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UNCLAS SECTION 01 OF 04 PRETORIA 003811 
 
SIPDIS 
 
DEPT FOR AF/S; AF/EPS; AF/EPS/SDRIANO 
DEPT ALSO FOR S/OFFICE OF GLOBAL AIDS COORDINATOR 
DEPT PLEASE PASS TO USAID FOR GLOBAL BUREAU KHILL 
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 DBIRX 
 
E.O. 12958:  N/A 
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH SEPTEMBER 9 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:  Drug-Resistant TB Threat to SA; Most of SA 
Accepts Euthanasia; Public Hospital Fees to Decline; Inquiry 
Launched to Determine if Ineffective AIDS Cure Still Sold; Rath 
Foundation Conducts Illegal Experiments; Release of Two Studies 
Delayed; Decline in 2005 SA Human Development Rating; and AIDS 
Infections still Increasing in Corporate Sector.  End Summary. 
 
Drug-Resistant TB Threat to SA 
------------------------------ 
 
¶2.  Research shows that the threat of drug-resistant TB is 
greater than previously thought.  The Center of Excellence for 
Biomedical Tuberculosis Research at Stellenbosch University 
released a study showing that TB strains causing drug-resistant 
disease may be even more resistant to drugs than previously 
believed.  People with drug-resistant strains of TB are freely 
passing on the dangerous bacteria, because diagnosis is too 
slow.  More than half of patients with drug-resistant TB tested 
in two of the Western Cape Province's four health districts 
were resistant to Pyrazinamide (PZA), one of the four drugs 
included in the main single-dose treatment of TB in the 
country.  The researchers said urgent efforts were needed to 
diagnose TB quickly.  If first-line treatment failed, the risk 
of multi drug-resistant TB grew in patients already infected 
with drug-resistant strains.  The university's Dr Tommie 
Victor, professor of medical biochemistry, said some patients 
in South Africa were already showing resistance to as many as 
five of the six frontline anti-TB drugs. 
 
¶3.  The second part of the threat is fear of the creation of 
new strains of TB, which become increasingly resistant and 
continue to spread among people.  New research by Dr. Rob 
Warren, also a professor of medical biochemistry at 
Stellenbosch, shows that two different strains of TB could be 
found in a single patient's lungs, implying infection more than 
once.  His latest research has challenged another common 
belief, that multidrug-resistant TB in a patient already being 
treated must be the result of the person not taking the 
prescribed drugs.  Instead, Warren found, some patients had 
both drug-sensitive and the drug-resistant strains of TB at the 
same time.  As the patient starts treatment with antibiotics, 
the therapy kills the drug-sensitive strain, allowing the 
resistant strain to emerge as the dominant strain.  Poor 
diagnosis means the multidrug-resistant strain is likely to be 
diagnosed only when the original treatment fails - and in the 
meantime whole communities are put at risk.  It usually takes 
six to eight weeks to identify whether a TB strain is 
resistant.  Drug-resistant TB is also expensive to treat - as 
much as R20,000 per year ($3,200 using 6.3 rands per dollar) a 
patient, compared to about R200 per year ($32) a patient for 
drug-susceptible TB.  In South Africa, 1,000 people die from TB 
every day.  Source:  Cape Times, August 29. 
 
Most of SA Accept Euthanasia 
---------------------------- 
 
¶4.  Seventy percent of adults agree that family members should 
be allowed to switch off the life support system of a brain- 
dead person, according to a Research Surveys telephone survey 
of 493.  However half opposed active euthanasia.  Religion 
played a significant role in responses.  Seventy percent of 
Christians, 89 percent of Muslims, and 65 percent of Ancestral 
believers, thought that families should turn off life support 
systems if the individual was brain-dead.  Gender had no impact 
on the responses. 
 
¶5.  On the issue of the right to die when terminally ill, 
people were sharply divided.  Half of those questioned agreed 
people should never be allowed to take their own life, even if 
they were terminally ill and in considerable pain.  Forty-four 
percent of respondents disagreed with the statement. 
Differences between the race groups are very strong; however, 
differences between different religions are not evident. 
 
¶6.  Another statement asked of respondents was that a 
terminally ill person had the right to die with medical 
assistance from doctors.  Forty-six percent of the respondents 
agreed with this, while 51 percent disagreed.  Differences in 
response between religions are not evident nor are there any 
age or gender differences.  Source:  SAPA, IOL, August 30. 
 
