Human Hepatocyte Nuclear Factors (HNF1 and LXRb) Regulates CYP7A1 in HIV-Infected Black South African Women with Gallstone Disease: A Preliminary Study

Background: Female sex, high estrogen levels, aging, obesity and dyslipidemia are some of the risk factors associated with gallstone formation. HIV infected patients on combination antiretroviral therapy (cART) are more prone to hypercholesterolemia. Bile acid synthesis is initiated by cholesterol 7-alpha hydroxylase (CYP7A1) and regulated by hepatocyte nuclear factors (HNF1α, HNF4α and LXRb).Aim/ Objective: To evaluate the expression of HNF1α, HNF4α, LXRb and miRNAs (HNF4α specific: miR-194-5p and miR-122*_1) that regulate CYP7A1 transcription in HIV-infected Black South African women on cART and presenting with gallstones relative to HIV negative patients with gallstone disease. Methods: Females (n = 96) presenting with gallstone disease were stratified based on HIV status. The gene expression of CYP7A1, HNF1α, HNF4α, LXRb, miR-194-5p and miR-122*_1 was determined using RT-qPCR. Messenger RNA and miRNA levels were reported as fold change expressed as 2-ΔΔCt (RQ min; RQ max). Fold changes >2 and <0.5 were considered significant. Results: HIV-infected females were older in age (p = 0.0267) and displayed higher low-density lipoprotein cholesterol (LDL-c) (p = 0.0419), CYP7A1 [2.078-fold (RQ min: 1.278; RQ max: 3.381)], LXRb [2.595-fold (RQ min: 2.001; RQ max: 3.000)] and HNF1α [3.428 (RQ min: 1.806; RQ max: 6.507] levels. HNF4α [0.642-fold (RQ min: 0.266; RQ max: 1.55)], miR-194-5p [0.527-fold (RQ min: 0.37; RQ max: 0.752)] and miR-122*_1 [0.595-fold (RQ min: 0.332; RQ max: 1.066)] levels were lower in HIV-infected females. Conclusions: HIV-infected women with gallstone disease displayed higher LDL-c levels and increased bile acid synthesis which was evident by the elevated expression of CYP7A1, HNF1α and LXRb. This could have been further influenced by cART and aging.

Ranking lifestyle risk factors for cervical cancer among Black women: A case-control study from Johannesburg, South Africa

Background Aside from human papillomavirus (HPV), the role of other risk factors in cervical cancer such as age, education, parity, sexual partners, smoking and human immunodeficiency virus (HIV) have been described but never ranked in order of priority. We evaluated the contribution of several known lifestyle co-risk factors for cervical cancer among black South African women. Methods We used participant data from the Johannesburg Cancer Study, a case-control study of women recruited mainly at Charlotte Maxeke Johannesburg Academic Hospital between 1995 and 2016. A total of 3,450 women in the study had invasive cervical cancers, 95% of which were squamous cell carcinoma. Controls were 5,709 women with cancers unrelated to exposures of interest. Unconditional logistic regression models were used to calculate adjusted odds ratios (ORadj) and 95% confidence intervals (CI). We ranked these risk factors by their population attributable fractions (PAF), which take the local prevalence of exposure among the cases and risk into account. Results Cervical cancer in decreasing order of priority was associated with (1) being HIV positive (ORadj = 2.83, 95% CI = 2.53–3.14, PAF = 17.6%), (2) lower educational attainment (ORadj = 1.60, 95% CI = 1.44–1.77, PAF = 16.2%), (3) higher parity (3+ children vs 2–1 children (ORadj = 1.25, 95% CI = 1.07–1.46, PAF = 12.6%), (4) hormonal contraceptive use (ORadj = 1.48, 95% CI = 1.24–1.77, PAF = 8.9%), (5) heavy alcohol consumption (ORadj = 1.44, 95% CI = 1.15–1.81, PAF = 5.6%), (6) current smoking (ORadj = 1.64, 95% CI = 1.41–1.91, PAF = 5.1%), and (7) rural residence (ORadj = 1.60, 95% CI = 1.44–1.77, PAF = 4.4%). Conclunsion This rank order of risks could be used to target educational messaging and appropriate interventions for cervical cancer prevention in South African women.

