THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE                                                              April  2010 5 m e s s a g e f r o m t h e e x e c u t i v e Weirdness appears to be affecting African HIV preven- tion efforts recently. Governments seem to think that criminalising HIV transmission, on a continent where the vast majority of people do not know their status, is an important way to control HIV. Legislation has been enacted, or is being considered in several countries, despite evidence that this simply stigmatises people with HIV. A particularly bizarre and disturbing bill be- ing considered in Uganda called for the death penalty against gay men who transmit HIV (implying that it is more OK to transmit if you are straight). It also implies that HIV in Uganda, where numbers of cases have been on the rise for the past few years, is driven by gay men, when all data suggest that the epidemic remains het- erosexual. Human rights and other organisations ap- pear to have stopped the Uganda bill; not because it was seen as dangerous, rather because it was a threat to donor funding – Obama called the bill ‘odious’. You can read our letter to the Ugandan parliament at http:// www.sahivsoc.org/. What is most frustrating, though, is the silence of the medical fraternity in all this. Where are the local health care worker and public health organisations, condemn- ing their government’s idiocy? For too long patients have had to rely on treatment activist organisations and international agencies to protect them. Health care worker organisations should loudly condemn un- scientific approaches to dealing with HIV, especially when these may harm their patients. HIV prevention has proven very complicated. Quick-fix, emotional, prejudiced and unscientific solutions are hardly going to help. Governments listen to health care workers, as we have status and power. Organisations need to stand up to dangerous policy and legislation. FRANCOIS VENTER President It is an interesting time in South Africa ... with public debate on education, the judicial system, and whether or not politicians should be allowed to say and sing what they like in public, to name just a few issues. The journal also takes on controversy this quarter, and I hope will elicit some debate. I remind you that the opinions ex- pressed in its pages are not necessarily supported by the editorial committee or the Clinicians Society! The first three papers in this issue are such articles, the first being the Ruben Sher Memorial Lecture de- livered by Judge Edwin Cameron some weeks ago. He describes his own testing experience and makes a case for why the human rights activism around testing is less relevant in the era of effective HIV treatment, and why HIV testing should be normalised. The SA Gov- ernment will be attempting to do just that through countrywide scale-up of testing. An intriguing article probes the impact of a ‘sexual abstinence month’, and Kenyon grapples with some epidemiological ‘holy cows’ and questions the attribution of poverty as a driver for the epidemic in southern Africa. The new public sector guidelines are out, and for easy reference we asked Celicia Serenata from SANAC to give a succinct summary of the differences. Our review this quarter looks at cytomegalovirus co-infection, but also comments on treatment options for South Afri- can practitioners and calls for antiviral price review. We thank visiting opthalmologist Sophia Pathai for her corroborating comment. The last three articles are original research. The first looks at mortality trends in a hospital district after the introduction of ART, the second at mental health, and the third at laboratory abnormalities in HIV-infected pregnant women. Remember, we will welcome your letters should any of the above invoke the need to respond! However, I hope this edition will also raise discussions at your place of work and among your colleagues. Whichever, I hope you enjoy it, and am happy that we have got to a po- sition in our country where relevant and appropriate issues can be freely debated. LINDA-GAIL BEKKER Editor F R O M T H E E D I TOR THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE                                                          WINTER  2008SPRING  2008                                                          THE SOUTHERN AFRICAN JOURNAL OF HIV MEDICINE                                                   F R O M T H E E D I TO R The Journal is starting to feel like Men’s Health, what with posters, guidelines and now a state-of-the art science update, HIV Treatment Bulletin, falling out of it. Exco is pleased to announce an important and strategic partnership with HIV i- Base, who publish HIV Treatment Bulletin. We are distributing the southern African version of their excellent newsletter, which will exclusively focus on the scientific reports and resources that have local relevance – with a strong focus on paediatrics and maternal health. HIV Treatment Bulletin neatly complements the Journal, providing the snobbish clinician and scientist with the most hot-off-the-press analysis of recent clinical trials and basic science research. Policy makers can authoritatively pronounce at their guidelines meetings, clinicians can expand their patients’ options, and, most importantly, you can show off at ward rounds. Thanks to all the people at i-Base, this is a major step forward for quality information sharing. We wish the new Health Minister, Barbara Hogan, all the best. She has very small shoes to fill, but a mammoth task ahead of her to repair South Africa’s woeful health service. At the time of writing, she and her deputy, Dr Molefi Sefularo, have been very impressive, dealing with a cholera disaster, drug stock-outs, issues of prevention, releasing controversial reports that were stuck on her predecessor’s desk for months, and a dozen other complex health problems. Finally, the EXCO welcomes two new members based in Durban, Professor Yunus Moosa and Dr Henry Sunpath, both highly respected clinicians and part of the team responsible for an excellent HIV clinical conference held in October. FRANCOIS VENTER President This Spring edition brings 2008 to a close. And what a year it has been. Not many breakthroughs in HIV or TB, but a lot of activity in terms of understanding early infection better, really getting to grips with early immune responses, and again thinking through our prevention options. In 2008 the concept of antiretrovirals for prevention as well as treatment has come to the fore with second-generation microbicides, pre-exposure prophylaxis and the notion that we may be able to ‘treat our way out of the epidemic’ becoming possibilities. Gratifyingly, this year also saw a record number of people being tested and accessing ART, and roll-out for both testing and treatment is truly scaling up. As chairperson of the 4th Southern African HIV Conference I must encourage EVERY ONE of you to think seriously about coming to Durban on 31 March. It promises to be a critical conference where we will really formulate the key steps in getting PMTCT, treatment, testing and prevention out there on a scale that will begin to turn the SA statistics around. (I promise that it will also be loads of fun!) Please note the early date this year: 31 March to 3 April. This is to ensure brilliant KZN weather! In this edition, we already begin to examine some of these key scale-up questions: Jerome Singh explores the ethics and legality of traditional healers performing HIV testing (I know many have asked why this HAS to be the domain of nurses only). Francesca Esposito and her team examine changes in body composition in women taking antivirals in a KZN clinic. We look at the role of mobile phones in the HIV response with William Mapham, and Polly Clayden gives us pointers to starting infants on ART. The role of a liver biopsy in diagnosis of opportunistic infections is described by Mark Sonderup and colleagues. The vexed question of when it is deemed safe to start HAART in patients co-infected with TB is discussed by Robin Wood, and Francois Venter and colleagues give a practical view on new antiretrovirals on the horizon for South African practitioners. No guidelines in this issue, but I will whet your appetites – look out for guidelines on prevention of TB occupational exposure for HIV-infected health care workers and on the non-infertile HIV infected couple, hot stuff coming up in the new year! Happy reading and every best wish for a restful and peaceful festive season from the whole editorial team. See you next year! LINDA-GAIL BEKKER Editor m e s s a g e f r o m t h e e x e c u t i v e � Msg from the executive.indd 5 12/17/08 3:16:23 PM