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This paper explores adolescent preferences for the setting, timing, delivery format, provider and key elements of tobacco control programmes. The need for programme sensitivity towards urban/rural, gender and ethnic subgroups is also discussed. Schools were purposively selected from the Southern Cape-Karoo Region, South Africa. Twelve prevention and nine cessation focus group discussions were conducted with Grade 6-8 students and Grade 8-9 smokers and ex-smokers, respectively. Adolescents reported similar preferences for prevention and cessation programmes. Although they were unaware of smoking prevention or cessation programmes, they reported a willingness to participate in such programmes. Programmes should include school-based activities that are supported by out-of-school activities held over weekends and holidays. Non-judgemental and empathetic teachers and peers, as well as ex-smokers were preferred as programme providers. School-based participatory delivery formats should be supported by community-based mass media approaches. Programmes can be jointly presented to boys and girls of diverse ethnic backgrounds with some gender-sensitive sessions. Programme participation and sustainability would be enhanced if it were exciting, fun filled and integrated into their daily lives. School-based programmes must be embedded within comprehensive approaches that involve community- and policy-level interventions.

Data is required on the motivational determinants of smoking cessation among a multi-ethnic sample of adolescents in South Africa. The I-Change Model was used to explore the determinants of smoking cessation among a sample of 1267 Black African, Colored and White Grade 9-11 monthly smokers and former smokers in the Southern Cape-Karoo region. Across the ethnic groups, former smokers displayed a more positive attitude toward non-smoking, were surrounded by a social environment that was more supportive of non-smoking, displayed higher self-efficacy not to smoke in stressful, routine and social situations, and were more positive about their intention not to smoke in the next year. The I-Change Model can be used to address the cognitions of smoking in a multi-ethnic society like South Africa. However, some ethnic tailoring will be required. Black African students will benefit from a focus on attitudinal cognitions and cultural factors that motivate smoking. Colored students require the involvement of their social environment, while White students will benefit from the development of refusal skills in social situations.

Background, The yield of screening for acute HIV infection among general medical patients in resource-scarce settings remains unclear. Our objective was to evaluate the strategy of using pooled HIV plasma RNA to diagnose acute HIV infection in patients with negative or discordant rapid HIV antibody tests in Durban, South Africa. Methods, We prospectively enrolled patients with negative or discordant rapid HIV antibody tests from a routine HIV screening programme in an out-patient department in Durban with an HIV prevalence of 48%. Study participants underwent venipuncture for pooled qualitative HIV RNA, and, if this was positive, quantitative RNA, enzyme immunoassay and Western blot (WB). Patients with negative or indeterminate WB and positive quantitative HIV RNA were considered acutely infected. Those with chronic infection (positive RNA and WB) despite negative or discordant rapid HIV tests were considered to have had false negative rapid antibody tests. Results, Nine hundred and ninety-four participants were enrolled with either negative (n5976) or discordant (n518) rapid test results. Eleven [1.1%; 95% confidence interval (CI) 0.6-2.0%] had acute HIV infection, and an additional 20 (2.0%; 95% CI 1.3-3.1%) had chronic HIV infection (false negative rapid test). Results, Nine hundred and ninety-four participants were enrolled with either negative (n5976) or discordant (n518) rapid test results. Eleven [1.1%; 95% confidence interval (CI) 0.6-2.0%] had acute HIV infection, and an additional 20 (2.0%; 95% CI 1.3-3.1%) had chronic HIV infection (false negative rapid test). Conclusions, One per cent of out-patients with negative or discordant rapid HIV tests in Durban, South Africa had acute HIV infection readily detectable through pooled serum HIV RNA screening. Pooled RNA testing also identified an additional 2% of patients with chronic HIV infection. HIV RNA screening has the potential to identify both acute and chronic HIV infections that are otherwise missed by standard HIV testing algorithms. [ABSTRACT FROM AUTHOR]

