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Daily Maverick
5 days ago
- Health
- Daily Maverick
Trump's HIV funding cuts will also exacerbate diabetes, cervical cancer and depression
The impact of the Trump administration slashing of more than half of South Africa's HIV and TB projects funded by the US government, transcends reduced access to HIV testing and HIV prevention and treatment drugs. Treatment for diabetes, high blood pressure, cervical cancer, depression and anxiety will become harder to come by too. The impact of US President Donald Trump's administration slashing more than half of South Africa's HIV and TB projects, transcends reduced access to HIV testing and HIV prevention and treatment drugs: treatment for noncommunicable diseases (NCDs) will become harder to come by too. As government clinics take on HIV patients who were previously treated by the President's Emergency Plan sor Aids Relief-funded projects, the treatment of diseases like diabetes and heart disease — for all people — will come under pressure. And mental health issues such as depression and anxiety — also noncommunicable illnesses — will most likely become more common among people with HIV, because many now face extra stress, such as having to travel further to clinics for treatment, and groups like sex workers increasingly face discrimination at government clinics. At a Bhekisisa and Southern African HIV Clinicians Society webinar in May, the health advocacy organisation Treatment Action Campaign (TAC) and the sex worker movement Sisonke, for example, reported cases where sex workers — who used to get their treatment from US government-funded clinics where health workers were trained to address their reproductive health needs — have recently been turned away from state clinics or were denied condoms. In 2020, noncommunicable diseases were the cause of more than half of all deaths in South Africa. But, compared to HIV, funding for noncommunicable diseases has traditionally been scarce. We look at five ways in which HIV funding cuts could affect noncommunicable diseases. Fewer data capturers means fewer people to keep track of NCDs Today, people over 50 make up the second-largest group of South Africa's HIV-positive population, Bhekisisa's data team has found. Twenty years ago, they were the smallest proportion. As people age, their chances of developing health problems like high blood pressure, heart disease and diabetes rise, which means more and more people will have to be treated for these conditions — on top of getting HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got about six million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. So, as the peak of the HIV-infected population shifts into an older age band, more and more people will probably have to be treated for noncommunicable diseases like heart conditions, diabetes, overweight and high blood pressure — on top of receiving HIV care. Studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure than younger HIV-positive people. But without tracking the numbers — which will be challenging with the loss of thousands of US government-funded data capturers in the wake of foreign aid cuts — putting plans in place to care for an ageing HIV population will be hard. And with many countries' governments, including South Africa's, scrambling to find the money to replace the thousands of data capturers for HIV programmes previously funded by the US government after the abrupt halt in aid, funds for tracking the health conditions of older people with HIV will probably be a low priority. Employing health workers to capture and manage health data would be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during the Bhekisisa and the Southern African HIV Clinicians Society webinar — something that, for a public health issue that might be ignored because its fallout wasn't immediately visible — could just make the problem so much worse. Fewer people on ARVs leads to more people with diabetes When people with HIV are not on treatment, or if they don't use their ARVs correctly, the virus gets a chance to make copies of itself in their bodies and attack their immune systems. That's when their immune systems get weak, and some then fall ill with diseases that scientists call opportunistic infections. The most common opportunistic infection for people with untreated HIV is tuberculosis (TB). And that's where the catch for one of the world's fastest-rising noncommunicable diseases, diabetes, lies: there's a link between TB and diabetes. Diabetes — a condition in which someone has too much sugar in their blood because their body doesn't get or respond to the signal from the hormone insulin to absorb glucose — kills more people in South Africa than any other disease. In 2020, it claimed 32,100 lives — about 40% of them before they turned 65. The condition is one of four noncommunicable diseases World Health Organization (WHO) member countries agreed to tackle. The goal is to lower deaths by 25% by the end of this year. But South Africa is far off track and that goal will now be even harder to achieve. TB changes how someone's body reacts to insulin. That's why some people with TB — who have never been diagnosed with diabetes — are found to have lots of sugar in their blood. In some cases, this is temporary and normalises after TB treatment. But the germ still increases the odds of developing diabetes later on. In fact, among people who have high sugar levels in their blood when getting diagnosed