Black South Africans Research Articles

The middle class and suburbia: desegregation towards non-racialism in South Africa?

ABSTRACT ‘Non-racial democracy’ is an aspirational goal of South Africa’s post-apartheid democracy. Deracialisation of public spheres, notably education and work, has led to high rates of upward social mobility among black South Africans and the increasing racial diversification of the middle class, which under apartheid, had remained overwhelmingly white. Despite the increased racial integration of public life, the majority of South Africans continue to live in mono-racial residential areas. Much of the responsibility for this lies in the legacy of apartheid geography. The legacy of apartheid has entrenched the spatial segregation of the officially defined races and ensured that white suburbs were the most socially advantaged and desirable places in which to live. Today, white suburbs continue to occupy the top rungs of the residential ladder, their privilege protected by the economic costs of entry. Nonetheless, high rates of black upward mobility and aspiration result in increased black entry into these historically white spaces, which are themselves undergoing considerable change in shape and character. As a result, white suburbia constitutes a major site where the struggle for non-racialism is taking place.

Applicability of the Nolla Classification Scheme within the KwaZulu-Natal population of South Africa

BackgroundDental age estimation is important in clinical practice for orthodontic treatment, forensic sciences and radiology. The Nolla (1960) classification scheme is one of the most frequently utilized estimation tools in teaching and clinical practice. However, the applicability of the Nolla (1960) classification scheme in determining age in a select KwaZulu-Natal population of South Africa is unknown. Therefore, this study aimed to determine the applicability of the Nolla Classification Scheme on a select South African sample of KwaZulu-Natal and develop a regression model to extend the Nolla (1960) maturation and age norm tables beyond 17 years. Materials and methods840 digital panoramic radiographs of individuals aged between 5 and 25 years met the inclusion criteria. The 8 maxillary and 8 mandibular teeth in the left quadrant was analysed using the Nolla (1960) Classification Scheme. The paired T-test, Wilcoxon and Polynomial Regression Analysis were performed. ResultsThe original Nolla (1960) method over-estimated age for the entire sample in this study by −0.39 and −0.57 years in females and males, respectively. While, the modified Nolla (1960), highlighted an overall under-estimation in females, but over-estimation in males aged between 18.00 and 18.99 years. ConclusionThe Nolla Classification scheme over- or under-estimated dental age with the select population group, therefore population-specific tables were developed for the South African Black and Indian population groups of KwaZulu-Natal. This may increase the accuracy of age estimation of the selected South African sample within the KwaZulu-Natal region.

Abstract 4060: Identification of anti-neoplastic compounds on a triple negative breast cancer cell line from T. violacea

Abstract Background: The incidence of Invasive triple negative breast cancer (TNBC) is higher than average in South Africa, with 90% of patients being Black South Africans. Current treatments for breast cancer are associated with severe side effects. Additionally, TNBC is resistant to hormone therapy commonly used to treat other forms of breast cancer. Tulbaghia violacea, a plant native to Southern Africa, is a medicinal herb used in traditional medicine. This study aims to establish the impact of water soluble extracts from T. violacea on TNBC cancer cell lines and identify any anti-cancer compounds present in this extract. Methods: Following the determination of the IC50 value for this extract. The anti-proliferative and anti-metastatic activities of the extract on the TNBC cell line were determined using scratch assays and cell invasion and migration assays, performed using real time cell analysis. The pro-apoptotic action of the extract on the TNBC cell line was determined using flow cytometry cell death assays. Once the anti-cancer activity of the extract was confirmed, the composition of the extract was determined in order to establish what known or possible anti-cancer compounds are present within it. This was performed using gas chromatography-mass spectroscopy (GC-MS). The structure of these identified compounds was then confirmed using Nuclear Magnetic Resonance (NMR). Results: The IC50 value for the T. violacea water soluble extract against MDA MB 231 cells was determined to be ~350 µg/mL. The extract was also shown to have anti migration and invasion as well as pro-apoptotic effects on these cells. Fourteen known anti-cancer compounds were identified in this water soluble extract. In addition to this multiple other compounds were shown to also be present in the extract. Discussion: The water soluble T. violacea leaf extract has cytotoxic effects and the ability to inhibit proliferation and metastasis in a TNBC cell line. The identification of fourteen compounds with known anti-cancer activity may explain the effects this extract has on these TNBC cells, however, the contribution made by any of the other compounds to this activity remains to be determined. Conclusion: These findings suggest that one or more of the compounds present in T. violacea may serve as lead compounds for the development of new treatments for TNBC. Citation Format: Zodwa Dlamini, Clement Penny, Rodney Hull, Mohammed Alouna. Identification of anti-neoplastic compounds on a triple negative breast cancer cell line from T. violacea [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4060.