Tobacco control programmes in multi-ethnic societies must take into account ethnic differences in the determinants of smoking. The 1-Change Model, an extension of the Theory of Planned Behaviour, was used to investigate the factors related to smoking among a sample of 3378 Black African, Coloured and White, monthly and non-monthly smokers in the Southern Cape-Karoo Region, South Africa. Across the ethnic groups, non-monthly smokers reported a more positive attitude towards nonsmoking, social influences that were more supportive of non-smoking, higher self-efficacy in stressful, routine and social situations, greater intention not to smoke in the next year and lower levels of depressive mood and risk behaviour. Regression analyses suggested that the weight of these determinants may differ in predicting monthly smoking among the ethnic groups. Black African students may benefit from the development of attitudinal cognitions and coping skills to counter peer influence. Coloured students also require skills to resist peer influence. White students require coping skills in stressful and social situations. Although there are more common than unique determinants of smoking among South African adolescents, further research is needed to understand the influence of differing social, economic and cultural contexts on smoking onset. [ABSTRACT FROM AUTHOR]

This paper explores adolescent preferences for the setting, timing, delivery format, provider and key elements of tobacco control programmes. The need for programme sensitivity towards urban/rural, gender and ethnic subgroups is also discussed. Schools were purpo- sively selected from the Southern Cape-Karoo Region, South Africa. Twelve prevention and nine cessation focus group discussions were conducted with Grade 6-8 students and Grade 8-9 smokers and ex-smokers, respectively. Adolescents reported similar preferences for prevention and cessation programmes. Although they were unaware of smoking prevention or cessation programmes, they reported a willingness to participate in such programmes. Programmes should include school-based activities that are supported by out-of-school activities held over weekends and holidays. Non-judgemental and empathetic teachers and peers, as well as ex-smokers were preferred as programme providers. School-based participatory delivery formats should be supported by community- based mass media approaches. Programmes can be jointly presented to boys and girls of diverse ethnic backgrounds with some gender- sensitive sessions. Programme participation and sustainability would be enhanced if it were exciting, fun filled and integrated into their daily lives. School-based programmes must be embedded within comprehensive approaches that involve community- and policy-level interventions. [ABSTRACT FROM AUTHOR]

Data is required on the motivational determinants of smoking cessation among a multi-ethnic sample of adolescents in South Africa. The I-Change Model was used to explore the determinants of smoking cessation among a sample of 1267 Black African, Colored and White Grade 9-11 monthly smokers and former smokers in the Southern Cape-Karoo region. Across the ethnic groups, former smokers displayed a more positive attitude toward non-smoking, were surrounded by a social environment that was more supportive of non- smoking, displayed higher self-efficacy not to smoke in stressful, routine and social situations, and were more positive about their intention not to smoke in the next year. The I-Change Model can be used to address the cognitions of smoking in a multi-ethnic society like South Africa. However, some ethnic tailoring will be required. Black African students will benefit from a focus on attitudinal cognitions and cultural factors that motivate smoking. Colored students require the involvement of their social environment, while White students will benefit from the development of refusal skills in social situations. [ABSTRACT FROM AUTHOR]

Aim: To determine the baseline data of secondary school students in the Midlands district of Kwa-Zulu, Natal, South Africa. The data provide details of students' knowledge about sexually transmitted infections (STIs) including HIV and AIDS, spread, prevention, how they can protect themselves from contracting an STI, their general awareness and sources of information, their perceptions of their vulnerability and their sexual practices. Methods: A cross-sectional study was carried out among 1113 grade 11 students in 19 randomly allocated secondary schools. Data were collected through structured questionnaires and analysed using the SPSS software package. Results: The results confirm that knowledge levels were high for causes and spread of STIs and the participants were well informed about issues relating to protection against STIs and seeking treatment. However, there was significant deviation in reported behaviours. Conclusion: This discrepancy between awareness and behaviour calls for a reorientation of sexuality education to include those elements critical for behavioural change, such as addressing gender discrepancies and promoting skills for communication through planned intervention programmes. [ABSTRACT FROM AUTHOR]

