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Background: Achieving universal health coverage (UHC) in the context of limited resources will require prioritising the most vulnerable and ensuring health policies and services are responsive to their needs. One way of addressing this is through the engagement of marginalised voices in the priority setting process. Public engagement approaches that enable group level deliberation as well as individual level preference capturing might be valuable in this regard, but there are limited examples of their practical application, and gaps in understanding their outcomes, especially with rural populations. Objective: To address this gap, we implemented a modified priority setting tool (Choosing All Together—CHAT) that enables individuals and groups to make trade‐offs to demonstrate the type of health services packages that may be acceptable to a rural population. The paper presents the findings from the individual choices as compared to the group choices, as well as the differences among the individual choices using this tool. Methods: Participants worked in groups and as individuals to allocate stickers representing the available budget to different health topics and interventions using the CHAT tool. The allocations were recorded at each stage of the study. We calculated the median and interquartile range across study participants for the topic totals. To examine differences in individual choices, we performed Wilcoxon rank sum tests. Results: The results show that individual interests were mostly aligned with societal ones, and there were no statistically significant differences between the individual and group choices. However, there were some statistically significant differences between individual priorities based on demographic characteristics like age. Discussion: The study demonstrates that giving individuals greater control and agency in designing health services packages can increase their participation in the priority setting process, align individual and community priorities, and potentially enhance the legitimacy and acceptability of priority setting. Methods that enable group level deliberation and individual level priority setting may be necessary to reconcile plurality. The paper also highlights the importance of capturing the details of public engagement processes and transparently reporting on these details to ensure valuable outcomes. Public Contribution: The facilitator of the CHAT groups was a member from the community and underwent training from the research team. The fieldworkers were also from the community and were trained and paid to capture the data. The participants were all members of the rural community‐ the study represents their priorities. [ABSTRACT FROM AUTHOR]

Introduction: The treatment gap for mental health disorders persists in low- and middle-income countries despite overwhelming evidence of the efficacy of tasksharing mental health interventions. Key barriers in the uptake of these innovations include the absence of policy to support implementation and diverting of staff from usual routines in health systems that are already overstretched. South Africa enjoys a conducive policy environment; however, strategies for operationalizing the policy ideals are lacking. This paper describes the Mental health INTegration Programme (MhINT), which adopted a health system strengthening approach to embed an evidence-based task-sharing care package for depression to integrate mental health care into chronic care at primary health care (PHC). Methods: The MhINT care package consisting of psycho-education talks, nurse-led mental health assessment, and a structured psychosocial counselling intervention provided by lay counsellors was implemented in Amajuba district in KwaZulu-Natal over a 2-year period. A learning health systems approach was adopted, using continuous quality improvement (CQI) strategies to facilitate embedding of the intervention. MhINT was implemented along five phases: the project phase wherein teams to drive implementation were formed; the diagnostic phase where routinely collected data were used to identify system barriers to integrated mental health care; the intervention phase consisting of capacity building and using Plan-Do-Study-Act cycles to address implementation barriers and the impact and sustaining improvement phases entailed assessing the impact of the program and initiation of system-level interventions to sustain and institutionalize successful change ideas. Results: Integrated planning and monitoring were enabled by including key mental health service indicators in weekly meetings designed to track the performance of noncommunicable diseases and human immunovirus clinical programmes. Lack of standardization in mental health screening prompted the validation of a mental health screening tool and testing feasibility of its use in centralized screening stations. A culture of collaborative problem-solving was promoted through CQI data-driven learning sessions. The province-level screening rate increased by 10%, whilst the district screening rate increased by 7% and new patients initiated to mental health treatment increased by 16%. Conclusions: The CQI approach holds promise in facilitating the attainment of integrated mental health care in resource-scarce contexts. A collaborative relationship between researchers and health system stakeholders is an important strategy for facilitating the uptake of evidence-based innovations. However, the lack of interventions to address healthcare workers' own mental health poses a threat to integrated mental health care at PHC. [ABSTRACT FROM AUTHOR]

Young children embark on a transitional nutritional journey, progressing from total reliance on caregivers to independence, autonomy and self-determination. Appropriate nutritional intake in young children is a diverse concept, incorporating suitable nutritional choices and feeding behaviours. Lessons learnt in childhood will have long-term effects on the individual and society overall. Since South African children are raised in a country where under- and over-nutrition exist simultaneously, a careful balance should be achieved in any national public health message. The South African paediatric food-based dietary guidelines for children younger than 7 years strive to facilitate the education of carers of young children in the adoption of healthy eating practices. The guidelines address issues regarding variety in the diet that has been shown to improve both micro- and macronutrient intakes. Specific reference is made to starchy foods, vegetables, fruit and water along with protein sources, which should be consumed regularly. Milk, has been emphasised in these guidelines because of the poor calcium intake in South African children. The only guideline that limits intake is the sweet treats or drinks message, because of public health concerns such as obesity and dental caries. Other messages pertaining to eating habits take cognisance of the child's physiological limitations in gastric capacity and suggest small regular meals. Clean, safe drinking water is the beverage of choice. Non-food-based guidelines are also included, which recognize the importance of active play, for developmental and health purposes, as well as regular clinic attendance. [ABSTRACT FROM AUTHOR]

The ability to predict which areas of conservation importance are most vulnerable to transformation and to rank the relative damage that transforming land uses could cause to biodiversity are important components of an effective and realistic conservation planning process. We used the South African grassland biome as a case study to illustrate the assessment of vulnerability to land-use transformation through the construction of a “threat map.” We identified the dominant transforming land uses and created suitability models based on area appropriateness for each. Land uses were scored according to their expected relative impacts on biodiversity, with a framework that included compositional, structural, and functional components. This information, once combined, resulted in a map that highlighted the areas most vulnerable to transformation in terms of the likelihood of their transformation and the impact on their biodiversity. We propose that such an analysis of the threat of transformation, in combination with species-representation approaches, will aid the integration of conservation planning theory and decision making. This approach can be applied at any scale and in any region with a robustness and accuracy dependent on data quality, resultant suitability models, and comprehension of how land uses affect an area's biodiversity. [ABSTRACT FROM AUTHOR]

To assess the correspondence between current avian distributions in the lowlands of northern South America with respect to the hypothesized importance of sea level rise and other events over the past 15 million years on speciation. Tropical lowlands of north-western South America. To establish which bird taxa may have originated in each area of endemism, I examined the ranges of all bird species occurring in the Pacific and the Caribbean lowlands. To determine land and sea distribution during a sea level rise of 100 m in north-western South America and eastern Central America, I traced the 100 m contour line from the Geoatlas of Georama and the Global 30-Arc-Second Elevation Data (GTOPO30) produced by the US Geological Survey. During a sea level rise of ∼100 m, marine incursions would have occurred from the Caribbean Sea and the Pacific Ocean. Several areas of tropical forest and dry/arid vegetation would have been isolated, currently known as the Darién, Chocó, Nechí, Catatumbo, Tumbesian and Guajiran areas of animal and plant endemism. A large part of the high diversity of forest and nonforest birds and other animals and plants in the Pacific rain forest and the Caribbean woodland likely arose as the result of sea level rises, dispersal and other geological and climatic events. [ABSTRACT FROM AUTHOR]

Societal Impact Statement: Opuntia ficus‐indica, commonly known as prickly pear, is a widely distributed plant originating in central America. Its wide distribution and popularity as a cultivated plant are due to the sweetness of its fruits. Here, the role of O. ficus‐indica in the livelihoods of people in Limpopo Province, South Africa, was investigated. Roadside traders of prickly pear were surveyed 2019–2020 using paper‐based questionnaires and a convenience sampling strategy. Evidence of O. ficus‐indica trading as a means to generate income was uncovered. Notably, none of the traders knew about invasive species. Future studies should seek to understand the motivations of purchasers. The extent to which rural communities use this species for food security and poverty alleviation is not fully understood. Summary: The Opuntia ficus‐indica (whose fruits are traded in South Africa) is a species that is classified according to the National Environmental Management: Biodiversity Act (10/2004) Alien and Invasive Species (NEM:BA A&IS) regulations as an invasive species. This study sought to provide an understanding of the socio‐economic value of O. ficus‐indica and the characteristic profiles of the people who trade with O. ficus‐indica in the Limpopo Province of South Africa.A convenience sampling strategy was conducted along trading roads in Limpopo province, and the data were collected by surveying traders' attitudes toward the prickly pear trade using questionnaires.Our findings show that at the time of sampling 72 traders participated in prickly pear trading along the roadside. Unemployment is cited as the primary reason for their involvement in trading. O. Ficus‐indica is an important fruit for rural communities in Limpopo province. It helps communities living below the poverty line to generate income and to support their livelihoods.Our study highlights the need for the establishment of a Prickly Pear Traders' Agency in order to promote the trade of O. ficus‐indica as a measure to generate income, alleviate poverty, and ensure food security. The paper concludes with recommendations for local government support for O. ficus‐indica traders through the formalization of the trade and through monetary support. [ABSTRACT FROM AUTHOR]

Aim: To better understand the aetiologies of epileptic spasms in infants, as well as the safety and efficacy of high dose corticosteroids in tuberculosis and human immunodeficiency virus (HIV) endemic resource‐limited settings. Method: This was a retrospective analysis of infants with epileptic spasms managed at the tertiary referral centres in the Western Cape, South Africa. Results: Of 175 children with epileptic spasms, the median age at onset was 6 months (interquartile range 4–8 months). Structural aetiologies were most common (115 out of 175 [66%]), with two‐thirds related to perinatal insults. A lead time to treatment (LTTT) of less than 1 month was more likely in the epileptic encephalopathy/developmental and epileptic encephalopathy (DEE) group: 58 out of 92 (63%), compared to 28 out of 76 (37%) of those with developmental encephalopathy (p = 0.001). Failure to recognize preceding developmental delay was common. Ninety‐nine children (57%) received first line hormonal therapy such as adrenocorticotropic hormone. A total of 111 out of 172 children (65%) from the developmental encephalopathy and epileptic encephalopathy/DEE groups had clinical and/or electroencephalogram resolution of spasms within 14 days. In our population, children in whom an aetiology could not be identified were statistically more likely to have moderate to profound developmental delay at 1 year of age: 33 out of 44 (p = 0.001). Based on reported incidence of epileptic spasms, 23 to 58 cases per annum would be expected but a far smaller proportion presented to our centres. Interpretation: Whilst this is the largest cohort of infants with epileptic spasms from sub‐Saharan Africa, the study size is less than expected; this may reflect misdiagnosis and failure of referral pathways. Despite a reported shorter LTTT, infants with DEE had worse developmental outcomes compared to international studies. Hormonal therapy was safe and effective in our setting, despite exposure to high levels of tuberculosis and HIV. What this paper adds: The number of unreferred cases of epileptic spasms in South Africa remains high.Caregivers and health care workers in primary care facilities often fail to recognize developmental delay.The burden of disease from hypoxic‐ischaemic encephalopathy remains high in our resource‐limited setting.Hormonal treatment (e.g. adrenocorticotropic hormone) was safe and effective despite the high prevalence of human immunodeficiency virus and tuberculosis. [ABSTRACT FROM AUTHOR]

South Africa has a documented high prevalence of stunting and increasing obesity in children as well as obesity in adults. The double burden of malnutrition, which can be on an individual‐, household‐ or population level, has implications for both health and the economic development of a community and country. This paper describes a large‐scale survey (N = 774) of infant feeding, growth monitoring and anthropometry among mother and child pairs aged 6 months of age in KwaZulu‐Natal (KZN), South Africa, conducted between January and August 2017. Among children, a large increase in the prevalence of stunting and obesity was seen between birth and 6 months of age increasing from 9.3% to 21.7% and 4.0% to 21.0%, respectively. 32.1% of the mothers were overweight [body mass index (BMI): 25.0–29.9] and 28.4% had obesity grade 1 (BMI: 30–<40). Although most mothers (93%; 563/605) initiated breastfeeding, the introduction of other foods started early with 17.6% (56/319) of the mothers having started giving other fluids or food to their child within the first month. At 6 months 70.6% (427/605) children were still breastfed and 23.5% were exclusively breastfed. In addition, we found that length measurements were done less frequently than weight measurements between birth and 6 months, on average 2.2 (SD: 1.3) versus 5.8 (SD: 1.5) times. Moreover, there is a need for improvement of health worker training and understanding regarding anthropometric measurements when assessing malnutrition in children in the clinics. Early detection and improved infant feeding practices are key in preventing both stunting and obesity in children. Key messages: The double burden of malnutrition is severe in KwaZulu‐Natal with high rates of maternal obesity and increasing prevalence of stunting and obesity among infants in the first 6 months of life.Breastfeeding and complementary feeding practices are suboptimal and additional support for breastfeeding is required in the post‐natal period and in the workplace to address breastfeeding challenges.Growth monitoring is inadequate in health facilities leading to many lost opportunities for early identification of malnutrition. Hence, anthropometric practices and interpretation of findings need to be strengthened. [ABSTRACT FROM AUTHOR]

Industrialization and urbanization processes have challenged deeply held traditional gender norms and facilitated the emergence of modern ideologies in South Africa. This paper seeks to explore the gendered roles of family members on maternal and child nutrition and investigate indications of perceived change in related practices. A qualitative secondary analysis was conducted of data from nine focus group discussions (FGDs) held with men (n = 3) and women (n = 6) aged ≥18. Data from the FGD were coded and thematic analysis conducted. We found that elderly women seem to have a central advisory role with respect to maternal and child nutrition and that men and elderly women upheld patriarchal gender divisions of labour, which entrust mothers with the primarily responsibility for young children's nutrition. Young mothers relied on elderly women for provision of childcare and nutritious foods for children; however, they demonstrated some resistance to traditionally feminized forms of food preparation. We found that men's involvement in children's nutrition was limited, though they expressed a preference to be more involved in maternal and child nutrition and care practices. A gender transformative approach to policy development, which includes elderly women and men, has the potential to promote more gender‐equitable nutrition practices, increase young women's self‐efficacy and support them to overcome barriers that could be limiting their decision making power in achieving optimal nutrition for themselves and their children. [ABSTRACT FROM AUTHOR]

Introduction: Policies for Universal Test & Treat (UTT) and same‐day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis. Methods: We enrolled three cohorts of newly diagnosed HIV‐infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre‐UTT, N = 144), May‐September 2017 (UTT, N = 178) and October‐December 2017 (SDI, N = 88). A baseline survey was administered immediately after HIV diagnosis after which follow‐up using clinical records (paper charts, electronic health records and laboratory data) ensued for 12 months. The primary outcome was patient loss to follow‐up (being >90 days late for the last scheduled appointment) at 12 months post‐HIV diagnosis. We modelled attrition across HIV policy periods with Cox proportional hazard regression. Results: Overall, 410 of 580 screened HIV‐positive patients were enrolled. Overall, attrition at 12 months was 30% lower in the UTT guideline period (38.2%) compared to pre‐UTT (47.2%, aHR 0.7, 95% CI: 0.5 to 1.0). However, the total attrition was similar between the SDI (47.7%) and pre‐UTT cohorts (aHR 1.0, 95% CI: 0.7 to 1.5). Older age at HIV diagnosis (aHR 0.5 for ≥40 vs. 25 to 29 years, 95% CI: 0.3 to 0.8) and being in a non‐marital relationship (aHR 0.5 vs. being single, 95% CI: 0.3 to 0.8) protected against LTFU at 12 months, whereas LTFU rates increased with longer travel time to the diagnosing clinic (aHR 1.8 for ≥30 minutes vs. ≤15 minutes, 95% CI: 1.1 to 3.1). In analyses adjusted for the time‐varying ART initiation status, compared to the pre‐ART period of care, the hazard of on‐ART LTFU was 90% higher among participants diagnosed under the SDI policy compared to pre‐UTT (aHR 1.9, 95% CI: 1.1 to 2.9). Conclusions: Overall, nearly two‐fifths of HIV positive patients are likely to disengage from care by 12 months after HIV diagnosis under the new SDI policy. Furthermore, the increase in on‐ART patient attrition after the introduction of the SDI policy is cause for concern. Further research is needed to determine the best way for rapidly initiating patients on ART and also reducing long‐term attrition from care. [ABSTRACT FROM AUTHOR]