Being near the action: bed and breakfast and guesthouse entrepreneurs and the hosting of black South African domestic tourists in the Cape Town townships

This article examines how black female bed and breakfast (B&B) and guesthouse entrepreneurs in the black townships of Cape Town, South Africa were providing accommodations to black South African domestic tourists that allowed these tourists to ‘be near the action’ in the townships. ‘Being near the action’ refers to being able to conveniently attend various life-cycle events, such as weddings, funerals, and circumcision celebrations that involve friends and/or family, or engage in work, business, and other activities in the townships. This research contributes to tourism mobilities studies by explaining how these entrepreneurs impacted and were being impacted by domestic tourism and how the social spaces or ‘moorings’ of the entrepreneurs’ accommodations produced and reproduced social and cultural life. In addition, this study provides an understanding of tourism in Africa, and specifically domestic tourism in South Africa, related to the discretionary mobilities of a growing population of middle-class black South Africans. For this study, data was collected through semi-structured interviews conducted with black female B&Bs and guesthouse entrepreneurs in the townships of Langa, Gugulethu, and Khayelitsha. The article also includes a discussion of the possible implications of the COVID-19 pandemic’s halting of travel mobilities on the economic sustainability of these entrepreneurs.

Targeted proteomics of appendicular skeletal muscle mass and handgrip strength in black South Africans: a cross-sectional study

Although appendicular skeletal muscle mass (ASM) and handgrip strength (HGS) are key components of sarcopenia, their underlying biological mechanisms remain poorly understood. We aimed to investigate associations of circulating biomarkers with ASM and HGS in middle-aged black South Africans. This study consisted of 934 black South Africans (469 men and 465 women, aged 41–72 years) from the Middle-aged Soweto cohort. Linear regression models were used to examine relationships between 182 biomarkers (measured with proximity extension assay) and dual-energy X-ray absorptiometry-measured ASM and dynamometer-measured HGS. Age, height, sex, smoking, alcohol, food insecurity, physical activity, visceral adipose tissue, HIV and menopausal status were included as confounders. Regression models showing sex-interactions were stratified by sex. The Benjamini–Hochberg false discovery rate (FDR) was used to control for multiple testing, and FDR-adjusted P values were reported. In the total sample, 10 biomarkers were associated with higher ASM and 29 with lower ASM (P < 0.05). Out of these 39 biomarkers, 8 were also associated with lower HGS (P < 0.05). MMP-7 was associated with lower HGS only (P = 0.011) in the total sample. Sex-interactions (P < 0.05) were identified for 52 biomarkers for ASM, and 6 for HGS. For men, LEP, MEPE and SCF were associated with higher ASM (P < 0.001, = 0.004, = 0.006, respectively), and MEPE and SCF were also associated with higher HGS (P = 0.001, 0.012, respectively). Also in men, 37 biomarkers were associated with lower ASM (P < 0.05), with none of these being associated with lower HGS. Furthermore, DLK-1 and MYOGLOBIN were associated with higher HGS only (P = 0.004, 0.006, respectively), while GAL-9 was associated with lower HGS only (P = 0.005), among men. For women, LEP, CD163, IL6, TNF-R1 and TNF-R2 were associated with higher ASM (P < 0.001, = 0.014, = 0.027, = 0.014, = 0.048, respectively), while IGFBP-2, CTRC and RAGE were associated with lower ASM (P = 0.043, 0.001, 0.014, respectively). No biomarker was associated with HGS in women. In conclusion, most biomarkers were associated with ASM and not HGS, and the associations of biomarkers with ASM and HGS displayed sex-specificity in middle-aged black South Africans. Proteomic studies should examine ASM and HGS individually. Future research should also consider sexual dimorphism in the pathophysiology of sarcopenia for development of sex-specific treatment and diagnostic methods.