Background: Hypertension is the second leading risk factor for death in South Africa, and rates have steadily increased since the end of Apartheid. Research on the determinants of hypertension in South Africa has received considerable attention due to South Africa's rapid urbanization and epidemiological transition. However, scant work has been conducted to investigate how various segments of the Black South African population experience this transition. Identifying the correlates of hypertension in this population is critical to the development of policies and targeted interventions to strengthen equitable public health efforts., Methods: This analysis explores the relationship between individual and area-level socioeconomic status and hypertension prevalence, awareness, treatment, and control within a sample of 7,303 Black South Africans in three municipalities of the uMgungundlovu district in KwaZulu-Natal province: the Msunduzi, uMshwathi, and Mkhambathini. Cross-sectional data were collected on participants from February 2017 to February 2018. Individual-level socioeconomic status was measured by employment status and educational attainment. Ward-level area deprivation was operationalized by the most recent (2011 and 2001) South African Multidimensional Poverty Index scores. Covariates included age, sex, BMI, and diabetes diagnosis., Results: The prevalence of hypertension in the sample was 44.4% (n = 3,240). Of those, 2,324 were aware of their diagnosis, 1,928 were receiving treatment, and 1,051 had their hypertension controlled. Educational attainment was negatively associated with hypertension prevalence and positively associated with its control. Employment status was negatively associated with hypertension control. Black South Africans living in more deprived wards had higher odds of being hypertensive and lower odds of having their hypertension controlled. Those residing in wards that became more deprived from 2001 to 2011 had higher odds of being aware of their hypertension, yet lower odds of receiving treatment for it., Conclusions: Results from this study can assist policymakers and practitioners in identifying groups within the Black South African population that should be prioritized for public health interventions. Black South Africans who have and continue to face barriers to care, including those with low educational attainment or living in deprived wards had worse hypertension outcomes. Potential interventions include community-based programs that deliver medication to households, workplaces, or community centers., (© 2023. The Author(s).)

Background: South Africa, with the highest burden of HIV infection globally, has made huge strides in its HIV/ART programme, but AIDS deaths have not decreased proportionally to ART uptake. Advanced HIV disease (CD4 < 200 cells/mm 3 ) persists, and CD4 count testing is being overlooked since universal test-and-treat was implemented. Point-of-care CD4 testing could address this gap and assure differentiated care to these vulnerable patients with low CD4 counts., Methods: A time randomised implementation trial was conducted, enrolling 603 HIV positive non-ART, not pregnant patients at a primary health care clinic in Durban, South Africa. Weeks were randomised to either point-of-care CD4 testing (n = 305 patients) or standard-of-care central laboratory CD4 testing (n = 298 patients) to assess the proportion initiating ART at 3 months. Cox regression, with robust standard errors adjusting for clustering by week, were used to assess the relationship between treatment initiation and arm., Results: Among the 578 (299 point-of-care and 279 standard-of-care) patients eligible for analysis, there was no significant difference in the number of eligible patients initiating ART within 3 months in the point-of-care (73%) and the standard-of-care (68%) groups ( P  = 0.112). The time-to-treat analysis was not significantly different in patients with CD4 counts of 201-500 cells/mm 3 which could have been due to appointment scheduling to cope with the large burden of cases. However, in patients with advanced HIV disease (CD4 < 200cells/mm 3 ) 65% more patients started ART earlier in the point-of-care group (HR 1.65 (95% confidence interval (CI) = 0.99-2.75; P  = 0.052) compared to the standard-of-care group., Conclusions: Point-of-care testing decreased time-to-treatment in those with advanced HIV disease. With universal test and treat for HIV, rollout of simple point-of-care CD4 testing would ensure early diagnosis of advanced HIV disease and facilitate differentiated care for these vulnerable patients as per the World Health Organisation 2020 target product profile for point-of-care CD4 testing., Trial Registration: ISRCTN14220457., Competing Interests: Competing interests: The authors completed the ICMJE Unified Competing Interest Form (available upon request from the corresponding author), and declare no conflicts of interest., (Copyright © 2022 by the Journal of Global Health. All rights reserved.)