Micronutrient deficiencies remain common among women and children in Sub‐Saharan Africa (SSA); in pregnant/lactating women, the intakes of essential fatty acids may also be low. Enriching home‐prepared foods with small‐quantity lipid‐based nutrient supplements (SQ‐LNSs) is a promising new strategy of delivering additional micronutrients, essential fatty acids and good quality protein to women and children. This narrative review aimed to examine the impact of SQ‐LNSs supplementation among women and infants and young children in SSA, and to discuss the differential impact of SQ‐LNS consumption across different settings. Papers reporting randomized trials conducted in SSA in which apparently healthy women and/or ≥6‐mo‐old children received SQ‐LNSs were identified through electronic and manual searches. Prenatal SQ‐LNS consumption reduced the prevalence of low gestational weight gain in Ghana when compared with multiple micronutrients supplementation, and was associated with poorer iron/hemoglobin status when compared with iron‐plus‐folic acid supplementation. SQ‐LNSs received alone or as intervention package improved infant/child growth in two trials in Ghana and one trial each in Burkina Faso, Kenya, Zimbabwe and South Africa, but had no impact on growth in two trials in Malawi. SQ‐LNSs supplementation improved motor development in Ghana, Burkina Faso, Malawi, Kenya, and South Africa, but had no impact on language, socio‐emotional, and executive functions in Ghana and Malawi and on Griffiths' developmental scores in Malawi. SQ‐LNSs may contribute to improving child growth in SSA. More research is needed to determine the iron level in SQ‐LNSs effective for improving both maternal hemoglobin/iron status and birth outcomes. [ABSTRACT FROM AUTHOR]

Aim: To describe the trajectory of clinical signs in children who developed human immunodeficiency virus encephalopathy (HIVE) after starting early antiretroviral therapy (ART).Method: This was a retrospective case-cohort description of HIVE among Cape Town participants from the Children with HIV Early AntiRetroviral treatment (CHER) trial. Criteria for HIVE diagnosis were at least two of: (1) acquired central motor deficit, (2) impaired brain growth, and (3) failure to attain or loss of developmental milestones in the absence of an alternative aetiology.Results: Of 133 surviving participants who initiated ART at a median age of 9 weeks and who were followed until a median age of 6 years, 20 (12%) developed HIVE at a median age 31 months (interquartile range 19-37). In these, the first neurological deterioration was noticed at a median age of 19 months, when 16 were on ART and nine had undetectable HIV viral load for a median of 12 months. Signs of upper motor neurons were present in 18, of whom 12 resolved and four had persistent spastic diplegia; 19 had motor delay, of whom 14 resolved; 12 had language delay, of whom 11 resolved; and 16 had impaired brain growth, of whom only five recovered. For the 16 participants already on ART at HIVE diagnosis, regimens were not altered in response to diagnosis.Interpretation: HIVE may occur despite early ART initiation and virological suppression and then resolve on unchanged ART, most likely as intrathecal inflammation subsides.What This Paper Adds: Despite suppressive antiretroviral therapy, children can develop human immunodeficiency virus encephalopathy, The most common manifestations are motor deficits and impaired brain growth. Most experience improvement, with many resolving without additional intervention. [ABSTRACT FROM AUTHOR]

The use of donor human breast milk instead of formula reduces the risk of necrotising enterocolitis in preterm infants when their mother's own milk is insufficient. Use of donor milk is limited by the cost of establishing a milk bank and a lack of donors, but the optimal rationing of limited donor milk is unclear. This paper uses an economic model to explore how a limited donor milk supply should be allocated across very low birthweight infants in South Africa considering 2 outcomes: maximising lives saved and minimising costs. We developed a probabilistic cohort Markov decision model with 10,000 infants across 4 birthweight groups. We evaluated allocation scenarios in which infants in each group could be exclusively formula‐fed or fed donor milk for 14 or 28 days and thereafter formula until death or discharge. Prioritising infants in the lowest birthweight groups would save the most lives, whereas prioritising infants in the highest birthweight groups would result in the highest cost savings. All allocation scenarios would be considered very cost‐effective in South Africa compared to the use of formula; the "worst case" was $619 per Disability Adjusted Life Year averted. There is a compelling argument to increase the supply of donor milk in middle‐income countries. Our analysis could be extended by taking a longer term perspective, using data from more than one country and exploring the use of donor milk as an adjunct to mother's own milk, rather than a pure substitute for it. [ABSTRACT FROM AUTHOR]

Introduction: Although HIV testing services (HTS) have been successfully task‐shifted to lay counsellors, no model has tested the franchising of HTS to lay counsellors as independent small‐scale business owners. This paper evaluates the effectiveness of a social franchisee (SF) HTS‐managed pilot project compared to the Foundation for Professional Development (FPD) employee‐managed HTS programme in testing and linking clients to care. Methods: Unemployed, formally employed or own business individuals were engaged as franchisees, trained and supported to deliver HTS services under a common brand in high HIV‐prevalent communities in Tshwane district between 2016 and 2017. SFs were remunerated per‐HIV test and received larger payments per‐HIV‐positive client linked to care. In the standard HTS, FPD employed counsellors received similar training and observed similar standards as in the SF HTS, but were remunerated through the normal payroll. We assessed the proportion of clients tested, HIV positivity, linkage to care and per‐counsellor cost of HIV test and linkage to care in the two HTS groups. Results: The SF HTS had 19 HIV counsellors while FPD HTS employed 20. A combined total of 84,556 clients were tested by SFs (50.5%: 95% confidence interval (CI) 50.2 to 50.8)) and FPD (49.5%: 49.2 to 49.8). SFs tested more females than FPD (54.1%: 53.6 to 54.6 vs. 48%: 47.7 to 48.7). SFs identified more first‐time testers than FPD (21.5%: 21.1 to 21.9 vs. 8.9%: 8.6 to 9.1). Overall, 8%: 7.9 to 8.2 tested positive with more clients testing positive in the SF (10.2%: 9.9 to 10.5) than FPD (5.9%: 5.6 to 6.1) group. The SFs identified more female HIV‐positive clients (11.1%: 10.7 to 11.6) than FPD (6.5%: 6.2 to 6.9). The SFs linked fewer clients to HIV care and treatment (60.0%: 58.5 to 61.5) than FPD (80.3%: 78.7 to 81.9%). It cost four times less to conduct an HIV test using SFs ($3.90 per SF HIV test) than FPD ($13.98) and five times less to link a client to care with SFs ($62.74) than FPD ($303.13). Conclusions: SF HTS was effective in identifying more clients, first‐time HIV testers and more HIV‐positive people, but less effective in linking clients to care than FPD HTS. The SF HTS model was cheaper than the FPD‐employee model. We recommend strengthening SFs particularly their linkage to care activities. [ABSTRACT FROM AUTHOR]

Abstract: The increase in greenhouse gases (GHG) emissions in the world has significantly contributed to climate change, prompting an active search for renewable and sustainable biofuels. Sweet sorghum (Sorghum bicolor (L.) Moench) is a leading biofuel feedstock that is produced with minimum inputs and does well even in semi‐arid areas with soils of low fertility. However, a sustainable production system for sweet sorghum is not yet established in South Africa. Lately, conservation agriculture (CA) has gained research focus because of its benefits as a sustainable crop production system. Therefore, CA may offset the negative impacts of intensive agronomic practices during biofuel crop production. This paper reviewed CA as a possible sustainable crop production system for sweet sorghum as a biofuel feedstock. CA enhanced soil quality, reduced carbon dioxide emissions, and increased yield of sorghum and related cereals. It was concluded that CA has potential to enhance sweet sorghum production as a biofuel feedstock under semi‐arid conditions in South Africa. Therefore, local field experiments on sweet sorghum production under CA are desirable in South Africa. [ABSTRACT FROM AUTHOR]