Skin cancer risk factors among Black South Africans-The Johannesburg Cancer Study, 1995-2016.

BackgroundThe Black population has lower skin cancer incidence compared to White, Indian/Asian, and Mixed‐race populations in South Africa; however, skin cancer still exists in the Black population. The aim of this study is to identify risk factors associated with skin cancer among Black South Africans.Materials and MethodsA case‐control study was conducted. Cases were patients with keratinocyte cancers (KCs) and/or melanoma skin cancers (MSCs) and controls were cardiovascular patients. Sociodemographic exposures, environmental health variables, smoking, and HIV status were assessed. Stepwise logistic regression was used to identify risk factors associated with KCs and MSCs.ResultsThe KCs histological subtypes showed that there were more squamous cell carcinomas (SCCs) (78/160 in females, and 72/160 in males) than basal cell carcinomas (BCCs). The SCC lesions were mostly found on the skin of the head and neck in males (51%, 38/72) and on the trunk in females (46%, 36/78). MSC was shown to affect the skin of the lower limbs in both males (68%, 27/40) and females (59%, 36/61). Using females as a reference group, when age, current place of residency, type of cooking fuel used, smoking, and HIV status were adjusted for, males had an odds ratio (OR) of 2.04 for developing KCs (confidence interval [CI]: 1.08–3.84, p = .028). Similarly, when age, current place of residency, and place of cooking (indoors or outdoors) were adjusted for, males had an OR of 2.26 for developing MSC (CI: 1.19–4.29, p = .012).ConclusionsDifferences in the anatomical distribution of KCs by sex suggest different risk factors between sexes. There is a positive association between being male, smoking, rural dwelling, and a positive HIV status with KCs and being male and rural dwelling with MSC. The rural dwelling was a newly found association with skin cancer and warrants further investigation.

Epistemic decoloniality of westernised higher education: A discourse on curriculum justice and knowledge integration at historically white universities in South Africa

This article seeks to delve deeper into the discourse about the epistemic decoloniality of Westernised higher education in South Africa. Discrete academic studies have indicated that African Knowledge paradigms have not found a home in South Africa’s Westernised academies yet; knowledge patterns remain foreign and colonized. The current curriculum at a section of Historically White Universities in South Africa largely reflects the colonial and apartheid worldviews and is disconnected from African realities, including the lived experiences of most black South Africans, taking into account Arts and Humanities. Based on an examination of the decoloniality project and curriculum dishonesty and reform through literature study, the article calls for critical rethinking and reconfiguration, which should position South Africa, Africa, and last of all, the globe at the centre of knowledge production. Epistemic decoloniality at South Africa’s Historically White Universities should not be pursued with knowledge violence but rather with scholarly debate. This article introduces the framework of decoloniality by tracing the genesis of (South) Africa’s knowledge coloniality and initiates a discussion on the current epistemic decoloniality in South Africa’s Westernised higher education. The focus is on curriculum justice and knowledge integration across Historically White Universities in South Africa. The last portion of the paper applies the proposed measures to evaluate the cogency of decolonial discourses.

Creating a ‘deplorable impression’: the Dryden Society’s 1969 tour of South Africa and the making of End of the Dialogue

ABSTRACT In July 1969, the Dryden Society, a University of Cambridge performing arts group, arrived in South Africa for a three month tour. Prior to its departure from the United Kingdom, the group’s decision to break the cultural boycott, imposed in response to apartheid, had already caused significant protest. This article discusses the nature of the campaign to stop the tour, as well as highlighting how the British government became involved. The article also demonstrates how, despite having no official support, the tour should be viewed within the prism of British cultural diplomacy, something the British representatives in South Africa were trying to expand at the time. Additionally, the article also draws attention to the ulterior motives of several members of the touring party, who used the tour as cover to clandestinely film the conditions in which South Africa’s black majority lived on behalf of the Pan-Africanist Congress. This was later used to make the critically acclaimed documentary film End of the Dialogue (known in South Africa by its Zulu name of Phela-ndaba) which drew greater international attention to the plight of black South Africans living under apartheid.