Public Hospital Fees to Decline 
------------------------------- 
 
¶7.  The Department of Health announced that patient fees at 
public hospital rates will decrease by up to 70% once a new fee 
structure has been approved by provincial hospitals.  Revised 
rates have been sent to all provincial health departments and 
will be implemented immediately after endorsement by provinces. 
The Department of Health wants the current uniform patient fees 
system (UPFS) to support its efforts to increase access to 
quality health care, saying that unless a more sustainable 
means of health care financing is introduced, the challenges of 
affordable health care will not be eliminated.  The main 
challenge is that users of public facilities come from poor 
communities and are not covered by any form of health insurance 
or medical aid.  The most affected are people with some income, 
who do not qualify for free health services.  These users are 
charged at various rates depending on their income, and they 
usually pay these debts out of pocket from a very limited 
disposable monthly income.  Public hospitals are not allowed to 
refuse patients who cannot settle their hospital bills.  The 
UPFS was first introduced in 1993 and has not been revised 
since.  Hospitals were instructed that patients should be 
charged a full consultation fee for every single hospital visit 
-- even if they had to be treated several times a week over the 
course of several years.  Source:  SAPA, Mail&Guardian, August 
¶31. 
 
Inquiry Launched to Determine if Ineffective AIDS Cure Still 
Sold 
--------------------------------------------- --------------- 
 
¶8.  The Medicine Control Council (MCC) has been ordered by the 
Department of Health to see if the industrial solvent, 
Virodene, is being openly sold on the internet as a cure for 
AIDS.  The MCC would establish whether any of the South African 
medicine regulatory requirements had been broken and recommend 
appropriate action.  The Democratic Alliance charged that 
Virodene Pharmaceutical Holdings' website was claiming the drug 
was "safe and efficacious" in treating HIV/AIDS, and approved 
by the MCC in July 1996.  Initially thought as a major 
breakthrough in the search for a cure for HIV/AIDS, Virodene 
was denied clinical trials by the MCC after a 22-month inquiry. 
It was reported on the internet that two South African 
employees of Virodene Pharmaceutical (Pty) Limited of SA were 
ordered to leave Tanzania in September 2001 over their alleged 
implication in clinical trials of Virodene PO 58.  They were 
arrested in 2000 for allegedly importing Virodene PO58 and four 
other drugs, PO 59, PO 60, PO 61 and PO 62, without official 
approval, raising fears that Tanzanians were being used as 
guinea pigs.  Source:  SAPA, September 7. 
 
Rath Foundation Conducts Illegal Experiments 
-------------------------------------------- 
 
¶9.  The Dr Rath Health Foundation, led by German national Dr 
Matthias Rath, claims that its vitamin products can reverse the 
course of AIDS and says on its website that it is conducting a 
"clinical trial" in the township.  However, the Foundation does 
not have the approval of the Medicines Control Council (MCC) to 
conduct a trial, has not registered its products with the MCC 
and makes unsubstantiated claims about their healing powers -- 
all in violation of the Medicines and Related Substances 
Control Act.  The MCC has been investigating the Rath 
Foundation since April 2005.  SA National Civic Organization 
(SANCO) members have been acting as agents for the Rath 
Foundation, and have set up "clinics" throughout the township. 
SANCO street committee members target people in their areas 
known to have HIV or to be sick, and encourage them to attend 
one of the "clinics" where they are prescribed up to 20 vitamin 
tablets a day. 
 
The Rath Foundation and SANCO have also been holding public 
meetings in Khayelitsha where a group of patients testify to 
the healing properties of the vitamins.  SANCO says it is 
"honored" to work with Rath, but the Congress of SA Trade 
Unions (COSATU), South African Communist Party (SACP) and local 
health workers have condemned the Foundation for conducting 
human experiments.  The Foundation's products, Vitacor Plus, 
Epican Forte, Lysin C Drink Mix and Vita Cell, contain 
vitamins, minerals and lesser known ingredients such as Green 
Tea Leaf extract and Bioflavonoids.  Patients at the "clinics" 
are being told to take doses that far exceed the recommended 
daily allowance for vitamins.  In interviews on Cape Town radio 
stations P4 and 786, Rath admits to running a clinical pilot 
study and doing blood tests.  The Dr Rath Foundation website 
states that: "In Khayelitsha, a township of Cape Town, South 
Africa, we conducted a clinical pilot study in HIV positive 
patients with advanced AIDS who had never taken any ARV drugs. 
The goal of the study was to show that a combination of 
micronutrients can reverse the course of AIDS.  Rath Foundation 
spokesperson Khaya Buthelezi declined to comment on any of the 
allegations and said "just go ahead without our response". 
Source:  Health e Newsletter, September 6; Sunday Times, 
September 4. 
 
Release of Two Studies Delayed 
------------------------------ 
 
¶10.  Release of two research reports commissioned by provincial 
governments about HIV/AIDS in the Eastern Cape and rape 
management in the Western Cape has been delayed.  The Eastern 
Cape Health Department wants a full investigation of the 
statistics, while the National Prosecuting Authority states 
that the rape management report was never intended for public 
use and that it will be released to public prosecutors once the 
results have been presented to the Danish government, who 
funded the study along with UNICEF. 
 