Background: The COVID-19 outbreak is in an accelerating phase, and South Africa (SA) has had the highest number of documented cases during the early phase of the pandemic in sub-Saharan Africa., Objectives: To assess South Africans' understanding of and response to COVID-19 during the first week of the country's lockdown period., Methods: An online survey was conducted in SA from 27 March to 2 April 2020. The survey was distributed widely among several websites and social media networks, including on a data-free platform. Descriptive statistics of knowledge, risk perception, access to and trust in information sources, and public and media opinions were calculated. Estimates were benchmarked to the 2019 national adult population estimates., Results: Of the 55 823 participants, the majority (83.4%) correctly identified the main symptoms of COVID-19. Over 90% had correct knowledge of the incubation period, with lower rates for 18 - 29-year-olds. Knowledge of symptoms and the incubation period varied significantly by population group (p&lt;0.001), dwelling type (p&lt;0.001) and sex (p&lt;0.001). A quarter (24.9%) perceived themselves as at high risk of contracting COVID-19. Risk perception varied by age, population group, employment status and dwelling type (p&lt;0.001). The most prevalent COVID-19 information sources were government sources (72.9%), news websites/apps (56.3%), satellite television (51.6%) and local television (51.4%)., Conclusions: Understanding knowledge, attitudes and behaviours of people facing the COVID-19 pandemic is crucial for guiding strategic policy. These findings provide public understanding of COVID-19 as the phases of the country-level epidemic progress, and also directly inform communication needs and gaps.

