Risk factors for Coronavirus disease 2019 (Covid-19) death in a population cohort study from the Western Cape province, South Africa

Risk factors for coronavirus disease 2019 (COVID-19) death in sub-Saharan Africa and the effects of human immunodeficiency virus (HIV) and tuberculosis on COVID-19 outcomes are unknown. We conducted a population cohort study using linked data from adults attending public-sector health facilities in the Western Cape, South Africa. We used Cox proportional hazards models, adjusted for age, sex, location, and comorbidities, to examine the associations between HIV, tuberculosis, and COVID-19 death from 1 March to 9 June 2020 among (1) public-sector “active patients” (≥1 visit in the 3 years before March 2020); (2) laboratory-diagnosed COVID-19 cases; and (3) hospitalized COVID-19 cases. We calculated the standardized mortality ratio (SMR) for COVID-19, comparing adults living with and without HIV using modeled population estimates.Among 3 460 932 patients (16% living with HIV), 22 308 were diagnosed with COVID-19, of whom 625 died. COVID19 death was associated with male sex, increasing age, diabetes, hypertension, and chronic kidney disease. HIV was associated with COVID-19 mortality (adjusted hazard ratio [aHR], 2.14; 95% confidence interval [CI], 1.70–2.70), with similar risks across strata of viral loads and immunosuppression. Current and previous diagnoses of tuberculosis were associated with COVID-19 death (aHR, 2.70 [95% CI, 1.81–4.04] and 1.51 [95% CI, 1.18–1.93], respectively). The SMR for COVID-19 death associated with HIV was 2.39 (95% CI, 1.96–2.86); population attributable fraction 8.5% (95% CI, 6.1–11.1)

Reimagining wellbeing: Using arts-based methods to address sexual, gender and health inequalities

The Creative Change Laboratory (CCoLAB) was conceived as an immersive learning space in which young people from the Western Cape province of South Africa could develop unconventional solutions to problems in their communities. Unlike most art-activism projects, CCoLAB harnessed a wide range of expressive forms (visual art, interactive drama, narrative writing and photography/videography) to identify, analyse and respond to social justice challenges. In many ways, CCoLAB was an experiment, asking what could be achieved if an art-activism project was held over a long period and was not constrained by a focus on just one theme/topic. Over eight months, CCoLAB’s twenty collaborators were exposed to different ways of thinking and doing activism, culminating in the development of original creative prototypes. Many of the final artworks spoke to the nuances of sexuality, gender and health, exploring topics such as sexual- and gender-based violence, the everyday challenges facing queer and trans youth, and physical, mental and emotional wellbeing. Drawing on artworks produced during the project, facilitator/collaborator reflections, and audio and visual recordings made during the process, this paper investigates the benefits and challenges of long-term, well-resourced art-activism interventions