Page 10 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 6 Editorial

Editor’s comment: Patients at high risk of treatment failure Editor’s comment: This is a observational study spanning a
(n = 165) were enrolled in an adherence club rather than being period of 3 months (August 2014 – April 2015) and involving
retained in their parent treatment facility viz. Ubuntu Clinic, 50 HIV-uninfected Sowetan women aged between 18 and 25
Khayelitsha, Western Cape, SA. Most of the patients (81.8%) who provided questionnaire-directed answers investigating
were women. Enrolment started in 2012–2014 and the study the frequency and nature of post-coital vaginal ‘cleansing’
ended in mid-2015. Data were analysed retrospectively. The practices. Do vaginal practices increase the risk of HIV
target population had demonstrated difficulty with ART acquisition, that is by causing low-level, but recurrent trauma
adherence prior to their integration into the study. The to the genital tract? The aim of the study was to describe local
outcomes with regard to both retention in care viz. 98% practice. The authors note that South Africa’s overall HIV
(6 months), 95% (12 months) and 89% (18 months) and viral prevalence among 20–24 year-olds is 16% and in Gauteng
suppression viz. < 400 cp/mL, 90% (6 months), 84% where this study was performed, prevalence in the general
(12 months) and 75% (18 months) are comparable with those population is 18%. Exposure to infection was high. On
of clinic-based adherence studies elsewhere. This is a clearly average, the study group recorded having sex 15.3 times per
written article with an important message: with commitment month with their main partner, having casual sex 10 times
from patients and the caregiver, high-risk patients can be per month and having sex with a ‘new’ casual partner 3.6
accommodated within a ‘differentiated’ model of ART times per month. Condom use was rare. However, this
delivery. Limitations? I would watch the 18-month numbers increased over the course of the study viz. 2% at baseline to
down the line and would want data that are more inclusive 20% (main partner) and to 56% (casual partner) by the end of
of men in the Western Cape. Despite the absence of a control the study. No HIV infections occurred. Cleansing practices
group, the retrospective nature of the study and the included washing the vagina with water (44%) and using
incomplete tracing of those lost to follow-up, it nevertheless fingers to facilitate cleaning (48%) and were more likely
is a good read. practised after inconsistent condom use or sex with a casual
partner, p = 0.001. These practices decreased over the course
8. Coetzee M, Delport SD. Peripartum HIV infection in very of the study. Despite being asymptomatic, 40%, n = 20 women
low birth weight infants fed ‘raw’ mother’s own milk. had positive baseline lab tests for a genital tract infection.
South Afr J HIV Med. 2019;20(1):a912. https://doi.
org/10.4102/sajhivmed.v20i1.912 10. Kateule E, Kumar R, Mwakazanga D, Mulenga M, Daka V,
Chongwe G. A cross-sectional study of the factors associated
with male circumcision status among college youth in
Editor’s comment: An important paper to read. This is Ndola, Zambia. South Afr J HIV Med. 2019;20(1):a952.
another retrospective study that identified 80 very low birth https://doi.org/10.4102/sajhivmed.v20i1.952
weight (< 1500 g) infants born to HIV-infected mothers
between 2010 and 2013. The authors are paediatricians from Editor’s comment: This report discusses the knowledge,
Kalafong Hospital in Pretoria. Two (2.5%) of the 80 infants attitudes and perceptions of 136 male Zambian students
tested HIV-positive after birth. Neither mother had been on with regard to male circumcision and voluntary medical
ART during pregnancy. Sixty-three infants (79%) had been male circumcision (VMMC) in particular. A total of 63% of
exposed to maternal ART during pregnancy. None tested the students had been circumcised and most (96%) had
positive at the 4–6 week follow-up clinic visit. The two infants taken the formal medical route viz. VMMC. This study has
who were infected belonged to a group of 17 ART-naïve several limitations: cohort-bias, the observational nature of
mothers. All the newborns received nevirapine prophylaxis. the data, self-reporting by the students and ‘predictable’
All were given mother’s milk – ‘raw mother’s milk’. A small results, for example the circumcised students viewed the
group (n = 21/80, 26%) required additional breast milk given procedure as safe (aOR = 5.13, CI = 2.09–14.82), and effective
by donors. When did the two acquire infection? Was the ‘raw’ in reducing viral transmission from infected women to
breast milk the source of virus or infection? The authors argue uninfected men (aOR = 3.65, CI = 3.12–11.67). (Note the wide
not. Both children developed clinical signs of ‘acute’ HIV confidence intervals). The 2012–2015 national coverage of
seroconversion shortly after birth. They tested HIV-polymerase VMMC in Zambia was only 54% while the adult prevalence
chain reaction (PCR) positive on day 9 and day 20 respectively. of HIV was 12.3% (ZAMPHIR fact sheet, December 2016).
Neither had been tested at birth. The authors did a good job What is it that makes adult men complacent in the face of
of taking the reader through the complicated evolution of this epidemic? This study does not provide the answer but
mother-to-child HIV prevention in the last decade in South certainly begs the question.
Africa. Current goal posts viz. birth testing of all exposed 11. Chakalisa U, Wirth K, Bennett K, et al. Self-reported risky
infants and universal HIV testing and treatment of all, ought sexual practices among adolescents and young adults in
to pre-empt the loop-holes identified in this study. This paper Botswana. South Afr J HIV Med. 2019;20(1):a899. https://
is an important read. Very low birth weight newborns are at- doi.org/10.4102/sajhivmed.v20i1.899
risk people who require focused care.
9. Lazarus E, Otwombe K, Dietrich J, et al. Vaginal practices Editor’s comment: Recommended reading. This is an
among women at risk for HIV acquisition in Soweto, important substudy of a cross-sectional, cluster-randomised
South Africa. South Afr J HIV Med. 2019;20(1):a866. Combination Prevention Project based in Botswana: the
https://doi.org/10.4102/sajhivmed.v20i1.866 ‘YaTsie Project’. The aim of the parent study is to evaluate the

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