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Thyroid gland vascular proliferations pose a challenge to pathologists, radiologists and surgeons. This is illustrated in the case of a 36-year-old woman who underwent a diagnostic thyroid lobectomy for a suspected follicular neoplasm according to cytology. Histological diagnosis confirmed a follicular adenoma as well as a cavernous haemangioma or venous malformation. Contribution: Thyroid vascular lesions are rare. Evolving nomenclature and application of the International Society for the Study of Vascular Anomalies classification are discussed. Pertinent radiological clues are highlighted to pre-empt the diagnosis and avoid potential surgical complications.

The Kruger National Park is the largest protected area in South Africa and one of the most extensively surveyed in sub-Saharan Africa. Scientific studies, passive sampling from rangers and citizen science records have resulted in comprehensive faunal species lists spanning the entire park. Albeit, numerous frog records from different sources exist, they reveal contrasting species assemblages for the northern reaches of the park. This inconsistency leads to problems in conducting ecological work and implementing conservation legislation, as the baseline data are not congruent across sources. This is problematic because the northern Kruger National Park is known as the Ramsar-declared Makuleke Wetland System. Although this system receives rigorous conservation efforts, there is a lack of a comprehensive and up-to-date list of frog species. In this study, we aimed to develop an updated regional baseline using a combination of published literature, citizen science and museum records, supplemented with active field surveys. Field surveys of the study region resulted in the identification of 18 species from 10 families of frogs. When combined with existing records, the Makuleke Contractual Park is expected to play host to at least 30 frog species. In addition to collating existing data into a single source, the field component of this study also revealed the first record of Tomopterna natalensis for the area during active surveys, reconfirmed the presence of several frogs, several of which have not been recorded in the region in over 50 years and provided the first confirmed national record of Afrixalus crotalus using phylogenetic reconstruction. Conservation implications: Comprehensive species lists are fundamental for robust management protocols and ecological research. By collating data from multiple sources, this article presents an improved and updated frog list for the region, which will aid conservation, management and any long-term wetland ecosystem monitoring efforts in the region.

No abstract available.

There has been an increasing awareness of the importance of physician mental health. Several South African studies show a high prevalence of burnout among doctors. Burnout is characterised by three components: exhaustion, depersonalisation, and a sense of a lack of efficacy. Burnout is a result of both external and internal pressures. While lifestyle modification is essential, mindfulness-informed programmes promote self-regulation and resilience. Mindfulness programmes comprise three components: present moment awareness, perspective-taking and wisdom, and compassion. Physician wellness begins with individuals recognising the need of self-care and giving themselves permission to prioritise this. Ongoing identification of self-care needs and acting compassionately to address these needs is essential.

No abstract available.

Purpose: High levels of online media use and permanent connectedness are common features of contemporary life in the developed world. In recent studies, the concept of online vigilance has been adopted to describe individuals’ chronic attentional orientation towards and engagement with their online spheres. The present study extends this notion by investigating its role in relation to stress and boundary management. Design/methodology/approach: A sample of 299 knowledge workers completed an online survey concerning the role of cross-domain online vigilance in the blurring of work-personal boundaries and the potential impact this may have on perceived stress. Findings/results: Contrary to extant evidence, the findings of this study indicate that cross-domain online vigilance does not predict stress, neither on its own nor when interacting with individuals’ domain segmentation preferences. However, the findings indicate that younger knowledge workers, more than their older colleagues, have trouble disconnecting from their personal online spheres while working. Practical implications: Work communication policies and norms should enable workers to psychologically disconnect from work during non-working hours and should be sensitive to the differences in personal preferences for boundary segmentation. Constant psychological connection to personal online communication may impact performance among younger knowledge workers. Originality/value: The present study is the first to consider the notion of online vigilance in relation to boundary management and stress among knowledge workers. The findings are particularly relevant given the increased blurring of work-personal boundaries that results from organisations adopting work-from-anywhere policies following the COVID-19 pandemic.

