Frantz Fanon and the Dialetic of Decolonisation

It has been more than five decades since the wave of decolonization swept across Africa. For people on the continent, the rise to power by the former liberation movements brought hope for a better future in the post-colonial state. However later developments showed that independence would, in fact, not change the material and social conditions of the ordinary people. Although the national liberation movement took over the government of the former colony, colonial institutions and structures of power, which were founded on the economic exploitation of the colony, remained unchanged. Thus in this thesis I set out to examine Frantz Fanon’s thought in order to provide a critique of post-independence failures in Africa. I will argue that whilst Fanon shared the same ideals as the anti-colonial movements in their objective to remove colonial regimes from power, that Fanon, in fact, had a critical attitude towards the anti-colonial movement. Whereas the latter conceived of freedom as independence, Fanon conceived of freedom as disalienation, premised on the complete recovery of the black self from the negative effects of colonialism. Thus the study sets out to examine the extent to which Fanon offered an alternative idea of freedom and liberation to the one which was being advanced by the national liberation movements

The concept of alienation in the work of Frantz Fanon.

Doctor of Philosophy. University of KwaZulu-Natal, Pietermaritzburg, 2017.No abstract available

Role of non-governmental organisations in provision of health services in KwaZulu-Natal.

Thesis (M.Admin)-University of Durban-Westville, 1999.This dissertation focuses on the role of non-governmental organisations in provision of health care services in KwaZulu-Natal. The study had three objectives which were: - identify the role of non-governmental organisations in the provision of health in KwaZulu-Natal. - describe mechanisms for enhancing collaboration between the government and non-government organisations. - investigate mechanisms for redistribution of resources from the public and private sectors to the non-government organisations. The Nationalist Party government, supported by its apartheid policies created imbalances in the provision of services in South Africa. Generally speaking, inequity in all spheres of life was visible between the white population which was the minority and their counterparts, the blacks which were the majority. Health care services were fragmented and divided in racial lines. The whites who were predominantly located in urban areas had access to curative health care which was affordable to them. The blacks were located in rural areas which were referred to as homelands. The health services were minimal and in most places they were unavailable. Curative facilities provided by hospitals and clinics were situated long distances from where the majority of the population could find them. Transport facilities like roads were not well developed, ambulances and health care workers were not available. Health care facilities was inadequate in these areas. The health care provided by the apartheid government was inadequate and structures which were outside the government known as non-government organisations were formed. These NGOs acted as the first line of health defence to the marginalised sectors of the South African communities. Non-governmental organisations were also functioning in the province of KwaZulu-Natal and some were comprehensive in approach and did not provide only health services but also training and education, housing, social services and other development activities. The role of these non-governmental organisations involved the following:- improving health in the most remote and disadvantaged communities, for example, informal settlements, rural and the ultra poor areas. - providing integrated and comprehensive services, for example, employment generating projects, education and training and housing. - unifying the different racial groups and breaking down prejudices and assumptions with regard to race and gender. Although non-governmental organisations operated in South Africa, there was always confrontation between the government structures and NGOs, particularly those which were actively involved in the upliftment of the lives of the previously disadvantaged communities, namely the blacks. These non-governmental organisations provided these services under a variety of unpleasant conditions, characterised by assassinations, tortures and imprisonment. These NGOs were banned by the government and others operated under restrictive and authoritarian government policies. The recent political changes which took place in South Africa - the unbanning of political organisations like the African National Congress and the Pan Africanist Congress highlighted the need for transformation in all aspects of life. In 1994 a democratic government which was ANC-Ied was legitimately elected. The government of national unity was committed to the upliftment of the lives of all South Africans, particularly the provision of health care for all. People were extremely optimistic when the new government (GNU) came into power. The role of non-government organisations was theoretically non-existence and minimal as the government was aiming at providing health care services to the previously disadvantaged communities. Foreign donors and funders redirected their financial assistance to the government and the funding was between government to government. The personnel from non-governmental organisations was recruited to business and government sectors which also challenged NGOs to replace these dedicated and committed people. The funding problem has become a major challenge to non-governmental organisations and most of them have been forced to shut down. The political transformation has challenged non-government organisations to reposition themselves and work with government in the upliftment of the lives of all South Africans. The government of national unity is committed to the provision of equitable, preventive, promotive, curative and rehabilitative services at all community levels, particularly the previously disadvantaged. The researcher has identified two non-governmental organisations as a case study and these NGOs are providing health care services in KwaZulu-Natal. The NGOs are the Health Systems Trust and the Valley Trust. In addition to these two NGOs literature which was relevant to this study was also reviewed. The researcher reached the following conclusions after the findings of the study were analysed: - Non-governmental organisations have played an important role in the past in the upliftment of the lives of South Africans. - Resources have been inequitable been distributed and there is a need to redistribute these resources equally. - South Africa is faced with health problems which needs all stakeholders to be involve in order to eradicate ill-health. The study offers a number of recommendations based from the conclusions which can be generalised to non-governmental organisations providing health services

