Formal scientific experimental investigations tend to rely on comparing situations where differences are to some extend directly controlled, or at least known. However, it is clearly impossible to investigate, in such a manner, every detail of life, or even a slightly narrower aspect like ‘healthcare’ – by examining each choice and evaluating its role in a ‘total package’ of ‘lifestyle’, ‘care’ or ‘policy’. The current edition of the SACEMA Quarterly features several pieces grappling explicitly with this challenge of understanding a bigger picture than any particular ‘scientific investigation’ can formally take on.
Intimate partner violence (IPV) is a worldwide epidemic. Physical and sexual violence are the most well-studied forms of IPV from an epidemiological point of view. Both of these have serious implications for other aspects of physical and mental health. In particular, women who have experienced IPV are more likely to be HIV-positive. In a modelling study we investigated some closely related questions about HIV and IPV in South Africa.
Using trends in the rate of new HIV infections in east and southern Africa we assess the current state of the epidemic and evaluate the future prospects for controlling it. If we let an incidence of 1 per 1,000 people represent a control threshold then this has been reached, or will probably be reached by 2020, in East Africa and is reachable by 2020 in those southern African countries that do not have strong social and economic ties to South Africa, if they continue to scale up their treatment programmes. South Africa, Lesotho, Mozambique and Swaziland could reach the control threshold by 2030 with sufficient political will and commitment to ‘treatment for all’.
The far-reaching, highly ambitious Sustainable Development Goals (SDGs) build upon the momentum generated by the Millennium Development Goals (MDGs) and are intended as a guide for health, social and economic initiatives until 2030. Implemented correctly, the STI agenda may well fit better within the SDGs than the MDGs, although that does not become directly clear at first glance. For refocusing attention on the control of STIs in the forthcoming years we propose a framework, most especially within low- and middle-income countries (LMICs).
Evidence that age-disparate relationships (ADR) between young women and older men are an important route of transmission of HIV infection is limited. The results from recent studies indicate that heterosexual relationships between young women and older men may help sustain the epidemic within some populations of South Africa and Malawi. However, the way in which age differences serve to sustain the epidemic of HIV may be different than what has been previously described in observational studies. This article proposes several public health intervention recommendations in relation to ADR and the epidemic of HIV.
Planet Earth has been here for over 4.5 billion years, but in just two human generations we have managed to place our only “home” at great risk. Given today’s uncertainties – social, economic, geopolitical, and environmental, it is clear that many lessons from history have not yet been learned and new lessons may prove equally, if not more, difficult to take on board as we head deeper into this century. My new book seeks to raise awareness about major global issues we face, stimulate discussion or debate and find ways forward to ensure planet and people sustainability.
There have been numerous papers and books on South Africa’s catastrophic era of AIDS denialism. There is much less known and written about the “when-to-start antiretrovirals (ARVs)” debate. This debate offers a fascinating look at how scientific disagreements between reasonable people, who are experts in the field, work, and how consensus evolves as evidence accumulates.
HIV and human papillomavirus (HPV) are two heavy hitting sexually transmitted infections (STIs). Meta-analyses of the association between HPV prevalence and HIV acquisition and the association between HIV prevalence and new HPV detection have estimated a two-fold increased risk in both directions, after adjusting for individual-level (sexual behavioural) factors. The studies argue that biological mechanisms may be responsible for these increased risks, but they also concur that residual confounding due to behaviour at the sexual network level cannot be ruled out. We used an individual based model to shed some light on the matter.