Displaced margins and misplaced equity: Challenges for South African higher education

This paper makes a single point: that the goal of institutional diversity falls short of the goal of equity in higher education. Put differently, while the margins for diversity have increasingly been displaced and dislocated, equity appears to be misplaced. I contend that through significantly increased access, the South African education system has made remarkable progress in achieving racial, ethnic and gender diversity in their student populations. Despite these achievements in diversity, however, equity, measured through the graduation rates of historically disadvantaged students, trails behind diversity achievements. At the risk of taking a parochial posture, my goal is use the challenges of the mature (American) and relatively immature higher systems (South African) to point to ‘lessons’ that may be locally valuable. I draw on selected quantitative data that illustrates the trends in diversity and equity. I use the challenges with respect to diversity and equity in the United States system as a foil against which to read the South African quantitative trends. In so doing I show that time and maturity, demonstrated through the highly reputed American system, may not fix issues of equity and that conscious and that the South African system requires active interventions to address these challenges. 

Short-term treatment outcomes of children starting antiretroviral therapy in the intensive care unit, general medical wards and outpatient HIV clinics at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa: A retrospective cohort study

Background: Many HIV-infected children are initiated on antiretroviral therapy (ART) during hospitalisation in South Africa (SA). No published data on these outcomes exist.Objectives: To assess the short-term outcomes of children initiated on ART in the intensive care unit (ICU), general medical wards (GMWs) and outpatient HIV clinics (OHCs) at Red Cross War Memorial Children’s Hospital (RCWMCH), Cape Town, SA.Methods: We conducted a retrospective cohort study of HIV-infected children aged <13 years commenced on first-line ART between January 2008 and December 2011. Outcomes included death, virological suppression and changes in CD4 count. Kaplan-Meier estimates, multivariate Cox proportional hazard ratios and logistic regression were used to estimate outcomes at 6 months.Results: One hundred and six children were commenced on ART in the ICU, 509 in the GMWs and 127 in the OHCs; 65.7% of all children were <12 months old. Of children qualifying for rapid ART initiation according to the 2013 national treatment guidelines, 182 (24.9%) started therapy within 7 days of diagnosis. Overall mortality was 6.4% (95% confidence interval (CI) 4.9 - 8.4). Of children remaining in care at RCWMCH, 51.0% achieved a CD4 percentage ≥25% and 62.3% a viral load ≤50 copies/mL 6 months after ART initiation. Mortality was higher in the ICU cohort (13.2%) than in the GMW and OHC cohorts (5.5% and 3.9%, respectively, log-rank p=0.004). Predictors of mortality included moderate underweight (adjusted hazard ratio (aHR) 2.4; 95% CI 1.1 - 5.2), severe underweight (aHR 3.2; 95% CI 1.6 - 6.5), absence of caregiver counselling sessions (aHR 2.9; 95% CI 1.4 - 6.0) and ART initiation in the ICU (aHR 2.6; 95% CI 1.4 - 4.9).Conclusion: These results highlight the importance of understanding the context in which children are initiated on ART, when comparing outcomes in different settings

Characteristics and early outcomes of children and adolescents treated with darunavir/ritonavir-, raltegravir- or etravirine-containing antiretroviral therapy in the Western Cape Province of South Africa

Background. There is an increasing need for third-line treatment regimens in HIV-infected children with antiretroviral treatment (ART) failure. Data are limited on darunavir/ritonavir (DRV/r)-, raltegravir (RAL)- and etravirine (ETR)-containing regimens in treatment-experienced children from resource-constrained settings receiving these drugs as part of routine care.Objective. To describe the characteristics and early outcomes of treatment-experienced children (<20 years of age) in the Western Cape Province of South Africa treated with DRV/r-, RAL- or ETR-containing regimens.Methods. This was a retrospective review of treatment-experienced children receiving a DRV/r-, RAL- or ETR-containing regimen as recommended by a paediatric expert review committee, based on HIV drug resistance testing.Results. Thirty-five children of median age 8.8 years (interquartile range (IQR) 5.5 - 11) who had received ART for a median of 6.9 years (IQR 5 - 9.9) and started a DRV/r-, RAL- or ETR-containing regimen were included. Before starting such a regimen, the median CD4+ lymphocyte count and HIV-1 RNA level were 405.5 cells/μL (IQR 251.5 - 541) and 28 314 copies/mL (IQR 5 595.5 – 120 186.5) (log 4.5 (IQR 3.7 - 5)), respectively, in 24 subjects with available results. After a median of 2 years (IQR 1.3 - 4) on treatment, 29/30 (96.7%) and 23/30 (76.7%) subjects with available results had HIV-1 RNA levels of <400 and <50 copies/mL, respectively.Conclusions. This study found DRV/r-, RAL- and ETR-containing regimens to be effective in a group of treatment-experienced children and adolescents with multidrug-resistant HIV. Although the treatment regimens in this study were individualised based on HIV genotyping results, further research evaluating the safety and efficacy of standardised third-line treatment regimens in children of all ages is needed

The rule in Hollington v Hewthorn in the light of section 17 Of The Civil Proceedings Evidence Act 25 of 1965 in South Africa

Magister Legum - LLMSouth Africa, among others, has adopted, and is bound by, the so-called 'rule in Hollington‘ that originated in England in 1943 in Hollington v Hewthorn (hereinafter the 'Hollington case‘). The issue, among others, that the English Appeal Court had to determine in this case was whether a judgement of a criminal court could be used in subsequent civil proceedings to prove the liability of either of the litigants. The Court reached the conclusion that a judgement of a criminal court is just an irrelevant and inadmissible opinion in later civil proceedings. The court adopted the view that had a criminal conviction been admissible evidence in civil proceedings, it would lead to a situation where the defendant would end up challenging the propriety of those convictions. In the light of that, the courts would be faced with a duty to retry the criminal case in the midst of the civil proceedings. Section 17 of the Civil Proceedings Evidence Act (CPEA) provides that a conviction or an acquittal can be proved by the production of a document dully certified by the relevant court that acquitted or convicted the person in question. Furthermore, section 18 of the Supreme Court Act (SuCA) now section 34 of the Superior Courts Act (SupCA) provides that whenever a judgement, among other things, of a court needs to be proved or referred to in any manner a duly certified copy thereof will serve as prima facie evidence thereof. These sections militate against the rule in Hollington in that they allow, or at least should be interpreted in a manner that accords with the allowance of, the admissibility of conviction evidence in later civil law suits

Teaching in the time of COVID-19: Shared perspectives from South Africa and the USA

In line with keeping people safe, social distancing has become a civilised norm across the world. Compulsory lockdowns have meant that universities closed their doors to students and staff, thus causing widespread disruption across the higher-education landscape. Pharmacy education is no exception. As pharmacy educators from institutions in different countries, with an existing partnership, we have identified common challenges between our different educational environments and have benefited from sharing possible solutions

Cave pecuniam: Lawyers as launderers

In South Africa there is something almost sacrosanct about an attorney's trust account. It is the prescribed destination of all funds paid in trust by a client to an attorney. Clients tend to have complete confidence in the fact that their money is entrusted thus. Its very designation as trust money encourages such confidence. The trust account is also the account in respect of which the Attorneys Fidelity Fund requires an annual audit to determine if an attorney is awarded the Fidelity Fund Certificate which he requires to practise. All in all, the trust account is the barometer of the good standing of a law practice, and the index of its trustworthiness. Hence the aura of venerability which surrounds it.International Bibliography of Social Science

Treatment of Young Children with HIV Infection: Using Evidence to Inform Policymakers

PMCID: PMC3404108This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited