Cotyledon orbiculata var. oblonga from the south coast of the Western Cape, South Africa

The jury is out and the verdict is in, according to most leftist commentators on the African National Congress (ANC) government. The South African political leadership has forgotten its institution...

Decision letter: COVID-19 pandemic dynamics in South Africa and epidemiological characteristics of three variants of concern (Beta, Delta, and Omicron)

South Africa's AIDS response: the next 5 years

South Africa is an upper middle–income country with a population of 59.6 million people (1). Gauteng is the most densely populated province, and houses 26% of the population, followed by KwaZulu-Natal (19%), and the Western Cape (12%). About 29% of the population are <15 years old and 9% are ≥60 years. Approximately 13% of the population are seropositive for HIV. Life expectancy is estimated at 68.5 years for females and 62.5 years for males, whereas the infant mortality rate is 23.6 per 1000 live births. In 2019, the gross national income per capita was approximately $6040 (Atlas method, current US$), with 8% of the country’s gross domestic product spent on health care (2). Despite the transition to democracy in 1994, a high level of inequality remains, reflected in a Gini coefficient of 0.63 and an unemployment rate of 30% (2,3). This inequality is also reflected in a two-tiered health system. Access to a well-resourced private health care sector depends on the ability to pay for services, usually via medical insurance. Treatment for CKD is included in the set of “prescribed minimum benefits” that all registered medical insurance schemes in South Africa are obliged to provide for their members. The majority of South Africans (84%), however, are dependent on an under-resourced, government-funded, public health care sector. Public health care facilities use a sliding scale, where the fees charged are dependent on income. Indigent patients are able to access services free of charge (4). South Africa is faced with a high burden of infectious diseases (such as tuberculosis and HIV infection), noncommunicable diseases, maternal and childhood diseases, and injury-related diseases (5). These factors drive an epidemic of AKI and CKD. Two studies have estimated the population prevalence of CKD in South Africa. Adeniyi et al. (6) reported the …

White-breasted cormorants Phalacrocorax [carbo] lucidus breed around South Africa's coast and at inland localities. Along the coasts of the Northern, Western and Eastern Cape provinces, numbers breeding were similar during the periods 1977–1981 (1 116 pairs at 41 localities) and 2008–2012 (1 280 pairs at 41 localities). Along the coast of KwaZulu-Natal (not counted in 1977–1981), 197 pairs bred at nine localities in 2008–2012, when the overall number breeding around South Africa's coastline was about 1 477 pairs. Between the two study periods, numbers decreased in the Northern and Western Cape provinces following the loss of several breeding localities, but they increased in the Eastern Cape. In the Western Cape, however, numbers were stable east of Cape Agulhas and at nine well-monitored West Coast localities that were surveyed from 1978 to 2012. White-breasted cormorants breed throughout the year, with breeding at some localities more seasonal than at others and the timing of peaks in breeding varying at and between localities. In the vicinity of Saldanha Bay/Langebaan Lagoon (Western Cape), in Algoa Bay (Eastern Cape) and in northern KwaZulu-Natal, it is likely that birds moved between breeding localities in different years, although breeding often occurred at the same locality over several years. Human disturbance, presence of predators, competition for breeding space and occurrence of breeding by other waterbirds may influence movements between colonies. Securing sufficient good habitat at which white-breasted cormorants may breed will be important for conservation of the species. The species may breed at an age of 4 years, possibly younger. The bulk of their diet around South Africa's coast consists of inshore marine and estuarine fish species that are not intensively exploited by humans.

Diet, Body Size, and Landscape Use among Holocene People in the Southern Cape, South Africa

Diet, Body Size, and Landscape Use among Holocene People in the Southern Cape, South Africa

Wheat stripe rust, caused by the fungal pathogen Puccinia striiformis f. sp. tritici (Pst), occurs in all major wheat‐growing regions worldwide and poses a constant threat to production. In South Africa, Pst first emerged in 1996 in the Western Cape and has since caused frequent epidemics with three further distinct races (pathotypes) recorded to date. Herein, we undertook detailed genomic‐based analyses of four Pst isolates that represent the four dominant Pst races in South Africa recorded between 1996 and 2005. This analysis identified a number of polymorphic genes with features of known effector proteins and provided additional support of the likely stepwise changes in virulence profile of these South African Pst isolates. Next, we carried out comparative genomic‐based analyses with 54 additional Pst isolates collected across wheat‐growing regions within South Africa between 1996 and 2017 and 58 Pst isolates from East Africa, Pakistan, the UK, and France. This revealed a close genetic relationship between Pst isolates in South Africa and a number from East Africa. Furthermore, we found the South African Pst isolates also grouped closely with isolates identified in the UK in 2013 that were specifically found on triticale, illustrating long‐distance transmission of Pst isolates either between these regions or from a common independent source area. This highlights the critical need for close monitoring of Pst. With wheat being the most planted winter cereal crop in South Africa, investment in continuous surveillance is essential to rapidly identify any future introductions that could quickly lead to rust epidemics.

The genus Micaria Westring, 1851 (Araneae, Gnaphosidae) is a group of small (1.85-5 mm) ant-like spiders that can be distinguished from other gnaphosids by their piriform gland spigots that are similar in size to the major ampullate gland spigots. According to the World Spider Catalog, there are 105 species of Micaria in the world, of which only three species are known from the African part of the Afrotropical Region, namely M. chrysis (Simon, 1910), M. tersissima Simon, 1910 and M. beaufortia (Tucker, 1923). The objectives of this study were to revise Micaria in the Afrotropical Region, providing new and updated records for each of the species, evaluating the relationships between them using COI barcoding data, and providing information on their biology, mimetic relationships and feeding ecology. These objectives were met by collecting fresh material from the KwaZulu-Natal, Western Cape, Northern Cape and Free State provinces in South Africa. Fresh material of M. tersissima and M. chrysis were collected from their type localities, Komaggas and Port Nolloth (Northern Cape Province), respectively, for identification and DNA analyses. COI sequences generated, together with those sourced from Barcode of Life Data Systems (BOLD) and GenBank, were aligned using the CulstalW alignment algorithm in the Mega X software, and molecular phylogenetic analyses were performed using MrBayes for Bayesian Inference (BI) and RaxML for maximum likelihood (ML) analyses. Morphological examination of the collected and voucher material yielded 17 new species for the Afrotropical Region, namely M. basaliducta sp. nov. (♀, ♂, South Africa), M. bimaculata sp. nov. (♀, ♂, Mauritania), M. bispicula sp. nov. (♀, ♂, Namibia, South Africa), M. durbana sp. nov. (♀, ♂, South Africa, Zambia), M. felix sp. nov. (♀, ♂, Cameroon, Ethiopia, Malawi, Mozambique, Namibia, South Africa, Zambia, Zimbabwe), M. gagnoa sp. nov. (♀, ♂, Côte d'Ivoire, Mozambique, Mozambique, Tanzania), M. koingnaas sp. nov. (♂, South Africa), M. lata sp. nov. (♂, Namibia, South Africa), M. laxa sp. nov. (♀, South Africa), M. mediospina sp. nov. (♂, South Africa), M. parvotibialis sp. nov. (♀, ♂, Senegal), M. plana sp. nov. (♀, ♂, Ethiopia), M. quadrata sp. nov. (♀, Ethiopia), M. quinquemaculosa sp. nov. (♀, ♂, Namibia, South Africa), M. rivonosy sp. nov. (♀, ♂, Madagascar), M. sanipass sp. nov. (♂, South Africa) and M. scutellata sp. nov. (♂, South Africa). Furthermore, both sexes of M. beaufortia, as well as the male of M. tersissima, are redescribed. Both sexes of M. chrysis are described for the first time, as this species was only known from a juvenile. Of the previously known species, M. beaufortia (Botswana, Ethiopia, Lesotho, Namibia, South Africa, Zimbabwe) and M. chrysis (Côte d'Ivoire, Ethiopia, Lesotho, Namibia, South Africa, Tanzania) are widespread in the Afroptropics, while M. tersissima is only known from South Africa. Both the Bayesian inference and the maximum likelihood analysess recovered Micaria (sensu lato) as monophyletic with the inclusion of the subopaca group. The pulicaria species group was recovered as polyphyletic in both the BI and ML analyses. Four Afrotropical species, as well as the M. rossica Thorell, 1875/M. foxi Gertsch, 1933 group, formed a clade sister to M. formicaria (Sundevall, 1831). Eight of the Afrotropical species now have COI barcoding data uploaded to BOLD.

The Cape gannet is endemic to the southern African coast where it currently breeds at six islands: Mercury, Ichaboe and Possession off South West Africa and Bird (Lambert's Bay), Malgas and Bird (Algoa Bay) off South Africa. Previously, breeding also occurred at Hollams Bird, Halifax and Seal (False Bay) Islands. Equivocal records for Marcus, Dassen and Dyer Islands are not accepted. Off South West Africa, gannets were breeding at Hollams Bird, Mercury and Ichaboe Islands at least as early as 1828, but they only occupied Halifax and Possession Islands sometime between that date and c. 1885, possibly as a result of displacement of gannets from Ichaboe Island during exploitation of accumulated guano deposits in the early 1840s. Gannets bred at Hollams Bird Island until at least 1938, but had ceased breeding at Halifax Island by 1928. Off South Africa the earliest records of breeding are 1648, 1687, 1755 and 1912 for Malgas, Seal (False Bay), Bird (Port Elizabeth) and Bird (Lambert's Bay) Islands respectively. Gannets have not been reported at Seal Island since the late 17th century. On the west coast of Africa the Cape gannet is a regular nonbreeding winter visitor as far north as 4°20′N 6°00′E, but west of 6°E it is rare. On the east coast of Africa it is a common winter visitor as far north as Delagoa Bay, but farther north it is rare. Within its normal range the Cape gannet seldom occurs farther off shore than 100 km; it hardly ever moves inland. Aerial censuses of Cape gannets at breeding islands in 1967, 1969, 1978, 1980 and 1981 are compared with an aerial census conducted in 1956 and other published estimates of abundance. Between 1956 and 1980 the estimated number of breeding pairs at all colonies decreased from c. 150 000 to c. 80 000 and numbers decreased at all three extant gannetries off South West Africa. These decreases are attributed to a greatly diminished food resource following the collapse of the South West African pilchard stock after the late 1960s. The number of gannets decreased at Bird (Lambert's Bay) and Malgas Islands between 1956 and the late 1960s but subsequently increased, trends that are related to performances of the Western Cape pilchard and anchovy resources respectively. At Bird Island (Algoa Bay) gannets were up to 3,5 times more abundant in the late 1970s than in 1956. Other marine resources located east of Cape Point have shown similar large increases in recent years. Rates of increase of gannets at islands off South Africa during the 1970s would have required an unrealistically high survival for the first year had other population parameters remained constant. It is possible that birds emigrated from the South West African Islands. Few gannets have been reported oiled, and conservation of the species seems to be mainly affected by greatly reduced prey availability and injudicious guano harvesting. Human exploitation of juvenile gannets off the West African coast is difficult to assess.

Introduction In May 2000, South Africa's President, Thabo Mbeki, convened an international panel to consider the causes of and appropriate solutions to AIDS in the African context. Significantly, the panel included representatives from the so-called AIDS dissident community. The willingness of the President to entertain, if not unequivocally endorse, dissident science created an international stir. It resulted in the Durban Declaration, a petition of more than 5000 scientists in support of the 'orthodox' views of HIV, launched at the International AIDS Conference in July 2000. However, in October 2000, after several months of intense national and international media coverage on the issue, the President informed his party, the African National Congress (ANC), that he was withdrawing from public debate over the science of HIV/AIDS [1]. Moreover, the government announced that it would make the antiretroviral drug nevirapine available in pilot sites to prevent mother-to-child-transmission (MTCT) of HIV [2], thus meeting a long-standing demand from the AIDS community. It thus appeared as if the national impasse that had characterized much of 2000 was showing signs of ending. In this context, the mobilization of an alliance, led by the Treatment Action Campaign and the Congress of South African Trade Unions, in support of the South African government in its court battle with the pharmaceutical industry, gave the impression of a united front against AIDS. Government and activists jointly celebrated when, in the face of international and local disapproval, the Pharmaceutical Manufacturers Association withdrew its 3-year-old legal action in April 2001. [The court action was instituted against the Medicines and Related Substances Control Amendment Act (90) of 1997, specifically Section 15C, allowing for measures (compulsory licenses and parallel imports) that would allow government to procure essential drugs at cheaper prices.] However, the hopes that these events would put the AIDS response in South Africa on a new footing were premature. As the social and epidemiological crisis of AIDS unfolded, the political crisis surrounding AIDS intensified. During the course of 2001, the presidency's efforts to shape discourse on HIV were never far from the public space. Between February and May 2001, as the prices of antiretrovirals started falling and the generic manufacture of these drugs became a legal possibility, ANC Today, the web-based newspaper of the ANC, carried a series of articles about the dangers of antiretrovirals [3–6]. In September 2001, the President wrote a letter to the Minister of Health questioning mortality data (and therefore the magnitude of the HIV epidemic) [7]. Finally, reference to the dissident position emerged again in March 2002 when ANC leaders renewed the assetion that 'the hypothesis that HIV causes AIDS is an assumption, not a fact' [8]. Despite a promise of change, it was clear that the dimensions of earlier controversies (questioning the effects of drugs, the seriousness of the epidemic and the aetiology of the disease) were still at stake. In the meantime, the pre-occupation and fascination with the AIDS problem in South Africa has continued unabated in the scientific literature, locally as well as internationally (see for example [9–12]). But is what is happening in South Africa that exceptional [13]? The present paper analyses the factors underlying recent events in the field of AIDS in South Africa. It suggests first that the often stark reporting of the controversies around AIDS fails to represent what is in reality a nuanced and ambiguous policy environment. Second, the paper suggests that the positions of the state, while incomprehensible on the surface, are driven by a set of pre-occupations that are worth noting and opening up for greater international debate. Denial and beyond AIDS activist Zackie Achmat was echoing a commonly held view when he wrote that 'Mbeki epitomizes leadership in denial and his stand has fuelled government inaction' [14]. Denial is generally seen as an individual or collective inability to face an intolerable reality by pretending that it does not exist. It is portrayed as a problematic but common phase in coming to terms with HIV; a pathological moment in the personal or national psyche that has to be overcome if appropriate responses are to evolve [15,16]. The slogan 'breaking the silence' has become a kind of global leitmotiv in AIDS, suggesting that denial is a universal phenomenon. In the South African context, denial responds to two distinct logics: denial of reality, and denial of justice [17]. The rapidity of evolution and the force of the AIDS epidemic in South Africa, for which there are neither clear reasons nor simple solutions, are extremely difficult for anybody, whether state leader or lay person, to assimilate. In a denial of reality, leaders proclaim that the presence of AIDS is not true; meaning, it is not possible, so it is not. In addition, AIDS has emerged as a kind of everlasting affiliction precisely at the point when the end of apartheid should have brought a better life for all. This is a denial of justice: it is not normal; meaning, it is so, but it should not be. As one journalist put it 'how is it possible that, at the very moment we assume our victorious place as the leaders of a democracy we struggled for decades to bring about, we are presented with a dying populace, with a plague to which we have no answers?' [18]. The society is denied justice but is also itself denying justice. The government's brakes on the roll-out of nevirapine for MTCT have been fought on the basis of an unjustifiable denial of constitutionally entrenched social and economic rights. To suggest, however, that the essential character of the state's positions on AIDS is one of denial is not an adequate explanation. First, it is necessary to ask why the South African president, regarded as a credible African leader and a skilled diplomat capable of enormous discursive flexibility [19,20], should feel compelled to take such an awkward and unpopular stand on AIDS. In the face of massive condemnation and at enormous political risk, he has actively promoted an alternative reading of AIDS and its causes, questioning scientific facts and insisting on poverty as a factor in AIDS. This implies less a stance of silence than one of active defiance. Second, this stand has often been directly at odds with public policy on AIDS, which over the past few years has involved large and ever-increasing budgetary allocations and the implementation of programmes based on standard precepts for AIDS policy. It has thus been possible for the Director of the AIDS Program to play a leading role in the drawing up of normative frameworks such as the Abudja Declaration [21], and to say that she could insulate herself from 'the politics' and 'stay focused on delivery' [22]. It is also conceivable that, in the absence of intense political pressure from activists, MTCT prevention would have been decided and implemented in much the same way that many other health interventions have been in the post-apartheid era. Between the discourse and the policies of the South African state on AIDS lies a complex and sometimes contradictory set of motivations and processes, shaped in part by several years of controversy and contestation between various players over national AIDS policy, and in part by the longer history and experience of apartheid. MTCT as the focal point The AIDS policy process in South Africa has been characterized by disagreement and often overt conflict between political leaders and activists and researchers [23,24]. Despite their common origins in the political traditions of the anti-apartheid movement, a series of events in the AIDS field in the post-1994 period led to increasing alienation between these actors. The first was Sarafina II, an expensive AIDS musical commissioned by the Minister of Health in 1995 and openly criticized by the AIDS fraternity, in period when few were willing to challenge the new government. This was followed by over-hasty support by the government for virodene, a local AIDS 'treatment' discovery in 1997. Although eventually discredited, virodene was the subject of a media polemic between senior politicians (including Mbeki, Deputy-President at the time) and the scientific and medical community. Then, as the government launched the prevention-oriented Presidential Partnership Against AIDS in 1998, the activist community presented its own, treatment-oriented demands for the introduction of zidovudine for the prevention of MTCT. Arguments about the toxicity of zidovudine, including those made by dissident scientists, emerged at this point, with Mbeki (becoming President in 1999) increasingly intervening in public debates on AIDS and MTCT. Despite broad support from within the state bureaucracy for an MTCT programme, plans to initiate pilot sites during 1998 and 1999 were brought to an abrupt halt by political leaders (except in the Western Cape, a non-ANC aligned province, which instituted a zidovudine-based MTCT programme). Although HIV-infected infants account for less than 5% of total HIV infections in South Africa, and preventing these infections involves a relatively uncomplicated intervention, the issue of MTCT has assumed a political and symbolic importance way beyond its epidemiological and public health relevance. State resistance to MTCT can be seen as an ongoing attempt to establish and maintain its authority over the content and pace of AIDS policy. For activists, MTCT represents one of the first significant interventions, affordable and implementable on a large scale, targeted at people already infected with HIV. As a symbol of hope centred on children, MTCT has broad public appeal. The highly publicized story of Nkosi Johnson, the HIV-infected child who died at the age of 12 years in June 2001, exemplified the tragedy of HIV. MTCT also signals the entry of and the possibility of broader access to antiretrovirals in the public sector. Not insignificantly, a local research community involved in MTCT studies has provided the evidence and scientific legitimacy for a focus on MTCT [25,26]. Conflict and consensus Between May and November 2001, after ongoing pressure from a range of stakeholders and 9 months after first indicating its intentions, the government established 18 MTCT pilot sites (based on nevirapine) across the country, reaching about one-tenth of pregnant women using the public sector [27]. Further roll-out was to wait for 2 years of experience in the pilot sites. Frustrated at the slow pace of implementations of the MTCT programme, the Treatment Action Campaign and two other groups launched an application in the Pretoria High Court in August 2001, seeking to make nevirapine immediately accessible in the public sector outside of pilot sites 'if the doctor or attending nurse feels this is necessary' [28] and 'demanding that the government institute a comprehensive programme across the country to reduce mother-to-child HIV transmission' [28]. This legal action set in motion a new period of conflict ultimately leading to a resolution, in April 2002, in which the national Cabinet gave the go-ahead to roll-out MTCT and to widen the use of antiretrovirals [29]. These struggles (presented chronologically in Table 1) were significant for a number of reasons.Table 1: Chronology of events initiated by various actors around mother-to-child-transmission (MTCT) in 2001 and 2002.Seen as a whole, the positions of the ANC, the president and the executive suggest considerable ambiguity towards MTCT. Echoing the general 'two steps forward-one step back' dynamic of AIDS policy in the recent era, at several points statements in support of MTCT were made and policy processes set in motion for a roll-out, only to be contradicted shortly afterwards. For example, in February 2002, on the occasion of the opening of parliament, the President announced increased spending for AIDS, including for the expansion of the MTCT progamme. This was seen by 'the general community of media and analysts … as a turning point' in which 'Mbeki had done a Muhammed Ali shuffle, deftly moving out of the corner of the lingering debate about his views on Aids' [35]. The official position had evolved from open denial of scientific facts to more subtle concerns with public health infrastructure. However, soon after, things appeared to go back to square one, when the Minister of Health countered an initiative by the Gauteng Province to roll-out MTCT and was supported by the ANC, which not only called a halt to further roll-outs, but once again opened the debates on the cause of HIV [36]. Then, just 1 month later in another major turn-around, Cabinet issued its wide-ranging statement on AIDS [29] in which, among others, it committed the government to respecting the court rulings on nevirapine, preparing an MTCT prevention roll-out plan as a matter of urgency and making antiretroviral drugs available as post-exposure prophylaxis to rape survivors. Furthermore, Thabo Mbeki formally distanced himself from the dissident scientists [37]. As the issue of MTCT began to threaten the legitimacy of the government, inside and outside South Africa, these seemingly contradictory positions appeared to be manifestations of intense contestation within the state. Not only were increasingly strong views being expressed on the issue within the ANC (including by the former president Nelson Mandela, the ANC's health desk and other ANC ministers in the cabinet), but HIV was at the centre of interactions with the parties and groupings in alliance with the ANC (the trade union federation the Congress of South African Trade Unions, the Communist Party and the Inkhatha Freedom Party). Using their autonomy in a quasi-federal system, two provincial governments began MTCT roll-outs despite national disapproval. These internal pressure and the external court process eventually led to the consensus outlined by the Cabinet in April 2002. Conflict as a resource The events around MTCT, relayed on a blow-by-blow basis to the nation and the world by avid media scrutiny, have had a number of political consequences that may ultimately reveal themselves as resources for democracy. There has been a striking degree of public criticism of executive decision-making on the part of all players, within and outside the state. A