ABSTRACT This paper provides an analysis of the interplays between climate risks, eco-systems and adaptation decisions using South American and Sub- Saharan African farm surveys. Climate risk indicators such as seasonal Coefficient of Variation in Precipitation ( CVP) and Diurnal Temperature Range ( DTR) are matched with major eco-systems. Adoption decisions of the six natural resource enterprises are modelled using a spatial Logit model. First, this paper finds that climate risks are higher in the grasslands and meadow eco-systems in South America as they are high in the lowland arid zones in Africa. However, climate risks across the continent are, compared with Sub-Saharan Africa, much lower in South America. Second, a higher temperature implies a higher climate risk in Africa, which is not the case in South America owing to the predominant influences of regional weather events such as the ENSO. Third, while the CVP is a dominant risk factor in Africa, the DTR is a dominant risk factor in South America due to the vast ranges of the Andes Mountain. Winter DTR is predicted to fall by 3 °C under both the UKMO and the GISS scenarios by the middle of this century. Altered climate risks will push a large number of farmers to switch away from a crops-only enterprise due to a large decrease in daily temperature variability. Farmers adapt by increasing a crops-livestock enterprise in the grasslands with wood cover and subtropical drought-deciduous forests. This paper provides a coupled analysis of global (climate), local (eco-systems) and individual (adaptation) processes. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: A number of antiretroviral HIV prevention products are efficacious in preventing HIV infection. However, the sexual and reproductive health needs of many women extend beyond HIV prevention, and research is ongoing to develop multi‐purpose prevention technologies (MPTs) that offer dual HIV and pregnancy protection. We do not yet know if these products will be an efficient use of constrained health resources. In this paper, we estimate the cost‐effectiveness of combinations of candidate multi‐purpose prevention technologies (MPTs), in South Africa among general population women and female sex workers (FSWs). Methods: We combined a cost model with a static model of product impact based on incidence data in South Africa to estimate the cost‐effectiveness of five candidate co‐formulated or co‐provided MPTs: oral PrEP, intravaginal ring, injectable ARV, microbicide gel and SILCS diaphragm used in concert with gel. We accounted for the preferences of end‐users by predicting uptake using a discrete choice experiment (DCE). Product availability and protection were systematically varied in five potential rollout scenarios. The impact model estimated the number of infections averted through decreased incidence due to product use over one year. The comparator for each scenario was current levels of male condom use, while a health system perspective was used to estimate discounted lifetime treatment costs averted per HIV infection. Product benefit was estimated in disability‐adjusted life years (DALYs) averted. Benefits from contraception were incorporated through adjusting the uptake of these products based on the DCE and through estimating the costs averted from avoiding unwanted pregnancies. We explore the additional impact of STI protection through increased uptake in a sensitivity analysis. Results: At central incidence rates, all single‐ and multi‐purpose scenarios modelled were cost‐effective among FSWs and women aged 16–24, at a governmental willingness‐to‐pay threshold of $1175/DALY averted (range: $214–$810/DALY averted among non‐dominant scenarios), however, none were cost‐effective among women aged 25–49 (minimum $1706/DALY averted). The cost‐effectiveness of products improved with additional protection from pregnancy. Estimates were sensitive to variation in incidence assumptions, but robust to other parameters. Conclusions: To the best of our knowledge, this is the first study to estimate the cost‐effectiveness of a range of potential MPTs; suggesting that MPTs will be cost‐effective among higher incidence FSWs or young women, but not among lower incidence older women. More work is needed to make attractive MPTs available to potential users who could use them effectively. [ABSTRACT FROM AUTHOR]

Introduction: Sex workers, people who use drugs, men who have sex with men, women who have sex with women and transgender people in South Africa frequently experience high levels of stigma, abuse and discrimination. Evidence suggests that such abuse is sometimes committed by police officers, meaning that those charged with protection are perpetrators. This reinforces cycles of violence, increases the risk of HIV infection, undermines HIV prevention and treatment interventions and violates the constitutional prescriptions that the police are mandated to protect. This paper explores how relationship building can create positive outcomes while taking into account the challenges associated with reforming police strategies in relation to key populations, and vice versa. Discussion: We argue that relationships between law enforcement agencies and key populations need to be re-examined and reconstituted to enable appropriate responses and services. The antagonistic positioning, ''othering'' and blame assignment frequently seen in interactions between law enforcement officials and key populations can negatively influence both, albeit for different reasons. In addressing these concerns, we argue that mediation based on consensual dialogue is required, and can be harnessed through a process that highlights points of familiarity that are often shared, but not understood, by both parties. Rather than laying blame, we argue that substantive changes need to be owned and executed by all role-players, informed by a common language that is cognisant of differing perspectives. Conclusions: Relational approaches can be used to identify programmes that align goals that are part of law enforcement, human rights and public health despite not always being seen as such. Law enforcement champions and representatives of key populations need to be identified and supported to promote interventions that are mutually reinforcing, and address perceived differences by highlighting commonality. Creating opportunities to share experiences in mediation can be beneficial to all role-players. While training is important, it is not a primary mechanism to change behaviour and attitudes. [ABSTRACT FROM AUTHOR]

This paper responds to Patricia Hayes's insightful readings of Santu Mofokeng's photographic work in South Africa. The paper operates from the premise that photography is a technology of visualization that both draws on and establishes a visual economy through which events and issues are materialized in particular ways. This allows the paper to pose questions and develop understandings about Mofokeng's work in terms of the way certain factors coalesced to enable a particular representation of black South Africans in the global image economy. Central to this is the role of assumptions about exposure and visibility in relation to violence, assumptions that Mofokeng's work, as a critique of conventional documentary work, explicitly contests. In exploring the invisibility of everyday life, Mofokeng expands notions of documentary photography and photojournalism. This paper demonstrates this point by connecting Mofokeng's work to a contemporary controversy in European photojournalism to highlight how a more complex understanding of documentary photography is necessary. [ABSTRACT FROM AUTHOR]

South Africans today inhabit a fragmented and discontinuous landscape, often despite their most cosmopolitan intentions. Grounded in the Coloured neighbourhood of Wentworth in Durban, this paper asks how remains of the past appear as differently temporalised artefacts, some buried in the archaic past and others more readily used to critique the present. In particular, I explore photographs of inmates of a concentration camp from 1902, township youth appropriating a specific commons in the early 1980s, black political photography from the late 1980s, and film wrestling with the ambiguities of post-apartheid political life in a Coloured neighbourhood next to an oil refinery. What unites these moments is not just a meta-theoretical concern with photography as both documentary and aesthetic, but the specific political uses of images, exemplified by the work of two black political photographers. Their practice provides cues for situating these other photographs in a long century of multiple dispossessions. The paper explores when and how photographs might shock the viewer into recognising resemblances, connections and potential solidarities, not just with the past, but with subaltern critique of racial space and subjectivity in the present. I suggest how we might view photographs from various moments relationally, to understand how, in one corner of contemporary South Africa, people continue to wait for justice despite uncertainty and official dissimulation, in a state of anticipatory frustration. [ABSTRACT FROM AUTHOR]

Objectives To investigate the nutritional status of Black South African teenagers by sex and compare it with nutritional profiles of teenagers from other countries. Methods The first South African Youth Risk Behaviour Survey (2002) was adapted to include anthropometric data and this paper reports on the prevalence of under and over nutrition among 5322 Black teenagers, aged 13.0–17.9 years, grades 8–11. Prevalence of over nutrition in this study was compared with other countries using a World Bank country economic classification. Results Significant sex differences were observed for under and over nutrition. Boys (18.4%) had a higher prevalence of underweight than girls (2.6%) ( P < 0.005), who were more at risk of overweight than boys (20.9% vs. 4.2%) ( P < 0.005). Boys (21.9%) were more stunted than girls (9.4%) ( P < 0.05), but stunted girls were at greater risk of overweight than boys across all levels of stunting. The prevalence of overweight among boys (4.2%) was lower than in other countries while for girls (20.9%) was similar to several upper middle and high income countries. Conclusion Gender sensitive strategies are required to address both under and over nutrition among South African teenagers to reduce stunting and future chronic disease epidemics in adulthood. This paper suggests that Black South African teenagers are experiencing an uneven nutritional transition across sex, from under nutrition to over nutrition. [ABSTRACT FROM AUTHOR]

This paper examines social, political and economic processes within the former KaNgwane bantustan to understand the changing relationships between society and space in the post-apartheid era. Research on rural development and reconstruction in South Africa attest to the spatial legacy of apartheid while suggesting that dynamic transformations are occurring within the former bantustans. A central concern of this paper is the ways the apartheid government constructed and presented KaNgwane as a development project in order to justify racial segregation and control. While the bantustans have been effectively erased from the popular imagination, these spaces continue to be framed developmentally in ways that provide limited attention to local context and change. In order to consider the shifts in environment and development discourses within these territories, a case study is employed to evaluate livelihood production systems, environmental change, and governance institutions. It is argued that these patterns reveal the simultaneously static and dynamic nature of the bantustans while demonstrating that their reincorporation will remain an ongoing process in the post-apartheid era. [ABSTRACT FROM AUTHOR]

This paper focuses on the spatial impact of land reform and the redrawing of internal boundaries on South Africa's former bantustans. It argues that, in contrast to the democratic government's intention to use land reform and boundary demarcation to effectively change the spatial legacy of apartheid, these processes tend to cement the geography of the former bantustans. Though earlier research correctly projected that post-apartheid policies could result in the enlargement of the areas of the former bantustans, the ways in which this could happen were still unclear. This paper draws on experiences of land reform and boundary demarcation to demonstrate how and why the areas of the former bantustans have been enlarged over the 12 years of democracy in South Africa. [ABSTRACT FROM AUTHOR]

This paper explores the use of personal solicited diaries as a qualitative research tool within social geography. Diaries were used with women from South Africa who recorded their experiences of violence over a period of one month. The paper analyses diaries in terms of their longitudinal benefits, their socially constituted nature, their use in conjunction with interviews and finally their potential for empowerment. The paper concludes with a discussion of the limitations of the diary as a methodological tool. [ABSTRACT FROM AUTHOR]

