Echoes of Lysenko: state-sponsored pseudo-science in South Africa

A major factor hampering the rollout of highly active antiretroviral treatment (HAART) for HIV/AIDS in the public health sector is state support of pseudo-science. This paper examines state-sponsored pseudo-science in South Africa with a particular focus on the case of Matthias Rath and his claim that HAART is an ineffective and harmful form of treatment and that multivitamins should instead be used as a substitute to treat and cure AIDS.? The paper examines similarities and differences between state support in South Africa for AIDS-denialists such as Rath and state support in the former Soviet Union for Lysenko, a pseudo-scientist who lacked scientific training. In both cases, state support for pseudo-science has had policy implications, and resulted in many deaths

Providing antiretroviral treatment for all who need it in South Africa

In August 2003, the South African government announced its support for the provision of highly active antiretroviral therapy (HAART) in the public sector. This was a major break-through (antiretrovirals are now explicitly recognised as beneficial) but the Cabinet statement was very cautiously worded about actual implementation. The Ministry of Health has been instructed to develop a 'detailed operational plan' but it is increasingly clear that one of the major constraints on the scale and pace of the roll-out will be the amount of resources allocated to it. Given the discourse of 'unaffordability' which has dogged South African AIDS policy making over the past five years (Nattrass, 2004 forthcoming) it is likely that South Africa will opt for a limited intervention on the grounds that resources are best spent elsewhere

Pattern recognition and the nondeterminable affine parameter problem

Bibliography: leaves 112-121.This thesis reports on the process of implementing pattern recognition systems using classification models such as artificial neural networks (ANNs) and algorithms whose theoretical foundations come from statistics. The issues involved in implementing several classification models and pre-processing operators - that are applied to patterns before classification takes place - are discussed and a methodology that is commonly used in developing pattern recognition systems is described. In addition, a number of pattern recognition systems for two image recognition problems that occur in the field of image matching have been developed. These image recognition problems and the issues involved in solving them are described in detail. Numerous experiments were carried out to test the accuracy and speed of the systems developed to solve these problems. These experiments and their results are also discussed

The cost of HIV prevention and treatment interventions in South Africa

This paper estimates the costs of introducing several AIDS-related prevention and treatment programmes in South Africa.1 Our approach combines detailed information about the costs of implementing these interventions with demographic projections of their impact. Information about prices, wages and other cost components is drawn from a range of primary and secondary sources. Johnson and Dorrington’s (2002) modelling of the demographic impact of four AIDS-related health interventions is a central input into our costing exercise. We begin the paper with an overview of the key characteristics and results of their ASSA2000 ‘Interventions Model’.2 The paper then discusses the cost components of each of these interventions. We draw attention to the additional costs not considered in our primary analysis, and to the effect of antiretroviral medicine prices on the total cost of providing highly active antiretroviral therapy (HAART) to those who need it. HAART is expensive, but the net costs to government are significantly lower than the direct costs of providing HAART. This is because people on HAART experience fewer opportunistic infections (OIs) – thereby saving the government the costs of treating those OIs. We estimate these ‘hospital costs averted’, provide a brief discussion of the savings associated with fewer orphans, and then conclude with a calculation of the cost of prevention and treatment programmes as a percentage of GNP

The cost of HIV prevention and treatment interventions in South Africa

This paper estimates the costs of introducing several AIDS-related prevention and treatment programmes in South Africa.1 Our approach combines detailed information about the costs of implementing these interventions with demographic projections of their impact. Information about prices, wages and other cost components is drawn from a range of primary and secondary sources. Johnson and Dorrington’s (2002) modelling of the demographic impact of four AIDS-related health interventions is a central input into our costing exercise. We begin the paper with an overview of the key characteristics and results of their ASSA2000 ‘Interventions Model’.2 The paper then discusses the cost components of each of these interventions. We draw attention to the additional costs not considered in our primary analysis, and to the effect of antiretroviral medicine prices on the total cost of providing highly active antiretroviral therapy (HAART) to those who need it. HAART is expensive, but the net costs to government are significantly lower than the direct costs of providing HAART. This is because people on HAART experience fewer opportunistic infections (OIs) – thereby saving the government the costs of treating those OIs. We estimate these ‘hospital costs averted’, provide a brief discussion of the savings associated with fewer orphans, and then conclude with a calculation of the cost of prevention and treatment programmes as a percentage of GNP