tendency towards 'solidarity' politics in the ruling class where 'party members in good standing are defended against criticism by outsiders even though they may have broken the moral code of the national community at state level' [38] has been challenged, and the right of social movements outside the formal political alliances of the ANC to participate in the AIDS policy process asserted. Apart from its impact on political practice, the MTCT issue has brought the judiciary into play in meeting the needs of the poor. The Treatment Action Campaign court application in August 2001 was based on the right to health care contained in the Bill of Rights in the new South African Constitution. This right forms part of a broader set of social and economic rights for which the state is required to take 'reasonable legislative and other measures within its available resources, to achieve the progressive realization of each of these rights' [39]. The eventual ruling by the Constitutional Court is seen as setting a precedent in clarifying the extent to which it can intervene in executive decision-making on social policy. On the contrary, despite a series of judgments against it, the executive has shown its repsect for the independence of the judiciary by rapidly countering a suggestion (made on one occasion by the Minister of Health) that one of the court rulings on nevirapine would not be heeded, and by repeatedly reiterating its intention to implement the decisions of the courts. If the political battles have created confusion in the minds of ordinary citizens and delayed necessary action, the effects on AIDS may not all be negative. The intense coverage of the issues has brought AIDS to the centre of national consciousness, and the growing link being made between HIV and broader socio-economic rights can only benefit the society's ability to deal with it in the long term. However, in the discourse around AIDS and in the frequent reference to issues of race, promiscuity and conspiracy, lies a set of unresolved tensions that are likely to resurface. Race and conspiracy As with ill-health generally, AIDS in South Africa is a highly unequal phenomenon, reflecting the gradients of racial advantage under apartheid [40]. Openly racist interpretations of the AIDS epidemic that were common in the apartheid era [41,42] now continue in deeply held stereotypes of African sexuality as violent and uncontrolled [43]. Intellectuals such as Frantz Fanon [44] have pointed out that such assumptions allow the West to create a self-image and identity of purity against the 'degenerate other' of Africa. Mbeki was no doubt referring to this, in his speech to (largely black) university students in October 2001, when he said: 'Convinced that we are but natural-born, promiscuous carriers of germs, unique in the world, they proclaim that our continent is doomed to an inevitable mortal end because of our unconquerable devotion to the sin of lust' [45]. Racism in AIDS is just one part of the daily reality faced by black people in South Africa. Eight years after the political transition, South Africa remains one of the most unequal societies in the world [46]. While the de-racialization of the state and civil service has permitted the rapid growth of a black middle class, social and economic privilege is still heavily concentrated in the hands of the white population [47]. A focus on AIDS through the lens of racial experience thus forms part of a general shift in the national political language from the Mandela era of reconciliation, to the Mbeki era in which widening social inequalities have to be both explained and confronted [20]. In Africa, discourses of persecution and conspiracy linked to AIDS, whether by the pharmaceutical industry, medical researchers or Westerners, have not been unusual, where they have been dismissed as a kind of post-colonial complex without factual grounding [48]. However, in the case of South Africa, not far back in people's memories is a long tradition of racial public health that included many attempts, for example, to control African fertility, both legally [49] and illegally. The Truth and Reconciliation Commission hearings revealed a covert Chemical and Biological Warfare Program intended to eliminate black leaders and to create infertility among black people [50]. It should not, therefore, come as a surprise that the experience of AIDS is interpreted in the light of past suspicion. The position of the President can thus be seen as an attitude of defiance towards official scientific knowledge, a deliberate act to challenge established truths of AIDS, whether biological or social, and an identification with those on the margins, whether of science or society. Such heterodoxy takes place often on behalf of Africa and within the framework of the ideological model of African Renaissance, emphasizing the necessity for the black continent to find its own solutions to its own problems [51]. This was the context of the Presidential AIDS Advisory Panel and its key question: 'Why is AIDS heterosexually transmitted in sub-Saharan Africa, while it is largely homosexually transmitted in the Western world?' [52]. Although this could be taken as a desire to assert a distance between 'African' sexuality and 'Western' homosexuality [16], the direction of inquiry is guided by another of the terms of reference in which panelists were asked to consider 'Prevention of HIV/AIDS, particularly in the light of poverty, the prevalence of co-existing diseases and infrastructural realities in developing countries'. AIDS in Africa is thus located in a specific social and economic reality, than in the of both is a resistance to the of African and the desire to alternative for the very often in the of These pre-occupations point to an international silence in AIDS research on the reasons for the of the epidemic in Africa, and for its in Africa. The of HIV in South Africa a series of HIV beyond a degree of we have of the reasons for the A by African with and HIV prevalence that could not account for epidemiological the reality is that AIDS in Africa is still with a of and a by the global of a rights discourse in such as the International Partnership Against AIDS in Africa and the of AIDS held in 2001. These reduce the problem to the of and reduce the response to This is in the view that the to control AIDS in from governments to own the problem of AIDS and to implement internationally is a of the social, economic and of the which could not only the reasons for the of AIDS in Africa and the large within the but also to suggest appropriate Such responses are likely to African for the epidemic in a context of local and global a better by AIDS activists in the past few In the case of South Africa, more than a of racial overt has the of the through economic of social and of and While in the earlier years of the epidemic there were at a of AIDS in Africa as points out has been is an that biological and social data into an of the social context of HIV in In other a social that on both social and the field of inequalities research in public health from the reality of Africa and from the of Thabo Mbeki, these may themselves be seen as a denial of justice.