The aim of this paper is to reassess the land degradation and desertification problem in South Africa. The country has a wide range of interrelated environmental and development challenges existing in a socio–political context recently subject to substantial change. The paper outlines the fundamental environmental constraints and opportunities that underlie degradation phenomena and illustrates the nature, extent and geographical distribution of the major forms of soil and vegetation degradation in the country. The principal causes of degradation are identified and some important land use and land tenure questions that need to be addressed in the near future are posited. [ABSTRACT FROM AUTHOR]

Introduction: Understanding the impact of curable sexually transmitted infections (STIs) on HIV transmissibility is essential for effective HIV prevention programs. Investigating the impact of longitudinally measured recurrent STIs on HIV seroconversion is the interest of the current paper. Methods: In this prospective study, data from a total of 1456 HIV-negative women who enrolled in a HIV biomedical trial were used. It was hypothesized that women who had recurrent STI diagnoses during the study share a common biological heterogeneity which cannot be quantified. To incorporate this "unobserved" correlation in the analysis, times to HIV seroconversion were jointly modelled with repeated STI diagnoses using Cox regression with random effects. Results and discussion: A total of 110 HIV seroconversions were observed (incidence rate of 6.00 per 100 person-years). In a multivariable model, women who were diagnosed at least once were more likely to seroconvert compared to those who had no STI diagnosis [hazard ratio (HR): 1.63, 95% confidence interval (CI): 1.04, 2.57]; women who had recurrent STI diagnoses during the study were 2.5 times more likely to be at increased risk of HIV infection (95% CI: 1.35, 4.01) with an estimated frailty variance of 1.52, with p<0.001, indicating strong evidence that there is a significant correlation (heterogeneity) among women who had recurrent STIs. In addition to this, factors associated with incidence of STIs, namely not being married and having a new sexual partner during the study follow-up, were all significantly associated with increased risk for HIV seroconversion (HR: 2.92, 95% CI: 1.76, 5.01 and HR: 2.25, 95% CI: 1.63, 3.83 respectively). Conclusions: The results indicated that women who were at risk for STIs were also at risk of HIV infection. In fact, they share the similar risk factors. In addition to this, repeated STI diagnoses also increased women's susceptibility for HIV infection significantly. Decreasing STIs by increasing uptake of testing and treatment and reducing partner change plays a significant role in the trajectory of the epidemic. [ABSTRACT FROM AUTHOR]

This paper exploits the unique institutional features of South Africa to estimate the impact of provincial public spending on firm productivity. In contrast to existing microeconomic evidence, we explore the effects of fiscal expenditures and remove the effects of revenue raising policies. Our identification strategy is based on differences in the effects of public spending across firms within the same industry and province. We show that public spending composition affects productivity depending on the capital intensity of firms, with less capital intensive firms being particularly affected. These effects appear to be robust. ( JEL D24, H32, H72) [ABSTRACT FROM AUTHOR]

This paper describes the first step in developing an approach to fire risk assessment aimed at balancing the reduction of risks to lives and livelihoods and maintaining fire regimes which protect ecosystem biodiversity and function in fire-prone ecosystems. Wildfires pose a major hazard to people's lives, livelihoods and ecosystems in South Africa with poor communities generally being highly exposed and vulnerable. Although general information exists, an adequate understanding of the fire regimes, how they vary spatially, and the related vegetation management requirements is lacking. This study resolves the environmental variation in fire regimes across South Africa into a systematic framework for wildfire risk assessment and ecologically sound ecosystem management. The available descriptions of fire regimes, vegetation classifications, and fire occurrence data from remote sensing are synthesized to derive a set of 13 distinct fire-ecology types, that is, sets of vegetation units which experience distinct fire regimes. Fuel dynamics, fire-dependence, ecologically acceptable fire regimes, and guidelines for fire management are described for each of these fire-ecology types and they are grouped into three categories: fire dependent, fire independent and fire sensitive. Fire-dependent ecosystems comprise more than 60% of South Africa and fire-independent ones 32%, the latter mainly in the arid west and northwest, while the remainder are fire sensitive. Fire-dependent systems require fires and generally coincide with the greatest rural population densities. The outputs from this framework can be used to analyse wildfire risk and translate the risk into practical management measures which are responsive to local ecological, social and institutional settings. [ABSTRACT FROM AUTHOR]

Old World vultures are in decline across their entire range. Although critical for the formulation of effective conservation measures, neither survival nor movement patterns of African vultures are adequately known. This paper presents survival and movement data on the African white-backed vultures ( Gyps africanus) from South Africa. Survival estimates were modelled on resightings of tagged vultures. Birds were captured en masse and resighted between November 2005 and December 2010. A total of 93 adult and subadult birds were fitted with uniquely numbered patagial tags, which were resighted 3707 times(mean of 39.8 resightings per bird). The programme MARK was used to estimate survival. The best model was one where survival and recaptures varied only with time (e.g. year). However, owing to the fading (illegibility) of tags in later years, the relationship with time is probably spurious. The second best model was one where survival and recaptures varied with age and time. Annual survival estimates increased from 85.2% in second-year birds to 99.9% in adults. This corresponds well with the survival of two other Gyps vultures that have been studied to date and underscores the point that additional mortality of adults in these long-lived species will result in rapid population declines. [ABSTRACT FROM AUTHOR]

The concept of a focused ethnographic study ( FES) emerged as a new methodology to answer specific sets of questions that are required by agencies, policymakers, programme planners or by project implementation teams in order to make decisions about future actions with respect to social, public health or nutrition interventions, and for public-private partnership activities. This paper describes the FES on complementary feeding that was commissioned by the Global Alliance for Improved Nutrition and highlights findings from studies conducted in three very different country contexts ( Ghana, South Africa and Afghanistan) burdened by high levels of malnutrition in older infants and young children ( IYC). The findings are analysed from the perspective of decision-making for future interventions. In Ghana, a primary finding was that in urban areas the fortified, but not instant cereal, which was being proposed, would not be an appropriate intervention, given the complex balancing of time, costs and health concerns of caregivers. In both urban and rural South Africa, home fortification products such as micronutrient powders and small quantity, lipid-based nutrient supplements ( LNS) are potentially feasible interventions, and would require thoughtful behaviour change communication programmes to support their adoption. Among the important results for future decision-making for interventions in Afghanistan are the findings that there is little cultural recognition of the concept of special foods for infants, and that within households food procurement for IYC are in the hands of men, whereas food preparation and feeding are women's responsibilities. [ABSTRACT FROM AUTHOR]

This paper is about the geopolitics of animal health governance. Through a biosecurity event in South Africa's pig sector we examine changes in the way the governance of disease risk is configuring intra-national spaces. Our case suggests an emerging geopolitics of animal health, one that is defined not by differences between nations but by a more complex patchwork of 'secure' and 'unruly spaces'. [ABSTRACT FROM AUTHOR]

This paper reports on a two-pronged qualitative research study that used leaders' life stories and the case research method to understand the leadership of change in 14 South African organizations. We describe how leaders led the changes required to balance the imperatives emanating from South Africa's socio-political changes and return the country to the international business arena, as well as the challenges created by years of inequality and neglect of the socio-economic development of the majority of its population. We found that the leaders' life stories played a significant role in how they perceived and responded to the change situation. Four themes summarizing the actions of the leaders - namely, their efforts to embrace change, to provide hope, to connect change to African values and culture, and to champion diversity - are described. The results of the study suggest that leaders' life stories can be an important source of information about how they perceive, interpret, and respond to change. [ABSTRACT FROM AUTHOR]

