Of Remedies and Poisons: Recreational Use of Antiretroviral Drugs in the Social Imagination of South African Carers

During an ethnographic study of barriers to, and compliance with, antiretroviral (ARV) treatment in the South Africa’s West Coast region, our team came across a general sense amongst heath care providers that there was a lively illicit trade in antiretroviral medications. In itself, this is seen to be a barrier to adherence for many of their patients whose medication is traded to, or stolen by, drug dealers. Independent anecdotal evidence is emerging about this trade, though there has been little hard data verifying the existence of a recreational market for ARVs. While there are rumours that Efavirenz (some of whose side effects are hallucinogenic) is being used in the manufacture of crystal methamphetamine (locally ‘tik’), such reports, in themselves, do not seem able to explain the ubiquity (and the confidence) of the belief in this trade amongst the health care providers with whom we have interacted. This paper explores aspects of the off-label trade of ARVs (as we have come to know it) and, as importantly, how rumor and knowledge of this trade has gained increasing currency in the social imagination of health and social care workers. This, we argue, could precipitate a real crisis in the Government’s public rollout programme.Keywords: Social Imagination, South Africa, antiretroviral treatment, Recreational drugs, HIV/AID

Between the Clinic and the Community: Temporality and Patterns of ART Adherence in the Western Cape Province, South Africa

In an ethnographic study conducted over thirty months in South Africa’s Western Cape Province ending in 2012, we explored ART adherence amongst almost 200 patients attending three clinics. This setting contained significant political, structural, economic and socio cultural barriers to the uptake of, and adherence to, treatment. Such barriers certainly impacted patient drug use and the labelling of clients as ‘adherent’ or ‘non-adherent’. Yet, as our fieldwork developed, it became apparent that these labels also bore little relationship to the amount and regularity of drug consumption outside the clinic. Indeed, the people that we knew moved through these labels in ways that could not simply be explained by brute socio-economic circumstances, poor understanding of the functions of the drugs, or varying levels of family and community support, which themselves often changed over time. This paper presents four on-going ‘patterns of adherence’, which are clearly discernible in the communities in which we worked. Each pattern is demonstrated through the life of an ‘index patient’ whose case is seen to be representative of the range of experiences and practices observed under the terms ‘adherent’ and ‘non-adherent’. We argue that such terms are deeply contextual and, crucially, temporally situated. The complex intertwining of political, economic, socio cultural, gender, and biological factors that constitute the lives of participants exists in time and we call for a focus on evolving lives in relationship to changing health systems that can follow (and respond to) such developments to better deliver both information and services.Keywords: ART adherence, community, health systems, socio-cultural barriers drug consumptio

Barriers to Access and Adherence to ARVs

Poster Presentatio

Incorporating pleiotropic quantitative trait loci in dissection of complex traits: seed yield in rapeseed as an example

© The Author(s) 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License http://creativecommons.org/licenses/by/4.0/), which permits use, duplication, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.Most agronomic traits of interest for crop improvement (including seed yield) are highly complex quantitative traits controlled by numerous genetic loci, which brings challenges for comprehensively capturing associated markers/ genes. We propose that multiple trait interactions underlie complex traits such as seed yield, and that considering these component traits and their interactions can dissect individual quantitative trait loci (QTL) effects more effectively and improve yield predictions. Using a segregating rapeseed (Brassica napus) population, we analyzed a large set of trait data generated in 19 independent experiments to investigate correlations between seed yield and other complex traits, and further identified QTL in this population with a SNP-based genetic bin map. A total of 1904 consensus QTL accounting for 22 traits, including 80 QTL directly affecting seed yield, were anchored to the B. napus reference sequence. Through trait association analysis and QTL meta-analysis, we identified a total of 525 indivisible QTL that either directly or indirectly contributed to seed yield, of which 295 QTL were detected across multiple environments. A majority (81.5%) of the 525 QTL were pleiotropic. By considering associations between traits, we identified 25 yield-related QTL previously ignored due to contrasting genetic effects, as well as 31 QTL with minor complementary effects. Implementation of the 525 QTL in genomic prediction models improved seed yield prediction accuracy. Dissecting the genetic and phenotypic interrelationships underlying complex quantitative traits using this method will provide valuable insights for genomics-based crop improvement.Peer reviewedFinal Published versio

Globalization and Health: developing the journal to advance the field

Founded in 2005, Globalization and Health was the first open access global health journal. The journal has since expanded the field, and its influence, with the number of downloaded papers rising 17-fold, to over 4 million. Its ground-breaking papers, leading authors -including a Nobel Prize winner- and an impact factor of 2.25 place it among the top global health journals in the world. To mark the ten years since the journal’s founding, we, members of the current editorial board, undertook a review of the journal’s progress over the last decade. Through the application of an inductive thematic analysis, we systematically identified themes of research published in the journal from 2005 to 2014. We identify key areas the journal has promoted and consider these in the context of an existing framework, identify current gaps in global health research and highlight areas we, as a journal, would like to see strengthened