In the mid 1990s, the HIV epidemic was initially impacting South Africa. Fear, stigma and denial surrounding sexual practices undermined treatment access and prevention initiatives. Significant strides have been made in reducing the HIV epidemic in South Africa and other areas in sub-Saharan Africa through effective programming and funding of prevention programs. Reinstatement of the Mexico City Policy threatens to negatively impact gains made in the HIV/AIDS community. Recognition that communication is essential to effective reproductive health and HIV/AIDS programming needs to be recognized by politicians enacting the Mexico City Policy and the possibility of viewing a rise in HIV/AIDS incidence in sub-Saharan Africa.

Most sub-Saharan African countries acted early and aggressively in response to the WHO COVID-19 warning by closing schools, international borders, limiting domestic travel and restricting large gatherings. The six most populous sub-Saharan African countries, at the beginning of July 2020 with the exception of Republic of South Africa, all had relatively modest COVID-19 case counts compared with European, North and South American and some Asian countries in spite of access to more limited medical resources and technologies. Shutdowns or shelter-in-places were put in place for 5 out of 6 countries surveyed well before the first reported COVID-19 death. Timely action to enact comprehensive public health measures are irreplaceable and cannot be substituted by later use of medical resources or technologies. In the case of Republic of South Africa, earlier and multiple instances of virus introduction may have made infection control much more difficult compared with other sub-Saharan African countries.

Abstract Background Hyperphosphatemia, serum phosphorus ≥ 4.4 mg/dL, is associated with increased risk for chronic kidney disease and cardiovascular disease. Previous studies have shown a weak association between dietary phosphorus intake and serum phosphorus concentrations. While much less common in the general population, hypophosphatemia (< 2.5 mg/dL) may be associated with metabolic syndrome and obesity. Methods Using three cycles from the National Health and Nutrition Examination Survey (NHANES) (2005–2010), this study evaluated independent risk factors for hyperphosphatemia and hypophosphatemia. Results Risk factors for hyperphosphatemia included higher adjusted calcium (OR 2.90, 95% CI 2.43-3.45), increasing cholesterol (OR 1.003, 95% CI 1.001-1.005), female gender (OR 1.61, 95% CI 1.39-1.87) and low hemoglobin (OR 1.52, 95% CI 1.17-1.98). Advanced age was protective (OR 0.98, 95% CI 0.977-0.987). Models that included fasting serum glucose found lower body mass index (BMI) to be protective (OR 0.97, 95% CI 0.96-0.99) and adjusting for serum vitamin D and parathyroid hormone removed the association with low hemoglobin and BMI. Risk factors for hypophosphatemia included the following protective factors: higher albumin (OR 0.56, 95% CI 0.35-0.93), higher BUN (OR 0.90, 95% CI 0.86, 0.95), corrected calcium (OR 0.38, 95% CI 0.23-0.63) and female gender (OR 0.47, 95% 0.24-0.94). In men, higher fasting glucose levels increased risk (OR 1.01, 95% CI 1.0004-1.01). Conclusion This study is the first to show an association between low hemoglobin levels and increased risk for hyperphosphatemia among individuals without chronic kidney disease. We did not find any association between diabetes mellitus, increasing BMI or fasting glucose levels and hypophosphatemia.