Algorithms for efficiently and effectively matching agents in microsimulations of sexually transmitted infections

Mathematical models of the HIV epidemic have been used to estimate incidence, prevalence and life-expectancy, as well the benets and costs of public health interventions, such as the provision of antiretroviral treatment. Models of sexually transmitted infection epidemics attempt to account for varying levels of risk across a population based on diverse | or heterogeneous | sexual behaviour. Microsimulations are a type of model that can account for fine-grained heterogeneous sexual behaviour. This requires pairing individuals, or agents, into sexual partnerships whose distribution matches that of the population being studied, to the extent this is known. But pair-matching is computationally expensive. There is a need for computer algorithms that pair-match quickly. In this work we describe the role of modelling in responses to the South African HIV epidemic. We also chronicle a three-decade debate, greatly influenced since 2008 by a mathematical model, on the optimal time for people with HIV to start antiretroviral treatment. We then present and analyse several pair-matching algorithms, and compare them in a microsimulation of a fictitious STI. We find that there are algorithms, such as Cluster Shuffle Pair-Matching, that offer a good compromise between speed and approximating the distribution of sexual relationships of the study-population. An interesting further finding is that infection incidence decreases as population increases, all other things being equal. Whether this is an artefact of our methodology or a natural world phenomenon is unclear and a topic for further research

The deadly hand of denial: Governance and politically-instigated AIDS denialism in South Africa

The 26 May 2005 issue of Drum magazine, a widely-read South African monthly, featured a comparison of two deeply contrasting approaches to treating HIV. The strap-line was 'They both look the picture of health.? And they're both living with HIV/AIDS.? Yet Judge Edwin Cameron and Nozipho Bhengu each do it their way'. Bhengu, daughter of African National Congress (ANC) grandee, Ruth Bhengu (a close associate in exile of former President Thabo Mbeki), was, so the article claimed, controlling her infection and CD4 count with a nutritional concoction. 'Like [the former] health minister Manto Tshabala-Msimang', the article recorded, 'Nozipho believes there is a direct link between nutrition and AIDS'. An interview with one of the writers, Edwin Cameron, was posted alongside. Cameron explained how he was treating his HIV infection using scientifically proven antiretroviral (ARV) treatment. The article epitomised the fraught debate on HIV in South Africa at the time

The medical proof doesn't get much better than VMMC

This forum debate article is in response to the editorial by Professor Ncayiyana concerning the national circumcision programme in South Africa (S Afr Med J 2011;101:775-777). Other articles in this debate: Kessinger and Millard. S Afr Med J 2012;102(3):123-124. Ncayiyana. S Afr Med J 2012;102(3):125-126

Civil society leadership in the struggle for AIDS treatment in South Africa and Uganda

Includes abstract.Includes bibliographical references.This thesis is an attempt to theorise and operationalise empirically the notion of ‘civil society leadership’ in Sub-Saharan Africa. ‘AIDS leadership,’ which is associated with the intergovernmental institutions charged with coordinating the global response to HIV/AIDS, is both under-theorised and highly context-specific. In this study I therefore opt for an inclusive framework that draws on a range of approaches, including the literature on ‘leadership’, institutions, social movements and the ‘network’ perspective on civil society mobilisation. This framework is employed in rich and detailed empirical descriptions (‘thick description’) of civil society mobilisation around AIDS, including contentious AIDS activism, in the key case studies of South Africa and Uganda. South Africa and Uganda are widely considered key examples of poor and good leadership (from national political leaders) respectively, while the Treatment Action Campaign (TAC) and The AIDS Support Organisation (TASO) are both seen as highly effective civil society movements. These descriptions emphasise ‘transnational networks of influence’ in which civil society leaders participated (and at times actively constructed) in order to mobilise both symbolic and material resources aimed at exerting influence at the transnational, national and local levels