesions in a female performance and image-enhancing drug user: the first African case report

The literature on performance and image-enhancing drug (PIED) use and their harms is dominated by studies of largely North American, European and Australian males. We present the first case of a non-athlete PIED user from Africa. We describe a 27-yearold South African female of African ancestry who presented with a 9-month history of acne involving mainly the trunk and face. After her initial denial, she confessed a 6-month illicit anabolic-androgenic steroid use. She was also using whey protein supplements. Her motive for PIED use was physique enhancement and endurance. Acne is an underestimated adverse effect of PIED use and health providers need to be aware of this. Polypharmacy and stacking may also exacerbate the risks of experiencing acne and other harms. Health providers must be empathic and open-minded with PIED-using patients to facilitate healthcare provision. This pioneering African case report adds to previous publications from other parts of the world.Keywords: Anabolic-androgenic steroids; acne; doping; performance and image-enhancing drugs; South Afric

Innovative mentorship: Implementation of an online mentorship programme for South African medical internship and junior doctors in KwaZulu-Natal, South Africa

No Abstrac

Colourism: a global adolescent health concern

PURPOSE OF REVIEW: Colourism, a form of prejudice and discrimination based solely upon skin colour, stands to jeopardize the physical health, wellbeing and life chances of adolescents of colour, globally. RECENT FINDINGS: Research shows that adolescents can experience colourism at school and college, in the criminal justice system, at work and in the media they consume. It is therefore unsurprising that adolescents of colour often express a desire for lighter skin tones and/or are dissatisfied with their skin tone. Although research is scarce, some studies include older adolescents in their samples of skin-lightening product users. This is significant as the evidence is clear that the unmonitored use of skin-lightening products can be harmful to physical and psychological health, with evidence linking skin-lightening use to skin damage, kidney failure and depression. SUMMARY: Although it is evident that colourism is central to the lives of adolescents of colour, more research is needed concerning the use of skin-lightening products among adolescents. Media literacy and critical race theory offer avenues in helping attenuate the harmful impact of colourism for adolescents of colour

Effects of incarceration of women on the family system: a case of Buffalo City Metropolitan Municipality

Incarceration is a world-wide phenomenon. It is aimed at punishing those who are in conflict with the law while ensuring that they also undergo rehabilitation processes. Whereas one cannot argue that incarceration is inevitable for those in conflict with the law, it is essential to realise that, when a woman is incarcerated, the remaining family unit members are left behind to deal with all the effects of having a family member taken away. It has been observed that there is an increase in the number of incarcerated women. About two-thirds of incarcerated women reported having one or more minor children, and most of them have lived with their children before incarceration compared to 36% of men (Woodard & Copp, 2016). This study aimed to understand the effects of incarceration of women on the family system in Buffalo City Metropolitan Municipality (BCMM). The study discussed the effects of women incarceration on their children, spouses/partners and care-givers. The available support services were also explored and the coping mechanisms adopted by these families during this period of incarceration. The study utilised a case study research design which was explorative in nature. The data was collected using semi-structured interviews with 15 participants who included eight children, one spouse, one partner and five care-givers. Bowen’s family system’s theory (1978) was utilised as an epistemological framework for the study. The study's findings revealed that the incarceration of women has a negative impact on the family members left behind. This increases the chances of school drop-out, alternative care placement and even criminal involvement of children themselves. It was also discovered that financial difficulties, infidelity and lack of proper support systems for these families are a challenge that is directly associated with incarceration. The study recommended that more efforts should be made to provide support through governmental, non-governmental and communitybased interventions to the families of incarcerated women to prevent these unintended effects.Thesis (MSW) -- Faculty of Social Sciences and Humanities, 202

Ethics matter: A critical realist account of research ethics for social science and humanities researchers

Thesis (MEd) -- Faculty of Education, Centre for Higher Education Research, Teaching and Learning, 202