How does ethnic diversity affect energy poverty? Insights from South Africa

We examine the effect of ethnic diversity on energy poverty in post-apartheid South Africa after several decades of racial segregation. We use both ethnic fractionalisation and polarisation indexes along with a multidimensional energy poverty measure from a five-year South African household-level panel data. Using historical information on ethnic diversity at the provincial level as an instrument to address endogeneity, we find that one standard deviation increase in ethnic diversity is associated with a 0.272 standard deviation decrease in energy poverty. This finding is robust across several quasi-experimental econometric approaches, different measures of ethnic diversity, and alternative cut-offs used to identify energy poor households in a multidimensional construct. Further analyses reveal that ethnic diversity reduces energy poverty only among people of colour, with the largest effect observed among native Black South Africans. Our mediation analysis highlights enhanced job opportunities and increased household incomes as the potential pathways through which ethnic diversity reduces energy poverty.

Perceived diversity, threat, and attitudes towards immigrants: the mitigating role of cross-group friendships and empathy

Little is known about whether the benefits of intergroup contact extend to contexts (e.g., a diverse underdeveloped township) likely to prove demanding for improved intergroup relations. There is a need for further research in these contexts on the potential inhibitors of contact (such as diversity and threat) and their effects. Perceived social diversity has been implicated in the deterioration of intergroup relations. This is particularly salient in the context of immigrant relations, where anti-immigrant sentiments are characterized by perceived threat and lower outgroup trust. Diversity can, however, have an indirect positive effect on outgroup attitudes, via intergroup contact, which reliably predicts lower perceived threat and prejudice. Moreover, recent evidence suggests that empathy could mitigate negative attitudes towards immigrants. We investigated the relationship between perceived neighbourhood diversity, cross-group friendships, realistic and symbolic threat, empathic responding, trust, and outgroup orientation within the volatile context of Black (African) South Africans’ relations with African immigrants. Survey data were collected from South Africans ( N = 317) living in a township. Structural equation modelling showed that perceived diversity was significantly positively associated with both realistic threat (which was significantly negatively associated with outgroup trust) and cross-group friendships (which was significantly negatively associated with realistic threat). There was a significant indirect association between cross-group friendships and positive orientation towards African immigrants via empathic responding towards African immigrants. These findings suggest that cross-group friendships and empathy might mitigate the negative impact of diversity and threat on attitudes towards immigrants, even in this demanding context.

Comorbidities in Black South Africans with established rheumatoid arthritis.

ObjectiveComorbidities contribute both to morbidity and mortality in rheumatoid arthritis (RA). The aim of the current study was to investigate the prevalence and spectrum of comorbidities in South Africans with established RA.MethodsA retrospective, consecutive case record review of 500 Black South African patients with established disease of ≥5 years attending a tertiary rheumatology service was performed. Common comorbidities including those listed in the Charlson Comorbidity Score (CCS) were documented.ResultsMost patients, 463 known alive (AG) and 37 known deceased (DG), were female (87%). Mean (SD) age and disease duration were 60 (11.1) and 10.7 (5.0) years respectively, and 98% had ≥1 comorbidities. Median CCS was 2, significantly higher in DG than AG (4 vs 2, P < .0001). Despite hypertension (70%) and hypercholesterolemia (47%) being the commonest comorbidities overall and type 2 diabetes (T2D) occurring in 15.4%, clinical cardiovascular events were rare (0.6%). Peptic ulcer disease (odds ratio [OR] = 8.67), congestive cardiac failure (OR = 7.09), serious infections (OR = 7.02) and tuberculosis (OR = 2.56) were significantly more common in DG than AG. Multivariate analysis showed that American College of Rheumatology functional class 3/4 was associated with increased risk for serious infections (OR = 3.84) and tuberculosis (OR = 2.10).ConclusionDespite the high burden of cardiometabolic comorbidities in South Africans with established RA, cardiovascular events were rare. Serious infections and tuberculosis, both associated with severe functional disability, are a major cause of morbidity and mortality.