for TB, studies show that between 8% and 87% are eventually diagnosed with diabetes. But, the opposite is also true: people with diabetes have a higher chance of falling ill with TB. So, in short: when there's less money to help people with HIV get diagnosed or to make it easy for diagnosed people to get on to treatment, and stick to it, more people get TB. And when more people have TB, diabetes becomes more common, because some people with TB are more likely to get diabetes. At the same time, people with diabetes who get TB, have a higher chance of falling very ill with TB, because diabetes makes their immune systems even weaker. Fewer women on ARVs means more with cervical cancer Last week, the Clinical HIV Research Unit at Wits University in Johannesburg shut its cervical cancer screening and prevention clinic at Helen Joseph Hospital, one of the biggest units in the country, following the termination of US funding. 'This closure will significantly impact cervical cancer prevention efforts in South Africa, which faces one of the highest rates of cervical cancer in the world,' the unit said in a press release. Cervical cancer is the second most common cancer among South African women, after breast cancer, but it's the leading cause of cancer-related deaths — even though it's preventable through vaccination and regular screenings such as pap smears and testing for the human papillomavirus (HPV), which causes most cervical cancer cases. 'With timely screening and early detection being key to preventing cervical cancer, the closure of this screening unit at Helen Joseph Hospital leaves a major gap in services and will further strain the health service,' the unit's communication department said. Women with untreated HIV infection are much more likely to develop cervical cancer after being infected with cancerous forms of the HPV virus, because their immune systems are too weak to clear the virus without treatment. Cervical cancer is the most common cancer among black South African women, who are also the group with the highest HIV infection rate in the country. About a quarter of people with HIV in South Africa are not on antiretroviral treatment. USAid programmes that have now been discontinued helped to find them by sending community health workers into communities to test people for HIV and find people who had already been diagnosed with HIV, but fell off treatment. The ending of USAid programmes has resulted in fewer HIV testing and treatment services, which in turn affects how many women become vulnerable to developing cervical cancer. Depression and anxiety will become more common Mental health conditions are also noncommunicable diseases. If more people with HIV are left without treatment as a result of US government funding cuts, mental health conditions like depression and anxiety will likely become more common. Why? Because Pepfar funded counsellors who would find people with HIV and get them on treatment immediately after they were tested. Without ART, some people develop HIV encephalopathy, a condition that damages brain tissue through inflammation from the virus. Encephalopathy raises the chances of depression or anxiety because it harms the areas of the brain that control movement, emotions and memory. People with HIV already face stigma that causes stress and anxiety that can lead to depression. 'There's still the shame, stigma and moral issues that come with HIV,' says Francois Venter, an HIV doctor and the director of Ezintsha at the University of the Witwatersrand. Depression makes it harder for people to stick to their treatment. Studies show that people with HIV and depression are more likely to stop taking their medication — weakening their bodies and raising the chances of them dying from opportunistic infections. Fewer nurses means noncommunicable diseases fall through the cracks Noncommunicable diseases are underdiagnosed in South Africa, experts say. 'If we went into the community aggressively looking for high sugar and blood pressure, we would do such a better job,' says Venter. 'Instead, we sit back and wait([until people turn up at clinics), which is why we do so badly with diabetes and hypertension.' Even at clinics, people are rarely tested, mostly because there are too few nurses at our clinics. On top of noncommunicable diseases, they also have to help treat HIV and gender-based violence, and see that pregnant women and newborn babies are healthy. And after February's US funding cuts, we have even fewer nurses. According to health department data, Pepfar funded 2,320 nurses, of which just over half (those programmes that received their funds through USAid) have now been laid off. Right now, the rest (programmes funded through the Centres for Disease Control and Prevention), only have jobs until the end of September. Pepfar also funded 2,705 lay counsellors, health department data shows. Without this staff who went into communities to screen people for HIV, TB and other diseases, patients now have to travel to clinics for help, which means more patients for nurses. And when nurses have more work, they have less time to treat each patient, which, says Venter, makes it even harder to pick up on noncommunicable diseases. 'Because of that, the actual interaction would take probably an hour and a half. When you've got a mile-long queue outside your door, you just don't have that time.' 'So they (nurses) go for the absolute basic stuff.' DM
News24
7 days ago
- General
- News24
Do ADHD meds work to cram during exams?