Psidium cattleyanum (Myrtaceae) is a widespread invasive species in several countries, particularly on oceanic islands. The species was first recorded in South Africa in 1948 and has since established self-sustaining populations. We present the first comprehensive evaluation of the invasiveness of P. cattleyanum in South Africa by: 1) mapping the current distribution of the species; 2) estimating its potential range using species distribution models in MaxEnt; 3) analysing the risk posed to South Africa using the risk analysis for alien taxa framework; and 4) developing recommendations for regulation. Psidium cattleyanum was recorded at 52 sites in four provinces across South Africa, with the population in the Western Cape being the first substantial invasive population reported from a temperate winter-rainfall region globally. Invasive populations were assessed in detail at four sites: Newlands Forest (Western Cape; n=2193 plants; covering ∼12 ha), Eshowe (KwaZulu-Natal; n=1561, ∼7.6 ha), Southbroom (KwaZulu-Natal; n = 449, ∼2.9 ha), and George (Western Cape; n=214, ∼2.4 ha). At all four sites the species is self-sustaining and there is evidence of spread. In South Africa, the east coast is climatically suitable for the species to expand its range. Although damaging invasions of P. cattleyanum have only been recorded on several islands to date, we find no reason to suggest that climatically suitable continental regions (including parts of South Africa) will not suffer harmful impacts if invasions progress unmanaged. As such, we support the current regulation of P. cattleyanum in South Africa, whereby the species must be controlled as part of a national management plan (category 1b) noting that while it is advisable to ban cultivation, the forcible removal of plants from people's gardens should perhaps only be prioritised if such plantings clearly pose a high risk (i.e., in climatically suitable regions near to riparian areas or natural areas).