Objective: Preeclampsia (PE) is a complex pregnancy-specific medical disorder arising from an ischaemic placenta releasing factors causing widespread endothelial damage involving multiple organs systems, such as the renal system. Two variant alleles, termed G1 and G2, of the APOL1 gene are strongly associated with progressive renal disease and preeclampsia in the recessive or compound heterozygous state. Hence, we investigated the role of maternal APOL1 genotype in the pathogenesis of preeclampsia in South African women of African ancestry., Study Design: This case-control study comprised three groups of South African pregnant women of African ancestry attending a regional hospital in Durban, South Africa: mothers experiencing normotensive pregnancies, early onset preeclampsia and late onset preeclampsia underwent APOL1 genotyping. Differences in G1 and G2 allele and genotype frequencies were analysed for the three groups., Results: Our study revealed a significant association between the maternal APOL1 G1 risk allele and early-onset PE development (OR 2.2, p = 0.03). Among the EOPE group, 5 % [OR(95 %CI) 0.94 (0.29-3.12)] of the study population carried two risk alleles, 49 % [OR(95 %CI) 1.34 (0.77-2.3)] carried at least one risk allele, while 46 % of the participants did not carry either risk allele, compared to the normotensive pregnant group, where 52 % carried no risk allele, 42 % had at least one risk allele and 6 % of the women had both risk alleles., Conclusion: Our results suggest that maternal APOL1 G1 risk allele may contribute to the development of early-onset PE in South African pregnant women of African ancestry either directly or by transmission of a APOL1 risk allele to the foetus., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: WHO guidelines recommend co-trimoxazole prophylaxis for HIV-exposed, HIV-uninfected infants. These guidelines date back to an era in which HIV testing of infants was impossible and mothers had poor access to antiretroviral treatment. To determine whether this guideline requires revision in the current era of effective prevention of mother-to-child transmission and early infant diagnosis programmes, we aimed to investigate whether receiving no co-trimoxazole prophylaxis is inferior to receiving co-trimoxazole prophylaxis in the resulting incidence of grade 3 or 4 common childhood illnesses or mortality in breastfed HIV-exposed, HIV-uninfected infants., Methods: We investigated our aim in a randomised controlled, non-inferiority trial. We enrolled the HIV-negative infants of mothers living with HIV who were actively involved in transmission prevention programmes in two clinics in Durban, South Africa. Infants were included in the study if they were breastfeeding at the screening and enrolment visits, and their mother was planning to breastfeed for at least 6 months; were a singleton birth and had a birthweight of 2 kg or more; had no clinically observed genetic disorders; and had no serious illnesses and had not received antibiotics or traditional medications (such as herbal remedies). Infants were randomly assigned (1:1) to receive co-trimoxazole or no co-trimoxazole. In the co-trimoxazole group, infants received the drug until all exposure to HIV had ceased (ie, 6 weeks after last exposure to breastmilk) and the infant was confirmed to be uninfected with HIV. The drug was administered by mothers in once-daily regimens of 20 mg trimethoprim and 100 mg sulfamethoxazole orally (age <6 months or bodyweight <5 kg), or 40 mg trimethoprim and 200 mg sulfamethoxazole orally (age >6 months or bodyweight >5 kg). Clinical and laboratory staff always remained masked to group assignment, but mothers and study counsellors were not. Infants and their mothers attended study visits at ages 6 weeks (for enrolment and randomisation), 10 weeks, 14 weeks, and then monthly from 4 to 12 months. Our primary outcome was the incidence of grade 3 or 4 common childhood illnesses (pneumonia or diarrhoea) or mortality in breastfed HIV-exposed, HIV-uninfected infants by age 12 months. A non-inferiority bound of 5% was used. The study is registered with the Pan African Clinical Trials Registry, number PACTR201311000621110, and the South African National Clinical Trials Registry, number DOH-27-0614-4728., Findings: We screened 1570 mother-child pairs for study enrolment, from whom (78%) eligible infants were enrolled into the study between Oct 16, 2013, and May 23, 2018. Of the infants enrolled, 611 (50%) were randomly assigned to the co-trimoxazole group and 609 (50%) were randomly assigned to the no co-trimoxazole group. One (<1%) infant in the no co-trimoxazole group was excluded from the analysis of the final outcomes for having received traditional medicine (which only became apparent after randomisation); therefore, 611 (50%) infants in the co-trimoxazole group and 608 (50%) infants in the no co-trimoxazole group were included in the final intention-to-treat analysis. 136 (22%) infants in the co-trimoxazole group and 139 (23%) infants in the no co-trimoxazole group did not complete the 12-month study visit, predominantly because of loss to follow-up (93 [15%] infants in the co-trimoxazole group; 90 [15%] infants in the no co-trimoxazole group). The cumulative probability of the composite primary outcome was 0·114 (95% CI 0·076 to 0·147; 49 events) in the co-trimoxazole group versus 0·0795 (0·044 to 0·115; 39 events) in the no co-trimoxazole group. The risk difference (no co-trimoxazole group minus co-trimoxazole group) was -0·0319 (-0·075 to 0·011), meaning that the risk was around 3 percentage points lower in the no co-trimoxazole group on the additive scale., Interpretation: We can conclude that no co-trimoxazole is not inferior to daily co-trimoxazole among breastfed HIV-exposed, HIV-uninfected infants whose mothers are accessing a prevention of mother-to-child transmission programme in an area unaffected by malaria. We therefore believe that WHO should revise the co-trimoxazole guidelines for HIV-exposed, HIV-uninfected infants in areas unaffected by malaria., Funding: HIV Prevention Research Unit of the South African Medical Research Council and the Family Larsson-Rosenquist Foundation., (Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Virulence-associated genes have been recognised and detected in Campylobacter species. The majority of them have been proven to be associated with pathogenicity. This study aimed to detect the presence of virulence genes associated with pathogenicity and responsible for invasion, expression of adherence, colonisation and production of the cytolethal distending toxin (cdt) in Campylobacter jejuni and Campylobacter coli. Commercial chicken faecal samples were randomly sampled from chicken farms within the Durban metropolitan area in South Africa. Furthermore, human clinical Campylobacter spp. isolates were randomly sampled from a private pathology laboratory in South Africa. Out of a total of 100 chicken faecal samples, 78% (n = 78) were positive for Campylobacter growth on modified charcoal cefoperazone deoxycholate and from the random laboratory collection of 100 human clinical isolates, 83% (n = 83) demonstrated positive Campylobacter spp. growth following culturing methods. These samples were screened for the presence of the following virulence genes: cadF, hipO, asp, ciaB, dnaJ, pldA, cdtA, cdtB and cdtC. As expected, the cadF gene was present in 100% of poultry (n = 78) and human clinical isolates (n = 83). Campylobacter jejuni was the main species detected in both poultry and human clinical isolates, whilst C. coli were detected at a significantly lower percentage (p < 0.05). Eight per cent of the C. jejuni from human clinical isolates had all virulence genes that were investigated. Only one C. coli isolate demonstrated the presence of all the virulence genes investigated; however, the pldA virulence gene was detected in 100% of the C. coli isolates in poultry and a high percentage (71%) in human clinical C. coli isolates as well. The detection of cdt genes was found at higher frequency in poultry than human clinical isolates. The high prevalence rates of virulence genes detected in poultry and human clinical isolates demonstrate their significance in the pathogenicity of Campylobacter species.

