Informing Comprehensive HIV Prevention: A Situational Analysis of the HIV Prevention and Care Context,North West Province South Africa

Objective

Building a successful combination prevention program requires understanding the community’s local epidemiological profile, the social community norms that shape vulnerability to HIV and access to care, and the available community resources. We carried out a situational analysis in order to shape a comprehensive HIV prevention program that address local barriers to care at multiple contextual levels in the North West Province of South Africa.

Method

The situational analysis was conducted in two sub-districts in 2012 and guided by an adaptation of WHO’s Strategic Approach, a predominantly qualitative method, including observation of service delivery points and in-depth interviews and focus groups with local leaders, providers, and community members, in order to recommend context-specific HIV prevention strategies. Analysis began during fieldwork with nightly discussions of findings and continued with coding original textual data from the fieldwork notebooks and a select number of recorded interviews.

Results

We conducted over 200 individual and group interviews and gleaned four principal social barriers to HIV prevention and care, including: HIV fatalism, traditional gender norms, HIV-related stigma, and challenges with communication around HIV, all of which fuel the HIV epidemic. At the different levels of response needed to stem the epidemic, we found evidence of national policies and programs that are mitigating the social risk factors but little community-based responses that address social risk factors to HIV.

Conclusions

Understanding social and structural barriers to care helped shape our comprehensive HIV prevention program, which address the four ‘themes’ identified into each component of the program. Activities are underway to engage communities, offer community-based testing in high transmission areas, community stigma reduction, and a positive health, dignity and prevention program for stigma reduction and improve communication skills. The situational analysis process successfully shaped key programmatic decisions and cultivated a deeper collaboration with local stakeholders to support program implementation.     

Endoplasmic reticulum stress in wake-active neurons progresses with aging

Fragmentation of wakefulness and sleep are expected outcomes of advanced aging. We hypothesize that wake neurons develop endoplasmic reticulum dyshomeostasis with aging, in parallel with impaired wakefulness. In this series of experiments, we sought to more fully characterize age-related changes in wakefulness and then, in relevant wake neuronal populations, explore functionality and endoplasmic reticulum homeostasis. We report that old mice show greater sleep/wake transitions in the active period with markedly shortened wake periods, shortened latencies to sleep, and less wake time in the subjective day in response to a novel social encounter. Consistent with sleep/wake instability and reduced social encounter wakefulness, orexinergic and noradrenergic wake neurons in aged mice show reduced c-fos response to wakefulness and endoplasmic reticulum dyshomeostasis with increased nuclear translocation of CHOP and GADD34. We have identified an age-related unfolded protein response injury to and dysfunction of wake neurons. It is anticipated that these changes contribute to sleep/wake fragmentation and cognitive impairment in aging.     

Regulation of growth,nutritive, phytochemical and antioxidant potential of cultivated <Emphasis Type="Italic">Drimiopsis maculata</Emphasis> in response to biostimulant (vermicompost leachate,VCL) application

The effect of vermicompost leachate (VCL, low-cost biostimulant) on the growth, elemental (macro and micro-nutrients) and phytochemical content as well as the antioxidant potential of Drimiopsis maculata was evaluated. Three dilutions (1:5; 1:10 and 1:20) of VCL were tested and the cultivation lasted for 3 months. In addition to the recorded growth parameters, dried and ground plant materials (leaves and bulbs) were evaluated for nutrients, phenolic acids and antioxidant capacity. Vermicompost leachate application enhanced the growth of D. maculata, particularly, the leaves (VCL 1:10) and bulbs (VCL 1:20) which were significantly bigger than the controls. Apart from the concentration of phosphorus which was significantly lower in the leaves of VCL (1:20)-treated plants, the quantity of all four macro-nutrients analysed were similar with and without VCL. Similar observations were also demonstrated in the majority of quantified micro-nutrients in D. maculata. Relative to the control, VCL-treated plants had higher concentrations of the 10 phenolic acids quantified in the leaves. However, the majority of the quantified phenolic acids were not significantly enhanced in bulbs. Antioxidant activity of D. maculata extracts was generally higher in leaves than in the bulbs. The leaf extract from VCL (1:10 and 1:20)-treated plants exhibited lower oxygen radical absorbance capacity (ORAC) when compared to the control. However, bulbs from VCL (1:5) treatment had significantly higher ORAC than the control. From a conservational perspective, the current findings provided insight on viable approaches useful for mitigating challenges associated with over-harvesting of highly utilized but slow-growing plant species.     

