Awareness, perceived risk and practices related to cervical cancer and Pap smear screening: A crosssectional study among HIV-positive women attending an urban HIV clinic in Johannesburg, South Africa

Background. Cervical cancer is a major cause of cancer-related deaths, especially in the context of the HIV epidemic.Objective. To examine awareness, perceived risk and practices related to cervical cancer screening among HIV-positive women.Methods. Interviewer-administered structured questionnaires were administered to HIV-positive women (aged ≥18 years) enrolled in a cervical cancer screening study at the Themba Lethu Clinic, Johannesburg, South Africa, from November 2009 to December 2011. Modified Poisson regression with robust standard errors was used to identify factors at enrolment associated with awareness, perceived risk and adequate practice related to cervical screening. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) are presented.Results. Of the 1 202 women enrolled, 71.3% and 18.2% were aware of the Pap smear and HPV, respectively. Of the 1 192 participants with data evaluated, 76.5% were worried and 23.5% were not worried about cervical cancer; 28.6% of the women had adequate screening practice. Older age (40 - 49 years or ≥50 years v. 18 - 29 years) (aRR 1.63, 95% CI 1.12 - 2.37; aRR 2.22, 95% CI 1.44 - 3.41), higher education (tertiary v. less than grade 10) (aRR 1.39, 95% CI 1.00 - 1.93), initiation on combination antiretroviral therapy (aRR 1.36, 95% CI 1.00 - 1.85) and awareness of Pap smear screening (aRR 16.18, 95% CI 7.69 - 34.01) were associated with adequate screening practice.Conclusions. High levels of Pap smear awareness and low levels of Pap smear screening uptake were observed. However, Pap smear awareness was associated with adequate screening practice. More research into effective health education programmes to address these gaps is needed

South Africans’ understanding of and response to the COVID-19 outbreak: An online survey

Background. The COVID-19 outbreak is in an accelerating phase, and South Africa (SA) has had the highest number of documented cases during the early phase of the pandemic in sub-Saharan Africa.Objectives. To assess South Africans’ understanding of and response to COVID-19 during the first week of the country’s lockdown period.Methods. An online survey was conducted in SA from 27 March to 2 April 2020. The survey was distributed widely among several websites and social media networks, including on a data-free platform. Descriptive statistics of knowledge, risk perception, access to and trust in information sources, and public and media opinions were calculated. Estimates were benchmarked to the 2019 national adult population estimates.Results. Of the 55 823 participants, the majority (83.4%) correctly identified the main symptoms of COVID-19. Over 90% had correct knowledge of the incubation period, with lower rates for 18 - 29-year-olds. Knowledge of symptoms and the incubation period varied significantly by population group (p<0.001), dwelling type (p<0.001) and sex (p<0.001). A quarter (24.9%) perceived themselves as at high risk of contracting COVID-19. Risk perception varied by age, population group, employment status and dwelling type (p<0.001). The most prevalent COVID-19 information sources were government sources (72.9%), news websites/apps (56.3%), satellite television (51.6%) and local television (51.4%).Conclusions. Understanding knowledge, attitudes and behaviours of people facing the COVID-19 pandemic is crucial for guiding strategic policy. These findings provide public understanding of COVID-19 as the phases of the country-level epidemic progress, and also directly inform communication needs and gaps

Influence of Climate on Conflicts and Migrations in Southern Africa in the 19th and Early 20th Centuries

Climate and other environmental factors continue to play important contributions on the livelihoods of communities all over the world. Their influence during historical periods and the roles they played remain under-reported. The main objective of this review is to investigate the climatological conditions during the time of the invasion of early European settlers in Southern Africa in the 19th and early 20th centuries. It establishes the possible relationships between climate variability and historical conflicts and wars, famines, disease pandemics, and the migration of African people to towns in search of sustainable and predictable livelihoods away from unreliable agriculture. A qualitative analysis of published peer reviewed literature in the form of reports, papers, and books was used in this review. At least 60 literature items were reviewed in this paper. There is a relationship between climate variability and the historical events of the 19th and early 20th centuries. Tribal conflicts and most of the wars between the settlers and the African people for land coincided with periods of droughts. Drought were key causes of famines, instabilities, and land degradation in the region. This study highlights the influence of environmental conditions on socio-economic conditions as the world enters an era of climate change and urbanization in developing countries, particularly in Africa. It shows that the hardships caused by environmental conditions have the potential to destabilize societies

Influence of Climate on Conflicts and Migrations in Southern Africa in the 19th and Early 20th Centuries