BACKGROUND: Awareness of federal nutrition programs and use of the nutrition facts label are associated with reduced risk for obesity and increased intake of fruits and vegetables. Relationships between nutrition programs, use of food labels and risk for overweight and obesity have rarely been evaluated in adolescents. METHODS: Using the National Health and Nutrition Examination Survey from 2005-6, we evaluated the frequency of nutrition awareness of USDA and CDC nutrition programs and use of food labels in adolescents. Risk for overweight (BMI ≥ 85-94th percentile) and obesity (BMI ≥ 95th percentile) was assessed in relation to nutrition awareness and label reading. RESULTS: Most adolescents (92.4%) were aware of the Food Guide Pyramid. Fewer (43.5%) were aware of the 5-A-Day Program, and even less (29.3%) were aware of the Dietary Guidelines for Americans. Less than 25% of adolescents decided which foods to purchase by reading material on the nutrition facts label. There were significant racial and ethnic differences in awareness of federal nutrition programs with Mexican-Americans having the lowest levels of awareness of the US Dietary Guidelines for Americans and the Food Guide Pyramid in comparison with other groups. Non-Hispanic whites had higher and African-American adolescents had lower frequencies of reading fat information on the nutrition label in comparison to Mexican-American and other Hispanics. Awareness of other nutrition programs or of other information on the nutrition facts label was not associated with increased or decreased risk for overweight or obesity. CONCLUSIONS: Use of the nutrition facts panel information is low among US adolescents. Additionally, less than half of adolescents are aware of federal nutrition programs including the Dietary Guidelines for Americans. Future studies should evaluate avenues to make nutrition information more accessible to young Americans.

While there have been considerable advances in the reduction of mother to child transmission of HIV (MTCT) in sub-Saharan Africa with the advance of anti-retroviral therapies (ART), there remain challenges in the late postpartum period.  Structural issues including food insecurity and stigma make better maternal ART adherence and exclusive breastfeeding unreachable for some women. There are no other scientifically researched feeding options as there have been few studies on different types of mixed feeding practices and risk of HIV infection. Additional studies are warranted to assess detailed feeding practices in HIV exposed infants in relation to clinical outcomes.

Childhood obesity disproportionately impacts disadvantaged communities, including Alaska Native children. In part, lack of access to fresh fruits and vegetables and over consumption of sugar sweetened beverages including energy drinks contribute to excessive weight gain in Alaska Native youth. This commentary reports the possibility of storeowners and workers partnering with community members to limit sales of nutrient-poor energy drinks through point-of-sale counselling in rural communities in the interior of Alaska. This model of intervention may be useful to implement in areas where there are limited health workers or others that can serve as health educators. This study reports preliminary evidence from rural Alaska and from other Arctic communities that store workers may effectively improve community health status by limiting or promoting specific products. Storeowners or workers may be helpful partners in the fight against childhood obesity as they are present at the point of sale of high-risk beverages to Alaska Native youth.

Alaska Native and American Indian children have among the highest prevalence of obesity in the United States. Canadian Aboriginal populations including First Nations also have high rates of obesity but obesity rates among children are noticeably lower. We highlight some of the important differences between American and Canadian approaches to healthy lifestyles and Aboriginal/Native health, including diet and physical activity, which may in part explain the differences in obesity prevalence. Specifically, the Canadian government provides a food subsidy program to bring perishable fruits and vegetable to remote, rural Canadian areas and secondly supports the use of traditional foods and harvesting/gathering through a number of government supported programs. Lastly, there may be a better sense of community and overall life satisfaction for Aboriginals compared with Alaska Natives, in part because of the incorporation of healthcare and other services within the larger overall community, as opposed to separate services as is the case for Alaska Natives. This perspective provides insight into some of these potential differences.

AbstractBackgroundAwareness of federal nutrition programs and use of the nutrition facts label are associated with reduced risk for obesity and increased intake of fruits and vegetables. Relationships between nutrition programs, use of food labels and risk for overweight and obesity have rarely been evaluated in adolescents.MethodsUsing the National Health and Nutrition Examination Survey from 2005–6, we evaluated the frequency of nutrition awareness of USDA and CDC nutrition programs and use of food labels in adolescents. Risk for overweight (BMI ≥ 85-94th percentile) and obesity (BMI ≥ 95th percentile) was assessed in relation to nutrition awareness and label reading.ResultsMost adolescents (92.4%) were aware of the Food Guide Pyramid. Fewer (43.5%) were aware of the 5-A-Day Program, and even less (29.3%) were aware of the Dietary Guidelines for Americans. Less than 25% of adolescents decided which foods to purchase by reading material on the nutrition facts label. There were significant racial and ethnic differences in awareness of federal nutrition programs with Mexican-Americans having the lowest levels of awareness of the US Dietary Guidelines for Americans and the Food Guide Pyramid in comparison with other groups. Non-Hispanic whites had higher and African-American adolescents had lower frequencies of reading fat information on the nutrition label in comparison to Mexican-American and other Hispanics. Awareness of other nutrition programs or of other information on the nutrition facts label was not associated with increased or decreased risk for overweight or obesity.ConclusionsUse of the nutrition facts panel information is low among US adolescents. Additionally, less than half of adolescents are aware of federal nutrition programs including the Dietary Guidelines for Americans. Future studies should evaluate avenues to make nutrition information more accessible to young Americans.