Background: The HLA class II molecules play a central role in the generation of human immunodeficiency virus (HIV)-specific CD4(+) T-helper cells, which are critical for the induction of cytotoxic CD8(+) T cell responses. However, little is known about the impact of HLA class II alleles on HIV disease progression., Methods: In this study we investigated the effect of HLA class II alleles on HIV disease outcome and HIV-specific T cell responses in a cohort of 426 antiretroviral therapy-naive, HIV-1 clade C-infected, predominantly female black South Africans., Results: The HLA class II allele DRB1*1303 was independently associated with lower plasma viral loads in this population (P = .02), an association that was confirmed in a second cohort of 1436 untreated, HIV-1 clade B-infected, male European Americans, suggesting that DRB1*1303-mediated protection is independent of ethnicity, sex, and viral clade. Interestingly, DRB1*1303 carriage was not associated with an increased frequency of interferon (IFN) γ-positive HIV-specific CD4(+) T cell responses., Conclusions: These data demonstrate the independent effect of an HLA class II allele, DRB1*1303, on HIV disease progression, in the absence of increased IFN-γ-positive HIV-specific CD4(+) T cell frequencies, suggesting that the protective activity of DRB1*1303 may be mediated via an alternative mechanism.

Recent studies suggest that innate immune responses by natural killer (NK) cells play a significant role in restricting human immunodeficiency virus type-1 (HIV-1) pathogenesis. Our aim was to characterize changes in NK cells associated with HIV-1 clade C disease progression. Here we used multiparametric flow cytometry (LSRII) to quantify phenotype and function of NK cells in a cross-sectional analysis of cryopreserved blood samples from a cohort of 41 chronically HIV-1-infected, treatment-naive adult South Africans. These individuals ranged in disease severity from early (CD4 count >500) to advanced HIV-1 disease (CD4 count <50). We found that the frequency of NK cells expressing KIR2DL1, an inhibitory receptor, and/or KIR2DS1, an activating receptor, tended to decrease with increasing HIV-1 viral load. We also discovered a significant increase (p < 0.05) in overall NK cell degranulation with disease progression. We found that acutely activated NK cells (CD69(pos)) were deficient in NKp46 expression ex vivo. In conclusion, we observed that with viremia and advanced HIV-1 disease, activated NK cells lack NKp46 expression, and KIR2DS1(pos) and/ or KIR2DL1(pos) NK cells are reduced in frequency. These findings suggest that modulation of receptor expression on NK cells may play a role in HIV-1 pathogenesis, and provide new insights on immunological changes in advanced HIV-1 disease.