Employment precarity and energy poverty in post-apartheid South Africa: Exploring the racial and ethnic dimensions

This study examines the link between employment precarity and energy poverty from racial and ethnic perspectives. Data are extracted from a five-year panel survey from South Africa—a country noted for its high rate of racial, ethnic and gender segregation of occupations. Both employment precarity and energy poverty are measured using multidimensional indices. Our endogeneity corrected results indicate that employment precarity is associated with higher likelihoods of energy poverty, with racial and ethnic heterogeneities. These findings are consistent across different endogeneity-resolving techniques, alternative ways of capturing energy poverty, and robust to different cut-offs and weighting schemes used for the energy poverty index. Based on race, we find that employment precarity increases energy poverty more among Black South Africans compared to White/Asian/Indian/Other South Africans. Ethnically, the increasing effect of employment precarity on energy poverty is lowest among the Afrikaans/English speakers and highest among the Venda ethnic group. Labour income is identified as an important pathway through which employment precarity influences energy poverty.

Obesity, blood pressure and retinal microvascular phenotype in a bi-ethnic cohort of young children

Background and aimsChildhood obesity and high blood pressure (BP) are main determinants for cardiovascular disease development with regional and ethnic differences. Narrower arteriolar (CRAE) and wider venular (CRVE) retinal vessel diameters are sensitive markers of early vascular compromise in children. We aimed to compare retinal vessel diameters and investigate associations and odds ratios with body mass index (BMI) and BP in a multi-national/ethnic childhood study. MethodsBMI, systolic (SBP) and diastolic BP (DBP) were screened in 929 black and white South African (SA) and 1171 Swiss children (aged 5–9 years). Retinal assessments were performed using a retinal vessel analyzer to determine CRAE and CRVE. ResultsBlack SA children had wider CRVE compared to white SA and Swiss children (all p < 0.001). However, BMI or BP was not associated with CRVE in black SA children. Higher BMI and BP associated with narrower CRAE in all children, except for BMI in black SA children, in whom narrower CRAE was found for every unit increase in SBP (β = −0.199 μm, p = 0.001) and DBP (β = −0.312 μm, p < 0.001). Obesity (OR:1.38[1.01; 1.89]), hypertension (OR:1.90[1.53; 2.36]) and black ethnicity (OR:1.50[1.18; 1.92]) increased the likelihood for arteriolar narrowing. ConclusionsBlack SA children presented with wider retinal venules compared to their white SA and Swiss peers, which was unexplained by conventional risk factors. The overall risk of arteriolar narrowing was driven by obesity, hypertension and ethnicity. Our findings indicate the importance to differentiate cardiovascular risk by microvascular phenotype in different populations and ethnicity early in life.

Lifestyle factors associated with sex differences in Kaposi sarcoma incidence among adult black South Africans: A case-control study

Kaposi Sarcoma (KS) is endemic in several countries in Southern and Eastern Africa, relatively rare worldwide but a leading cancer among people living with HIV. KS has always been more common in adult males than females. We assessed the prevalence of known cancer modifying factors (parity, hormonal contraceptive use in females, sex-partners, smoking and alcohol consumption in both sexes), and their relationship to KS, and whether any of these could account for the unequal KS sex ratios. We calculated logistic regression case-control adjusted odds ratios (ORadj), and 95% confidence intervals (95%CI), between KS and each of the modifying factors, using appropriate comparison controls. Controls were cancer types that had no known relationship to exposures of interest (infection or alcohol or smoking or contraceptive use). The majority of the 1275 KS cases were HIV positive (97%), vs. 15.7% in 10,309 controls. The risk of KS among those with HIV was high in males (ORadj=116.70;95%CI=71.35–190.88) and females (ORadj=93.91;95%CI=54.22–162.40). Among controls, the prevalence of smoking and alcohol consumption was five and three times higher in males vs. females. We found a positive association between KS and heavy vs. non-drinking (ORadj=1.31;95%CI=1.03–1.67), and in current heavy vs. never smokers (ORadj=1.82;95%CI=1.07–3.10). These associations remained positive for alcohol consumption (but with wider CIs) after stratification by sex, and restriction to HIV positive participants. We found no evidence of interactions of smoking and alcohol by sex. Smoking and alcohol consumption may provide a possible explanation for the KS sex differences, given both exposures are more common in men, but confounding and bias cannot be fully ruled out. The role smoking and alcohol play in relation to viral loads of HIV/KSHV, differences in immunological responses or other genetic differences between males and females warrant further studies.