Aim Anthropogenic introductions of Australian Acacia spp. that become classed as alien invasive species have consequences besides the physical, spatial and ecological: there are also cultural, ethical and political considerations that demand attention from scholars in the humanities and social sciences. As practitioners in these disciplines, our aim is to reflect upon some of the social and conceptual ideas and attitudes relating to the spread of Australian Acacia spp. around the world. We therefore provide a longer-term historical and philosophical perspective using South Africa as a key example. We explain some of the cultural aspects of Australian acacias, relating them to history, philosophy and societal ideas that were once, or indeed remain, important, either regarding their exportation from Australia or their importation into other countries. Focussing principally on South Africa and Australia but including brief references to other locations, we augment the literature by making connections between acacia introductions and environmental ethics and aesthetics, national and environmental history and symbolic and other discourses. We evaluate a number of the cultural and philosophical dimensions of invasion biology as a societal response and explicate the interesting contradiction of Australian acacia introductions as simultaneously economically valuable and environmentally transformative in South Africa. Location South Africa, Australia, with references to other parts of the world. Methods This paper has been written by an interdisciplinary team (two historians, two geographers, a philosopher and an ecologist) and is conceptual and historical, conforming in language and structure to the humanities style. It relies on published and unpublished literature from this disciplinary domain and the critical evaluation of these sources. Results Many Acacia spp. from Australia have been introduced around the world, generally guided in different eras by a variety of overarching mindsets, including the colonial ethos of 'improvement' (1800s to mid 1900s), an economically driven mindset of 'national development' (1900s), by a people-centred frame combining concerns of environment and livelihood in 'sustainable development' (1980s onwards), and an aesthetic ethos of ornamental planting that surfaces in all periods. The newest ethos of controlling or managing alien invasive species, a normative attitude deriving from the burgeoning of invasion biology, has more recently shaped the ideology of these plant exchanges and sharpened the focus on species that may be simultaneously both weeds and commercially valuable crops. Our perspective from the humanities and social sciences calls for a more transparent approach that clearly acknowledges such contradictions. Main conclusions We conclude that the global experiment of human-mediated Australian acacia introductions raises a number of issues that reflect changing societal concerns and demand attention from scholars in disciplines apart from the natural sciences. Here we highlight the impact of historical context in plant exchanges, the history and philosophy of science as it relates to invasion biology, and changing - sometimes divisive - societal priorities in terms of aesthetic, economic and conservation values. In particular, the case of Acacia spp. in South Africa highlights the contradictory aspects of introductions in that some species are both commercially important and environment-altering invasive plants. We argue that the contribution of disciplines beyond ecology to the debates about the invasive status of acacias enlarges our understanding and provides useful insights for botanists, foresters, managers and policy makers. [ABSTRACT FROM AUTHOR]

This paper argues that participation in natural resource management, which is often coupled with moves for more local ownership of decisionmaking, is based on three sets of assumptions: about the role of the state, the universality of application of such approaches and the transformatory potential of institutional reform. The validity of these assumptions requires investigation in view of the rapid institutionalisation and scaling-up of participatory approaches, particularly in developing country contexts. Post-apartheid South Africa is widely recognised as a pioneer of participatory and devolutionary approaches, particularly in the field of water resources. It is 12 years since the promulgation of the forward-thinking 1998 National Water Act, and thus an opportune moment to reflect on South Africa's experiences of participatory governance. Drawing on empirical research covering the establishment of the first Catchment Management Agency, and the transformation of existing Irrigation Boards into more inclusive Water User Associations in the Inkomati Water Management Area, it emerges that there may be fundamental weaknesses in the participatory model and underlying assumptions, and indeed such approaches may actually reinforce inequitable outcomes: the legacy of long-established institutional frameworks and powerful actors therein continues to exert influence in post-apartheid South Africa, and has the potential to subvert the democratic and redistributive potential of the water reforms. It is argued that a reassessment of the role of the state is necessary: where there is extreme heterogeneity in challenging catchments more, rather than less, state intervention may be required to uphold the interests of marginalised groups and effect redistribution. [ABSTRACT FROM AUTHOR]

Stories of the nation unite and divide: those who are perceived as or who perceive themselves as authorized to speak from those who are not; those who belong 'within' from those who are consigned to the outside. By examining affective responses to a planned artistic appropriation of a historically significant site for Afrikaner separatists in post-apartheid South Africa, this paper explores the process of relating the 'nation' to stories of the past and resulting contestations to this process. Significantly, it considers the implications of dis-owned histories on its possessors and their relationship to 'nation'. [ABSTRACT FROM AUTHOR]

This paper explores two very different contexts in South Africa where witnessing and secondary witnessing have a special impact on the nature of national memorialization: women's narrative accounts of their prison experiences; and therapeutic initiatives around HIV/AIDS. It asks whether experiences related through testimony of one kind or another can be embodied in forms which might enable access for non-participants, especially since the power of witnessing relies so heavily on qualities of voice and performance. What would be an adequate and relevant form which might translate personal trauma into a publicly accessible and affective monument or memorial? And if, unlike most of the public commemorative initiatives in South Africa since 1994, we take gender into consideration, is there anything particular about aspects of women's experience that might influence such a decision? Is it possible for us as non-participants to adopt an ethical viewing position in relation to this material which takes on board both Susan Sontag's caution about voyeurism and Gayatri Spivak's insistence on the importance of listening without engaging in a necessarily narcissistic empathy that might obliterate the speaker's right to an incommensurable experience? [ABSTRACT FROM AUTHOR]

Determining the potential range of invasive alien species under current conditions is important. However, we also need to consider future distributions under scenarios of climate change and different management interventions when formulating effective long-term intervention strategies. This paper combines niche modelling and fine-scale process-based modelling to define regions at high risk of invasion and simulate likely dynamics at the landscape scale. Our study species is Schinus molle (Peruvian pepper tree; Anacardiaceae), a native of central South America, introduced to South Africa in about 1850 where it was widely planted along roads. Localities of planted and naturalized trees were mapped along 5380 km of roads - a transect that effectively samples a large part of western South Africa. Correlative modelling was used to produce profiles of present and future environmental conditions characterizing its planted and naturalized ranges. A cellular-automata simulation model was used to estimate the dynamics of S. molle under future climates and different management scenarios. The overall potential range of S. molle in the region is predicted to shrink progressively with predicted climate change. Some of the potential range of S. molle defined based on current conditions (including areas where it is currently highly invasive) is likely to become less favourable. The species could persist where it is well established long after conditions for recruitment have deteriorated. Some areas where the species is not widely naturalized now (notably the fynbos biome) are likely to become more favourable. Our modelling approach allows for the delineation of areas likely to be invaded in future by considering a range of factors at different scales that mediate the interplay of climatic variables and other drivers that define the dimensions of human intervention such as distance from planted trees and the density of planted plants, both of which affect propagule pressure. [ABSTRACT FROM AUTHOR]

This paper reports the results of the first study on secondary seed removal of seeds dispersed by Sykes' monkeys ( Cercopithecus albogularis) using camera traps in Africa. Patterns of primary seed dispersal are often superimposed by secondary conveyance, emphasising the need to study these secondary processes carefully. As the agents and mechanisms of seed dispersal are often concealed, being carried out by cryptic or nocturnal animals in dense vegetation, camera trapping was deemed a viable means to investigate secondary removal of seeds disseminated by C. albogularis in the Western Soutpansberg, South Africa. Camera traps were established at preferred feeding trees of the focal Sykes' monkey group to identify animal species that remove seeds and fruits spat and dropped to the forest floor and seed removal observations were carried out. This method proved to be effective in identifying seed removers and also allowed to get indications about the quantities of seeds removed. Ten animal species were recorded visiting the trees, of which eight were observed removing seeds and fruits. Overall seed and fruit removal rates were high, indicating that the foraging behaviour of C. albogularis attracts many terrestrial frugivores. [ABSTRACT FROM AUTHOR]

Research shows that gender power inequity in relationships and intimate partner violence places women at enhanced risk of HIV infection. Men who have been violent towards their partners are more likely to have HIV. Men's behaviours show a clustering of violent and risky sexual practices, suggesting important connections. This paper draws on Raewyn Connell's notion of hegemonic masculinity and reflections on emphasized femininities to argue that these sexual, and male violent, practices are rooted in and flow from cultural ideals of gender identities. The latter enables us to understand why men and women behave as they do, and the emotional and material context within which sexual behaviours are enacted. In South Africa, while gender identities show diversity, the dominant ideal of black African manhood emphasizes toughness, strength and expression of prodigious sexual success. It is a masculinity women desire; yet it is sexually risky and a barrier to men engaging with HIV treatment. Hegemonically masculine men are expected to be in control of women, and violence may be used to establish this control. Instead of resisting this, the dominant ideal of femininity embraces compliance and tolerance of violent and hurtful behaviour, including infidelity. The women partners of hegemonically masculine men are at risk of HIV because they lack control of the circumstances of sex during particularly risky encounters. They often present their acquiescence to their partners' behaviour as a trade off made to secure social or material rewards, for this ideal of femininity is upheld, not by violence per se, by a cultural system of sanctions and rewards. Thus, men and women who adopt these gender identities are following ideals with deep roots in social and cultural processes, and thus, they are models of behaviour that may be hard for individuals to critique and in which to exercise choice. Women who are materially and emotionally vulnerable are least able to risk experiencing sanctions or foregoing these rewards and thus are most vulnerable to their men folk. We argue that the goals of HIV prevention and optimizing of care can best be achieved through change in gender identities, rather than through a focus on individual sexual behaviours. [ABSTRACT FROM AUTHOR]