ADHD medication is sometimes abused, for example, when university students without the condition use it to study better. The reality, however, psychiatrist Renata Schoeman tells Mia Malan in this podcast, is that the medicine doesn't work for people without ADHD. In fact, it can worsen their performance. The results for the first medicine to treat attention deficit and hyperactivity disorder (ADHD) was released in 1937, and over the years, many other medicines have been tested and come onto the market. People with ADHD find it harder to concentrate and control their emotions than people without the condition, and they often also struggle with time management, are disorganised and can be impulsive. People with attention deficit and hyperactivity disorder (ADHD) often also have other mental health conditions such as depression, anxiety, or autism spectrum disorders. Like all other medicine, ADHD treatment has side effects, of which appetite suppression and insomnia are the most common. In the last of Bhekisisa's two-part podcast series on ADHD, Mia Malan asks psychiatrist Renata Schoeman: how does ADHD medicine work, what it can and can't do, what happens if ADHD is left untreated. How does ADHD medicine work and what can — and can't — it do? The medication is often abused by university students wanting to cram during exams. But, as Schoeman tells Malan, ADHD meds don't work for people without the condition.
Mail & Guardian
27-05-2025
- Business
- Mail & Guardian
Trump's HIV funding cuts will also hit diabetes, cervical cancer and depression hard
The impact of the Trump administration's slashing of over half of South Africa's HIV and TB projects funded by the US government, transcends reduced access to HIV testing and HIV prevention and treatment drugs. Treatment for diabetes, high blood pressure, cervical cancer, depression and anxiety will become harder to come by too. (Flickr) The impact of US President Donald Trump administration's slashing of As government clinics take on HIV patients who were previously treated by Pepfar-funded projects, the treatment of conditions like And mental health issues such as depression and anxiety — also noncommunicable illnesses — will probably become more common among people with HIV, because many now face extra stress, such as having to travel further to clinics for treatment and groups At a In 2020, NCDs were the cause of more than We look at five ways in which HIV funding cuts could affect NCDs. Fewer data capturers, fewer people to keep track of NCDs Today, Bhekisisa 's data team As people age, their chance of developing health problems like high blood pressure, heart disease and diabetes rises, which means more and more people will have to be treated for these conditions — on top of getting HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment So, as the peak of the HIV-infected population shifts into an older age band, Studies have shown that people with HIV who are older than 50 have But without tracking the numbers — which would be challenging with the loss of thousands of US government-funded data capturers in the wake of foreign aid cuts — putting plans in place to care for an ageing HIV population will be hard. And with many countries' governments, Employing health workers to capture and manage health data will be a hard sell, said Kate Rees, a public health specialist with the Bhekisisa and the Southern African HIV Clinicians Society webinar — something that, for a public health issue that might be ignored because its fallout isn't immediately visible — could just make the problem so much worse. Fewer people on ARVs leads to people with diabetes When people with HIV are not on treatment, or if they don't use their ARVs correctly, the virus gets a chance to make copies of itself That's when their immune systems get weak, and some then fall ill with diseases that scientists call And that's where the catch for The condition is one of four NCDs World Health Organisation-member countries have But The TB germ In fact, among people who have high sugar levels in their blood when getting diagnosed for TB, studies show that But, the opposite is also true — people with diabetes have a So, in short, when there's less money to help people with HIV to get diagnosed or to make it easy for diagnosed people to get on to treatment, and stick to it, Fewer women on ARVs mean more with cervical cancer Last week, the 'This closure will significantly impact cervical cancer prevention efforts in SA, which faces one of the highest rates of cervical cancer in the world,' the unit Cervical cancer is the 'With timely screening and early detection being key to preventing cervical cancer, the closure of this screening unit at Helen Joseph Hospital leaves a major gap in services and will further strain the health service,' Women with Cervical cancer is the About a The ending of USAid programmes has resulted in fewer HIV testing and treatment services which, in turn, affects how many women become vulnerable to developing cervical cancer. Depression and anxiety will become more common Mental health conditions are also NCDs. If more people with HIV are left without treatment as a result of US government funding cuts, mental health conditions like depression and anxiety will become more common. Why? Because Pepfar- Without ART, some people develop People with HIV already face stigma which Depression makes it harder for people to stick to their treatment. Studies Fewer nurses means NCDs fall through the cracks NCDs are underdiagnosed in South Africa, experts say. 'If we went into the community aggressively looking for high sugar and blood pressure, we would do such a better job,' says Venter. 'Instead, we sit back and wait [until people turn up at clinics], which is why we do so badly with diabetes and hypertension.' Even at clinics, people are rarely tested, mostly because there are too few nurses at our clinics with too much to do. On top of And after February's US funding cuts, Pepfar also funded 2 705 lay counsellors, health department data And when nurses have more work, they have less time to treat each patient which, Venter says, makes it even harder to pick up NCDs. 'Because of that, the actual interaction would take probably an hour and a half. When you've got a mile-long queue outside your door, you just don't have that time.' 'So they [nurses] go for the absolute basic stuff.' Additional reporting by Linda Pretorius and Jacques Verryn. This story was produced by the . Sign up for the .
