In developing countries, risk of human papillomavirus (HPV) infection may be increased by the high prevalence of human immunodeficiency virus (HIV) infection. We evaluated the safety and immunogenicity of the HPV-16/18 AS04-adjuvanted vaccine in HIV-infected women in South Africa. Asymptomatic HIV-positive women aged 18-25 years (N=120) were stratified by CD4⁺ T-cell count and randomised (1:1) to receive HPV-16/18 vaccine (Cervarix®; GlaxoSmithKline Vaccines) or placebo (Al[OH]3) at 0, 1 and 6 months (double-blind). HIV-negative women (N=30) received HPV-16/18 vaccine (open label). Anti-HPV-16/18 antibody and CD4⁺ T-cell responses, CD4⁺ T-cell count, HIV viral load, HIV clinical stage and safety were evaluated for 12 months. The safety and reactogenicity profile of the HPV-16/18 vaccine was comparable in HIV-positive and HIV-negative women. Irrespective of baseline HPV status, all HIV-positive and HIV-negative women who received the HPV-16/18 vaccine were seropositive for both HPV-16 and HPV-18 after the second vaccine dose (month 2) and remained seropositive for both antigens at month 12. Anti-HPV-16/18 antibody titres at month 12 remained substantially above levels associated with natural infection. The HPV-16/18 vaccine induced sustained anti-HPV-16/18 CD4⁺ T-cell responses in both HIV-positive and HIV-negative women. No impact of baseline CD4⁺ T-cell count or HIV viral load was observed on the magnitude of the immune response in HIV-positive women. In HIV-positive women, CD4⁺ T-cell count, HIV viral load and HIV clinical stage were unaffected by HPV-16/18 vaccine administration. In conclusion, the HPV-16/18 AS04-adjuvanted vaccine appears immunogenic and well-tolerated in women with HIV infection. Study ID: 107863/NCT00586339.

Intimate partner violence (IPV) is a silent public health epidemic in South Africa (SA). Interpersonal violence in SA is the second highest burden of disease after HIV/AIDS, and for women 62% of the former is ascribed to IPV. SA, therefore, has the highest reported intimate femicide rate in the world. IPV has far-reaching consequences, stretching across generations. The cost to the economy and burden on health services are considerable. IPV presents in many ways, cutting across all medical disciplines. Therefore, all medical professionals should be conversant with this issue. This article provides essential, practical steps required for identifying and managing IPV, applicable to any setting. These steps are summarised as six Rs: Realise that abuse is happening (be aware of cues); Recognise and acknowledge the patient's concerns; Relevant clinical assessment; Risk assessment; cRisis plan; and Refer as needed for medical, social, psychological and/or legal assistance.

The wellbeing of sexual and gender minorities (SGM) is undermined by widespread homophobia that extends to health systems, and is exacerbated by medical curricula underrepresenting the health needs of this key population group. In 2012, under the auspices of the Department of Obstetrics and Gynaecology at the University of Cape Town in South Africa, a student-inspired curriculum intervention led to the introduction of interactive participatory workshops centred on the health needs of SGM. This paper describes the experiences of two of the workshop facilitators who embraced the risk of introducing an unchartered topic in a student-centred manner, which frequently led to unpredictable events that were challenging. Here, the authors reflect on their own vulnerabilities, which are considered alongside the value of moving through risk to transform present curricular practices and student attitudes, especially in a country like South Africa where prejudice against SGM patients by healthcare providers is well-documented.

Research on the extent and nature of commonly misunderstood fundamental biomedical concepts across a medical curriculum is scarce. These misunderstandings could point toward robust misconceptions. We examined first whether common misunderstandings persist throughout a medical curriculum, followed by a fine-grained analysis to identify their nature. We designed and administered a 2-tier test to 987 medical students across our curriculum, with 8 questions covering the respiratory and cardiovascular systems, cell division, and homeostatic processes. Proportions of incorrect responses were computed. Four questions where misunderstandings persisted were further qualitatively analyzed. A one-way ANOVA showed the proportion of incorrect responses decreased significantly by students’ academic year [ F(6, 986) = 96.05, P < 0.001]. While novices and end-of -first-year students showed similar proportion of incorrect responses ( P > 0.05), incorrect responses decreased significantly between first years and second years ( P < 0.001). Thereafter, the proportion of incorrect responses remained stable from second to final year ( P > 0.05), with ∼35% of incorrect responses. Five questions showed no decrease of incorrect responses between second and final years, with two questions where final year students performed marginally better than novices. A Chi-square analysis, with Bonferroni post hoc test, showed certain misunderstandings appeared frequently across the curriculum. The qualitative analysis of the open-ended questions yielded 15 categories of common misunderstandings of fundamental biomedical concepts in all years of training. If educators become aware of commonly misunderstood biomedical concepts, preventative measures could be taken to prevent robust misconceptions.