Background: Changemakers are justice-minded individuals working toward implementing positive and sustainable change within their communities. Aim: The project created a space for Changemakers to connect, engage in critical dialogue, and leave with shared knowledge and skills to dismantle oppressive, deficit-based educational systems in the aftermath of COVID-19. Setting: From October 2021 to June 2022, 18 American and South African Changemakers from primary, secondary, and higher education institutions exchanged messages about their regional context and attended the Changemaker Symposium in South Africa. Method: This qualitative study examined how the Changemaker framework guided educators to frame [ubuntu], convene [masikhule], and ignite change [skep verandering]. They framed the strengths and challenges in their regions. Teams convened to address challenges using assets-based ideas that oppose deficit thinking and allow them to become leaders who ignite agency to ignite systemic change. The individual and group narratives were collected via open-ended questions, group discussions, and written artifacts. Results: They developed statements on: exploring reasons for teaching, collaborating with critical friends, and developing critical leadership skills. A phenomenological analysis of the narratives examined commonalities within each Changemakers’ lived experience. Conclusion: Findings indicate that this process allowed participants to collaborate and reimagine ways to inspire others while renewing their commitment to the responsibilities they face as educators affected by the pandemic. Contribution: From this project, educators have a framework to participate in global discourse that illuminates commonalities through critical friendships, decreases burnout, humanizes their experiences and increases the implementation of culturally responsive and sustaining inclusive practices.

Background: Fruit is an important export commodity for South Africa and accounts for 35% of its agricultural exports. South Africa is the second largest citrus exporter in the world, behind Spain. Maintaining the postharvest cold chain is key to ensuring that fruit quality meets export standards. Objectives: The main objectives of this research were to investigate the frequency, location, magnitude and duration of temperature deviations in the South African leg of the clementine and navel orange cold chain. Method: Temperature trials were conducted on two consignments of clementines and two consignments of navels. Each consignment contained 36 iButtons®, of which 18 measured pulp temperature and 18 measured ambient temperature. Data were successfully retrieved from 130 of the 144 iButtons®. Results: This research identified areas where the temperature went outside the prescribed range along the South African portion of the export cold chain of navel oranges and clementines from Citrusdal, South Africa to the Port of Newark, United States of America. Conclusion: The temperature incidents identified could result in a breach of the cold sterilisation (steri) protocols and quality defects. Recommendations were made to address these deficiencies to improve the South African citrus industry’s global competitiveness. Contribution: This research allowed the citrus industry to investigate and adjust current cold chain practices to improve the integrity of the entire export cold chain, potentially resulting in a higher quality product and increased revenue.

Orientation: In business rescue, when pursuing the sale of the business to a third party, the business rescue practitioner (BRP) may use different bidding processes to interact with and select buyers. Research purpose: This study aimed to provide a framework to classify and describe the various bidding processes, including identifying the factors that would preserve value to the benefit of creditors and shareholders. Motivation for the study: Chapter 6 of the Companies Act is silent on the requirements regarding bidding processes. Therefore, the industry and legislator may benefit from guidance from industry experts. Research approach/design and method: Qualitative exploratory, using semi-structured interviews with 11 South African senior business rescue practitioners. Main findings: Three types of bidding processes were identified. In a sophisticated bidding process, information is communicated to buyers using a virtual data room. The second bidding process is less sophisticated; printed document packs are provided to bidders, and bids are submitted in tender boxes. Thirdly, the private bid-out process, where preferred bidders compete against each other in a closed envelope boardroom auction. The findings also revealed that deal certainty is more important in business rescue than ordinary mergers and acquisitions. Moreover, an equitable value, rather than a general market value, is often applied because of the bidding process. Lastly, the study identified a need for the pre-involvement of the BRP before a company files for business rescue, an aspect not currently allowed by the Companies Act. Practical/managerial implications: BRPs can benefit from the explication of the types and detailed steps of bidding processes. Moreover, the findings fill the void of limited guidance in the Companies Act. Contribution/value-add: The classification and description of the various bidding processes and key considerations in the context of a business rescue will assist BRPs in South Africa in preserving value under business rescue and guide the legislator in amending the Companies Act.