BACKGROUND: Previous studies showed that youths who are obese are more likely to have asthma; however, some studies found important sex differences in the risk for asthma. METHODS: We retrospectively assessed the asthma incidence in a Latino cohort of children recruited from birth and followed up until 9 years of age. We subsequently assessed risk factors for asthma and for an early asthma (defined as <4 years of age) diagnosis in relation to obesity. Asthma was assessed via maternal reports and medical records review of the children at 9 years of age. Each childs weight and height were collected annually. Independent and sex-specific risk factors for asthma diagnosis were assessed by using multivariable logistic regression models. RESULTS: In our cohort, 24.6% (42/164) of the children were diagnosed with asthma by 9 years of age. The mean ± standard deviation age of asthma diagnosis was 29.5 ± 4.5 months; 79.5% had a diagnosis of asthma at <4 years of age. In girls, any breast-feeding at 6 months was associated with a reduced risk of asthma (odds ratio [OR] 0.21 [95% confidence interval {CI}, 0.05-0.86]) and obesity at 2 years of was associated with increased risk for asthma (OR 12.14 [95% CI 2.79-53.05]). Exposure to environmental toxins and consumption of sugar-sweetened beverages were associated with a risk for asthma diagnosis after 4 years of age. CONCLUSION: In our high-risk Latino cohort, obesity was associated with asthma development in the girls. In addition, an asthma diagnosis after 4 years of age may be related to environmental toxin exposure and early consumption of sugar-sweetened beverages compared with an earlier diagnosis.

BACKGROUND: American Indians/Alaska Natives (AI/AN) have the highest prevalence of obesity for any racial/ethnic group. Previous studies examining risk factors for obesity have identified excessive sugar-sweetened beverage (SSB) and inadequate water consumption as major risk factors for this population group. The historical scarcity of water in rural Alaska may explain consumption patterns including reliance on SSBs and other packaged drinks. METHODS: Our study was designed to assess SSB, water and other beverage consumption and attitudes towards consumption in Alaska Native children and adults residing in rural Alaska. During summer 2014, 2 focus groups were conducted employing community members in a small rural village more than 200 air miles west of Fairbanks, Alaska. Interviews were completed with shop owners, Early Head Start and Head Start program instructors (n=7). SSB and total beverage intakes were measured using a modified version of the BEVQ-15, (n=69). RESULTS: High rates of SSB consumption (defined as sweetened juice beverages, soda, sweet tea, energy drink or sports drinks) and low rates of water consumption were reported for all age groups in the village. All adolescents and 81% of children reported drinking SSBs at least once per week in the last month, and 48% of adolescents and 29% of younger children reported daily consumption. Fifty-two per cent of adults reported consuming SSBs at least once per week and 20% reported daily consumption. Twenty-five per cent of adolescents reported never drinking water in the past month, and 19% of younger children and 21% of adults did not consume water daily. CONCLUSION: Alaska Native children and adults living in the Interior Alaska consume high amounts of SSBs including energy drinks and insufficient amounts of water. Interventions targeting beverage consumption are urgently needed for the Alaska Native population in rural Alaska.