Background: The extent to which immunologic and clinical biomarkers influence human immunodeficiency virus type 1 (HIV-1) infection outcomes remains incompletely characterized, particularly for non-B subtypes. On the basis of data supporting in vitro HIV-1 protein-specific CD8 T lymphocyte responses as correlates of immune control in cross-sectional studies, we assessed the relationship of these responses, along with established HIV-1 biomarkers, with rates of CD4 cell count decrease in individuals infected with HIV-1 subtype C., Methods: Bivariate and multivariate mixed-effects models were used to assess the relationship of baseline CD4 cell count, plasma viral load, human leukocyte antigen (HLA) class I alleles, and HIV-1 protein-specific CD8 T cell responses with the rate of CD4 cell count decrease in a longitudinal population-based cohort of 300 therapy-naive, chronically infected adults with baseline CD4 cell counts >200 cells/mm(3) and plasma viral loads >500 copies/mL over a median of 25 months of follow-up., Results: In bivariate analyses, baseline CD4 cell count, plasma viral load, and possession of a protective HLA allele correlated significantly with the rate of CD4 cell count decrease. No relationship was observed between HIV-1 protein-specific CD8 T cell responses and CD4 cell count decrease. Results from multivariate models incorporating baseline CD4 cell counts (201-350 vs >350 cells/mm(3)), plasma viral load (< or =100,000 vs >100,000 copies/mL), and HLA (protective vs not protective) yielded the ability to discriminate CD4 cell count decreases over a 10-fold range. The fastest decrease was observed among individuals with CD4 cell counts >350 cells/mm(3) and plasma viral loads >100,000 copies/mL with no protective HLA alleles (-59 cells/mm(3) per year), whereas the slowest decrease was observed among individuals with CD4 cell counts 201-350 cells/mm(3), plasma viral loads < or =100,000 copies/mL, and a protective HLA allele (-6 cells/mm(3) per year)., Conclusions: The combination of plasma viral load and HLA class I type, but not in vitro HIV-1 protein-specific CD8 T cell responses, differentiates rates of CD4 cell count decrease in patients with chronic subtype-C infection better than either marker alone.

Objective: The present paper reports the prevalence of underweight, overweight and obesity by gender, ethnicity and grade, among participants in a 2002 national survey among South African school-going youth that included height and weight measurements., Design: A stratified two-stage sample was used. Nationally representative rates of underweight, overweight and obesity were calculated using weighted survey data and compared using chi2 analysis., Setting: In all, 9224 grade 8 to grade 11 students, present at school in selected classes within selected South African government-funded schools in all nine provinces, participated in this study. Most of the students were between 13 and 19 years of age., Results: Higher rates of underweight were observed for males than females as well as for black and 'coloured' than white students. Within each gender group, black and 'coloured' students had significantly higher rates of underweight than their white counterparts. Higher percentages of females than males were overweight and obese, overall and among black students. Furthermore, white male students had significantly higher rates of overweight than their black and 'coloured' counterparts. Among females, black and white students had significantly higher rates than 'coloured' students. Students in higher grades showed significantly lower rates of underweight and higher rates of overweight., Discussion: These data confirm that South Africa, a developing nation in socio-economic transition, is experiencing both undernutrition and overnutrition. However, these problems are disproportionately distributed by gender, socio-economics and ethnicity. Continued surveillance of nutritional status may be one important component of a national strategy to prevent and control malnutrition.

How Black women are represented, conceptualized, and researched in the field of psychology has dramatic and far-reaching effects on arriving at an understanding of personality and psychopathology. This point becomes especially salient as researchers try to develop alternative strategies for researching gendered experiences and for generating meaningful information about African women's experiences of alcohol misuse. On the African continent, there is a paucity of research on Black women's access to alcohol treatment. Therefore, this review has implications for research and practice with the potential to stimulate future health disparities research affecting Black African women. The article focuses on a South African population and explores the importance of theorizing alcohol misuse and sex by discussing the history of alcohol misuse in South Africa, women and alcohol misuse in South Africa, and women's treatment history; interpreting women's experiences of treatment; and addressing recommendations for future research.

