Treatment of HIV/AIDS at South Africa's Largest Employers: Myth and Reality

Background: In the past three years, many large employers in South Africa have announced publicly their intention of making antiretroviral treatment (ART) available to employees. Reports of the scope and success of these programs have been mostly anecdotal. This study surveyed the largest private sector employers in South Africa to determine the proportion of employees with access to ART through employer-sponsored HIV/AIDS treatment programs. Methods: All 64 private sector and parastatal employers in South Africa with more than 6,000 employees were identified and contacted. Those that agreed to participate were interviewed by telephone using a structured questionnaire. Results: 52 companies agreed to participate. Among these companies, 63% of employees had access to employer-sponsored care and treatment for HIV/AIDS. Access varied widely by sector, however. Approximately 27% of suspected HIV-positive employees were enrolled in HIV/AIDS disease management programs, or 4.4% of the workforce overall. Fewer than 4,000 employees in the entire sample were receiving antiretroviral therapy. In-house (employer) disease management programs and independent disease management programs achieved higher uptake of services than did medical aid schemes. Conclusions: Publicity by large employers about their treatment programs should be interpreted cautiously. While there is a high level of access to treatment, uptake of services is low and only a small fraction of employees medically eligible for antiretroviral therapy are receiving it.

The Private Sector and HIV/AIDS in Africa: Taking Stock of Six Years of Applied Research

Background: Until recently, little was known about the costs of the HIV/AIDS epidemic to businesses in Africa and business responses to the epidemic. This paper synthesizes the results of a set of studies conducted between 1999 and 2006 and draws conclusions about the role of the private sector in Africa’s response to AIDS. Methods: Detailed human resource, financial, and medical data were collected from 14 large private and parastatal companies in South Africa, Uganda, Kenya, Zambia, and Ethiopia. Surveys of small and medium-sized enterprises (SMEs) were conducted in South Africa, Kenya, and Zambia. Large companies’ responses or potential responses to the epidemic were investigated in South Africa, Uganda, Kenya, Zambia, and Rwanda. Results: Among the large companies, estimated workforce HIV prevalence ranged from 5%¬37%. The average cost per employee lost to AIDS varied from 0.5-5.6 times the average annual compensation of the employee affected. Labor cost increases as a result of AIDS were estimated at anywhere from 0.6%-10.8% but exceeded 3% at only 2 of 14 companies. Treatment of eligible employees with ART at a cost of $360/patient/year was shown to have positive financial returns for most but not all companies. Uptake of employer-provided testing and treatment services varied widely. Among SMEs, HIV prevalence in the workforce was estimated at 10%-26%. SME managers consistently reported low AIDS-related employee attrition, little concern about the impacts of AIDS on their companies, and relatively little interest in taking action, and fewer than half had ever discussed AIDS with their senior staff. AIDS was estimated to increase the average operating costs of small tourism companies in Zambia by less than 1%; labor cost increases in other sectors were probably smaller. Conclusions: Although there was wide variation among the firms studied, clear patterns emerged that will permit some prediction of impacts and responses in the future.

An Historical and Theological Analysis of Campus Crusade for Christ's Evangelistic Practice in Two American University Contexts

This dissertation, an exercise in practical theology, consists of a critical conversation between the evangelistic practice of Campus Crusade for Christ in two American university contexts, Bryan Stone's ecclesiologically grounded theology of evangelism, and William Abraham's eschatologically grounded theology of evangelism. It seeks to provide these evangelizing communities several strategic proposals for a more ecclesiologically and eschatologically grounded practice of evangelism within a university context. The current literature on evangelism is long on evangelistic strategy and activity, but short on theological analysis and reflection. This study focuses on concrete practices, but is grounded in a thick description of two particular contexts (derived from qualitative research methods) and a theological analysis of the ecclesiological and eschatological beliefs embedded within their evangelistic activities. The dissertation provides an historical overview of important figures, ideas, and events that helped mold the practice of evangelism inherited by the two ministries of this study, beginning with the famous Haystack Revival on Williams College in 1806. Both ministries, Campus Crusade for Christ at Bowling Green State University (Ohio) and at Washington State University, inherited an evangelistic practice sorely infected with many of the classic distortions that both Abraham and Stone attempt to correct. Qualitative research methods detail the direction that Campus Crusade for Christ at Bowling Green State University (Ohio) and Washington State University have taken the practice of evangelism they inherited. Applying the analytical categories that emerge from a detailed summary of Stone and Abraham to qualitative data of these two ministries reveals several ways evangelism has morphed in a manner sympathetic to Stone's insistence that the central logic of evangelism is the embodied witness of the church. The results of this analysis reveal the subversive and pervasive influence of modernity on these evangelizing communities—an influence that warrants several corrective strategic proposals including: 1) re-situating evangelism within a reading of the biblical narrative that emphasizes the present, social, public, and realized nature of the gospel of the kingdom of God rather than simply its future, personal, private, and unrealized dimensions; 2) clarifying the nature of the evangelizing communities and their relationship to the church; and 3) emphasizing the virtues that characterize a new evangelistic exemplar who is incarnational, intentional, humble, and courageous.

THE ROLE OF ACOUSTIC CAVITATION IN ENHANCED ULTRASOUND-INDUCED HEATING IN A TISSUE-MIMICKING PHANTOM

A complete understanding of high-intensity focused ultrasound-induced temperature changes in tissue requires insight into all potential mechanisms for heat deposition. Applications of therapeutic ultrasound often utilize acoustic pressures capable of producing cavitation activity. Recognizing the ability of bubbles to transfer acoustic energy into heat generation, a study of the role bubbles play in tissue hyperthermia becomes necessary. These bubbles are typically less than 50μm. This dissertation examines the contribution of bubbles and their motion to an enhanced heating effect observed in a tissue-mimicking phantom. A series of experiments established a relationship between bubble activity and an enhanced temperature rise in the phantom by simultaneously measuring both the temperature change and acoustic emissions from bubbles. It was found that a strong correlation exists between the onset of the enhanced heating effect and observable cavitation activity. In addition, the likelihood of observing the enhanced heating effect was largely unaffected by the insonation duration for all but the shortest of insonation times, 0.1 seconds. Numerical simulations were used investigate the relative importance of two candidate mechanisms for heat deposition from bubbles as a means to quantify the number of bubbles required to produce the enhanced temperature rise. The energy deposition from viscous dissipation and the absorption of radiated sound from bubbles were considered as a function of the bubble size and the viscosity of the surrounding medium. Although both mechanisms were capable of producing the level of energy required for the enhanced heating effect, it was found that inertial cavitation, associated with high acoustic radiation and low viscous dissipation, coincided with the the nature of the cavitation best detected by the experimental system. The number of bubbles required to account for the enhanced heating effect was determined through the numerical study to be on the order of 150 or less.

Object Oriented Animation on the World Wide Web

This report describes our attempt to add animation as another data type to be used on the World Wide Web. Our current network infrastructure, the Internet, is incapable of carrying video and audio streams for them to be used on the web for presentation purposes. In contrast, object-oriented animation proves to be efficient in terms of network resource requirements. We defined an animation model to support drawing-based and frame-based animation. We also extended the HyperText Markup Language in order to include this animation mode. BU-NCSA Mosanim, a modified version of the NCSA Mosaic for X(v2.5), is available to demonstrate the concept and potentials of animation in presentations an interactive game playing over the web.