Marital experiences and depressive symptoms among older adults in rural South Africa

This paper advances the understanding of how marital transitions may influence mental health by investigating these associations among a population of rural, Black South Africans aged 40+ that was directly impacted by apartheid. Using two waves of data from 4,176 men and women in Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI), we investigated associations between marital experiences and depressive symptoms, by gender, and explored whether economic resources is a moderator of these associations. We found that experiencing a marital dissolution was associated with more depressive symptoms than remaining married for both men and women. We also found that men, but not women, report greater depressive symptoms if they remained separated/divorced, remained widowed, or remained never married between waves. We found no evidence that a decline in wealth moderated the impact of marital dissolution on depressive symptoms for women or men. These findings suggest that the documented benefits of marriage for mental health, and differences by gender in those benefits, may extend to older, rural South Africans, despite the unique experiences of this population.

Age-related differences in the vascular function and structure of South Africans living with HIV

Background: As the life expectancy of people living with the HIV increases because of antiretroviral treatment (ART), their risk for vascular co-morbidities and early vascular ageing (EVA) also increases.Objective: We aimed to investigate whether HIV infection relates to vascular structure and function in black South African adults and whether this relationship is age dependent.Method: This cross-sectional study carried out in urban and rural areas of North West province, South Africa, included 572 age- and sex-matched people living with HIV (PLWH) and without HIV. Participants from the EndoAfrica study and PURE study were stratified according to tertiles of age. Measures of vascular structure (carotid intima-media thickness) and function (carotid-femoral pulse wave velocity, central systolic blood pressure, central pulse pressure and pulse pressure amplification) were determined.Results: Blood pressure measures were lower in PLWH compared with their controls (all P ≤ 0.001), especially in the younger and middle-aged groups (all P ≤ 0.031), whilst vascular measures did not differ (all P ≥ 0.611). In multivariate linear regression analyses, vascular measures were not associated with a HIV- positive status in either the total or any of the age groups.Conclusion: Black South Africans living with HIV have a less adverse blood pressure profile than their counterparts without HIV. The HIV-positive status was not associated with measures of vascular structure or function in any age group. The results suggest that HIV does not contribute to EVA in this population; however, further longitudinal investigation is warranted.

A divided schooling system: the spatial nature of secondary education in Ladybrand, Free State, South Africa

ABSTRACT School choice and commuting in Ladybrand’s three high schools was explored. While all were numerically dominated by Black African children, only the fee-charging former whites-only public school, in the heart of Ladybrand, had a multiracial learner profile. Black African learners enrolled in this school hailed from mostly middle-class homes in the neighbouring Black African township of Lesotho. The homes are financially resourced. Parents are educated, married and employed in skilled or professional jobs. These learners passively commuted to school. The profile of the two no-fee schools, located in the former ‘black only’ designated peripheral townships, was different. Here learners are almost exclusively Black South Africans, living in poorly educated, single-parent homes. Household finances were weak with parents either unemployed or working in semi-skilled or unskilled jobs. These learners either used a subsidized government bus, mini-bus taxis or walked (in some cases long distances from neighbouring farms) to school. Parents said they selected no-fee schools on geographical proximity and low cost; whereas education quality drove choice for the former white school. The socio-economic and demographic profile of learners in no-fee versus fee-paying schools was statistically significant. Ladybrand’s high schools are segregated by class, a situation reflecting much of urban South Africa.

Waist circumference thresholds predicting incident dysglycaemia and type 2 diabetes in Black African men and women.