Lycodonomorphus is a genus of lamprophiid water snake endemic in Africa. Although widespread, abundant and presumably an important component of many aquatic and semi-aquatic food webs, these snakes are poorly understood taxonomically, particularly from a phylogenetic perspective. With only four of the nine species currently sequenced, this study attempts to improve our understanding of the evolutionary relationships within the genus through the phylogenetic placement of one of the most elusive species, Lycodonomorphus obscuriventris. Collected in the Ramsar declared Makuleke Wetlands in northern Kruger National Park (South Africa), the sample used in this study not only yielded the first DNA sequences for the taxon but also represented the most northerly South African record, bridging the gap between the southern and northern populations. The snake was sequenced for three partial mitochondrial genes (16S, Cyt-b, ND4) and one partial nuclear gene (c-mos) and phylogenetically placed, relative to the rest of the genus, using maximum likelihood (ML) and Bayesian inference (BI). Sequence divergences between sister taxa were also estimated using pairwise distance analysis. The concatenated phylogenetic reconstruction yielded similar topological structuring when compared to phylogenies from past articles, with both the ML and BI algorithms recovering strong support for L. obscuriventris as sister to a clade comprising of L. whytii + L. laevissimus + L. rufulus. The phylogenetic placement, albeit based on a single sample, challenges the original placement (morphological) of L. obscuriventris as sub-specific within L. whytii, suggesting that multiple species concepts should be considered when delineating species within this group. Conservation implications: Prior to the discovery of the new record, the global distribution of L. obscuriventris was characterised by two disjunct populations. The new record bridges the distribution gap between these two populations, rendering the distribution continuous. This bodes well for the species as there is likely no barrier to gene flow, thereby buffering the species from localised threats given the more expansive distribution. Furthermore, given that the specimen was sampled from the Kruger National Park, the species is likely to be well-protected as much of its distribution within South Africa seems to fall within protected areas.

No abstract available.

Background: The coronavirus disease 2019 (COVID-19) pandemic hit South Africa in March 2020, severely disrupting health services and health education. This fundamentally impacted the training of future health professionals and catalysed a significant response from across the health education sector. In 2020, the South African Association of Health Educationalists requested members to submit reflections on different aspects of their COVID-19 related educational responses. Responding to the pandemic: Seven vignettes focused specifically on clinical training in the context of primary care and family medicine. This short report highlights the key insights that emerged from these vignettes, considering what has been learnt in terms of health professions education and what we need to take forward. These insights include building on what was already in place, the student role, technology in the clinical learning context, taking workshops online, vulnerability and presence and the way going forward. Discussion and conclusion: The contributions emphasised the value of existing relationships between the health services and training institutions, collaboration and transparent communication between stakeholders when navigating a crisis, responsiveness to the changed platform and dynamic environment and aligning teaching with healthcare needs. It is more important than ever to set explicit goals, have clarity of purpose when designing learning opportunities and to provide support to students. Some of these learning points may be appropriate for similar contexts in Africa. How we inculcate what we have learned into the post-pandemic period will bear testimony to the extent to which this crisis has enabled us to re-imagine health professions education.

This article observes that both the similar and the dissimilar are of ethical importance in discourse on human identity. There is a need for a common humanity and to guard against domination in the name of difference – precisely by recognising the otherness of the other. This also applies to reflections on what it means to be human in the age of the human, namely the Anthropocene. A survey is offered of how this tension between the similar and the dissimilar plays itself out in the work of five theorists, namely Dipesh Chakrabarty, Clive Hamilton, Dona Harraway, Michel Serres and Kathryn Yusoff. On this basis, six tentative conclusions are offered: (1) Despite the appropriate ethical emphasis on difference and otherness, the quest for the universal in the particular cannot be readily abandoned. (2) Such a sensitivity for the universal in the particular needs to be extended to a recognition of the way in which an integrated earth system functions. (3) The ethical emphasis on difference and otherness should be extended to non-human animals. (4) Human dignity and the ‘integrity of creation’ are not necessarily inversely proportioned. (5) Relations may well have an ontological priority over individuals. (6) Identity need not be constituted by the distant past or the immediate presence as if continuity over time forms a guarantee for a sense of identity. Contribution: This article explores a core question in discourse on the Anthropocene, namely ‘What does it mean to be human in the age of humans?’ It compares the views on human identity of five theorists, namely Dipesh Chakrabarty, Clive Hamilton, Dona Harraway, Michel Serres and Kathryn Yusoff and on this basis offers six observations to take the debate forward.

