A profile of selected psychiatric out-patients in South Africa

This article reflects the results of three studies done between 1988 and 1991 describing psychiatric outpatients in different towns and cities of South Africa. Two of the samples consist of Black patients and one of Asian patients. In all three studies demographic, socio-economic and illness data were gathered and analysed. A total of 230 patients were surveyed. The typical psychiatric outpatient seems to be in productive period of his life, single, but living with family. He is poorly educated, may never have been employed and is probably now unemployed. The income of this person and the household is very limited, with many people dependent on the few ecomonically active members of the household

Boundary work: becoming middle class in suburban Dar es Salaam

Suburban space provides a useful window onto contemporary class practices in Africa, where it is difficult to identify social classes on the basis of income or occupation. In this article I argue that the middle classes and the suburbs are mutually constitutive in the Tanzanian city of Dar es Salaam. Using interviews with residents and local government officials in the city's northern suburbs, I discuss the material and representational practices of middle-class boundary work in relation to land and landscape. If the middle classes do not presently constitute a coherent political-economic force, they are nevertheless transforming the city's former northern peri-urban zones into desirable suburban residential neighbourhoods

Anti-HIV drugs promote β-amyloid deposition and impair learning and memory in BALB/c mice

Objectives:Growing evidence suggested that antiretroviral drugs (ARV) may promote β-amyloid accumulation in HIV-1-infected brain and the persistence of HIV-associated neurocognitive disorders (HAND). It has also been shown that lipid peroxidation upregulates β-site APP-cleaving enzyme 1 (BACE1) expression and subsequent promote β-amyloid peptide production. In the present study, we examined whether chronic exposure to the anti-HIV drugs tenofovir disoproxil fumarate and nevirapine induces lipid peroxidation thereby promoting BACE1 and β-amyloid generation and consequently impair cognitive function in mice.Methods:Tenofovir disoproxil fumarate or nevirapine were orally administered to female BALB/c mice once a day for 8 weeks. On the 7th week of treatment, spatial learning and memory were assessed using the Morris water maze test. The levels of lipid peroxidation, β-site APP cleaving enzyme 1 (BACE1), β-amyloid 1-42 and β-amyloid (Aβ) deposits were measured in the hippocampal tissue upon completion of treatment.Results:Chronic administration of nevirapine induced spatial learning and memory impairment in the Morris water maze test, whereas tenofovir disoproxil fumarate did not have an effect. Tenofovir disoproxil fumarate and nevirapine administration increased hippocampal lipid peroxidation and β-amyloid 1-42 concentration. Nevirapine further upregulated BACE1 expression and β-amyloid (Aβ) deposits.Conclusion:Our results suggest that chronic exposure to tenofovir disoproxil fumarate and nevirapine contributes to hippocampal lipid peroxidation and β-amyloid accumulation, respectively, as well as spatial learning and memory deficits in mice even in the absence HIV-infection. These findings further support a possible link between antiretroviral drug toxicity, β-amyloid accumulation and the persistence of HIV associated neurocognitive disorders

Acceptability and feasibility of leveraging community‐based HIV counselling and testing platforms for same‐day oral PrEP initiation among adolescent girls and young women in Eastern Cape, South Africa

IntroductionCommunity-based delivery of HIV pre-exposure prophylaxis (PrEP) to South African adolescent girls and young women's (AGYW) could increase access but needs evaluation. We integrated PrEP services via home-based services and pop-up tents into existing community-based HIV testing services (CB-HTS) in Eastern Cape Province, South Africa.MethodsAfter accessing CB-HTS via a "pop-up" tent or home-based services, HIV-negative AGYW aged 16-25 years were invited to complete a baseline questionnaire and referred for PrEP services at a community-based PrEP site co-located with pop-up HTS tents. A 30-day supply of PrEP was dispensed. PrEP uptake, time-to-initiation, cohort characteristics and first medication refill within 90 days were measured using descriptive statistics.ResultsOf the 1164 AGYW who tested for HIV, 825 (74.3%) completed a questionnaire and 806 (97.7%) were referred for community-based PrEP. Of those, 624 (77.4%) presented for PrEP (482/483 [99.8%] from pop-up HTS and 142/323 [44.0%] from home-based HTS), of which 603 (96.6%) initiated PrEP. Of those initiating PrEP following home-based HTS, 59.1% initiated within 0-3 days, 25.6% within 4-14 days and 15.3% took ≥15 days to initiate; 100% of AGYW who used pop-up HTS initiated PrEP the same day. Among AGWY initiating PrEP, 37.5% had a detectable sexually transmitted infection (STI). Although AGYW reported a low self-perception of HIV risk, post-hoc application of HIV risk assessment measures to available data classified most study participants as high risk for HIV acquisition. Cumulatively, 329 (54.6%) AGYW presented for a first medication refill within 90 days of accepting their first bottle of PrEP.ConclusionsLeveraging CB-HTS platforms to provide same-day PrEP initiation and refill services was acceptable to AGYW. A higher proportion of AGYW initiated PrEP when co-located with CB-HTS sites compared to those referred following home-based HTS, suggesting that proximity of CB-HTS and PrEP services facilitates PrEP uptake among AGYW. The high prevalence of STIs among those initiating PrEP necessitates the integration of STI and HIV prevention programs for AGYW. Eligibility for PrEP initiation should not be required among AHYW in high HIV burden communities. Community-based service delivery will be crucial to maintaining access to PrEP services during the COVID-19 pandemic and future health and humanitarian emergencies