AimsTo determine the waist circumference (WC) thresholds for the prediction of incident dysglycaemia and type 2 diabetes (T2D) in Black South African (SA) men and women and to compare these to the advocated International Diabetes Federation (IDF) Europid thresholds.Materials and MethodsIn this prospective study, Black SA men (n = 502) and women (n = 527) from the Middle‐aged Sowetan Cohort study who had normal or impaired fasting glucose at baseline (2011‐2015) were followed up until 2017 to 2018. Baseline measurements included anthropometry, blood pressure and fasting glucose, HDL cholesterol and triglyceride concentrations. At follow‐up, glucose tolerance was assessed using an oral glucose tolerance test. The Youden index was used to determine the optimal threshold of WC to predict incident dysglycaemia and T2D.ResultsIn men, the optimal WC threshold was 96.8 cm for both dysglycaemia and T2D (sensitivity: 56% and 70%; specificity: 74% and 70%, respectively), and had higher specificity (P < 0.001) than the IDF threshold of 94 cm. In women, the optimal WC threshold for incident dysglycaemia was 91.8 cm (sensitivity 86%, specificity 37%) and for T2D it was 95.8 cm (sensitivity 85%, specificity 45%), which had lower sensitivity, but higher specificity to predict incident dysglycaemia and T2D than the IDF threshold of 80 cm (sensitivity: 97% and 100%; specificity: 12% and 11%, respectively)).ConclusionsWe show for the first time using prospective cohort data from Africa that the IDF Europid WC thresholds are not appropriate for an African population, and show that African‐specific WC thresholds perform better than the IDF Europid thresholds to predict incident dysglycaemia and T2D.

From Cadre Deployment to Professionalizing Public Service in South Africa: A Reflective Approach to Service Delivery Improvement

While there is nothing idiosyncratic about deploying professionally knowledgeable and astute cadres guided by high ethical morality to drive levers of executive authority in public sector institutions, deployment of political cadres in South African government’s positions has left much to be desired. The approach in which cadre deployment has been practiced in the South African public service sector has undermined the state’s capacity to improve quality of service delivery and requires serious re-examination. The focus of the article is on conceptualization of the notion of professionalism, its attributes and how it can be embedded within the South African public service sector. The debates centre around contextualizing public service administration that can be fit-for-purpose to drive transformational agenda and critique a theory of cadre deployment within the South African context. It is a qualitative inquiry, sourced through desktop reviews of documents and previous studies that have examined issues relating to the professionalization of the public service in South Africa. Thematic analysis is employed to analyse qualitative data from numerous documentary sources gathered in South Africa and internationally. The findings revealed that cadre deployment practice is incongruent with ANC’s election promises of reconstruction and development, and building better life for all South Africans as it steals resources meant for service delivery improvement. Cadre deployment practice further denies qualified graduates of opportunities to be employed in public sector institutions that need to be professionalised as it is skewed in favour of unqualified political appointees. Cadre deployment should be jettisoned by professionalising South African public service where employment selection is guided by meritocracy and performance efficacy but take cognisance of the need to fast-track professional development of formerly disadvantaged black South Africans.

Race, place, and HIV: The legacies of apartheid and racist policy in South Africa

Black South Africans accounted for 6.2 out of 6.4 million people living with HIV in South Africa in 2012, highlighting extreme racial disparities in HIV infection. These racial disparities are the result of structural and historical factors, specifically, the racist policies which were facilitated by segregation before, during, and after Apartheid. First, we describe the theoretical context of how racist policies and segregation are linked to HIV prevalence. Next, using data from a 2012 national survey of South Africans (SABSSM IV) and Statistics South Africa (StatsSA), we describe the race-specific geospatial distribution of HIV in South Africa, provide empirical evidence for the impact of Apartheid on important risk factors for HIV infection, and describe the relationship between these risk factors and HIV within racial groups. Using multilevel logistic regression, we find that segregation increases the odds of HIV infection among Black South Africans, even after adjusting for many covariates which are sometimes blamed, in place of structural factors, for a higher HIV prevalence in Black South Africans. We found that the estimated odds of infection in the most segregated municipality was 1.95 (95% CI: 1.15, 3.32) times the odds of infection in the least segregated municipality for Black South Africans. In addition to segregation, we also find other covariates to be differentially associated with HIV infection depending on race, such as gender, age, and sexual behavior. We also find that the HIV infection odds ratio comparing Black and Coloured (i.e., multiple ethnic groups with mixed ancestries from Africa, Asia, and Europe) South Africans varies over space. These results continue to build evidence for the influence of structural and historical factors on the modern geospatial and demographic distribution of HIV.