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11 December 2019 | Story Leonie Bolleurs
Aids read more

According to Global Statistics, there were approximately 37,9 million people across the globe with HIV/Aids in 2018. They also state that in 2018, an estimated 1,7 million individuals worldwide became newly infected with HIV. 

In the city of Masvingo, Zimbabwe, Claris Shoko is a Statistics lecturer at the Great Zimbabwe University. In her PhD thesis at the University of the Free State (UFS) in the Department of Mathematical Statistics and Actuarial Sciences, she presented the argument that the inclusion of both the CD4 cell count and the viral-load counts in the monitoring and management of HIV+ patients on antiretroviral therapy (ART), is helping in reducing mortality rates, leading to improved life expectancy for HIV/Aids patients. 

She received her doctoral degree at the December UFS Graduation Ceremonies, with her thesis: Continuous-time Markov modelling of the effects of treatment regimens on HIV/Aids immunology and virology. 

CD4 cell count and viral-load count

Dr Shoko explains: “When the human immunodeficiency virus (HIV) enters the human body, the virus attacks the CD4 cells in their blood. This process damages CD4 cells, causing the number of white blood cells in the body to drop, making it difficult to fight infections.”

“Clinical markers such as CD4 cell count and viral-load count (number of HIV particles in a ml of blood) provide information about the progression of HIV/Aids in infected individuals. These markers fully define the immunology and the virology of HIV-infected individuals, thereby giving us a clear picture of how HIV/Aids evolve within an individual.”

Dr Shoko continues: “The development of highly active antiretroviral therapy (HAART) has helped substantially to reduce the death rate from HIV. HAART reduces viral load-count levels, blocking replication of HIV particles in the blood, resulting in an increase of CD4 cell counts and the life expectancy of individuals infected with HIV. This has made CD4 cell counts and viral-load counts the fundamental laboratory markers that are regularly used for patient management, in addition to predicting HIV/Aids disease progression or treatment outcomes.”

In the treatment of HIV/Aids, medical practitioners prescribe combination therapy to attack the virus at different stages of its life cycle, and medication to treat the opportunistic infections that may occur. “The introduction of combined antiretroviral therapy (cART) has led to the dramatic reduction in morbidity and mortality at both individual level and population level,” states Dr Shoko.

Once HIV-positive patients are put on cART, the effectiveness of treatment is monitored after the first three months and a further follow-up is done every six months thereafter. During the monitoring stages, CD4 cell count and viral load is measured. Patients are also screened for any tuberculosis (TB) co-infection and checked for any signs of drug resistance. These variables determine whether or not there is a need for treatment change. 

She continues: “Previous studies on HIV modelling could not include both CD4 cell count and viral load in one model, because of the collinearity between the two variables. In this study, the principal component approach for the treatment of collinearity between variables is used. Both variables were then included in one model, resulting in a better prediction of mortality than when only one of the variables is used.”

“Viral-load monitoring helps in checking for any possibilities of virologic failure or viral rebound, which increases the rate of mortality if not managed properly. CD4 cell count then comes in to monitor the potential development of opportunistic infections such as TB. TB is extremely fatal, but once detected and treated, the survival of HIV/Aids patients is assured,” Dr Shoko explains.

Markov model

She applied the Markov model in her study. The model, named after the Russian mathematician Andrey Markov, represents a general category of stochastic processes, characterised by six basic attributes: states, stages, actions, rewards, transitions, and constraints. 

According to Dr Shoko, Markov models assume that a patient is always in one of a finite number of discrete states, called Markov states. All events are modelled as transitions from one state to another. Each state is assigned a utility, and the contribution of this utility to the overall prognosis depends on the length of time spent in each state. For example, for a patient who is HIV positive, these states could be HIV+ (CD4 cell count above 200 cells/mm3), Aids (CD4 cell count below 200 cells/mm3) and Dead.

“Markov models are ideal for use in HIV/Aids studies, because they estimate the rate of transition between multiple-disease states while allowing for the possible reversibility of some states,” says Dr Shoko, quoting Hubbard and Zhou.

“Relatively fewer HIV modelling studies include a detailed description of the dynamics of HIV viral load count during stages of HIV disease progression. This could be due to the unavailability of data on viral load, particularly from low- and middle-income countries that have historically relied on monitoring CD4 cell counts for patients on ART because of higher costs of viral load-count testing,” Dr Shoko concludes

News Archive

Questions about racial integration in residences answered
2007-07-31

Answers to frequently asked questions about the racial integration of student residences at the UFS

1. Why does the UFS want to change the current situation in the student residences?

There are many reasons why a new approach to placement in the student residences is necessary. However, the main reason is of an educational nature. As a university, the UFS should create an environment in its residences where students can learn to appreciate and respect the rich diversity that is on offer at the university. A university accommodates students from many different backgrounds in terms of race, language, religion, economic status, culture and other aspects. If a student can learn to appreciate the value in this rich diversity at university, he or she will also be able to appreciate the value of this diversity in the workplace and broader society.

The current situation of predominantly white and predominantly black residences has not been able to cultivate such an appreciation for diversity and respect for one another as human beings, and will not equip students with the knowledge and skills required to manage diversity.

Besides this, there are many other areas of life in the residences that need attention. For one, we need to urgently establish a human rights culture in the residences so that the rights of all students can be respected. We need to address the abuse of alcohol, provide disabled students with their rightful place, and last but not least, really entrench a culture of learning in student residences.

Let us make the residences places we can be proud of – places of learning, of diversity, of respect; places of growth and development. This is the ideal we should all strive to achieve.  