This contribution is structured in the form of a letter to Van Huyssteen focussing on his magnum opus, Alone in the World? (2006). It recognises, with Van Huyssteen, the danger of docetic detachment and scientific reductionism. It suggests that what is at stake in debates on human uniqueness is a defence of human dignity, human rights and human responsibility. It points to a dilemma in this regard, namely that affirming the evolutionary continuity of humans with other species as well as human dignity on the basis of human uniqueness is only possible on the basis of a hierarchy of intrinsic worth and not equal intrinsic worth. However, amongst humans, such a hierarchy cannot be sustained given the need to affirm equal human dignity. The underlying problem here is to address the dangers of anthropocentrism, especially in the so-called Anthropocene where humans have become a ‘geological force of nature’. Van Huyssteen is challenged to consider the reverse side of the emergence of human uniqueness, namely the emergence of human sin. Are humans unique in this regard too? Intradisciplinary and/or interdisciplinary implications: The theme of human uniqueness is by definition of multi-disciplinary interest as demonstrated in the work of Wentzel van Huyssteen. This contribution highlights an unresolved anthropocentrism, especially in the context of what is termed the ‘Anthropocene’, that is also of significance within multiple disciplines, including Christian theology and discourse on theology and science.

Orientation: Conventional accounting education is presented from a business perspective that rationalises the prioritisation of shareholder interests. Such a paradigm, viewed as the hegemony of business, fails to deliver on the emancipatory intent of social and environmental justice. Research purpose: To determine whether a postgraduate diploma in integrated reporting (PGDIR) (advancing the principles of social and environmental justice) offered participants an explicitly transformative experience. Motivation for the study: As educators, first, the authors set out to determine whether graduates of the PGDIR achieved a critical awareness of the tension between sustainability and the hegemony of business, and second, they wanted to determine whether the PGDIR prepared students to deal with hegemonic domination in practice. Research approach/design and method: In this qualitative study, the first 4 years PGDIR graduates were interviewed. Main findings: Postgraduate diploma in integrated reporting graduates, after critical self-reflection, expressed a sense of disillusionment arising from having attempted to implement the theory presented in the PGDIR. Whilst prior studies have identified critical thinking skills as necessary components of critical accounting education, this study suggests the need for emotional intelligence, and skills in consultation and negotiation as equally important tools to empower graduates to deal with hegemonic tension in practice. Practical/managerial implications: The findings of the study could inform accounting pedagogies, as it explains how integrated reporting, with its purpose of advancing the principles of social and environmental justice, was taught in the PGDIR. Contribution/value-add: The PGDIR, the object of the study, is based on the principles of social and environmental justice and provides insights into the way that these concepts can be taught in a progressive way.

This article offers an overview of various theological discourses on the concept of nature. These are illustrated with examples of contributions to reformed theology from within the South African context. It is argued that there is ample room for confusion to reign in the connotations attached to ‘nature’ and the underlying theological problems that emerge. Often such connotations are merely adopted from other disciplines. To juxtapose such discourses would not by itself help to overcome such confusion but is a necessary step in that direction. Contribution: This article analyses the conflicting uses of the term ‘nature’ especially in reformed theological discourse in the South African context. It circumscribes the distinctive theological problems that emerge in each case without seeking to resolve them.

No abstract available.