Background: The human immunodeficiency virus type 1 (HIV-1) epidemic is associated with a significant increase in the incidence of tuberculosis (TB); however, little is known about the quality of Mycobacterium tuberculosis (MTB)-specific cellular immune responses in coinfected individuals., Methods: A total of 137 HIV-1-positive individuals in Durban, South Africa, were screened with the use of overlapping peptides spanning Ag85A, culture filtrate protein 10 (CFP-10), early secretory antigen target 6 (ESAT-6), and TB10.4, in an interferon (IFN)-gamma enzyme-linked immunospot (ELISPOT) assay. Intracellular cytokine staining for MTB-specific production of IFN-gamma, tumor necrosis factor (TNF)-alpha, and interleukin (IL)-2 was performed, as was ex vivo phenotyping of memory markers on MTB-specific T cells., Results: A total of 41% of subjects responded to ESAT-6 and/or CFP-10, indicating the presence of latent MTB infection. The proportion of MTB-specific IFN-gamma(+)/TNF-alpha(+) CD4(+) cells was significantly higher than the proportion of IFN-gamma(+)/IL-2(+) CD4(+) cells (P = .0220), and the proportion of MTB-specific IL-2-secreting CD4 cells was inversely correlated with the HIV-1 load (P = .0098). MTB-specific CD8 T cells were predominately IFN-gamma(+)/TNF-alpha(+)/IL-2(-). Ex vivo memory phenotyping of MTB-specific CD4 and CD8 T cells indicated an early to intermediate differentiated phenotype for the population of effector memory cells., Conclusions: Polyfunctional MTB-specific CD4 and CD8 T cell responses are maintained in the peripheral blood of HIV-1-positive individuals, in the absence of active disease, and the functional capacity of these responses is affected by HIV-1 disease status.

Purpose: This study describes the levels of nicotine dependence, withdrawal symptoms, depressive mood, and risk behavior reported by male and female weekly and monthly adolescent smokers in South Africa., Methods: A cross-sectional survey was conducted among 554 grade 9-11 weekly and monthly smokers in the Southern Cape-Karoo Region. Differences between the gender groups and smoking status were analyzed while controlling for demographic characteristics., Results: Weekly and monthly smokers were classified as light smokers having smoked 6-10 cigarettes and 0-1 cigarettes a week, respectively. However, they displayed substantial levels of dependence, with 11.6% of weekly smokers classified as highly dependent. Furthermore, 55.9% of weekly smokers and 47.1% of the overall sample experienced more than two withdrawal symptoms. Although dependency levels and withdrawal symptoms were higher among weekly smokers, the levels were not negligible among monthly smokers. Weekly smokers reported higher levels of depressive mood and risk behavior than monthly smokers. Females reported higher levels of dependence, withdrawal symptoms, depressive mood, and lower levels of risk behavior than males. Gender differences were not found on the number of cigarettes smoked in a week., Conclusions: This study demonstrates multiple symptoms of dependence among a large sample of adolescent occasional smokers in a multi-ethnic cultural setting. Smoking cessation programs may, therefore, be required to help adolescents quit smoking and possibly consider pharmacotherapy for highly dependent smokers. Prevention programs should also consider providing occasional smokers skills to identify and cope with withdrawal symptoms.

Selection of T-cell vaccine antigens for chronic persistent viral infections has been largely empirical. To define the relationship, at the population level, between the specificity of the cellular immune response and viral control for a relevant human pathogen, we performed a comprehensive analysis of the 160 dominant CD8(+) T-cell responses in 578 untreated HIV-infected individuals from KwaZulu-Natal, South Africa. Of the HIV proteins targeted, only Gag-specific responses were associated with lowering viremia. Env-specific and Accessory/Regulatory protein-specific responses were associated with higher viremia. Increasing breadth of Gag-specific responses was associated with decreasing viremia and increasing Env breadth with increasing viremia. Association of the specific CD8(+) T-cell response with low viremia was independent of HLA type and unrelated to epitope sequence conservation. These population-based data, suggesting the existence of both effective immune responses and responses lacking demonstrable biological impact in chronic HIV infection, are of relevance to HIV vaccine design and evaluation.