Subtle Longitudinal Alterations in Env Sequence Potentiate Differences in Sensitivity to Broadly Neutralizing Antibodies following Acute HIV-1 Subtype C Infection

Broadly neutralizing antibodies (bNAbs) for HIV-1 prevention or cure strategies must inhibit transmitted/founder and reservoir viruses. Establishing sensitivity of circulating viruses to bNAbs and genetic patterns affecting neutralization variability may guide rational bNAbs selection for clinical development. We analyzed 326 single env genomes from nine individuals followed longitudinally following acute HIV-1 infection, with samples collected at ~1 week after the first detection of plasma viremia; 300 to 1,709 days postinfection but prior to initiating antiretroviral therapy (ART) (median = 724 days); and ~1 year post ART initiation. Sequences were assessed for phylogenetic relatedness, potential N- and O-linked glycosylation, and variable loop lengths (V1 to V5). A total of 43 env amplicons (median = 3 per patient per time point) were cloned into an expression vector and the TZM-bl assay was used to assess the neutralization profiles of 15 bNAbs targeting the CD4 binding site, V1/V2 region, V3 supersite, MPER, gp120/gp41 interface, and fusion peptide. At 1 μg/mL, the neutralization breadths were as follows: VRC07-LS and N6.LS (100%), VRC01 (86%), PGT151 (81%), 10-1074 and PGT121 (80%), and less than 70% for 10E8, 3BNC117, CAP256.VRC26, 4E10, PGDM1400, and N123-VRC34.01. Features associated with low sensitivity to V1/V2 and V3 bNAbs were higher potential glycosylation sites and/or relatively longer V1 and V4 domains, including known "signature" mutations. The study shows significant variability in the breadth and potency of bNAbs against circulating HIV-1 subtype C envelopes. VRC07-LS, N6.LS, VRC01, PGT151, 10-1074, and PGT121 display broad activity against subtype C variants, and major determinants of sensitivity to most bNAbs were within the V1/V4 domains. IMPORTANCE Broadly neutralizing antibodies (bNAbs) have potential clinical utility in HIV-1 prevention and cure strategies. However, bNAbs target diverse epitopes on the HIV-1 envelope and the virus may evolve to evade immune responses. It is therefore important to identify antibodies with broad activity in high prevalence settings, as well as the genetic patterns that may lead to neutralization escape. We investigated 15 bNAbs with diverse biophysical properties that target six epitopes of the HIV-1 Env glycoprotein for their ability to inhibit viruses that initiated infection, viruses circulating in plasma at chronic infection before antiretroviral treatment (ART), or viruses that were archived in the reservoir during ART in subtype C infected individuals in South Africa, a high burden country. We identify the antibodies most likely to be effective for clinical use in this setting and describe mutational patterns associated with neutralization escape from these antibodies

Dolutegravir twice-daily dosing in children with HIV-associated tuberculosis: a pharmacokinetic and safety study within the open-label, multicentre, randomised, non-inferiority ODYSSEY trial

Background: Children with HIV-associated tuberculosis (TB) have few antiretroviral therapy (ART) options. We aimed to evaluate the safety and pharmacokinetics of dolutegravir twice-daily dosing in children receiving rifampicin for HIV-associated TB. Methods: We nested a two-period, fixed-order pharmacokinetic substudy within the open-label, multicentre, randomised, controlled, non-inferiority ODYSSEY trial at research centres in South Africa, Uganda, and Zimbabwe. Children (aged 4 weeks to <18 years) with HIV-associated TB who were receiving rifampicin and twice-daily dolutegravir were eligible for inclusion. We did a 12-h pharmacokinetic profile on rifampicin and twice-daily dolutegravir and a 24-h profile on once-daily dolutegravir. Geometric mean ratios for trough plasma concentration (Ctrough), area under the plasma concentration time curve from 0 h to 24 h after dosing (AUC0–24 h), and maximum plasma concentration (Cmax) were used to compare dolutegravir concentrations between substudy days. We assessed rifampicin Cmax on the first substudy day. All children within ODYSSEY with HIV-associated TB who received rifampicin and twice-daily dolutegravir were included in the safety analysis. We described adverse events reported from starting twice-daily dolutegravir to 30 days after returning to once-daily dolutegravir. This trial is registered with ClinicalTrials.gov (NCT02259127), EudraCT (2014–002632-14), and the ISRCTN registry (ISRCTN91737921). Findings: Between Sept 20, 2016, and June 28, 2021, 37 children with HIV-associated TB (median age 11·9 years [range 0·4–17·6], 19 [51%] were female and 18 [49%] were male, 36 [97%] in Africa and one [3%] in Thailand) received rifampicin with twice-daily dolutegravir and were included in the safety analysis. 20 (54%) of 37 children enrolled in the pharmacokinetic substudy, 14 of whom contributed at least one evaluable pharmacokinetic curve for dolutegravir, including 12 who had within-participant comparisons. Geometric mean ratios for rifampicin and twice-daily dolutegravir versus once-daily dolutegravir were 1·51 (90% CI 1·08–2·11) for Ctrough, 1·23 (0·99–1·53) for AUC0–24 h, and 0·94 (0·76–1·16) for Cmax. Individual dolutegravir Ctrough concentrations were higher than the 90% effective concentration (ie, 0·32 mg/L) in all children receiving rifampicin and twice-daily dolutegravir. Of 18 children with evaluable rifampicin concentrations, 15 (83%) had a Cmax of less than the optimal target concentration of 8 mg/L. Rifampicin geometric mean Cmax was 5·1 mg/L (coefficient of variation 71%). During a median follow-up of 31 weeks (IQR 30–40), 15 grade 3 or higher adverse events occurred among 11 (30%) of 37 children, ten serious adverse events occurred among eight (22%) children, including two deaths (one tuberculosis-related death, one death due to traumatic injury); no adverse events, including deaths, were considered related to dolutegravir. Interpretation: Twice-daily dolutegravir was shown to be safe and sufficient to overcome the rifampicin enzyme-inducing effect in children, and could provide a practical ART option for children with HIV-associated TB