Orientation: Professional workers increasingly have the ability to do their work outside normal working hours, while being away from the workplace or from the comfort of their homes. Advancements in technology have made flexible work arrangements (FWAs) much easier and viable for corporates to consider. Research purpose: Although research mostly confirms the benefits of FWAs, research on the outcomes of FWAs is somewhat inconclusive and sometimes contradicting, both within and across developed and emerging economies. Motivation for the study: It is important to advance our understanding of the use of FWAs and their outcomes so that organisations in emerging economies have a valid basis for considering the implementation of FWAs. Research approach/design and method: This study applied survey-based research to investigate the use and outcome of two of the most common FWAs – flexible working-time hours and telecommuting – amongst software developers in an emerging economy. Main findings: The results indicate that employers in South African software development sector have largely adopted FWAs, and that developers use flexible working arrangements and perceive them to be beneficial for themselves and their organisations. The study results confirm that FWAs do not correlate with fewer working hours but do correlate with increased levels of both engagement and performance. Practical/managerial implications: The findings are important in the light of critical shortage of and the resulting high pressure on software developers. Employers in emerging economies such as South Africa could seriously consider implementing FWAs, can probably do so with confidence and are likely to receive support from their staff. Contribution/value-add: The findings of this study are significant because they confirm that the workplace flexibility provided by FWA is effective, also in a developing economy such as South Africa.

The purpose of this paper is firstly to determine whether the International Integrated Reporting (IR) Framework is sufficiently robust to act as the guide for the IR movement. The secondary purpose is to speculate on the constraints that IR will face on its journey towards achieving the aims and vision of the IIRC (International Integrated Reporting Council). The paper is written in the form of a critical viewpoint, and will engage with the relevant academic literature and industry-led initiatives to achieve its objectives. The main finding of this paper is that the potential of the International Framework towards achieving its objectives lies more with the way it is applied than the way it was written. Academic literature does however highlight a number of potential constraints that will have to be overcome if integrated reporting is to achieve its long-term vision of financial stability and sustainability.

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.

This contribution offers a critical rejoinder with regard to 12 articles submitted for publication in HTS Theological Studies ‘to stimulate a discussion on the Holy Trinity for the 21st century within the South African environment’. It raises the provocative question: what if these 12 articles may be regarded as a barometer for contemporary South African discourse on the Trinity – even if this is evidently (and hopefully!) not the case? It addressed five questions in this regard: (1) who are the authors that contributed articles and where are they situated? (2) Who are their conversation partners or interlocutors? (3) What issues, themes and problems have they focused on? (4) How is the public significance of the doctrine of the Trinity portrayed within the (South) African context? (5) What issues, themes and problems were not discussed? It concludes that there are crucial problems related to the economic Trinity that are, by and large, not addressed in this set of contributions.

No abstract available.

No abstract available.

Literacy on birds and the natural environment among young citizens is critical in addressing current and emerging environmental challenges. To improve the future awareness, involvement, knowledge, values and pro-environmental behaviour of young South Africans towards birds, the natural habitat of birds and avi-tourism, this article benchmarks avi-tourism literacy rates among secondary school learners. The study arrived at an avi-tourism literacy rate of 43.66% which presupposes passive behaviour of learners towards birds, bird habitat and avi-tourism activities. Besides lacking basic bird and environmental knowledge, learners have also not yet reached the desired levels of emotional affection towards birds and the natural environment. However, increased awareness and affinity, involvement, values and behavioural intention will most likely entice pro-avi and environmental behaviour. The research poses clear challenges to professionals and educators within the tourism industry of South Africa to increase learners’ willingness and motivation to act pro-environmentally through dedicated education. This supports the need to introduce an intervention programme in order to promote awareness, knowledge, values and pro-avi and environmental behaviour among learners.

