This record is a partial extract of the original cable. The full text of the original cable is not available.

UNCLAS SECTION 01 OF 03 PRETORIA 005509 
 
SIPDIS 
 
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO 
DEPT FOR S/OFFICE OF GLOBAL AIDS COORDINATOR 
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,WSTEIGER AND NIH,HFRANCIS 
CDC FOR SBLOUNT AND EMCCRAY 
 
E.O.  12958: N/A 
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH DECEMBER 24 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:  Blood Bank Drops Race as a Risk Factor; 
Genetic Discovery Brings AIDS Vaccines Closer; South African 
Vaccine Search; Study Focuses on Human Cost of AIDS; AIDS 
Infections Peaking in KZN; South African Children Victim of 
Fire; and Court Rules Against Pharmaceutical Pricing 
Regulations.  End Summary. 
 
Blood Bank Drops Race as a Risk Factor 
-------------------------------------- 
 
¶2.  The South African National Blood Service said that it would 
revise its controversial profiling system to enable it to risk- 
rate donors without using race.  To ensure patient safety, the 
current system would remain in place until the new model was 
developed, said the organization's CEO, Prof Anthon Heyns.  The 
developments follow a politicized row that the organization 
found itself embroiled in last week, after it emerged that it 
used race as one factor to risk-rate blood donors for possible 
HIV infection.  It was reported that blood donated by black and 
coloured donors was routinely discarded; although it later 
emerged that the organization destroyed only some of the blood 
products from those donors. The organization used low-risk 
blood products such as plasma, which can be treated to destroy 
HIV and discarded high-risk components such as red cells, from 
which the virus cannot be eradicated.  It said race-based risk 
rating was necessary as there was a higher incidence of HIV 
among blacks than other races in SA.  Although all donated 
blood is screened for HIV, the tests are unable to detect it in 
someone who has been recently infected.  Following a meeting 
with officials from the Health Department on Friday, the 
organization issued a statement saying it had agreed that it 
was unacceptable to use race as a risk-determinant.  It said 
its risk model was flawed because it was too heavily weighted 
for race, and would be "appropriately modified to identify the 
profile of a safe donor without taking race into account".  The 
new risk model would be developed by a committee of experts 
from the SA Blood Service, the Health Department, the Medical 
Research Council, the Council for Scientific and Industrial 
Research, and National Health Laboratory Services.  The 
committee has been given until the end of January to devise the 
new risk-rating system.  Source:  Business Day, December 14. 
 
Genetic Discover Brings AIDS Vaccines Closer 
-------------------------------------------- 
 
¶3.  An international study, involving South African scientists 
published in Nature shows which category of immune cells are 
actually fighting the HIV virus, which may be the first step 
towards finding ways of circumventing the virus's ability to 
avoid vaccines by rapid mutation.  Professor Coovadia and Dr. 
Kiepiela from the University of KwaZulu-Natal worked with the 
Partners Aids Research Center at Massachusetts General Hospital 
on the study.  The researchers found that the human leukocyte 
antigen B molecules (HLA-B), which send an alarm to the T cells 
when a virus or foreign body is present, were important in 
fighting the HIV virus, while the HLA-A and HLA-C were 
ineffective.  Patients who had particular HLA-B molecules coped 
better with HIV infection and had a lower viral load.  Infected 
pregnant mothers with a protective version of HLA-B were more 
likely to survive and less likely to pass the infection to 
their infant at birth.  The three-year research program was 
conducted in communities hardest hit by the HIV epidemic, most 
of which are in Africa.  Source:  The Sunday Independent, 
Sunday Times, December 12. 
 
South African Vaccine Search 
---------------------------- 
 
¶4.  In South Africa, efforts to find a HIV/AIDS vaccine are led 
by the South African AIDS Vaccine Initiative (SAAVI), operating 
with a budget of $15 million per year, focusing on molecular 
biology engineering.  SAAVI was formed in 1999 by the 
government and Eskom (an electricity parastatal) in a public- 
private partnership to coordinate the research, development and 
testing of a HIV/AIDS vaccine in South Africa.  The Departments 
of Health and Science and Technology along with Eskom, Transnet 
(a transportation parastatal) and Impala Platinum have 
contributed its major funding.  SAAVI focuses on the 
development of subtype C HIV/AIDS vaccines, as this subtype 
accounts for more than 90 percent of infections in Southern 
Africa.  Globally, most HIV vaccines that have been tested to 
date have been developed for the subtype B virus.  There is no 
conclusive evidence as yet showing that a vaccine based on one 
subtype of HIV will or will not protect against infection with 
another HIV subtype.  There are two phase-one trials of 
possible HIV/AIDS vaccines started in South Africa last year. 
There are another two products that are in the ethics and 
regulatory approval processes preceding phase one and could 
possible go into trials soon.  Estimates are that there are 
more than two dozen different designs for a preventive AIDS 
vaccine currently on trial internationally.  The two current 
South African trial sites, enrolling only volunteers, are at 
the University of the Witwatersrand HIV/AIDS Vaccine Division 
of the Perinatal HIV Research Unit at the Chris Hani 
Baragwanath Hospital in Johannesburg, and the SAAVI Clinical 
Trial Unit at the Medical Research Council in Durban.  Two 
additional trial locations in Cape Town and Orkney (North West 
Province) will be added to future sites.  Source:  Engineering 
News, December 3-9. 
 
