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UNCLAS SECTION 01 OF 04 PRETORIA 004610 
 
SIPDIS 
 
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO 
DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR 
DEPT FOR AID WASHINGTON DC 
STATE PLEASE PASS TO USAID FOR GLOBAL BUREAU APETERSON 
USAID ALSO FOR GH/OHA/CCARRINO AND RROGERS, AFR/SD/DOTT 
ALSO FOR AA/EGAT SIMMONS, AA/DCHA WINTER 
HHS FOR THE OFFICE OF THE SECRETARY, LWILEY, WSTEIGER 
CDC FOR EMCCRAY 
 
E.O.  12958: N/A 
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH OCTOBER 15 ISSUE 
 
Summary 
------- 
 
¶1.  Summary.  Every two weeks, USEmbassy Pretoria publishes 
a public health newsletter highlighting South African health 
issues based on press reports and studies of South African 
researchers.  Comments and analysis do not necessarily 
reflect the opinion of the U.S. Government.  Topics of this 
week's newsletter cover:  a new survey on youth risk 
behavior; vaccine research struggles in finding trial 
participants; criticism by auditor of Health Department for 
lax funds allocation; lack of vitamins in Africa; results of 
Western Cape's HIV/AIDS antenatal survey; an outline by the 
Health finance chief on health funds; the HIV crisis among 
health workers; and risk behavior in South Africa.  End 
Summary 
 
South African National Youth Risk Behavior Survey Released 
--------------------------------------------- ------------- 
 
¶2.  The 2002 South African National Youth Risk Behavior 
Survey, using results from 10,699 students in grades 8-11, 
highlighted sexual practices of students in South African 
high schools.  The findings include:  (1) 40 percent of 
South African high school pupils are sexually active; (2) 
more than 14 percent of these students had their first 
sexual experience before the age of 14, and some of them had 
already had more than two sexual partners by the age of 14, 
and (3) in a sampling of 4,182 students, 8.1 percent has had 
an abortion or had a partner who has had an abortion. 
Provincially, in KwaZulu-Natal, of 1,151 students sampled, 
15.6 percent admitted to having had sex before the age of 
14; in Gauteng of the 1,129 sampled, 19.1 percent answered 
positively; in the Western Cape of the 1,390 sampled, 12.5 
percent answered positively.  In the Eastern Cape, 12.5 
percent of students admitted to having had sex before the 
age of 14 (1,108 sampled); in the Free State, 18.8 percent 
of the 1,101 students sampled; in the Limpopo province 11.5 
percent of the 964 students sampled; in Mpumalanga 15.7 
percent of the 1,220 sampled; in the Northern Cape 10.8 
percent of the 1 041 sampled; and in the North West province 
9.9 percent of the 1,162 sampled.  The survey, which 
consisted of a sampling of 23 schools per province, was 
conducted for the purpose of providing nationally and 
provincially representative data on the prevalence of key 
risk behaviors, namely: intentional and unintentional 
injuries, violence and traffic safety, suicide-related 
behavior, behaviors related to substance abuse, sexual 
behavior, nutrition and dietary behaviors, physical 
activity, and hygiene-related behaviors.  Source:  The Star, 
October 2. 
 
South Africa: Vaccine Research Struggles to Find Trial 
Participants 
--------------------------------------------- ---------- 
 
¶3.  South African HIV vaccine research efforts are being 
threatened by the low number of people willing to 
participate in trials, said the Medical Research Council 
(MRC).  According to researchers from the MRC in Durban, the 
fear of stigma and discrimination from their communities 
prevented people from taking part in the trials. The country 
began conducting vaccine trials in November 2003.  The 
stringent eligibility criteria also saw many potential study 
participants being rejected.  Although more than 400 people 
have attended the MRC's HIV vaccine information sessions in 
the past two years, only 90 have returned for the screening 
process - a medical check-up that establishes eligibility. 
Of these 90, only 18 have been enrolled in Phase I vaccine 
trials. The MRC has managed to find a further 30 eligible 
candidates during the past twelve months.  Eighteen 
volunteers is the minimum amount required to proceed with 
the trials at the Durban site, as the first phase needs a 
small number of participants. But the vaccine trials could 
be at risk if the existing participants drop out.  The MRC's 
HIV Vaccine Research Unit, based in Durban and the Perinatal 
HIV Research Unit at the Chris Hani Baragwanath Hospital in 
Soweto, Johannesburg are the only two trial sites. Two more 
sites are expected to start vaccine testing in the next few 
months.  Despite ongoing education campaigns, misconceptions 
and myths about the trials and the vaccine present another 
obstacle. A large number of people believed they could be 
infected with the HI virus by being inoculated with a test 
vaccine, researchers said.  Such fears were unfounded, "as 
no live viruses are injected," explained MRC senior clinical 
research nurse Armstrong Makhofola.  The stigma associated 
with joining an HIV vaccine trial remains a big challenge. 
In addition, many willing volunteers also do not meet the 
stringent eligibility criteria, such as belonging to a 
certain age group, being in good health, having a good level 
of education, being HIV-negative and at low risk of 
contracting HIV, as well as not planning a pregnancy in the 
near future.  Phase I trials in Durban and Soweto will end 
in mid-2005. These results will dictate whether the research 
can move into its second and third phases.  The main 
objective of Phase I trials is to test the safety of the 
vaccine prototype. They will also determine its possible 
side effects.  Despite being in the early stages of the 
first phase of trials, "so far, the [test] vaccine appears 
to have strengthened immune response," Makhofola said.  The 
candidate-vaccine had also not shown any unexpected side 
effects so far.  The next phase will focus on maintaining 
the safety level of the vaccine, as well as finding the best 
dosage and method of administering the vaccine. The third 
phase involves tens of thousands of participants to assess 
whether the vaccine pre-vents natural infection from HIV. 
Source: UN Integrated Regional Information Networks, October 
¶5. 
 