Background: AIDS-associated Kaposi's sarcoma is an important, life-threatening opportunistic infection among people living with HIV/AIDS in resource-limited settings. In western countries, the introduction of combination antiretroviral therapy (cART) and new chemotherapeutic agents has resulted in decreased incidence and improved prognosis of AIDS-associated Kaposi's sarcoma. In African cohorts, however, mortality remains high. In this study, we describe disease characteristics and risk factors for mortality in a public sector HIV programme in South Africa. Methods: We analysed data from an observational cohort study of HIV-infected adults with AIDS-associated Kaposi's sarcoma, enrolled between May 2001 and January 2007 in three primary care clinics. Paper records from primary care and tertiary hospital oncology clinics were reviewed to determine the site of Kaposi's sarcoma lesions, immune reconstitution inflammatory syndrome stage, and treatment. Baseline characteristics, cART use and survival outcomes were extracted from an electronic database maintained for routine monitoring and evaluation. Cox regression was used to model associations with mortality. Results: Of 6292 patients, 215 (3.4%) had AIDS-associated Kaposi's sarcoma. Lesions were most commonly oral (65%) and on the lower extremities (56%). One quarter of patients did not receive cART. The mortality and lost-tofollow- up rates were, respectively, 25 (95% CI 19-32) and eight (95% CI 5-13) per 100 person years for patients who received cART, and 70 (95% CI 42-117) and 119 (80-176) per 100 person years for patients who did not receive cART. Advanced T stage (adjusted HR, AHR = 5.3, p < 0.001), advanced S stage (AHR = 5.1, p = 0.008), and absence of chemotherapy (AHR = 2.4, p = 0.012) were associated with mortality. Patients with AIDS-associated Kaposi's sarcoma presented with advanced disease and high rates of mortality and loss to follow up. Risk factors for mortality included advanced Kaposi's sarcoma disease and lack of chemotherapy use. Contributing factors to the high mortality for patients with AIDS-associated Kaposi's sarcoma likely included late diagnosis of HIV disease, late accessibility to cART, and sub-optimal treatment of advanced Kaposi's sarcoma. Conclusions: These findings confirm the importance of early access to both cART and chemotherapy for patients with AIDS-associated Kaposi's sarcoma. Early diagnosis and improved treatment protocols in resource-poor settings are essential. [ABSTRACT FROM AUTHOR]

Abstract. Recent developments of automated methods for monitoring animal movement, e.g., global positioning systems (GPS) technology, yield high-resolution spatiotemporal data. To gain insights into the processes creating movement patterns, we present two new techniques for extracting information from these data on repeated visits to a particular site or patch ("recursions"). Identification of such patches and quantification of recursion pathways, when combined with patch-related ecological data, should contribute to our understanding of the habitat requirements of large herbivores, of factors governing their space-use patterns, and their interactions with the ecosystem. We begin by presenting output from a simple spatial model that simulates movements of large-herbivore groups based on minimal parameters: resource availability and rates of resource recovery after a local depletion. We then present the details of our new techniques of analyses (recursion analysis and circle analysis) and apply them to data generated by our model, as well as two sets of empirical data on movements of African buffalo (Syncerus caffer): the first collected in Klaserie Private Nature Reserve and the second in Kruger National Park, South Africa. Our recursion analyses of model outputs provide us with a basis for inferring aspects of the processes governing the production. of buffalo recursion patterns, particularly the potential influence of resource recovery rate. Although the focus of our simulations was a comparison of movement patterns produced by different resource recovery rates, we conclude our paper with a comprehensive discussion of how recursion analyses can be used when appropriate ecological data are available to elucidate various factors influencing movement. Inter alia, these include the various limiting and preferred resources, parasites, and topographical and landscape factors. [ABSTRACT FROM AUTHOR]

Aim Spatial scale is critical for understanding and managing biological invasions. In providing direction to managing alien plant invasions, much emphasis is placed on collecting spatially explicit data. However, insufficient thought is often given to how the data are to be used, frequently resulting in the incompatibility of the data for different uses. This paper explores the role of spatial scale in interpreting, managing and monitoring alien plant invasions in a large protected area. Location Kruger National Park, South Africa. Methods Using 27,000 spatially-explicit records of invasive alien plants for the Kruger National Park (> 20,000 km2) we assessed alien plant species richness per cell at nine different scales of resolution. Results When assessing the patterns of alien plants at the various scales of resolution, almost identical results are obtained when working at scales of quarter-degree grids and quaternary watersheds (the fourth level category in South Africa's river basin classification system). Likewise, insights gained from working at resolutions of 0.1–0.5 km and 1–5 km are similar. At a scale of 0.1 × 0.1 km cells, only 0.4% of the Kruger National Park is invaded, whereas > 90% of the park is invaded when mapped at the quarter-degree cell resolution. Main conclusions Selecting the appropriate scale of resolution is crucial when evaluating the distribution and abundance of alien plant invasions, understanding ecological processes, and operationalizing management applications and monitoring strategies. Quarter-degree grids and quaternary watersheds are most useful at a regional or national scale. Grid cells of 1 to 25 km2 are generally useful for establishing priorities for and planning management interventions. Fine-scale data are useful for informing management in areas which are small in extent; they also provide the detail appropriate for assessing patterns and rates of invasion. [ABSTRACT FROM AUTHOR]

Aim The aim of this paper is to examine taxonomic homogenization in ungulates globally and at the local scale in South Africa. Specifically, we aim to examine the roles of distance, scale, time, extinctions vs. introductions, and extralimital vs. extraregional introductions in the homogenization of ungulate biotas, and to determine pathways of introduction of ungulate species globally and the proximate explanatory variables of ungulate introductions in South Africa. Location Forty-one countries globally and three spatial resolutions in South Africa. Methods Indigenous, extirpated and established introduced ungulate species data were obtained for countries globally, and at a quarter-degree grid-cell resolution in South Africa. Homogenization was calculated using Jaccard’s index of similarity (JI) for countries globally and for three spatial resolutions in South Africa. Zoo holdings and transfer data from the International Species Information System database were used to investigate the relationship between non-indigenous ungulate species introductions and the number of non-indigenous ungulate species in zoos. Relationships between JI and species richness, and between numbers of introductions and several environmental and social factors were examined using generalized linear models. Results Homogenization in ungulates was 2% for countries globally and 8% at the coarsest resolution in South Africa. Homogenization increased with increasing resolution and with time, but it decreased with increasing percentage change in species richness. Globally, introductions contributed more to homogenization than did extinctions. Within South Africa, extralimital introductions contributed more to the homogenization of ungulate assemblages than did extraregional ones, and ungulates were typically introduced to high-income areas with high human population and livestock densities. The same was not true in the past, when ungulates were introduced to ungulate species-poor areas. The number of non-indigenous ungulate species established in a country is significantly related to the number of non-indigenous ungulate species in zoos in the country, possibly owing to sales of surplus animals from zoos. Main conclusions Ungulate faunas are homogenized at both the global scale and in South Africa, with extralimital introductions being of considerable significance regionally. In consequence, increasing attention will have to be given to the conservation consequences of ungulate translocations, both within particular geopolitical regions and across the globe. [ABSTRACT FROM AUTHOR]

Aim Models of the potential distributions of invading species have to deal with a number of issues. The key one is the high likelihood that the absence of an invading species in an area is a false absence because it may not have invaded that area yet, or that it may not have been detected. This paper develops an approach for screening pseudo-absences in a way that is logical and defensible. Innovation The step-wise approach involves: (1) screening environmental variables to identify those most likely to indicate conditions where the species cannot invade; (2) identifying and selecting the most likely limiting variables; (3) using these to define the limits of its invasion potential; and (4) selecting points outside these limits as true absence records for input into species distribution models. This approach was adopted and used for the study of three prominent Hakea species in South Africa. Models with and without the false absence records were compared. Two rainfall variables and the mean minimum temperature of the coldest month were the strongest predictors of potential distributions. Models which excluded false absences predicted that more of the potential distribution would have a high invasion potential than those which included them. Main conclusions The approach of applying a priori knowledge can be useful in refining the potential distribution of a species by excluding pseudo-absence records which are likely to be due to the species not having invaded an area yet or being undetected. The differences between the potential distributions predicted by the different models convey more information than making a single prediction, albeit a consensus model. The robustness of this approach depends strongly on an adequate knowledge of the ecology, invasion history and current distribution of that species. [ABSTRACT FROM AUTHOR]