Uptake of HIV testing is critical to halting the spread of HIV. Our study aimed to examine the coverage of HIV testing and self-testing and the individual-level, household-level and community-level factors associated with HIV testing and self-testing awareness. We analysed data of 12 312 men and women from 2016 SADHS and used multilevel mixed-effects models to examine the factors associated with uptake of HIV testing and self-testing awareness. About 80% of participants had ever tested for HIV, and 64% had tested in the past year. Only 49% of adolescents aged 15-19years had ever tested for HIV compared with over 80% of adults. Self-testing awareness was low (22%), and only 2.9% of respondents had ever self-tested for HIV. The odds of having ever tested for HIV were significantly higher among respondents who were aged 25-29 (AOR: 4.02; 95% CI: 3.27-4.95), had a higher level of education (AOR: 3.18; 95% CI: 2.19-4.61), were married (AOR: 1.63; 95% CI: 1.36-1.94), had high media exposure (AOR: 1.23; 95% CI: 1.06-1.44) and had ever had sex (AOR: 5.57; 95% CI: 4.67-6.64), but lower among men (AOR: 0.39; 95% CI: 0.35-0.44). In conclusion, HIV testing coverage is high in South Africa relative to most countries in sub-Saharan Africa, but falls short of the UNAIDS first 95. We found no evidence of socioeconomic and geographic inequalities in access to HIV testing. However, adolescents had a lower level of HIV testing uptake, suggesting a need for interventions to expand testing in this age group.

To provide a model to estimate human resource needs for community-based mental health services in South Africa. A situation analysis was conducted of current community-based mental health service provision in South Africa, which comprise outpatient and emergency services, residential care and day care. Service utilisation rates and staffing needs were estimated for two levels of service coverage, using data from the situation analysis, local epidemiological studies and consultation with key stakeholders. For a population of 100,000 people, 7.3-23.8 full-time equivalent staff would be required to provide services in outpatient services, 14.9-41.6 in day care and 11.5-23.0 in residential care at minimum and full coverage levels respectively. The model can facilitate rational planning by requiring transparency and accountability in the assumptions used. This method can be adapted to a range of countries, by entering relevant country data. The model fills a gap, particularly in low- and middle-income countries, where community-based mental health services are sparse, and decisions regarding allocations to them are hampered by a lack of good quality data. The results of the model are limited by the quality of data and the assumptions upon which the modelling are based.

Understanding the Implications of Mitochondrial DNA Variation in the Health of Black Southern African Populations: The 2014 Workshop.