New insights into HIV epidemic in South Africa: key findings from the national HIV prevalence: incidence and behaviour burvey; 2012

This article presents key findings from the 2012 HIV prevalence; incidence and behaviour survey conducted in South Africa and explores trends in the HIV epidemic. A representative household based survey collected behavioural and biomedical data among people of all ages. Chi-squared test for association and formal trend tests (2002; 2005; 2008 and 2012) were used to test for associations and trends in the HIV epidemic across the four surveys. In 2012 a total of 38 431 respondents were interviewed from 11 079 households; 28 997 (67.5%) of 42 950 eligible individuals provided blood specimens. HIV prevalence was 12.2% [95% CI: 11.4-13.1] in 2012 with prevalence higher among females 14.4% than males 9.9%. Adults aged 25-49 years were most affected; 25.2% [95% CI: 23.2-27.3]. HIV prevalence increased from 10.6% [95%CI: 9.8-11.6] in 2008 to 12.2% [95% CI: 11.4-13.1] in 2012 (p 0.001). Antiretroviral treatment (ART) exposure doubled from 16.6% in 2008 to 31.2% in 2012 (p 0.001). HIV incidence in 2012 among persons 2 years and older was 1.07% [95% CI: 0.87-1.27]; with the highest incidence among Black African females aged 20-34 years at 4.5%. Sexual debut before 15 years was reported by 10.7% of respondents aged 15-24 years; and was significantly higher among male youth than female (16.7% vs. 5.0% respectively; p 0.001). Reporting of multiple sexual partners in the previous 12 months increased from 11.5% in 2002 to 18.3% in 2012 (p 0.001). Condom use at last sex dropped from 45.1% in 2008 to 36.2% in 2012 (p 0.001). Levels of accurate HIV knowledge about transmission and prevention were low and had decreased between 2008 and 2012 from 31.5% to 26.8%. South Africa is on the right track with scaling up ART. However; there have been worrying increases in most HIV-related risk behaviours. These findings suggest that there is a need to scale up prevention methods that integrate biomedical; behavioural; social and structural prevention interventions to reverse the tide in the fight against HIV

Who is the Nutrition Workforce in the Western Cape?

Objectives: The aim of the present study was to determine the current nutrition staffing profile of the Integrated Nutrition Programme (INP) in Department of Health in the Western Cape; and establish whether it is adequate to meet the objectives of the INP. Method: Self-administered questionnaires compiled in eng were used as the main data collection instrument for nutrition staff in districts and at hospitals (n = 647). Eight individual questionnaires; one per staff category; were developed and utilised in the study. Results: Foodservice workers were the largest group of nutrition personnel (n = 509; 79); followed by dietitians (n = 64; 10); managers (n = 31; 5); auxiliary workers (n = 28; 4); and administrative workers (n = 15; 2). Sixty-two per cent of the nutrition workforce was located in urban areas and 38 in rural districts. Hospital and district dietitians experienced common problems; as well as specific differences. Regarding problems; both categories referred to limited resources; inadequate number of available posts; and lack of acknowledgement and support from administrative and supply chain management. District dietitians were also hampered by lack of space for consultations; poor referrals from doctors; insufficient posts for nutrition advisers; and difficulty in communicating with Xhosa-speaking patients. Hospital dietitians were hampered by insufficient interaction with district dietitians and lack of dietitians for specialised units.They also mentioned that poor salaries were affecting morale

Obstructive Sleep Apnoea and Obesity

The global obesity epidemic continues to gain momentum; and South Africa is one of those countries with an extremely high prevalence of obesity. The reported association between obstructive sleep apnoea (OSA) and obesity has resulted in a parallel increase in the incidence of OSA. Obesity and OSA interact by inducing systemic inflammation; metabolic aberrations and endocrine abnormalities; all of which predispose patients to atherosclerosis and cardiovascular disease. OSA is associated with a pro-inflammatory state; and increased serum C-reactive protein concentrations. Cardiovascular complications of OSA include myocardial infarction; stroke; congestive heart failure; hypertension and cardiac arrhythmias. The complications of OSA and obesity result in reduced quality of life; significant morbidity; and increased mortality; for untreated patients. OSA causes symptoms such as snoring; apnoea; excessive daytime sleepiness; and morning headaches; but 80-90 of patients are never diagnosed; or treated for their condition. Recognition of these symptoms; and referral of patients for a polysomnogram (home- or laboratory-based); expedites the diagnosis and therapy of OSA. While continuous positive airway pressure (CPAP) remains the mainstay of therapy; dietary measures are important; and should be implemented. Loss of weight can lead to significant reductions in the apnoea-hypopnoea index (AHI) of patients with OSA; and obese patients with OSA should aim for a 10 reduction in body weight