Study Focuses on Human Cost of AIDS 
------------------------------------ 
 
¶5.  "The Demographic Impact of HIV/AIDS in South Africa: 
National Indicators for 2004", compiled by the Medical Research 
Council's Burden of Disease Research Unit, the Center for 
Actuarial Research and the Actuarial Society of South Africa, 
highlights on the human costs of the HIV/AIDS pandemic.  The 
study was based on the latest antenatal clinic results, death 
register information and data on HIV/AIDS interventions.  In 
2004, HIV/AIDS related diseases have killed 311,000 people and 
5 million out of 46 million South Africans were HIV-positive. 
By the end of 2004, 600,000 children under 18 will have lost 
their mothers to AIDS, and by 2015, 2 million children will be 
maternal orphans.  The estimate of 5 million infected people 
was about a third lower than previous estimates, because 
condoms, voluntary testing and ARV treatment are starting to 
impact infections.  The incidence of HIV infections passed its 
peak in all age and gender groups between 1997 and 2001, except 
for males in the 15-24 age group, which is projected to peak 
around 90,000 new infections in 2006.  According to the 2004 
ASSA model, the national average life expectancy is just under 
50 years old.  The model also suggests that in 2005, around 
500,000 people need ARV treatment.  Currently 19,500 HIV- 
positive people are on public sector provided treatment and 
45,000 are on private sector dispensed treatment.  Women from 
the ages of 15-49 account for 2.55 million of all HIV 
infections to date, while HIV prevalence peaks between the ages 
of 25-29 for females and 30-34 for males.  The HIV virus is 
responsible for a declining annual population growth rate, from 
a high of 2.7 percent in 1994-96 to 0.8 percent in 2004; and a 
projected 0.3 percent by 2015.  The most economically active 
segment of the population, aged 35 to 49 will not grow by 2015. 
By 2015, 743,000 South Africans will need ARV treatment. 
Source:  The Star, December 4. 
 
AIDS Infections Peaking in KZN 
------------------------------ 
 
¶6.  The rate of new HIV and Aids infections appears to have 
peaked in KwaZulu-Natal, according to Professor Alan Whiteside, 
the head of the Health, Economics and HIV and Aids Division at 
the University of KwaZulu-Natal.  The latest research showed an 
increase in the number of orphans, and a greater burden on 
provincial health care.  Whiteside's department had been 
conducting a four-year study into the effects of HIV and Aids 
on orphans in the Newcastle area.  He said that while the 
incidence of orphans in the area was growing, research had 
shown that the community was coping with the problem.  He 
commended the quality of the care given to HIV/AIDS patients in 
KZN provincial hospitals.  Whiteside said the South African 
authorities would have to formulate a "new agenda" to deal with 
the effects of HIV/Aids by the time of the next election in 
¶2009.  By then, the government would have a better idea of the 
impact of HIV/Aids.  Source:  The Mercury, December 13. 
 
South African Children Victim of Fire 
------------------------------------- 
 
¶7.  An estimated 1,100 children younger than five are burnt to 
death each year, most dying in their own homes.  A Medical 
Research Council study found fires account for about two 
percent of deaths in children aged one and four.  In the five 
to nine age group, fire accounts for four percent of all 
deaths.  The Fire Protection Association of SA reports that 
more than 10 percent of fire emergency calls involve homes. 
Open flames, electrical faults and cooking are the most common 
causes, says the association.  Burns specialist Dr Ian Thompson 
says most child-burn patients are injured at home due to not 
being supervised. Often, in the case of informal dwellings, a 
sleeping child is burnt when the structure catches fire. 
Sepsis, or the infection of burn wounds, causes up to 85 
percent of deaths.  Serious burn injuries not only result in 
physical trauma but in severe psychological trauma.  Source: 
Cape Argus, December 11. 
 
Court Rules Against Pharmaceutical Pricing Regulations 
--------------------------------------------- --------- 
 
¶8.  The Supreme Court of Appeal ruled against the Department of 
Health's pharmaceutical pricing regulations by stating that the 
dispensing fees proposed by the regulations were not 
appropriate because they did not consider the viability of the 
dispensing industry and that the regulations relating to the 
single exit price introduced a price control mechanism, which 
the Act had not intended.  The Department of Health raised 
jurisdictional issues since the Cape High Court denied the 
industry a chance of appeal.  The Court of Appeal dismissed 
these issues of jurisdiction by ruling that the Cape High 
Court's delay in granting leave to appeal was so unreasonable 
as to breach the constitutional right to a fair hearing.  The 
regulations provided for a pricing system that defined a single 
exit price of manufacturers and a dispensing fee, which, for 
pharmacists, amounted to R16 without a medical prescription and 
R26 with a prescription.  The court did not challenge 
government's right to administer prices but stated that the 
lack of any document describing how dispensing fees were 
calculated meant that the government did not consider the long- 
term viability of the retail drug sector. The Health Department 
was ordered to pay the court costs.  Source:  Independent 
Foreign Service, December 20. 
 
¶9.  Comment.  The Health Department has signaled that it would 
file an appeal against this court judgment in the 
Constitutional Court (equivalent to the U.S. Supreme Court), 
stating that international experts regarded the pricing 
regulations as reasonable and beneficial to consumers. 
According to the department, the single exit price set by drug 
manufacturers since June 2004 reduced the price of medicines by 
19 percent.  Drug retailers have long argued that the 
dispensing fee set by the government was so low that many 
retailers would be forced to close.  Until the Constitutional 
Court rules, the existing price regulations have been rescinded 
and pharmacists are again entitled to charge varied dispensing 
fees, while manufacturers can charge different prices to 
different buyers. End comment. 
 
FRAZER