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Our final days in South Africa were spent in Hluhluwe-iMfolozi Game Reserve, a humongous wildlife reserve located in KZN. About half of us - including me - stayed in luxury tents (like the one in Harry Potter), and the rest stayed in a decent sized house. We stayed at Mpila Camp, pretty much right in the middle of the park, and there really was no barrier between us and the rest of the park. Seeing animals like Impala, Nyala, Zebra, Monkeys, and Warthogs wandering the camp was common. I even got in a Western stand-off with a giant male warthog...and lost.

Throughout the day, we had several options. There were some walking safaris, game drives, or we could just relax at the park. I went on 2 drives and a walking safari, and most of us also went to St. Lucia Park and spent half a day at iSimangaliso Wetlands.

This experience was absolutely fantastic. Pictures cannot truly express how awesome it was. Seeing the wildlife, gazing at the Milky Way, standing on "Pride Rock", and nearly getting mauled by a confused rhino, are all experiences I know I will never forget. I took a boatload of pictures (mouse over "Blog" and click the "Pictures" link) that you can check out, but keep in mind that these stills don't do this park justice.

This is my last post and if you've been reading, thank you. For me, this was the trip of a lifetime, and I really have enjoyed sharing it. If you have any questions or comments, feel free to leave it in the "comments" section, or shoot me an email at [email protected].

Sala kahle!

 
A quick note on vaccines - Every research organization we talked to said they were far from synthesizing a true vaccine, because of the nature of the disease. If you're interested, check out the Prezi that I created for class and here are a few links to look at:
Types of Experimental HIV Vaccines
AIDSVAX Journal Article (Wiki link)
STEP/Phambili - Wiki, NYTimes
 
 
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During our stay in Durban, we were able to visit CAPRISA - the Center for the AIDS Program of Research in South Africa - both in the heart of Durban and in Vulindlela, a large village located about 90 minutes west of Durban. CAPRISA is most famous for their preventive vaginal microbicide study of Tenofovir gel, a vaginal gel that was shown to reduce HIV transmission by 39%. This gel works as a Nucleotide Reverse Transcriptase Inhibitor (NRTI), meaning it blocks the HIV enzyme in charge of converting RNA to DNA. This was a huge step, considering there were really no preventive options against HIV (besides basics like using protection, etc) at the time.

At Vulindlela, we discussed the Tenofovir study but also spent a long time discussing their clinic's focus on circumcision. Circumcision has been found to significantly reduce the risk of HIV transmission. CAPRISA offers circumcisions (for free) to men of all ages and also provides transportation to local schools so boys can get circumcised. Unfortunately, sometimes this can be a double-edged sword and can instill a feeling of immortality, of immunity, and not to use protection. But overall, it has been working well.

The village of Vulindlela was humongous, way bigger than I pictured a village to be. Between wandering the village and interacting with some eccentric locals, it was pretty cool. Check out my pics from Vulindlela here:

 
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During our stay in Pretoria, we were also able to go to one of the most famous landmarks in South Africa - The Voortrekker Monument. It sits atop a hill and the entire city of Pretoria is visible from the top of this building. It was incredible.

For those of you too lazy to click on the wiki link, this monument was built to honor the Voortrekkers (also referred to as the Boers or Voors), the Dutch settlers who had colonized large parts of the Western Cape. This colonization wasn't pretty - they slaughtered and enslaved the native Zulus and Ndebele. They were able to win the wars because of their advanced weaponry and thus they took the land.

Let's think about this. This monument commemorates a group who slaughtered the original Pretorians. Even the name Pretoria comes from Andries Pretorius - the leader of the Voertrekkers. Why would any Black South African want to go there? They don't. We learned that only White South Africans ever go to the Voertrekker monument (besides tourists, obviously). So why is it still up? White South Africans are a minority compared to the Blacks. Should such an insulting monument even be up?

But let's not get ahead of ourselves - the Boers weren't necessarily evil. They didn't want to be in Pretoria; they were being forced out of the Eastern Cape by the British and were trying to survive. This monument doesn't symbolize their brutality; it celebrates their innovation and ability to survive. But is it possible to ignore one while embellishing the other? I personally don't think it's possible to turn a blind eye to such savagery. But it's a matter of opinion.

Check out my pics here:

 
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Our second destination was The University of Limpopo - Medunsa, where we met with Professor Jeffrey Mphahlele, the head of the Virology department. He showed us around campus and then provided us with a delicious lunch. While the good food, dim lighting, and jet lag made it difficult for some to stay awake, most listened as he discussed the history of the university and their current major projects.

UL-M actually used to be a historically black university (from the apartheid perspective, it was to make black doctors to treat black patients). In 2005, the Medical University of South Africa - MEDUNSA - merged with the University of the North to create the University of Limpopo. The vast majority of students today are Black.