This contribution engages with Klaus Nürnberger’s eschatology as expressed in his Invitation to Systematic Theology. It suggests that his notion of Christian hope has to be understood in terms of the triad of core concepts that he offers, namely creative power, benevolent intentionality and a vision of comprehensive optimal well-being. These are dialectically related as thesis, antithesis and synthesis. Moreover, this dialectic comes to expression in his understanding of faith in the Triune God, namely as belief in God against God, God as Saviour against God as Creator. Two questions regarding the vision of comprehensive optimal well-being are raised in conversation with Nürnberger: Firstly, is the content of Christian hope focused on optimal well-being itself, that God’s project will prevail, that the vision itself will prevail or that God will prevail. Can these be treated as rough synonyms? Secondly, what are the implications of the emphasis on God’s Word for Nürnberger’s eschatology? Does his emphasis on conceptual clarification not allow a form of idealism that undermines his own emphasis on the historical? If so, is there sufficient room for the consummation of all things as part of the narrative of God’s work? Intra- and interdisciplinary implications: This contribution is of an intradisciplinary nature and is located within the field of Christian systematic theology. It is a review article that engages critically with the position on eschatology adopted by Professor Klaus Nürnberger in his two-volume work Faith in Christ Today (2016).

This article sketches how the debate on Christian faith and evolution has evolved. Seven challenges are identified and described in the debate, namely, regarding a recognition of deep (geological) time (challenging the historicity of the biblical creation narratives), understanding the role of chance in natural selection (posing questions about the nature of divine action, e.g., providence), human descent (challenging presumed human distinctiveness), a recognition of natural suffering (challenging the benevolence of the Creator), identifying the evolutionary roots of evil (challenging Christian views on the fall of humanity), a recognition of natural disselection (challenging notions of divine election) and, finally, evolutionary explanations of the emergence of morality and of religion (reiterating the challenge of atheism). It is argued that with each of these challenges, some of the underlying problems were provisionally resolved, only to reappear later in an even more challenging form. Intradisciplinary and/or interdisciplinary implications: The contribution describes shifts in Christian discourse on evolution and challenges the tacit assumption that any one aspect of the debate has been fully resolved by articulating some of the questions that have been resolved and others that remain unresolved.

Background: Burnout among doctors negatively affects health systems and, ultimately, patient care. Aim: To determine the prevalence of burnout among doctors working in the district health system in the Overberg and Cape Winelands districts of the Western Cape Province and to compare the findings with those of previous South African studies. Setting: Rural district hospitals. Methods: During 2013, a validated questionnaire (Maslach Burnout Inventory) was sent to 42 doctors working in the district health system within the referral area of the Worcester Hospital, consisting of the Overberg health district and the eastern half of the Cape Winelands. Results: Response rate was 85.7%. Clinically significant burnout was found among 81% of respondents. High levels of burnout on all three subscales were present in 31% of participants.Burnout rates were similar to those of a previous study conducted among doctors working in the Cape Town Metropolitan Municipality primary health care facilities. Scores for emotional exhaustion (EE) and depersonalisation (DP) were greater than those of a national survey;however, the score for personal accomplishment (PA) was greater. EE and PA scores were similar to that of a study of junior doctors working in the Red Cross Children’s Hospital;however, EE was smaller. Conclusion: This study demonstrates high burnout rates among doctors working at district level hospitals, similar to the prevalence thereof in the Cape Town Metropolitan primary health care facilities. Health services planning should include strategies to address and prevent burnout of which adequate staffing and improved work environment are of prime importance.

Background: Business rescue, in terms of Chapter 6 of the Companies Act No 71 of 2008, is still relatively new to the South African business environment. The need for a successful business rescue regime is beyond doubt. However, a consistent manner to measure the success of the regime has not been determined. Previous research into possible indicators of business rescue success was based on a review of international business rescue regimes that share the same underlying philosophy as the South African business rescue regime. Aim and Setting: This study extends previous research efforts by soliciting the opinions of 16 South African, senior business rescue practitioners on the indicators of business rescue success. Method: The researchers used a qualitative research approach. The Delphi research technique was used to gather qualitative and quantitative empirical data from business rescue practitioners. Results: The experts reached a high level of consensus on various indicators of a successful business rescue. Most notable are that business rescue should save as many jobs as possible and that the actual outcome should be compared to that estimated in the business rescue plan. A novel indicator of success is the business rescue points saved or rescued, when using the public interest score. Conclusion: The study makes a valuable contribution to the debate on what constitutes a successful business rescue by adding the considered opinion on indicators of success by one group of experts in the field of business rescue, namely senior business rescue practitioners.