Neuropsychiatric manifestations and sleep disturbances with dolutegravir-based antiretroviral therapy versus standard of care in children and adolescents: a secondary analysis of the ODYSSEY trial

BACKGROUND: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy. METHODS: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment. We assessed neuropsychiatric adverse events (reported by clinicians) and responses to the mood and sleep questionnaires (reported by the participant or their carer) in both groups. We compared the proportions of patients with neuropsychiatric adverse events (neurological, psychiatric, and total), time to first neuropsychiatric adverse event, and participant-reported responses to questionnaires capturing issues with mood, suicidal thoughts, and sleep problems. FINDINGS: Between Sept 20, 2016, and June 22, 2018, 707 participants were enrolled, of whom 345 (49%) were female and 362 (51%) were male, and 623 (88%) were Black-African. Of 707 participants, 350 (50%) were randomly assigned to dolutegravir-based antiretroviral therapy and 357 (50%) to non-dolutegravir-based standard-of-care. 311 (44%) of 707 participants started first-line antiretroviral therapy (ODYSSEY-A; 145 [92%] of 157 participants had efavirenz-based therapy in the standard-of-care group), and 396 (56%) of 707 started second-line therapy (ODYSSEY-B; 195 [98%] of 200 had protease inhibitor-based therapy in the standard-of-care group). During follow-up (median 142 weeks, IQR 124–159), 23 participants had 31 neuropsychiatric adverse events (15 in the dolutegravir group and eight in the standard-of-care group; difference in proportion of participants with ≥1 event p=0·13). 11 participants had one or more neurological events (six and five; p=0·74) and 14 participants had one or more psychiatric events (ten and four; p=0·097). Among 14 participants with psychiatric events, eight participants in the dolutegravir group and four in standard-of-care group had suicidal ideation or behaviour. More participants in the dolutegravir group than the standard-of-care group reported symptoms of self-harm (eight vs one; p=0·025), life not worth living (17 vs five; p=0·0091), or suicidal thoughts (13 vs none; p=0·0006) at one or more follow-up visits. Most reports were transient. There were no differences by treatment group in low mood or feeling sad, problems concentrating, feeling worried or feeling angry or aggressive, sleep problems, or sleep quality. INTERPRETATION: The numbers of neuropsychiatric adverse events and reported neuropsychiatric symptoms were low. However, numerically more participants had psychiatric events and reported suicidality ideation in the dolutegravir group than the standard-of-care group. These differences should be interpreted with caution in an open-label trial. Clinicians and policy makers should consider including suicidality screening of children or adolescents receiving dolutegravir

Racial alienation and the psychology of oppression in Mzansi

Freedom, sovereignty, liberation, democracy, these are some of the terms that have been used to describe post-independence experiences in Africa. In this study, the researcher moves from the premise that freedom resulting from the processes of struggle ought to facilitate conditions for individual self-realisation and prosperity. As a number of critical commentaries have observed, however, post-independence social reality has not changed the lives of formerly oppressed peoples in any meaningful way. Instead, it has seen the continuation of social marginality under the guise of independence and democracy. This article reports on part of the investigation done for a Doctoral thesis (Ndlovu 2017) focusing on the concept of alienation in the work of the psychiatrist, Frantz Fanon. A qualitative research approach in particular, a case study design, was undertaken in order to understand the manifestation and extent of alienation within the South African context. The study found that, owing to the legacy of apartheid, the majority of South Africans still live in a state of despair and that genuine freedom, self-legislation remains elusive for majority of the population.Keywords: Independence, South Africa, freedom, despair, oppressio