We also got to see Tsepang (the Zulu name for Pretoria) Clinic and George Mukhari Hospital, both of which were next to the medical school. At the clinic, we sat down with Dr. Kongawonza along with several nurses and we discussed how their clinic operated, how they are funded, how many patients they see, etc.

During the Q&A session, Kathe was on fire with the questions and the point of stigma was brought up once again - this time toward both the patients and toward the doctors/nurses working in the HIV clinic. Dr. Kongawonza said that the stigma was as bad as ever and made several interesting points: first of all, in a country that has such an astronomical prevalence of HIV, why is there no emphasis on HIV/AIDS in medical school? This disease isn't going to go away overnight and it makes sense to make sure the doctors of tomorrow are especially good at catching HIV early, when it can be treated relatively easily. Also, one way to reduce stigma is to have speakers come in who are living with HIV, thus humanizing the disease and also helping people understand that being diagnosed with HIV is not a death sentence.

We were also given a tour of the facility, but couldn't take any pictures to protect patient privacy. I did take a lot of pictures of the campus, and other stuff. Again, please comment with any questions/comments you have and keep checking back!

 
Here's the link to Topsy's official website and here's a link to their award-winning commercial.

Bright and early the morning after landing in South Africa, we bussed off to Topsy Foundation. We drove for a few hours, seemingly to the middle of nowhere, until we reached a small village. There, we all sat in a boardroom, drank some tea/coffee and had a talk with several of the prominent members (and I quickly realized that central heating was nonexistent...) about how Topsy began and the work they do now.

Topsy provides free ARV treatment and also has a free clinic with several physicians. They also provide psychosocial help for those who require it, and send food parcels to those in aid. Their funding is mostly from the government (PEPFAR, the South African government, and others), private donations, and selling small merchandise.

One of the coolest things about Topsy was their Vegetable Garden project (part of their Community Outreach Program). In a partnership with the Food Gardens Foundation, Topsy set up vegetable gardens on people's front yards, and then taught them how to maintain their gardens. This is important because, in their own words, "a person who has not eaten cannot be given medication, whilst a child who has not eaten cannot learn."

During the presentation, somebody asked if they knew of a stigma with being HIV positive - did their patients ever discuss it? Were people ever ashamed to be coming in to the clinic? The answer was a pretty solid no; their had been a stigma at the outbreak of this disease, but there wasn't anymore. This was interesting, because no other clinic or hospital said the same thing - in fact, they said the exact opposite.

We were also able to take a tour of the facility with Dr. Susan Preller, one of the major founders of Topsy. I, of course, took a bunch of pictures, that you can check out here:
 
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Greetings from Mason, Ohio! Obviously, my original plan of live-blogging during our trip didn't work due to technical difficulties, so this blog is going to much more reflective than I originally intended. If you are interested in seeing a live feed of our trip, check out juliainsouthafrica.tumblr.com, an excellent blog that details our daily activities in the form of journal entries, pictures, and videos.

My goal with this post is to give you a little background on this course and why the heck we went to South Africa in the first place. The title of this course is Public Health & Infectious Disease: The South African Experience, and our focus was HIV/AIDS. We left the US on June 5th and returned on the 19th, visiting Pretoria, Durban, and Hluhluwe-iMfolozi Game Park.

But why South Africa? South Africa has the highest prevalence of HIV in the world, with Black South Africans at a whopping 13.6% (Check out more stats here and more detailed breakdown here). Also, remember that these numbers represent those who are willing to get tested. There is a very significant stigma against those who are HIV+ in South Africa, and being seen walking into an HIV testing facility can be humiliating for many.

So, roughly 1 in 9 South Africans suffer from HIV. There are several theories as to why South Africa was hit so hard, including the effects of poor government housing for Blacks during Apartheid, the lack of education regarding safe sex, the high rates of rape, the low percentage of male circumcisions (Research has shown that circumcisions can substantially lower the possibility of transmission). Chances are, the answer is that all of these factors had an impact.

But the real question is what's being done about it? There are several organizations dedicated to increase awareness of this epidemic, promoting sex education, and providing treatment (anti-retroviral therapy - ART) to those who are HIV+. One organization we visited, Topsy, is dedicated to providing free care and treatment, especially to children (Check out their heart-wrenching ad here. For those who watched it, Selinah is doing well and the ad received a lot of publicity for Topsy). There are also several research organizations dedicated to finding more preventive means, which I'll touch on later. And, of course, lots of clinics have sprouted, both through hospitals and other organizations, to provide free testing and treatment.

I know I'm being very general, but I'll discuss more in depth when I post about the actual topic. Also, here's an excellent video that discusses HIV's life cycle and ARV therapy (for those who aren't very familiar with the virus).

Feel free to comment with any questions, comments, or puns you may have. I'll try to post a couple of times a week  (with lots of pictures, of course) so check back often!