2. Why does the management want to force us to integrate?

It is a false argument to debate the issue in terms of “force”. Any decision by a University, or any other organisation, regarding matters of policy, rules and regulations implies a restriction on the choice of an individual and an obligation to comply.  What we should focus on is whether this decision of the Council is in the best interests of our students.

The management of the university believes that it has a responsibility to give students the best education possible, not only in terms of what you learn in the lecture rooms, but especially in the residences as well. The residences can be very powerful places of learning about matters of great importance, both academic and non-academic.

The parallel-medium language policy separates students into largely white/Afrikaans and black/English classes. Efforts are being made to bridge this divide in the classroom, but we can also try to eliminate it in the residences.

The university is committed to building a new culture for the entire institution that is based on values and principles – such as an academic culture, non-racialism, respect for human rights and diversity – among staff and students.

In the context of student residences, the application of these values and principles still allows substantial room for the voluntary exercising of choice by individuals as well as by Residence Committees, notably with regard to the placement of students (they can still place 50 percent of first-year students), as well as the determination of the future character and traditions of a diverse residence.

Furthermore, students can still choose their residences (subject to availability of places), can choose a roommate, and so forth.

3. What about freedom of association?

The rights we enjoy in a democracy must be balanced against other rights, as well as the laws of the country. This means that the right to freedom of association must be balanced against laws that make it illegal to discriminate against other people on the basis of race, language or religion, for instance.

Freedom of association pertains to the right of individuals to form voluntary organisations such as clubs or private boarding houses, or their right to join or not join existing organisations.  You exercise that right when you decide to become a student of the UFS, and again when you choose to live in one of its residences.

However, once you have decided to join an organisation voluntarily, you cannot subsequently demand that that organisation should provide a “club” or residence to your liking where, for instance, you only associate with your choice of co-members. You must accept the policies of that organisation.

In any case, how would that right of yours be balanced against the right of another individual who wishes to associate with a different set of co-members? (For instance – what about the freedom of a student to associate with students NOT from his own background, but indeed from another language, cultural, racial or economic background?) 

The constitutional right to freedom of association can, in any case, not be used to exclude or discriminate on the basis of race or religion (Section 18 of the Bill of Rights).

Besides, the new policy guidelines will still make provision for freedom of association. This right can be exercised freely within a diverse residence with regard to friendships, joint academic work, socialising, sport, etc.

4. Will residences not lose their traditions?

The University appreciates that there are many valuable elements of tradition in residences. However, we must bear in mind that the traditions and character of student residences have evolved and changed over time, and they will continue to evolve and to change. In addition, we do not need to accept all aspects of residence life purely on the basis of tradition, including the unacceptably high level of alcohol abuse and unsavoury, humiliating and discriminatory orientation practices. The new approach to integrated residences provides the opportunity to retain the positive aspects of the current traditions and character, but also to develop new traditions and give residences a new character.

We can now establish a tradition and a character for each residence that are reconcilable with the values of the University as a place of scholarship and are aligned with the human rights approach of our country’s Constitution, the laws of our country and the strengths and diversity of the students in a particular residence.

5. Have students been involved in this process? Is there a role for them to play after the decision has been taken by the Council of the UFS?

In the first semester of 2007, during two rounds of consultations, the primes, SRC and student organisations were consulted about the proposed new placement policy to increase diversity in residences. Some residences also made written submissions on the matter (such as Madelief, Soetdoring, Wag-'n-bietjie, Vergeet-my-nie, Emily Hobhouse). Other residences requested and were granted more time, but did not make any submissions in the end (such as Reitz and Armentum).

Management also had several meetings with the above-mentioned structures to hear first-hand from students their concerns and solutions regarding possible challenges presented by integration in residences.

During these interactions, several excellent ideas and proposals were put forward by students. These views had a definite impact on the eventual proposal that was taken to the University Council, in particular regarding the minimum level of diversity (30%) in junior residences and the fact that residences still want to have a say in the placement of students, rather than the placement decision being left in the hands of Management alone (hence the 50% placement portion of residences). Management values the effort that was put into the process by the primes and residence committees, and thanks them for their contributions.

However, it should be stressed that consultation should not be understood as a process of negotiation, nor does it imply that consensus must be reached. What it means is that Management must take a considered decision after hearing the views of stakeholders.

Management would like students to continue to provide input and ideas regarding the implementation details of the policy guidelines. Task teams have been established and students will be informed about how they can interact with the task teams on an ongoing basis.

6. But integration in the residences was tried in the past (in the late 1990s), and then it failed. Why will it work now?

Yes, the University of the Free State did integrate its residences as far back as 1993, and for a few years it worked. The UFS did it at that time and is now doing so again, because it is the right thing to do. Yet it is important to understand why the previous attempt at racial integration in residences was not successful.

Firstly, both black and white students were much polarised because of the apartheid past. Secondly, there was insufficient management support for students in the residences, the student leaders generally as well as residence heads, in terms of dealing with diversity and related issues. Thirdly, the institutional culture of the UFS and the residences in particular was not addressed as part of broader transformation and integration in residences, whereas it is now being addressed.

In addition, the current decision to integrate residences has the benefit of being implemented after several more years of integration in schooling, sport, workplaces and other aspects of life.

This decision is also based on Management’s commitment to give all the possible support it can to this process.

This is a very important initiative that the UFS is undertaking. Management, in co-operation with students, must ensure that it succeeds. Integrated residences that produce high-quality graduates equipped to deal with the challenges of the workplace and our society is a worthwhile ideal we should all strive to achieve.

If you would like to make a proposal regarding the implementation and practical aspects of the new policy, please send it to the following email address: rector@ufs.ac.za

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