An overview of some of the key legal developments in HIV/AIDS and the law — 2003

South Africa has a strong legal framework that offers a high level of protection to people living with HIV/AIDS. Although the Constitution does not explicitly refer to HIV/AIDS, it does prohibit unfair discrimination on the grounds of disability. International jurisprudence has developed a broad definition of ‘disability\', which goes beyond so-called functional disability and has successfully accommodated HIV-related discrimination cases in Australia, Canada and the USA. It is likely that South African courts will ultimately do the same. Employment legislation does refer specifically to HIV-related discrimination and prohibits unfair discrimination on the grounds of HIV status in the workplace. Pre-employment and employment HIV testing is prohibited, unless the permission of the Labour Court is obtained before to testing takes place. There are other laws, dealing with the provision of medical aid services, access to education and health care, that also prevent HIV-related discrimination. Despite this, however, people with HIV/AIDS continue to suffer high levels of discrimination and prejudice. The disclosure of HIV status remains a fearful experience for many South Africans and may well be accompanied by violence and economic and social deprivation. This article examines some of the most important cases that have come before the courts and other tribunals in 2003 and have sought to establish the rights of people with HIV/AIDS to live lives of dignity without fear. Southern African Journal of HIV Medicine Vol. 5 (1) 2004: 40-4

Ukrainian Culture Under Attack: Erasure of Ukrainian Culture in Russia's War Against Ukraine

In the first days of the Russian invasion of Ukraine, a missile struck the Ivankiv local history museum, setting it on fire. It was the only building in the village to be struck. The Mariupol Drama Theatre was sheltering hundreds of civilians, including children, when Russian aircraft dropped two bombs on it in March 2022. Amid that rubble and death is a stark casualty: Ukrainian culture, identity, and heritage.PEN America and PEN Ukraine's new report gathers evidence of intentional and indiscriminate attacks on Ukraine's cultural infrastructure, in cities and rural areas. The report is damning, undeniable evidence of a concerted campaign of erasure. Hundreds of cultural buildings, monuments, and places of worship have been destroyed. Museums looted. Language suppressed. Books destroyed. Poets, writers, journalists, and translators detained, tortured, and killed. Preserved cultural heritage sites uprooted.The report makes clear that culture is not collateral damage in the war against Ukraine: it's a target, a central pillar of Russian President Vladimir Putin's justification for the war. Putin has repeatedly claimed that Ukrainian culture and language simply don't exist. By targeting art museums, music halls, libraries, theaters, and historical sites, he attempts to make it s

Access of abandoned children and orphans with HIV/AIDS to antiretroviral therapy - a legal impasse

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HIV-related nephropathy: A South African perspective

Human immunodeficiency virus (HIV)-associated nephropathy (HIVAN) is an important cause of renal failure in those of African origin. A number of other kidney diseases occur in HIV-positive patients. We conducted a retrospective review of renal biopsies in HIV-positive Black African patients to determine the prevalence of both ‘classic HIVAN’ and non-HIVAN pathologies in this group. Clinical and laboratory data from HIV-positive patients who underwent renal biopsy from 1st January 2003 to 31st December 2004 were collected. Similar information on HIV-negative patients biopsied during the same period was also recorded by way of comparison to try and assess the influence of the virus on renal histologic patterns. HIV-positive group – 99 biopsies were suitable for study. The main histologic categories were ‘classic HIVAN’ (27%) and HIV immune complex kidney disease (‘HIVICK’) (21%). The subepithelial immune deposits in ‘HIVICK’ induced a newly described ‘ball-in-cup’ basement membrane reaction. Other glomerulonephritides included membranous, post-infectious disease, mesangial hyperplasia, and immunoglobulin A nephropathy. Overlapping clinical presentations prevented pre-biopsy histologic predictions. HIV-negative group – There were no examples of collapsing focal segmental glomerulosclerosis or nonspecific immune complex disease, but increased numbers of minimal change and membranoproliferative disease. ‘Classic HIVAN’ accounted for less than a third of the nephropathies occurring in HIV-positive Black South Africans. ‘HIVICK’ is another important cause of chronic kidney disease in this group. Future research is needed into the earlier detection and treatment of these diseases, which have a high mortality in our context