What gender legislative reforms have meant for women in South Africa

South Africa is a much better place to live in today than before 1994. Having witnessed a largely peaceful transition from a pariah apartheid State to a democratic State where equality is guaranteed before the law, the country offers rights and justice for all. The Constitution of the Republic of South Africa , 1996 set out to rectify the injustices of the past and eliminate the various forms of discrimination that were the hallmarks of an apartheid State. Gender equality was a focal point in the reforms introduced in legislation and government programmes in a new democratic society. In this article I explore what these gendered legislative reforms and measures have meant to South African women, and whether these measures have brought about a positive change in their lives. Framed within a feminist epistemological and methodological approach, I draw on the results of a qualitative study of South Africa women. The results form part of a larger mixed methods study employing both qualitative and quantitative components. Qualitative individual interviews as well as focus groups were conducted. For the majority of women interviewed, the promulgation of legislation was viewed as positive and progressive. Women are now recognised as full citizen, have access to various opportunities, and experience more autonomy and choice. However, participants raised numerous shortcomings in legislation, and challenges that they experienced in their daily lives. For some of the participants, the transformative changes anticipated in the social and economic spheres have not been realised.

A discourse on the plight of South African women in the face of abuse and neglect

An upsurge in the rate of violence against women has an adverse effect on women in South Africa. Sadly, many South African women who are the victims of violent sexual conduct, such as, rape and other forms of violent sexual abuse, have in part contributed to the prevalence of HIV/AIDS infection among women. Of the 7,7 million South African living with HIV/AIDS in 2018, 4,7 million were women, while another 69 000 were among the new infections. They are more vulnerable to HIV infections with 21,17 percent of women living with the disease. Using personal conversations, literature searches and documents for primary and secondary data, this article argues that value orientation that ascribes superiority to men has damaging consequences on the status of women. South African women are exposed to violent habitual actions of men that denigrate their womanhood. The article, therefore, submits that there is a need to reinforce civil society and strengthen the justice system for the protection and promotion of the rights and freedom of women. Aside from this, the government should increase its commitment to the enforcement of requisite legislative frameworks that safeguard the rights and freedom of women, and review punishments for any acts of violence against women.

Obesity in young South African women living with HIV: A cross-sectional analysis of risk factors for cardiovascular disease

Background Young South African women are faced with a dual epidemic of HIV and obesity, placing them at a high risk of developing atherosclerotic cardiovascular disease (CVD). We sought to determine the prevalence of CVD risk factors in a cohort of reproductive-aged South African women living with HIV (WLHIV). Methods While the main purpose of an ongoing intervention study is the reduction of cardiovascular disease through the integration of CVD screening and prevention in the HIV management plan for women of reproductive age (ISCHeMiA trial), we present the prevalence of risk factors for CVD in this cohort of young women at baseline. Sociodemographic, conventional CVD risk factors, HIV-related factors and self body image perception were assessed through study questionnaires and standardized clinical and laboratory procedures. Results Of the 372 WLHIV enrolled from November 2018 to May 2019, 97% had received efavirenz-based antiretroviral treatment (ART) for at least 1 year and 67.5% (248/367) of women were overweight or obese at the time of enrolment. The prevalence of metabolic syndrome was 17.6% (95%CI 11.6–22.8) at a median age of 35 years (IQR 30.5–40.5). A significant proportion of women had abnormally low levels of high-density lipoprotein (43.2%, 80/185) and elevated levels of high sensitivity C-reactive protein (59.5%, 110/185). Seventy five percent of overweight women with an increased waist circumference reported to be satisfied with their body image. Conclusions The high prevalence of metabolic syndrome, obesity and elevated markers of inflammation in young South African WLHIV, underscores the need for a proactive integrated management approach to prevent atherosclerotic cardiovascular disease in low and middle income settings.

The Motherhood Penalty—Understanding the Gendered Role of Motherhood in the Life Histories of Incarcerated South African Women

The number of incarcerated women in South Africa has steadily increased over the last decade. However, as a minority in the carceral population of the country, their narratives are underrepresented. An emergent body of feminist, gender responsive research has found that motherhood is central to the narratives of incarcerated women. This study endeavored to document the life histories of 17 women who are incarcerated in the largest correctional center in South Africa. The narratives of these women explicate how the gendered role of motherhood impacted on their incarceration pathways, contributing to the developing literature of justice-involved women in South Africa.

Transkingdom Analysis of the Female Reproductive Tract Reveals Bacteriophages Form Communities

The female reproductive tract (FRT) microbiome plays an important role in maintaining vaginal health. Viruses play a key role in regulating other microbial ecosystems, but little is known about how the FRT viruses (virome), particularly bacteriophages, impacts FRT health and dysbiosis. We hypothesize that bacterial vaginosis is associated with alterations in the FRT virome, and these changes correlate with bacteriome shifts. We conducted a retrospective, longitudinal analysis of vaginal swabs collected from 54 bacterial vaginosis (BV)-positive and 46 BV-negative South African women. Bacteriome analysis revealed samples clustered into five distinct bacterial community groups (CG). Bacterial alpha diversity was significantly associated with BV. Virome analysis on a subset of baseline samples showed FRT bacteriophages clustering into novel viral state types (VSTs), a viral community clustering system based on virome composition and abundance. Distinct BV bacteriophage signatures included increased alpha diversity along with Bacillus, Burkholderia and Escherichia bacteriophages. Discriminate bacteriophage-bacteria transkingdom associations were also identified between Bacillus and Burkholderia viruses and BV-associated bacteria, providing key insight for future studies elucidating transkingdom interactions driving BV-associated microbiome perturbations. In this cohort, bacteriophage-bacterial associations suggest complex interactions which may play a role in the establishment and maintenance of BV.