TimesLIVE
27-05-2025
- Health
- TimesLIVE
Trump's HIV funding cuts will also hit diabetes, cervical cancer and depression hard. Here's how
The impact of the US President Donald Trump administration's slashing of over half of South Africa's HIV and TB projects, transcends reduced access to HIV testing and HIV prevention and treatment drugs: treatment for noncommunicable diseases (NCDs) will become harder to come by too. As government clinics take on HIV patients who were previously treated by Pepfar-funded projects, the treatment of diseases such as diabetes and heart disease — for all people — will come under pressure. And mental health issues such as depression and anxiety — also noncommunicable illnesses — will most likely become more common among people with HIV, because many now face extra stress, such as having to travel further to clinics for treatment and groups such as sex workers increasingly face discrimination at government clinics. At a Bhekisisa and Southern African HIV Clinicians Society webinar in May, the health advocacy organisation Treatment Action Campaign (TAC) and the sex worker movement Sisonke, for example, reported cases where sex workers — who used to get their treatment from US government-funded clinics where health workers were trained to address their reproductive health needs — have recently been turned away from state clinics or were denied condoms. In 2020, NCDs were the cause of more than half of all deaths in South Africa. But, compared to HIV, funding for NCDs has traditionally been scarce. We look at five ways in which HIV funding cuts could affect NCDs. Fewer data capturers, means fewer people to keep track of NCDs Today, people over 50 make up the second largest group of South Africa's HIV-positive population, Bhekisisa's data team has found. Twenty years ago, they were the smallest proportion. As people age, their chance for developing health problems like high blood pressure, heart disease and diabetes rises, which means more and more people will have to be treated for these conditions — on top of getting HIV care. Because antiretroviral drugs (ARVs) keep people healthy and increase their life expectancy, the scale-up of treatment in South Africa — public sector treatment started in 2004 and in 2025 we've got about 6-million people on ARVs — means that most people with HIV and who take ARVs correctly now live just as long as those without the virus. So, as the peak of the HIV-infected population shifts into an older age band, more and more people will likely have to be treated for noncommunicable diseases like heart conditions, diabetes, overweight and high blood pressure — on top of receiving HIV care. Studies have shown that people with HIV who are older than 50 have double the chance of having conditions like diabetes or high blood pressure too than what is seen in younger HIV-positive people. But without tracking the numbers — which will be challenging with the loss of thousands of US government-funded data capturers in the wake of foreign aid cuts — putting plans in place to care for an ageing HIV population will be hard. And with many countries' governments, including South Africa's, scrambling to find the money to replace the thousands of data capturers for HIV programmes previously funded by the US government after the abrupt halt in aid, funds for tracking health conditions of older people with HIV will likely be a low priority. Employing health workers to capture and manage health data will be a hard sell, said Kate Rees, a public health specialist with the Anova Health Institute, during the Bhekisisa and the Southern African HIV Clinicians Society webinar — something that, for a public health issue that might be ignored because its fallout isn't immediately visible — could just make the problem so much worse.