¶11.  Some of the statistics that needed confirmation in the 
HIV/AIDS study include:  (1) One in ten people in the Eastern 
Cape is HIV-positive, (2) 96,000 people currently need ARV 
treatment, yet the Eastern Cape's Health Department 2005/6 goal 
is to register 15,169 people for treatment by the end of the 
current financial year, (3) The number of people on ARV 
treatment will have to increase by 20 times in order to serve 
the people who need treatment by 2006, (4) The Eastern Cape 
Health Department failed to account for the use of 73% of its 
HIV/ADIS budget between 2000 and 2003, while 27% went unspent, 
(5) 7 million Eastern Cape residents will die of AIDS by 2015 
if there is no effective intervention, and (6) 120,000 orphans 
are currently eligible for foster care, rising to 328,000 by 
¶2010.  Rhodes University's Center for AIDS Research and 
Evaluation performed the study. 
 
¶12.  The Western Cape rape management study, Reflections on 
Integrated Rape Case Management, was conducted between January 
2001 and May 2003 by the Gender Health and Justice Research 
Unit at the University of Cape Town.  The report shows very 
poor handling of rape cases by both the police and public 
prosecutors.  Among its findings include:  (1) 61% of rape 
cases in Manenberg (a Cape Town township) were dismissed on the 
basis of there being no prima facie case; (2) 13% of rape cases 
in Khayelitsha and 33% in Guguletu (both Cape Town townships) 
were unsolved; the Khayelitsha figure rose from 23% to 44% 
between January and April 2003; (3) 30% of rape cases in 
Khayelitsha were withdrawn at the request of the complainant; 
and (4) a 2002 report found that 40% of all reported rapes in 
the country were child rapes and only 8.9% of these resulted in 
convictions.  The data was collected from the Thuthuzela Care 
Center, which uses a centralized multi-disciplinary team of 
police investigators, social workers, and prosecutors and 
receives rape cases from Khayelitsha, Manenberg and Guguletu 
police stations.  Source:  Mail&Guardian, September 2. 
 
Decline in 2005 SA Human Development Rating 
------------------------------------------- 
 
¶13.  South Africa's United Nations Human Development Index 
(HDI) reached 120 out of 177 countries, slightly lower than 
2004's HDI of 119, largely due to a fall in life expectancy 
because of HIV/AIDS and high levels of inequality.  The HDI 
index tracks indicators including life expectancy, equality of 
income and education, based on 2003 data.  South Africa was 
rated higher than India and most African countries, and lower 
than the occupied Palestinian territory, Mongolia and 
Indonesia.  Positive trends include increasing real income and 
advances in gender rights.  However, South Africa has an 
average HIV/AIDS prevalence rate of 21% for people aged 15-49. 
Largely due to HIV/AIDS, life expectancy dropped from 53 years 
in the period 1995-2000 to 49 years in the past five years. 
South Africa's income inequality was also problematic.  The 
richest 10% of the population took 44% of the income, while the 
poorest 10% got 1.4%.  South Africa was assigned an inequality 
rating worse than Zimbabwe or Niger, even though South African 
per capita income was much higher.  On a Human Poverty Index of 
developing countries, South Africa ranked in the middle, at 56 
out of 103 countries.  South Africa's GDP per capita of $3,489 
was higher than many of the countries of similar rank, growing 
faster than Russia and the United Arab Emirates.  Source: 
SAPA, Business Day, September 8. 
 
AIDS Infections Still Increasing in Corporate Sector 
--------------------------------------------- ------- 
¶14.  The HIV/AIDS prevalence rate in the corporate sector has 
risen to 19.4% compared to 15% in 2003, suggesting prevalence 
of the disease has not yet peaked, according to a survey by Old 
Mutual.  Old Mutual's health-care survey, whose sample 
contained 100 companies, provides the most up-to-date snapshot 
of HIV infections among workers, and is one of the only studies 
on prevalence in the corporate sector.  The study showed most 
companies were not even aware of the level of infection in 
their organizations.  Only 25 of the 100 companies had done 
prevalence testing.  Even though companies' anonymity was 
guaranteed, only 12 of the 25 that had tested agreed to release 
their prevalence figures.  Extrapolating prevalence figures 
from this limited sample could be distorted since companies 
that did prevalence testing were likely to be those most 
worried about AIDS, such as those in high-risk sectors like 
mining or transport.  Several factors, including objections 
from trade unions fearing persecution of their members, mean 
many companies still did not do prevalence testing.  According 
to Statistics SA, 16.7% of all people in SA aged 15-49 are 
infected, while the United Nations puts it closer to 21%.  Old 
Mutual's figures for the corporate sector, despite their 
limitations, suggest the UN figures are more accurate.  Source: 
Business Day, September 9. 
 
TEITELBAUM