Management of patients with chronic kidney disease

Co-operation between primary healthcare workers (clinic staff and general practitioners) and nephrologists is essential and the ability to refer patients timeously should be on a pre-negotiated and organised basis. This article deals with these aspects, including follow-up guidelines and management and treatment strategies, including lifestyle changes where indicated and referral for end-stage renal failure, i.e. for dialysis and transplantation

Developing and implementing programmes for early detection, management and prevention of kidney and cardiovascular disease

Chronic Kidney Disease (CKD) and Cardiovascular Disease (CVD) appear to be closely linked but also share common risk factors, making prevention, early detection and management for both diseases similar. In 1998 CVD accounted for 30% of deaths worldwide and in South Africa for almost 40% in the same year. The number of these deaths due to underlying CKD remains unanswered, but it is clear that early detection and management of CKD through screening of patients at high risk, e.g. those with uncontrolled hypertension, diabetes and proteinuria or proteinuria alone, is an appropriate way to control this massive chronic disease burden. Added to this equation is the impact of HIV and/or proteinuria as a cause of CKD and CVD. Against a backdrop of poor control and management of chronic illnesses, there is a growing number of clinicians attempting to tackle this problem through the development of CVD and CKD prevention and early detection programmes. Recognising the common risk factors makes it easier to plan and implement such programmes.This article looks at an “Integrated Model” for managing chronic illnesses, which has been adopted internationally and locally. It discusses the experiences and challenges faced in attempting to implement programmes for CVD and CKD

Strategies for the early detec tion and management of chronic kidney disease– tertiary and primary health care working together

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Management of patients with chronic kidney disease

Co-operation between primary healthcare workers (clinic staff and general practitioners) and nephrologists is essential and the abilityto refer patients timeously should be on a pre-negotiated and organised basis. This article deals with these aspects, including follow-upguidelines and management and treatment strategies, including lifestyle changes where indicated and referral for end-stage renal failure,i.e. for dialysis and transplantation

Renal impairment in a rural African antiretroviral programme

Background: There is little knowledge regarding the prevalence and nature of renal impairment in African populations initiating antiretroviral treatment, nor evidence to inform the most cost effective methods of screening for renal impairment. With the increasing availability of the potentially nephrotixic drug, tenofovir, such information is important for the planning of antiretroviral programmes Methods: (i) Retrospective review of the prevalence and risk factors for impaired renal function in 2189 individuals initiating antiretroviral treatment in a rural African setting between 2004 and 2007 (ii) A prospective study of 149 consecutive patients initiating antiretrovirals to assess the utility of urine analysis for the detection of impaired renal function. Severe renal and moderately impaired renal function were defined as an estimated GFR of ≤ 30 mls/min/1.73 m2 and 30–60 mls/min/1.73 m2 respectively. Logistic regression was used to determine odds ratio (OR) of significantly impaired renal function (combining severe and moderate impairment). Co-variates for analysis were age, sex and CD4 count at initiation. Results: (i) There was a low prevalence of severe renal impairment (29/2189, 1.3% 95% C.I. 0.8–1.8) whereas moderate renal impairment was more frequent (287/2189, 13.1% 95% C.I. 11.6–14.5) with many patients having advanced immunosuppression at treatment initiation (median CD4 120 cells/μl). In multivariable logistic regression age over 40 (aOR 4.65, 95% C.I. 3.54–6.1), male gender (aOR 1.89, 95% C.I. 1.39–2.56) and CD4<100 cells/ul (aOR 1.4, 95% C.I. 1.07–1.82) were associated with risk of significant renal impairment (ii) In 149 consecutive patients, urine analysis had poor sensitivity and specificity for detecting impaired renal function. Conclusion: In this rural African setting, significant renal impairment is uncommon in patients initiating antiretrovirals. Urine analysis alone may be inadequate for identification of those with impaired renal function where resources for biochemistry are limited

The African Women's Protocol: Bringing Attention to Reproductive Rights and the MDGs

Andrew Gibbs and colleagues discuss the African Women's Protocol, a framework for ensuring reproductive rights are supported throughout the continent and for supporting interventions to improve women's reproductive health, including the MDGs