Climate and other environmental factors continue to play important contributions on the livelihoods of communities all over the world. Their influence during historical periods and the roles they played remain under-reported. The main objective of this review is to investigate the climatological conditions during the time of the invasion of early European settlers in Southern Africa in the 19th and early 20th centuries. It establishes the possible relationships between climate variability and historical conflicts and wars, famines, disease pandemics, and the migration of African people to towns in search of sustainable and predictable livelihoods away from unreliable agriculture. A qualitative analysis of published peer reviewed literature in the form of reports, papers, and books was used in this review. At least 60 literature items were reviewed in this paper. There is a relationship between climate variability and the historical events of the 19th and early 20th centuries. Tribal conflicts and most of the wars between the settlers and the African people for land coincided with periods of droughts. Drought were key causes of famines, instabilities, and land degradation in the region. This study highlights the influence of environmental conditions on socio-economic conditions as the world enters an era of climate change and urbanization in developing countries, particularly in Africa. It shows that the hardships caused by environmental conditions have the potential to destabilize societies

Awareness, perceived risk and practices related to cervical cancer and Pap smear screening: A cross-sectional study among HIV-positive women attending an urban HIV clinic in Johannesburg, South Africa

Background. Cervical cancer is a major cause of cancer-related deaths, especially in the context of the HIV epidemic.Objective. To examine awareness, perceived risk and practices related to cervical cancer screening among HIV-positive women.Methods. Interviewer-administered structured questionnaires were administered to HIV-positive women (aged ≥18 years) enrolled in a cervical cancer screening study at the Themba Lethu Clinic, Johannesburg, South Africa, from November 2009 to December 2011. Modified Poisson regression with robust standard errors was used to identify factors at enrolment associated with awareness, perceived risk and adequate practice related to cervical screening. Adjusted relative risks (aRRs) with 95% confidence intervals (CIs) are presented.Results. Of the 1 202 women enrolled, 71.3% and 18.2% were aware of the Pap smear and HPV, respectively. Of the 1 192 participants with data evaluated, 76.5% were worried and 23.5% were not worried about cervical cancer; 28.6% of the women had adequate screening practice. Older age (40 - 49 years or ≥50 years v. 18 - 29 years) (aRR 1.63, 95% CI 1.12 - 2.37; aRR 2.22, 95% CI 1.44 - 3.41), higher education (tertiary v. less than grade 10) (aRR 1.39, 95% CI 1.00 - 1.93), initiation on combination antiretroviral therapy (aRR 1.36, 95% CI 1.00 - 1.85) and awareness of Pap smear screening (aRR 16.18, 95% CI 7.69 - 34.01) were associated with adequate screening practice.Conclusions. High levels of Pap smear awareness and low levels of Pap smear screening uptake were observed. However, Pap smear awareness was associated with adequate screening practice. More research into effective health education programmes to address these gaps is needed

Dolutegravir in real life: self-reported mental and physical health outcomes after transitioning from efavirenz- to dolutegravir-based antiretroviral therapy in a prospective cohort study in Lesotho

INTRODUCTION: HIV programmes across many countries in Africa have recently transitioned people living with HIV from efavirenz (EFV)- to dolutegravir (DTG)-containing antiretroviral therapy (ART). As both drugs are associated with neuropsychiatric adverse effects, this study assessed the mental health and HIV/ART-associated symptoms of people living with HIV before and after transition to DTG. METHODS: The prospective DO-REAL cohort enrolled people starting DTG-based ART in Lesotho from February to December 2020. For this analysis within DO-REAL, we included adults changing from tenofovir disoproxil fumarate (TDF)/lamivudine (3TC)/EFV to TDF/3TC/DTG within first-line therapy. At transition and 16 weeks thereafter, participants completed the Patient Health Questionnaire-9 (PHQ-9; depression screening), the 12-item Short-Form Health Survey (SF-12; mental and physical health), and a modified HIV Symptom Index (mHSI; HIV/ART-related symptoms). We also assessed weight change. We used McNemar tests with Bonferroni corrections to assess binary outcomes. CLINICALTRIALS: gov: NCT04238767. RESULTS: Among 1228 participants, 1131 completed follow-up. Of these, 60.0% were female, the median age was 46 years (interquartile range [IQR] 38-55), and the median time taking ART was 5.7 years (IQR 3.5-8.9). No change was observed for weight or overall PHQ-9 or SF-12 outcomes. However, three mHSI items decreased at follow-up: 'feeling sad/down/depressed' (bothered 6.0% vs. 3.3% of participants at least 'a little' before vs. after transition; adjusted p = 0.048); 'feeling nervous/anxious' (7.4% vs. 3.4%; adjusted p = 0.0009); and 'nightmares, strange/vivid dreams' (6.3% vs. 3.5%; adjusted p = 0.027). Individual PHQ-9 or SF-12 items also improved. Being symptom free across all measures increased from 5.1% to 11.4% (p < 0.0001). CONCLUSIONS: We observed no negative impacts and potential moderate improvements with DTG, providing further support for the rollout of DTG