Q. Abdool Karim

Informed consent for HIV testing in a South African hospital: is it truly informed and truly voluntary?

OBJECTIVE The purpose of this study was to assess informed consent to human immunodeficiency virus (HIV) testing in a perinatal HIV transmission study in a major referral hospital serving a largely Black population in South Africa. METHODS First-time antenatal clinic attenders who were randomly selected from those enrolled in the perinatal HIV study (n = 56) answered questionnaires before and after counseling. RESULTS Knowledge of HIV transmission and prevention, high at the outset, was little improved after counseling. The acceptance rate for HIV testing was high. Despite assurances that participation was voluntary, 88% of the women said they felt compelled to participate in the study. CONCLUSIONS Informed consent in this setting was truly informed but not truly voluntary.

Screening for ‘window-period’ acute HIV infection among pregnant women in rural South Africa

The aim of this study was to evaluate the HIV‐1 RNA pooled nucleic acid amplification testing (NAAT) strategy to screen pregnant women in the ‘window period’ of acute HIV infection (AHI) in rural South Africa.

The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal, South Africa

Abstract This study aims to understand the influence of AIDS stigma and discrimination, and social cohesion to HIV testing, and willingness to disclose an HIV status. A cross-sectional, interviewer administered survey (N=594) was conducted. Independent sample t-tests explored the mean differences between sex and age groups on stigma, discrimination, and social cohesion measurement. Logistic regression models were fitted with the above independent variables, and the binominal dependent variables: having had a test, willingness to have a test and disclose a positive status. The mean age of participants was 25.3 years and 60% were women. Only 28% had an HIV test, 63% were willing to have a test, and 82% reported a willingness to disclose an HIV status. High levels of stigma and discrimination were anticipated from the community, less so from their partners, and very little from families. Low levels of social distance exist towards people with HIV/AIDS, membership to social networks seems limited, and inadequate social support for people with HIV/AIDS was reported. The analysis indicates that AIDS stigma and discrimination, and inadequate social cohesion, limit access to voluntary counselling and testing (VCT), inhibit disclosure, and are, thus, barriers to care, support and prevention. Interventions need to extend the focus on information and education to strengthen social capital within a participatory and sustainable development framework.

Distinct genital tract HIV-specific antibody profiles associated with tenofovir gel.

The impact of topical antiretrovirals for pre-exposure prophylaxis on humoral responses following HIV infection is unknown. Using a binding antibody multiplex assay, we investigated HIV-specific IgG and IgA responses to envelope glycoproteins, p24 Gag and p66, in the genital tract (GT) and plasma following HIV acquisition in women assigned to tenofovir gel (n=24) and placebo gel (n=24) in the CAPRISA 004 microbicide trial to assess if this topical antiretroviral had an impact on mucosal and systemic antibody responses. Linear mixed effect modeling and partial least squares discriminant analysis was used to identify multivariate antibody signatures associated with tenofovir use. There were significantly higher response rates to gp120 Env (P=0.03), p24 (P=0.002), and p66 (P=0.009) in plasma and GT in women assigned to tenofovir than placebo gel at multiple time points post infection. Notably, p66 IgA titers in the GT and plasma were significantly higher in the tenofovir compared with the placebo arm (P<0.05). Plasma titers for 9 of the 10 HIV-IgG specificities predicted GT levels. Taken together, these data suggest that humoral immune responses are increased in blood and GT of individuals who acquire HIV infection in the presence of tenofovir gel.

High AIDS-related mortality among young women in rural KwaZulu-Natal

OBJECTIVE To establish mortality rates and cause of death in a rural community in KwaZulu-Natal. This study was conducted as part of a demographic and health survey to assess the impact of HIV infection in this community. METHODS A cross-sectional survey was conducted between February and July 2004. The survey made use of structured questionnaires and verbal autopsies, which yielded detailed information at household level, including the demographic profile of residents, mortality rates and cause of mortality between February 2003 and February 2004. RESULTS The overall mortality rate in this community was 2.9 deaths per 100 person-years (95% confidence interval (CI): 2.5 - 3.3 per 100 person-years). The highest mortality rate among women occurred in the 30 - 34-year age group, while among men it occurred in the 35 - 39 and > 60-year age groups. Of the 185 verbal autopsies reported, 77 deaths (42%) were attributable to AIDS. The survey revealed that women aged 20 - 24 and men aged 35 - 39 years were bearing a disproportionately large burden of AIDS-related mortality in this community. CONCLUSION AIDS-related mortality was found to be disproportionately high in young women in this small rural community, and the majority of deaths resulted from pulmonary tuberculosis. The need to strengthen prevention and treatment efforts in this and similar settings is highlighted.

The need for multipurpose prevention technologies in sub-Saharan Africa.

Women bear a disproportionate burden of the HIV epidemic in sub‐Saharan Africa and account for about 60% of all adults living with HIV in that region. Young women, including adolescent girls, unable to negotiate mutual faithfulness and/or condom use with their male partners are particularly vulnerable. In addition to the high HIV burden, women in Africa also experience high rates of other sexually transmitted infections and unwanted pregnancies. The development of technologies that can simultaneously meet these multiple sexual reproductive health needs would therefore be extremely beneficial in the African setting.

Microbicides and their potential as a catalyst for multipurpose sexual and reproductive health technologies

There is an urgent need for technologies to prevent sexual acquisition of HIV infection in young women in sub‐Saharan Africa. After two decades of 11 pivotal trials of seven products, anti‐retroviral‐based topical microbicides are showing promise. Building on the CAPRISA 004 trial findings, several trials of new anti‐viral agents, novel delivery mechanisms and combination/multipurpose products that address challenges of adherence and meet the sexual and reproductive health needs of men and women, including preventing HIV infection, are underway.

Erratum: Distinct genital tract HIV-specific antibody profiles associated with tenofovir gel (Mucosal Immunology (2016) 9, (834)) doi:10.1038/mi.2016.21

Correction to: Mucosal Immunology (2016); advance online publication, 27 January 2016; doi: 10.1038/mi.2015.145 The version of this article published online contained several incorrect elements: some of the authors’ names and some of the affiliations; Figures 1 and 3; Tables 2 and 3; some references; Supplementary Figures 2–6.

Infrequent, low magnitude HIV-specific T cell responses in HIV-uninfected participants in the 1% tenofovir microbicide gel trial (CAPRISA004)

Background Macaque studies of antiretroviral-containing microbicide gels administered rectally or vaginally followed by SIV challenge have documented priming of SIV-specific T cell responses in the blood of protected animals. This concept has been termed “chemo-vaccination”, where aborted viral replication is thought to leave an immune footprint of exposure, which may augment protection provided by microbicides/PrEP. We investigated whether T cell responses were detectable in women participating in CAPRISA004 1% tenofovir microbicide trial, which showed 39% efficacy in reducing HIV acquisition.