Mail & Guardian
19-05-2025
- Health
- Mail & Guardian
Why so many newborns and foetuses are abandoned in landfills and the veld
Why are so many newborns and foetuses being abandoned in landfills and velds in SA? We asked leading forensic pathologist Shakeera Holland what her team found. (Nicole Ludolph) They were wrapped in plastic or foil or a piece of clothing, tucked inside a backpack or pulled from a burnt pile of rubbish. Those were some of the ways the remains of newborns and foetuses were found before being taken to the Diepkloof Forensic Pathology Service in Soweto. Although discoveries like these rarely To help figure out why, researchers from Wits University Studies show this is extremely rare in countries like Of the 158 cases in the Diepkloof facility studied, 68 were found to be non-viable, which means they would not be able to survive outside of the mother; 29 were The researchers — Rachel Gill, Roxanne Thornton and Shakeera Holland — believe the high number of non-viable cases could be linked to SAMJ study. Their initial findings point to a lack of information and education about abortion and inadequate medical care, which In a recent episode of Bhekisisa 's monthly TV programme, Mia Malan spoke to her at Soweto's forensic pathology service facilities in Diepkloof. This interview was edited for clarity. Mia Malan: How many abandoned foetuses and newborns are found? Shakeera Holland: We don't have accurate statistics about this because there is no digital database of unnatural deaths in the whole of South Africa. What we do know is that we have about 70 000 unnatural deaths in South Africa, and of those, we estimate that approximately 2% are abandoned neonates [newborns in the first few weeks of life] and foetuses. MM: In the study you supervised at the mortuary, where were the remains of these abandoned foetuses and newborns found? SH: The majority of the time, the remains are left where it is convenient, and probably where people think they won't be found easily. So usually in open veld, landfills and dumping areas. It's less common to find them in toilets in shopping centres and other public toilets. MM: Is there a difference in the number of female remains versus male remains? SH: Most of the foetuses in our study were male. And most of our paediatric deaths happen to be more commonly in boys than girls — and this is what we see in MM: What do your autopsies show? What are the causes of death? SH: The most common cause that we see are non-viable foetuses. This means that the foetuses haven't completed sufficient time in the pregnancy for them to survive outside of the mother. We also see a lot of stillbirths. These are babies that have completed enough gestational time in the mother to be considered viable, but they're not born deceased. In a minority of the causes we see trauma, and that can either be accidental or homicidal — but this is in very few cases. MM: What are the most common causes of the trauma? SH: A lot of the common causes are head injuries, and a few are related to suffocation, and we've maybe had one or two where there's sharp force injury. For example, the foetuses or neonates have had their necks cut. MM: Why did you do the study? SH: We see these cases of abandoned neonates and foetuses every day. You see newspaper reports about these cases, but they make it seem as if they never happen. In fact, they are happening every single day. I had a student that was particularly passionate about the topic and wanted to look at what is exactly going on in this area, and hopefully spark research in other places, because we don't know much about it. MM: So when a foetus or neonate lands here, what happens to it? SH: They undergo a medical and legal post-mortem examination, which includes an autopsy. That autopsy includes any investigations that are necessary to determine the cause and circumstances of death. Once that is completed, we compile a post-mortem report. That report then goes to the South African Police Service for further investigation, for them to decide whether or not there needs to be prosecution in this case and what happens to the remains. In foetuses that are less than 26 weeks the remains are discarded as medical waste. Neonates of 26 weeks and older are buried as paupers if nobody claims the remains, which means the state assumes the cost of the burial. MM: Do you have enough doctors to conduct these autopsies? SH: At present, our doctors are doing between 500 to 600 post-mortems per doctor per year. The ideal amount would be about 250 because we need to take into consideration that the process is not just doing autopsies. In fact, the doctor has to do the autopsy then compile a meticulous report that needs to stand up in court. MM: We have more than 1 000 unemployed doctors in this country. Why can't you use them? SH: We do not have enough funded posts for doctors, even though we do have a lot of doctors who would like to come and work in our service. MM: Have you got a specific policy intervention you'd like to see? SH: That's exactly why we do these studies. We're hoping that if we are able to shine a light on where the problems lie, we are able to give a basis for policy development to show where intervention is necessary. I think it's very sad that the This story is based on the , 'Why are thousands of babies dumped each year in SA instead of being safely aborted?,' which was broadcast on 29 March on eNCA. View the full programme on Bhekisisa's If you are seeking information about abortion services, has a list of providers in South Africa, which is regularly updated. This story was produced by the . Sign up for the .