Auditor Criticizes Health Department for Lax Funds 
Allocation 
--------------------------------------------- -------------- 
 
¶4.  Auditor-General Shauket Fakie has criticized the Health 
Department for paying out billions of rands in conditional 
grants to provinces and then failing to follow up on how 
these funds were spent.  Fakie qualified the department's 
annual report tabled in Parliament yesterday, saying there 
were fundamental deficiencies, and noncompliance with the 
law, particularly the Division of Revenue Act.  Fakie said 
the health department did not verify or follow up on all of 
the payments it made to provincial departments amounting to 
R7 billion ($1.1 billion using 6.5 rands per dollar), or 
91.4 percent of the department's budget for conditional 
grants to the provinces. "The act requires funds to be 
withheld when significant under spending and the no 
achievement of objectives occurs. It was noted that, in 
spite of the grants being under spent, transfers were still 
made. In 18 instances, under spending of conditional grants 
amounting to R279 million occurred in the provinces on the 
various programs," he said.  On-site monitoring of the 
Health Professions Training and Development conditional 
grant of R1.8 billion was inadequate in Gauteng, Free State, 
Eastern Cape, North West and Limpopo.  The Health Department 
transfers conditional grants to the provinces for combating 
HIV/AIDS, hospital revitalization, integrated nutrition and 
hospital management, among other things.  Fakie also said 
the department transferred R110 million to non-governmental 
organizations and failed to ensure that audited statements 
for the use of the money were provided, or even that there 
were effective financial management and control systems in 
place at the organizations.  Source:  Business Day, October 
¶8. 
 
Africa's Countries Lack Vitamins 
-------------------------------- 
 
¶5.  It is estimated that vitamin and mineral deficiencies 
are costing sub-Saharan economies more than $2.3 billion a 
year in lost productivity. Iron deficiency alone costs South 
Africa 0.4% of its gross domestic product.  A report 
released by the World Health Organization, the Macronutrient 
Initiative, the United Nations Children's Fund, the Global 
Alliance for Improved Nutrition and the Development Bank of 
Southern Africa (DBSA) finds that adding essential vitamins 
and minerals to foods regularly consumed by a significant 
proportion of the population can cost as little as a few 
cents per person per year.  In South Africa, it is estimated 
that 37 percent of children under the age of five suffer 
iron deficiency; 160,000 children are born each year with 
severe mental impairments; and about 26 percent of women 
between the ages of 15 and 49 have iron-deficiency anemia. 
Also, 6,000 children under the age of six die each year 
because they lack vitamin A.  In May 2002 the United Nations 
General Assembly agreed that the elimination or reduction of 
vitamin deficiencies should be one of the principal goals of 
development to be achieved early this century.  Almost two 
years ago South Africa joined a global initiative to fortify 
flour with iron and folic acid and vitamin A, investing $11 
million a year over the next five years.  South Africa 
iodizes 62 percent of salt sold, hoping to save the lives of 
5800 children and prevent 3400 birth defects a year.  In 
South Africa, 33% of children under the age of six have 
subclinical vitamin A deficiency.  Source:  Business Day, 
October 8. 
 