The oldest records of mammal-like therapsids in Laurasia are from the Ocher Complex of Russia and the Xidagou Formation of China, whereas in Gondwana they are restricted to the Eodicynodon Assemblage Zone, Beaufort Group of the South African Karoo. This fauna, which is relatively depauperate when compared with younger assemblage zones from the Karoo, shows an amazing diversity of therapsids including: dinocephalians (already represented by the carnivorous anteosaurids and the herbivorous tapinocephalids), anomodonts (including dicynodonts), gorgonopsians, and therocephalians. The last group is represented by two specimens in this assemblage zone. This paper presents a full description of these therocephalians, which are assigned to the scylacosaurid species Glanosuchus macrops and Ictidosaurus angusticeps. We also discuss diversity trends of therocephalians and explore some hypotheses implicated by the diverse oldest record of therapsids, represented by five of the six major lineages of the group. [ABSTRACT FROM AUTHOR]

This paper reports two studies among white South African students on feelings of collective guilt about apartheid and attitudes to affirmative action. Study 1 reports on 21 in-depth interviews, Study 2 on results from 180 survey questionnaires. Substantial proportions of the participants in both studies displayed feelings of collective guilt. Among participants in both studies who identified strongly with white South Africans, some displayed strong feelings of collective guilt while others displayed no such feelings. Our survey data suggest that political ideology functions as a moderator. Strong feelings of guilt were found among students who identified strongly with white South Africans and defined themselves as liberals. If they defined themselves as conservatives then no feelings of collective guilt were observed. Strong feelings of collective guilt were accompanied by positive attitudes toward affirmative action. The influence of political ideology on attitudes toward affirmative action was mediated by collective guilt. [ABSTRACT FROM AUTHOR]

Post-Apartheid South Africa has witnessed an outpouring of testimony to past and present inequities, using varied means and to varied effect. This paper addresses challenges faced by people engaged in social justice work as they devise evidence specifically for political ends. Political evidence poses several challenges to people consciously engaged in transforming their social conditions. I ask how various forms of political evidence and testimony to post-Apartheid racism are produced in the neighbourhood of Wentworth, Durban – a mixed industrial-residential landscape saturated with petrochemical pollution. People engaged in political work in Wentworth struggle to demonstrate evidence of environmental racism against official dissimulation. Wentworth's residents often face the limits of legal-juridical notions of evidence exemplified in compensatory disputes. I explore how evidence is mobilized in political work through specific tools and authorizing discourses that privilege compensation alongside other forms of activist witnessing of social inequality. Certain kinds of evidence are deemed more legitimate as political evidence, whether or not these kinds can help transform persisting inequalities after Apartheid. While official dissimulation points to the limits of narrowing the focus to compensation, official silencing also highlights emergent forms of witness to legal, racialized social inequality. Wentworth speaks to innovations in political evidence in the wake of a racially fragmented archive, and in relation to new forms of state-sanctioned racism. Résumé L'Afrique du Sud post-apartheid a vu se multiplier les témoignages d'iniquités présentes et passées, présentés par différents moyens et avec différents résultats. L'auteur s'intéresse ici aux difficultés rencontrées par ceux qui œuvrent pour la justice sociale lorsqu'il s'agit de concevoir des preuves à des fins spécifiquement politiques. La preuve politique crée plusieurs défis aux personnes qui s'engagent consciemment dans la transformation de leur condition sociale. L'auteur s'interroge sur la manière dont différentes formes de preuve politique et de témoignages de racisme post-apartheid sont produites à Wentworth, un quartier de Durban à la fois industriel et résidentiel, saturé de pollution pétrochimique. Dans ce quartier, les militants tentent d'apporter la preuve d'un racisme écologique face à la dissimulation officielle. Les habitants de Wentworth se heurtent aux limites des notions juridiques et légales de preuve notamment dans les demandes de dédommagement. L'auteur étudie la façon dont la preuve est mobilisée dans le travail politique par des outils spécifiques et des discours d'autorisation, privilégiant le dédommagement, parallèlement à d'autres formes de témoignages d'activistes sur les inégalités sociales. Certains types de preuves sont jugés plus légitimes que la preuve politique, qu'ils puissent ou non aider à transformer les inégalités qui persistent après la fin de l'apartheid. Bien que la dissimulation officielle fasse apparaître les limites d'une vision limitée au dédommagement, elle met également en lumière des formes émergentes de témoignages sur les inégalités sociales juridiques et racialisées. Wentworth appelle à des innovations en matière de preuve politique sur fond d'archives racialement fragmentées, en relation avec de nouvelles formes de racisme cautionnées par l'État. [ABSTRACT FROM AUTHOR]

What is already known about this subject • Studies conducted primarily in developed countries have shown that adverse drug reactions (ADRs) are a significant cause of hospital admission, prolong hospital stay and consequently increase the cost of disease management in patients. • Cardiovascular medicines, hypoglycaemic agents, nonsteroidal anti-inflammatory drugs and antibiotics are the most frequently implicated medicines in these studies. • A large proportion of these ADRs have been shown to be preventable through improved drug prescribing, administration and monitoring for adverse effects. What this paper adds • This is the first Sub-Saharan African study in the HIV/AIDS era that describes the contribution of ADRs to patient morbidity, hospitalisation and mortality. • Cardiovascular medicines and antiretroviral therapy contributed the most to community-acquired ADRs at the time of hospital admission while medicines used for opportunistic infections (such as antifungals, antibiotics and antituberculosis medicines were most frequently implicated in hospital acquired ADRs. • ADRs in HIV-infected patients were less likely to be preventable. Aims To describe the frequency, nature and preventability of community-acquired and hospital-acquired adverse drug reactions (ADRs) in a South African hospital serving a community with a high prevalence of human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome. Methods A 3-month prospective observational study of 665 adults admitted to two medical wards. Results Forty-one (6.3%) patients were admitted as a result of an ADR and 41 (6.3%) developed an ADR in hospital. Many of the ADRs (46.2%) were considered preventable, although less likely to be preventable in HIV-infected patients than in those with negative or unknown HIV status (community-acquired ADRs 2/24 vs. 35/42; P < 0.0001; hospital-acquired ADRs 3/25 vs. 14/26; P = 0.003). Patients admitted with ADRs were older than patients not admitted with an ADR (median 53 vs. 42 years, P = 0.003), but 60% of community-acquired ADRs at hospital admission were in patients <60 years old. Among patients <60 years old, those HIV infected were more likely to be admitted with an ADR [odds ratio (OR) 2.32, 95% confidence interval (CI) 1.17, 4.61; P = 0.017]. Among HIV-infected patients, those receiving antiretroviral therapy (ART) were more likely to be admitted with an ADR than those not receiving ART (OR 10.34, 95% CI 4.50, 23.77; P < 0.0001). No ART-related ADRs were fatal. Antibiotics and drugs used for opportunistic infections were implicated in two-thirds of hospital-acquired ADRs. Conclusions ADRs are an important, often preventable cause of hospitalizations and inpatient morbidity in South Africa, particularly among the elderly and HIV-infected. Although ART-related injury contributed to hospital admissions, many HIV-related admissions were among patients not receiving ART, and many ADRs were associated with medicines used for managing opportunistic infections. [ABSTRACT FROM AUTHOR]

In this paper, we argue that ideology is fought over through lived environments. In making this argument, we build on Antonio Gramsci's writings on hegemony. In particular, we extend the analysis of the terrain over which hegemony operates from civil society to urban environments. Here, we argue that the socio-natural relations established through everyday activities are crucial to the consolidation (and contestation) of particular worldviews. Overall, we seek to put Gramsci to work in understanding the politics and the possibilities in the informal settlement of Inanda and more generally within post-apartheid South Africa. [ABSTRACT FROM AUTHOR]

In a recent paper we demonstrated that elephant bull groups and mixed herds exhibited spatial and resource segregation across the Kruger National Park. It was found, inter alia, that both bull groups and mixed herds occurred more frequently closer to rivers than expected if they were randomly distributed, but that only bull groups occurred more frequently closer to the artificial waterholes. Although Chamaillé-Jammes et al. (2007 ) accepted these results, they disagreed with our interpretation regarding the potential effect that closure of artificial waterholes might have. Here we address some of the specific concerns expressed and provide a broader context regarding water provision and elephant management. Although water provision can influence elephant density and distribution, we argue that the effectiveness of surface-water manipulation as a management tool will depend on (1) natural surface-water availability, (2) forage quality, (3) elephant densities, (4) position of a population on its growth trajectory, and (5) management objectives. Even though elephants are water-dependent, the effectiveness of water provision as a management tool will therefore be area- and population-specific and will depend on management objectives. [ABSTRACT FROM AUTHOR]