The gap in HIV testing remains significant and new modalities such as HIV self-testing (HIVST) have been recommended to reach key and under-tested populations. In December 2016, the World Health Organization (WHO) released the Guidelines on HIV Self-Testing and Partner Notification: A Supplement to the Consolidated Guidelines on HIV Testing Services (HTS) and urged member countries to develop HIVST policy and regulatory frameworks. In South Africa, HIVST was included as a supplementary strategy in the National HIV Testing Services Policy in 2016, and recently, guidelines for HIVST were included in the South African National Strategic Plan for HIV, sexually transmitted infections and tuberculosis 2017–2022. This document serves as an additional guidance for the National HIV Testing Services Policy 2016, with specific focus on HIVST. It is intended for policy advocates, clinical and non-clinical HTS providers, health facility managers and healthcare providers in private and public health facilities, non-governmental, community-based and faith-based organisations involved in HTS and outreach, device manufacturers, workplace programmes and institutes of higher education.

These guidelines are intended as an update to those published in the Southern African Journal of HIV Medicine in 2014 and the update on when to initiate antiretroviral therapy in 2015. Since the release of the previous guidelines, the scale-up of antiretroviral therapy (ART) in southern Africa has continued. New antiretroviral drugs have become available with improved efficacy, safety and robustness. The guidelines are intended for countries in the southern African region, which vary between lower and middle income.

Introduction: Nursing staff working with intellectually disabled in-patients experience unique stress factors that can influence their personal well-being and work performance. Objectives: To compile a profile of stress factors experienced by nursing staff working with intellectually disabled in-patients at the Free State Psychiatric Complex (FSPC). Methods: This descriptive study included 89 nursing staff members from this environment. A questionnaire was used to collect socio-demographic information and determine personal and occupational stressors. The data were summarised by frequencies and percentages (categorical variables) and means or percentiles (numerical variables). Results: Most participants were aged between 46 and 55 (41.2%), female (93.2%) and black (93.2%), and 76.7% had children or dependant minors. The main stressors among participants were pressure providing financially for their children and dependant minors (71.2%), caring for them (39.4%) and fearing them moving away (25.8%). Occupational stressors included high workload (66.3%), lack of decision-making by superiors (58.1%), underpayment (53.5%), endangerment of physical health (52.3%) and safety (50.0%), working hours (51.2%), pressure of expectations from superiors (48.8%), uncertainty of employment (48.8%), work responsibilities (47.7%) and perceiving that skills and training were not appreciated. They experienced stress regarding health issues such as hyper- and hypotension (35.3%). Because of stress 34.5% of participants took leave, 34.5% developed depression and 14.3% had panic attacks. Conclusion: Most of the respondents experienced personal and occupational stress that influenced their health, which poses serious challenges for the management of the FSPC. Security should be upgraded, medical and psychological support for the staff and care facilities for their dependants should be provided, and financial problems experienced by these staff members should be addressed. The workload of the nursing staff at FSPC needs urgent attention. This can be done by means of a workforce analysis to determine minimum staffing levels for nursing.

This article engages with John Haught’s views on original sin. It offers a brief orientation todiscourse on sin in the context of theological debates on human evolution. This is followed bya thick description of Haught’s so-called note on original sin. A series of five observations andquestions regarding Haught’s position is offered. It is observed that Haught’s way of tellingthe story of sin and salvation follows a classic Roman Catholic plot, namely one based on graceelevating nature. This is contrasted with the more typically reformed plot of restoration.

Background. The recent scale-up of antiretroviral therapy (ART) coverage in resource-limited settings has greatly improved access to treatment. However, increasing numbers of patients are failing first- and second-line ART. Objective. To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing both individual and structural perceived barriers. Methods. Research was conducted at a large primary care tuberculosis (TB)/HIV clinic in Khayelitsha, a peri-urban township in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant interviews with staff (n=11), in-depth interviews with patients (n=10) and a Photovoice workshop (n=11). Responses and photographs were coded by content; data were transformed into variables and analysed accordingly. Results. Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients were concerned about missing medical records and poor staff attitudes in the clinic. Conclusion. These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning medication adherence.