Effects of Community-Based Natural Resource Management on Household Welfare in Namibia

Biodiversity conservation, as an environmental goal, is increasingly recognized to be connected to the socioeconomic well-being of local communities. The development of a widespread community-based natural resource management (CBNRM) program in Namibia makes it an ideal location to analyze the connection between conservation and socioeconomic well-being of local communities. Namibia’s CBNRM program involves the formation of communal conservancies within rural communities and previous studies have found it to be successful on both ecological and economic fronts. In order to broaden the understanding of the program’s impact to include social factors, we have conducted a comparative analysis to determine the effects of this program on household welfare outcomes. Data from two rounds of the Namibia Demographic and Health Surveys (2000 and 2006/07) and quasi-experimental statistical methods were used to evaluate changes in various health, education and wealth outcomes of those living in conservancies, relative to non-conservancy comparison groups. Regression results indicate mixed effects of the conservancy program at the household level. The program had positive effects on some health outcome variables, including bednet ownership, which was twice as likely to increase over time in conservancy compared to non-conservancy households. Program impacts were negative for education outcomes, with the proportion of school attendance of conservancy children being 45% less likely to increase over time than non-conservancy children. Wealth outcome results were inconclusive. Our findings highlight the importance of analyzing community conservation programs at a variety of scales when evaluating overall impact, as community-level benefits may not necessarily extend down to the household level (and vice versa).     

Two flavonols from Distemonanthus benthamianus

The structure of the new 5,6-dihydroxy-3,7,2′,4′,5′-pentamethoxyflavone and its fully methylated analogue were established by physico-chemical and chemical techniques.     

Differences in daily stem size variation and growth in two hybrid eucalypt clones

Understanding daily stem size variation is important as the net increment of a forest stand is ultimately determined by the accumulation of daily increment events. In this study, measurements of stem size at high spatial and temporal resolution were made using two commercial hybrid Eucalyptus clones [E. grandis × urophylla (GU) and E. grandis × camaldulensis (GC)] over a period of more than 3.5 years in order to better understand how daily stem growth is effected by variations in environmental conditions. It was evident that GU had fewer days on which net growth occurred than GC. However, when growth did occur, GU grew for longer each day and at a higher rate than GC. Thus, it still had an overall larger net stem increment during the study period. The GU clone had a markedly intermittent pattern of growth, such that growth essentially ceased under drought conditions, but responded rapidly when water became available. This confirms other findings that E. grandis × urophylla is more susceptible to drought stress than E. grandis × camaldulensis, but emphasizes that a strategy of “rapid response” when environmental conditions become temporarily non-limiting is a good one in terms of net increment at sites such as in this study.

Identification of immunoreactive tissue prokallikrein on the surface membrane of human neutrophils

Putative binding sites for prokallikrein, the endogenous zymogen of the vasoactive and pro-inflammatory tissue kallikrein-kinin system, were recently demonstrated on human neutrophils. However, the occurrence and distribution of neutrophil-bound prokallikrein itself have so far not been examined. In this study, a specific anti-peptide antibody directed against the propart of the zymogen was used to localize the kallikrein precursor by confocal laser-scanning microscopy on unstimulated human blood neutrophils. Our results describe, for the first time, the presence of tissue prokallikrein on the membrane of circulating neutrophils. Immunoreactive prokallikrein was associated into punctate clusters occupying the external surface of the neutrophil membrane and, after addition of exogenous zymogen, immunolabeling was enhanced four-fold. In contrast, only moderate immunoreactivity to prokallikrein was observed intracellularly. These results suggest that resting neutrophils provide a circulating platform for tissue prokallikrein whose surface density may be upregulated as part of the inflammatory process.     

Integrating economic costs into conservation planning

Recent studies that incorporate the spatial distributions of biological benefits and economic costs in conservation planning have shown that limited budgets can achieve substantially larger biological gains than when planning ignores costs. Despite concern from donors about the effectiveness of conservation interventions, these increases in efficiency from incorporating costs into planning have not yet been widely recognized. Here, we focus on what these costs are, why they are important to consider, how they can be quantified and the benefits of their inclusion in priority setting. The most recent work in the field has examined the degree to which dynamics and threat affect the outcomes of conservation planning. We assess how costs fit into this new framework and consider prospects for integrating them into conservation planning.     

Differential effects of nitrogen and phosphorus enrichment on growth of dwarf Avicennia marina mangroves

The effects of N and P enrichment were investigated on growth and physiological responses of dwarf Avicennia marina mangroves in a hypersaline (58 ± 8 psu) field site in Richards Bay, South Africa. It was hypothesized that at high salinities mangroves allocate more resources to roots than shoots, and that nutrient enrichment with N and P will shift resource allocation to shoots and enhance growth and productivity. In unvegetated areas of the dwarf zone, 1-year-old A. marina seedlings were planted in pots and enriched bimonthly with N, P, N + P, or remained unfertilized (control-C), and growth and morphology of plants were monitored for 2 years. Enrichment with N and N + P shifted resource allocation to shoots from 38% to 55%, and increased dry biomass accumulation by over 500%, compared to the control treatment. In the N and N + P treatments, plant height, number of leaves, leaf chlorophyll content and photosynthesis increased by over 50%, 330%, 30% and 30%, respectively, compared to the C and P treatments. Enrichment with N and N + P increased N concentrations in roots by over 60% (from 1.0 ± 0.1% to 1.6 ± 0.2% of dry mass) and in shoots by over 100% (from 1.3 ± 0.1% to 2.7 ± 02% of dry mass). Plants enriched with P alone were similar to those of the control. This study has demonstrated that dwarf A. marina in Richards Bay is N limited, and that N enrichment shifts resource allocation from roots to shoots and increases growth and productivity.