Western Cape's HIV/AIDS Antenatal Survey Results 
--------------------------------------------- --- 
 
¶6.  Western Cape's latest antenatal survey reveals that 13 
percent of pregnant women attending public health facilities 
have HIV (up from 12.4 percent in 2002) and that teenage 
infection rates have been increasing by 1 percent annually, 
with 8.5 percent of all pregnant 15-19 year olds having HIV. 
52 percent of districts reported HIV prevalence rates of 
greater or equal to 10 percent. There had been a rapid rate 
of increase in urban settings, where over 65 percent of the 
province's populations reside.  The HIV prevalence rate in 
the under 20 age group has continued to rise consistently 
over the last eight years with the rate highest among 
younger women. It continues to increase rapidly among 15 to 
24 year old women.  The district with the highest infection 
rate is Gugulethu/ Nyanga, where 28 percent of pregnant 
women are infected.  The Western Cape has the lowest HIV 
prevalence of all provinces and around one-third of that of 
KwaZulu-Natal.  To combat the rise among teenagers, the 
Health Department is planning peer education programs in 
every high school this year. Around a quarter already run 
these programs.  The survey showed that:   (1) The districts 
with the highest prevalence were Gugulethu/ Nyanga, with 28 
percent prevalence, Khayelitsha (27.2 percent), Helderberg 
(19 percent), Oostenberg (16 percent), and the Knysna- 
Plettenberg Bay area (15.6 percent); (2) there were fewer 
infections in rural (8.3 percent) than in urban (14.7 
percent) areas, although infections were high along the N2 
between Plettenberg Bay and Cape Town; (3) lowest infection 
rates were found in the Klein Karoo (5.4 percent), the 
Central Karoo (6.5 percent), Mitchells Plain (6.3 percent) 
and Blaauwberg (4.4 percent); (4) the epidemic in the 
Western Cape is around five years behind the national 
epidemic; and (5) the HIV infection rate of the total 
population in the Western Cape is probably half that of 
pregnant women at around 6.5 percent.  The evidence 
indicates that the largest risk group in our province is the 
under-20s.  Source:  Cape Times, October 8; Health E-News, 
October 7. 
 
Health Finance Chief Outlines Action on Health Funds 
--------------------------------------------- ------- 
 
¶7.  The Health Department's chief financial officer, Gerrit 
Muller, conceded that the department had failed to properly 
oversee the spending of billions of rands given to provinces 
as conditional grants, but said remedial steps had been 
taken to address the problem.  Muller's comments came after 
auditor-general Shauket Fakie's damning report on the Health 
Department's spending, which became public when its annual 
report was tabled in Parliament (see above article).  Muller 
provided the parliamentary portfolio on health with details 
of the department's R172 million under spending during the 
2003-04 financial year, and said the department's staff 
complement would be strengthened to improve financial 
monitoring.  Co-ordination with the provinces would also be 
improved, he said, using forums such as the provincial chief 
financial officers gathering, the meeting of the health 
minister and the nine provincial ministers and meetings of 
the provincial heads of health.  Regarding the lack of 
oversight for nongovernmental organizations (NGOs) that 
received funding from government, Muller said it was 
difficult to obtain financial statements from NGOs that 
received once-off funding. Those requesting more funding had 
to provide financial statements and audited reports. 
Source:  Business Day, October 13. 
 
HIV Crisis Among South Africa's Health Workers 
--------------------------------------------- - 
 
¶8.  October's issue of South African Medical Journal 
published an article showing a high prevalence rate of 
HIV/AIDS of health workers in KwaZulu-Natal, Free State, 
Mpumalanga, and North West provinces.  Out of 595 
respondents, an estimated 15.7 percent of health workers in 
the four provinces had HIV/AIDS in 2002.  The authors said 
the high HIV prevalence among health workers had serious 
implications including increased absenteeism, and the fact 
that non-infected workers had to compensate by working much 
harder, leading to lower morale and burnout.  The study used 
a stratified cluster sample, drawn from 5% of health 
facilities in the country that represented the public and 
private health sectors in Free State, Mpumalanga, KwaZulu- 
Natal and North West.  The sample was designed to obtain a 
representative, nation-wide sample of medical professionals 
and nonprofessional health workers, with a sub-sample 
comprising workers in four provinces tested for HIV.  Among 
younger health workers, the HIV prevalence rates were even 
higher.  The group, aged between 18 and 35, had an estimated 
HIV prevalence rate of 20 percent.  About 20.3 percent of 
nonprofessionals were infected with HIV, while 13.7 percent 
of professionals were HIV-positive.  Black health workers 
had a much higher HIV prevalence than other race groups, 
however caution needed to be exercised in interpreting the 
results, because the figures among the other race groups 
were too small to yield meaningful results.  Source: 
Business Day, October 13. 
 
South Africa's Risk Behavior 
---------------------------- 
 
¶9.  Results from Durex's eighth annual online global sex 
survey, in which more than 3,000 South Africans 
participated, highlighted continuing South African risky 
sexual behavior. 
While 78 percent of South Africans are seriously concerned 
about HIV-Aids, 58 percent are having unprotected sex with 
partners whose sexual history they do not know.  The survey 
showed that of the South Africans who completed the 
questionnaire, 21 percent have never received any formal sex 
education.  The survey is internet-based with 350,000 people 
participating from 41 countries.  Source:  SAPA, October 12. 
 
MILOVANOVIC