Temporal Changes in Vaginal Microbiota and Genital Tract Cytokines Among South African Women Treated for Bacterial Vaginosis

The standard treatment for bacterial vaginosis (BV) with oral metronidazole is often ineffective, and recurrence rates are high among African women. BV-associated anaerobes are closely associated with genital inflammation and HIV risk, which underscores the importance of understanding the interplay between vaginal microbiota and genital inflammation in response to treatment. In this cohort study, we therefore investigated the effects of metronidazole treatment on the vaginal microbiota and genital cytokines among symptomatic South African women with BV [defined as Nugent score (NS) ≥4] using 16S rRNA gene sequencing and multiplex bead arrays. Among 56 BV-positive women, we observed short-term BV clearance (NS &lt;4) in a proportion of women six weeks after metronidazole treatment, with more than half of these experiencing recurrence by 12 weeks post-treatment. BV treatment temporarily reduced the relative abundance of BV-associated anaerobes (particularly Gardnerella vaginalis and Atopobium vaginae) and increased lactobacilli species (mainly L. iners), resulting in significantly altered mucosal immune milieu over time. In a linear mixed model, the median concentrations of pro-inflammatory cytokines and chemokines were significantly reduced in women who cleared BV compared to pre-treatment. BV persistence and recurrence were strongly associated with mucosal cytokine profiles that may increase the risk of HIV acquisition. Concentrations of these cytokines were differentially regulated by changes in the relative abundance of BVAB1 and G. vaginalis. We conclude that metronidazole for the treatment of BV induced short-term shifts in the vaginal microbiota and mucosal cytokines, while treatment failures promoted persistent elevation of pro-inflammatory cytokine concentrations in the genital tract. These data suggest the need to improve clinical management of BV to minimize BV related reproductive risk factors.

Developing a model for reducing maternal mortality in South Africa

Objective High maternal mortality ratios (MMRs) remain a concern in many parts of the world, especially in developing countries like South Africa. Different models have been developed, tried, and tested worldwide, in the hope that they will reduce maternal mortality, but without much success. Methods A qualitative approach was used to conveniently select a sample of 10 women attending an antenatal clinic in a rural area, in one of the districts of KwaZulu-Natal (KZN) Province. Data were collected by means of interviews with the women. Data were analyzed employing Burnard's content analysis approach. Results Four themes emerged: (1) age at first pregnancy; (2) birth intervals, risks in pregnancy and hospitalization; (3) the use of contraception; and (4) HIV status. All themes that emerged revealed inattention to reproductive health (RH) needs, resulting in poor RH outcomes as an area of concern. Conclusions Greater emphasis needs to be placed on meeting the sexual and reproductive health (SRH) needs of South African women, if maternal mortality rates are to be reduced. An alternative model for reducing maternal mortality in South Africa is proposed.

PROTECTING A WIFE FINANCIALLY AT THE TIME OF DIVORCE – A COMPARISON BETWEEN SOUTH AFRICAN WOMEN MARRIED IN TERMS OF SOUTH AFRICAN CIVIL LAW AND ISLAMIC LAW, WITH SPECIFIC REFERENCE TO THE MAHR

This article compares the South African civil-law and Islamic-law positions with regard to the financial protective measures available to a wife at the time of marriage and divorce. In this regard, the respective matrimonial property systems are discussed, with special emphasis on civil antenuptial and Muslim marriage contracts. In addition, other protective measures inherent to the two systems to prevent prejudice both during the marriage and at the time of divorce, are discussed. It is submitted that, although the provisions of Islamic law do not provide the same financial protection for wives compared to the South African civil law, the Islamic concept of mahr could potentially be used in the Muslim marriage contract to enhance financial security of a Muslim wife at the time of divorce. The article also considers dual marriages where the same spouses marry each other in terms of both civil and Islamic law. In particular, the incorporation of the Islamic concept of mahr into civil antenuptial contracts is discussed with reference to the legal position in Canada to illustrate potential legal problems.