Objective. To describe and evaluate the outcomes of a support programme for patients with virological failure while receiving second-line antiretroviral therapy (ART) in South Africa. Method. We described a comprehensive medical and counselling patient support programme for patients receiving secondline ART and with two consecutive viral loads (VLs) >1 000 copies/ml. Patients with >3 months follow-up and at least one VL measurement after inclusion in the programme were eligible for analysis. Results. Of 69 patients enrolled in the programme, 40 had at least one follow-up VL and no known drug resistance at enrolment; 27 (68%) of these re-suppressed while remaining on second-line ART following enhanced adherence support. The majority (18/27; 67%) achieved re-suppression within the first 3 months in the programme. Five patients with diagnosed second-line drug resistance achieved viral re-suppression (

Drug-induced liver injury (DILI) in HIV/tuberculosis (TB) co-infected patients is a common problem in the South African setting, and re-introduction of anti-TB drugs can be challenging for the healthcare worker. Although international guidelines on the re-introduction of TB treatment are available, the definition of DILI is not uniform, management of antiretroviral therapy (ART) in HIV co-infection is not mentioned, and the guidance on management is not uniform and lacks a practical approach. In this consensus statement, we summarise important aspects of DILI and provide practical guidance for healthcare workers for different patient groups and healthcare settings on the re-introduction of anti-TB drugs and ART in HIV/TB co-infected individuals presenting with DILI.

The Agulhas Plain is a remarkable recreational site which combines the attraction of a pristine marine environment with exceptional plant biodiversity, rural tranquillity and the novelty of being at the southernmost tip of Africa. The resource is a public good to which the market cannot assign a full value. This paper presents an estimated recreational value based on individual travel cost models and a sample of 370 visitors surveyed in 2010. Trip demands were estimated with zero truncated negative binomial models to account for over-dispersion. The study established a recreational value of R2.167 billion in 2010 prices for the site as a whole. By partitioning the sample into visitors who indicated having been attracted or not to the area by its nature and biodiversity, a net biodiversity value of R2 866 per trip was calculated. Allocated between marine and terrestrial resources based on the proportion of activities related to each type of resource, the value of plant biodiversity was estimated to be R2 268 per hectare in 2010to 2010 prices.

Lipodystrophy is a well-recognised adverse effect of HIV and antiretroviral therapy, with certain antiretrovirals, specifically thymidine analogues, implicated in the aetiology and pathogenesis. Lipodystrophy is often accompanied by metabolic complications, such as hyperlipidaemia and insulin resistance, which increase risk for cardiovascular disease. There are limited data on the effect of treatment modification, pharmacological interventions and surgical management on this condition. Here we summarise the latest data on lipodystrophy, with the aim of facilitating informed decision-making in managing this condition. In light of the absence of cost-effective measures to treat lipoatrophy and lipohypertrophy, prevention remains the best option; we recommend targeted annual screening. Healthcare workers should be sensitised to early detection in patients on thymidine-based regimens, and affected patients should be switched to an appropriate regimen as soon as feasible. There is no evidence to support the use of new-generation ARVs, except in patients with significant hypercholesterolaemia, where atazanavir and raltegravir may present better options. S Afr J HIV Med 2013;14(1):29-33. DOI:10.7196/SAJHIVMED.871

This contribution is aimed at some provocation by questioning the basic assumptions ofcurrent development discourse (also in the context of religion and theology). It asks forconceptual clarification and differentiation on the meaning of various process terms. It needsto be recognised that the word development remains a metaphor than can indeed be extendedbut can also become over-extended and ossified. The concept of development is then contrastedwith the process of maturation. It is argued that the concept of maturation is, (1) better able toindicate the final goal of the process than most other process terms, (2) recognises inherentlimitations and (3) follows natural cycles better than exponential growth, sustaineddevelopment or endless progress.

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines.