VZCZCXRO4749
RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #4971/01 3570731
ZNR UUUUU ZZH
R 230731Z DEC 05
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 0612
INFO RUCNSAD/SOUTHERN AFRICAN DEVELOPMENT COMMUNITY
RUCPDC/DEPT OF COMMERCE WASHDC
RUEATRS/DEPT OF TREASURY WASHDC
RUEAUSA/DEPT OF HHS WASHDC
RUEHPH/CDC ATLANTA GA 0944

UNCLAS SECTION 01 OF 05 PRETORIA 004971 
 
SIPDIS 
 
DEPT PASS AID WASH DC 
 
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 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, NIH/HFRANCIS 
CDC FOR SBLOUNT AND DBIRX 
 
E.O.  12958: N/A 
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH DECEMBER 23 ISSUE 
 
Summary 
------- 
 
¶1.  Summary.  Every two weeks, Embassy 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:  African Women More Vulnerable to HIV/AIDS; 
HIV Treatment Reduces Risk of TB in South Africa More than 
Previously Thought; Mozambique and SA to Sign Health Agreement; 
Eastern Cape Struggling with AIDS; SA Still Losing Health Care 
Professionals; Awareness of South African HIV/AIDS Media 
Strategy; Global Fund Withdraws Support for loveLife; HAART 
Found Cost Effective in South Africa; and Cape Town Conference 
Highlights Links between Poverty and HIV/AIDS.  End Summary. 
 
African Women More Vulnerable to HIV/AIDS 
----------------------------------------- 
 
¶2.  Not only are women biologically more prone to HIV/AIDS 
infection than men, but for a variety of social, cultural and 
economic reasons they also have a harder time coping with the 
illness once infected, particularly in Africa, according to 
Helen Jackson, HIV/AIDS Advisor for Southern Africa with the UN 
Population Fund.  The physiological data seem to indicate it is 
twice as easy for women to become infected as for men.  African 
women are particularly hard hit.  Of women affected worldwide, 
77% are Africans, according to Michel Sidibe, deputy director 
of UNAIDS.  In southern Africa, young women aged between 15 and 
24 are at least three times more likely to be HIV-positive than 
men of the same age.  Infection often occurs between older men 
and young women.  There is a greater chance of the women's 
partners being HIV-positive and the immature vaginal tract is 
more easily infected.  An UNAIDS study pointed out that among 
women surveyed in Harare (Zimbabwe), Durban and Soweto (South 
Africa), 66% reported having one lifetime partner, 79% had 
abstained from sex at least until the age of 17; yet 40% of the 
young women were HIV-positive.  Source:  Sapa-AFP, IOL, 
December 8. 
 
HIV Treatment Reduces Risk of TB in South Africa More than 
Previously Thought 
--------------------------------------------- ------------- 
 
¶3.  Antiretroviral therapy appears to reduce the risk of 
developing tuberculosis (TB) to a greater extent than was 
previously thought, according to a South African study 
published in a recent edition of AIDS.  Investigators found 
that the incidence of new cases of tuberculosis fell to just 
one case per 100 patient years after five years of 
antiretroviral therapy. 
 
¶4.  Doctors in Cape Town studied the incidence of new cases of 
tuberculosis in individuals during their first five years of 
antiretroviral therapy.  A total of 346 individuals who 
received HIV therapy between 1996 and 2005 were included in the 
analysis.  The majority (55%) were men, the median age was 33 
years, and just over half were assessed as having a low 
socioeconomic status.  Before HIV therapy was initiated, the 
median CD4 cell count was 242 cells/mm3 and median viral load 
was 80,000 copies/ml.  A total of 51% of individuals had 
symptoms of HIV/AIDS and 14% had a previous history of 
tuberculosis.  During a total of 1108 person years of follow- 
up, 27 new diagnoses of tuberculosis were made.  All but five 
cases affected the lungs (extra-pulmonary tuberculosis is 
normally much more common in HIV-positive individuals) and 
three people with tuberculosis died. 
 
¶5.  The overall incidence of tuberculosis was 2.44 cases per 
100 person years of follow-up. However, there was a significant 
decline in incidence from 3.35 cases per 100 person years in 
the first year to just 1.01 case per 100 person years in year 
five.  Development of tuberculosis was found to be 
significantly associated with the following baseline 
characteristics:  age under 33 years; a CD4 cell count below 
100 cells/mm3; and symptomatic HIV/AIDS.  Source:  AIDS 19: 
2109 - 2116, 2005AIDSMAP, December 8 
 
 
PRETORIA 00004971  002 OF 005 
 
 
Mozambique and SA to Sign Health Agreement 
------------------------------------------ 
 
¶6.  Senior health officers from South Africa and Mozambique 
will sign an agreement formalizing the treatment of Mozambicans 
in health facilities along South Africa's borders.  The 
initiative was part of the Health Department's efforts to 
address Mozambicans' use of South African resources in those 
rural and underdeveloped areas.  The agreement would take into 
account the daily movement of people across the countries' 
borders and the hospitals affected would be identified.  So 
far, the Tonga District Hospital has been earmarked for 
referrals from Mozambique.  Health professionals would record 
the number of Mozambicans being treated and a patient referral 
system between the two countries would be established. 
Mozambique would then be billed when their citizens were 
treated in South African facilities.  Source:  Sapa and Mail 
and Guardian, December 7. 
 
Eastern Cape Struggling With AIDS 
--------------------------------- 
 
¶7.  The Public Service Accountability Monitor (PSAM) reported 
to the Joint Civil Society Monitoring Forum (made up of 
organizations including the Aids Law Project, the Health 
Systems Trust and the Institute for Democracy in South Africa, 
meeting regularly to assess the progress of Government's 
treatment plan) that during the 2004/5 financial year the 
Eastern Cape Health Department under spent its overall budget 
by R50.8 million ($8 million, using 6.3 rands per dollar).  The 
department also recorded under spending across all eight 
programs, including the HIV/AIDS program which failed to spend 
12.7% or R16.8 million ($2.6 million) of its overall budget. 
Over the past four years, the Eastern Cape Health Department 
has failed to spend R172 million ($27 million) on HIV/AIDS 
programs.  However, there are signs of progress.  There are now 
26 accredited antiretroviral sites, with 20 providing treatment 
at the end of September.  They were treating almost 10,000 
patients, including almost 1,000 children.  The patient target 
by March 2006 is 15,000 patients.  According to a report by the 
International Treatment Preparedness Coalition, called "Missing 
the Target - A Report on HIV/AIDS Treatment Access from the 
Frontlines", lack of effective national political leadership as 
well as denialism and pseudoscience were barriers to AIDS 
treatment in South Africa.  Specific recommendations for South 
Africa include launching an international campaign to hold 
government accountable and expanding human resources.  Latest 
figures show that at least six million South Africans are 
currently living with HIV/AIDS, while 600,000 need 
antiretroviral treatment.  According to South African 
government figures, 86,000 people are currently accessing 
treatment in the public health system.  Source:  Health-e News 
Service, December 13. 
 
SA Still Losing Health Care Professionals 
----------------------------------------- 
 
¶8.  Despite an agreement to stop active recruitment for the 
national public service in the United Kingdom, South Africa is 
still losing healthcare professionals as the agreement does not 
include the private sector whose recruitment agencies continue 
to recruit South African staff.  The recruitment process 
involves large-scale distribution of circulars and printed 
advertisements of foreign posts in monthly journals such as one 
from the Democratic Nurses Organization of South Africa, which 
relies on revenue from those ads to fund the publication of 
their magazine.  Although the national public service of the 
United Kingdom, which takes in the largest number of health 
care professionals from South Africa out of all receiving 
countries, can no longer actively recruit in South African, the 
United States, Canada, Australia and New Zealand are locations 
where an increasing number of South African health care workers 
are going.  Source:  The Pretoria News, December 12. 
 
Awareness of South African HIV/AIDS Media Strategy 
--------------------------------------------- ----- 
 
¶9.  Part of the 2005 South African National HIV Prevalence, HIV 
Incidence, and Behavior Communication Survey focuses on the 
 
PRETORIA 00004971  003 OF 005 
 
 
awareness of HIV/AIDS national media campaigns in South Africa. 
These campaigns use a variety of media, such as television, 
radio, outdoor media, or some combination of all.  Certain 
campaigns focus only on particular age groups.  Seven media 
campaigns were highlighted in the 2005 Survey:  Soul City, Soul 
Buddyz and Takalani Sesame (both aimed at children), Khomanani, 
loveLife, Gazlam and Tsha Tsha.  Khomanani, loveLife and Soul 
City use broadcast, print and outdoor media, while Gazlam and 
Tsha Tsha use television and Takalani Sesame use television and 
 
SIPDIS 
radio.  The campaigns receiving the most funding are Khomanani 
and loveLife. 
 
¶10.  The Khomanani: Caring Together for Life campaign is the 
government's main communication initiative on HIV/AIDS. 
(Khomanani is a Tsonga word meaning caring together.)  The 
South African government spent approximately R165million ($26 
million) for the 2004-to-2006 period on the campaign.  Yet, the 
2005 South African National HIV Prevalence, HIV Incidence, 
Behavior and Communication Survey showed that of all the AIDS 
information campaigns underway, Khomanani reached the fewest 
people.  Only 33.8% of teenagers aged between 12 and 14, and 
46.7% of young people between 15 and 24, were aware of the 
campaign.  For those aged 25 to 49, the figure was 41.7%. 
According to Nathan Geffen, spokesperson for the Treatment 
Action Campaign, Khomanani's message is acceptable, but there 
isn't enough of it.  Even more importantly, high-level 
officials need to become more vocal about safe sex and 
ascertaining HIV status. 
 
¶11.  loveLife, South Africa's best-funded campaign, receives 
R200 million ($32 million), although less than R26-million ($4 
million) comes from the South African government.  The Global 
Fund, one of loveLife's major supporters recently announced 
withdrawal in their support (see next article).  loveLife 
produces weekly radio programs and works to ensure that anti- 
AIDS messages are communicated in all 11 official languages. 
About 72% of young people aged 15 to 24 are aware of loveLife, 
according to the South African National HIV Prevalence, HIV 
Incidence, Behavior and Communication Survey.  However, critics 
point to loveLife's unclear messages and lack of accountability 
in demonstrating its campaign's effectiveness. 
 
¶12.  Previous research indicated that the media had virtually 
no effect on behavior and that more emphasis should be placed 
on face-to-face programs, such as those in clinics and youth 
centers.  However, the South African National HIV Prevalence, 
HIV Incidence, Behavior and Communication Survey found that of 
those who were being reached by the campaigns, a large 
proportion saw the information as useful.  The survey also 
noted that work still needs to be done in reaching rural areas 
and informal settlements.  As newspapers and television sets 
are luxuries in many South African homes, radio remains an 
important means for communicating with such audiences.    The 
government also funds a number of other campaigns, such as Soul 
City, which uses television and radio dramas to warn people 
about HIV.  The South African National HIV Prevalence, HIV 
Incidence, Behavior and Communication Survey noted that 
awareness of Soul City, the longest-running campaign operating 
since 1992, was the highest across all age groups.  Note:  Soul 
City receives PEPFAR funding.  Source:  Mail and Guardian, 
December 19; South African National HIV Survey, 
hsrcpress.ac.za. 
 
Global Fund Withdraws Support for loveLife 
------------------------------------------ 
 
¶13.  The Global Fund to fight HIV/AIDS, Tuberculosis and 
Malaria has refused to fund any additional activities of 
loveLife, a South African youth-targeted HIV/AIDS campaign. 
The Global Fund board stated that loveLife "was deemed to not 
have sufficiently addressed weaknesses in its implementation". 
Global Fund spokesman Jon Liden said it had become difficult to 
measure how the prevention campaign was contributing to the 
reduction of HIV/AIDS among young people.  Global Fund had 
repeatedly requested loveLife to revise its proposals and 
address concerns regarding performance, financial and 
accounting procedures, and the need for an effective governance 
structure.  In 2003, loveLife received about US $12 million 
from the Fund, a third of its operating budget.  Citing other 
 
PRETORIA 00004971  004 OF 005 
 
 
less expensive programs that show effective results, Liden 
stated that the Global Fund needs to see evidence of loveLife's 
effectiveness before spending more money.  However, loveLife's 
Deputy CEO, Grace Matlhape, stressed that loveLife is working, 
citing a 2004 study conducted by the University of 
Witwatersrand's Reproductive Health Research Unit study of more 
than 11,000 young people aged between 15 and 24.  Those who had 
participated in a number of loveLife programs were less likely 
to be HIV-positive, and were also more likely to report using 
condoms and be tested for HIV.  However, the study did not show 
whether the project had caused these differences.  Source:  UN 
Integrated Regional Information Networks, December 19. 
 
HAART Found Cost Effective in South Africa 
------------------------------------------ 
 
¶14.  A recent study investigating the cost effectiveness of the 
highly active antiretroviral therapy (HAART) in South Africa 
found that the cost savings of treating patients with AIDS 
using HAART ranged between $209 and $2,116 per patient. 
Patients on HAART required fewer hospital admissions and 
depending on how long the patient survived and the price of 
antiretrovirals, it costs less to treat the HAART patients with 
AIDS. 
 
¶15.  During the study period (January 1995 to the end of 
December 2000), HAART was not available in the publicly funded 
South African health care system.  The study took place in HIV 
clinics affiliated with the University of Cape Town. 
Researchers compared the cost of services for 292 patients who 
were given HAART with the costs for a comparison group (with 
the same number of patients) who were not given any 
antiretroviral drugs.  There were 27 patients in each group 
that had AIDS; the others were HIV-infected but did not have 
AIDS.  Researchers calculated costs per patient year and per 
life-year gained (the total cost divided by the number of extra 
years the treated patients lived). 
 
¶16.  HAART proved to be a more cost-effective way for South 
African hospitals to treat HIV infection than simply to wait 
for patients to come and be treated for HIV symptoms.  Indirect 
costs were not addressed in this study.  Source:  Plos 
Medicine, January 2006, Volume 3, Issue 1. 
 
Cape Town Conference Highlights Links Between Poverty and 
HIV/AIDS 
--------------------------------------------- ------------ 
 
¶17.  In December 2005, a Cape Town conference sponsored by the 
International Union for the Scientific Study of Population 
(IUSSP) presented demographic studies that highlighted the 
interactions between poverty and HIV/AIDS in Southern African 
nations of Malawi, Zambia, and South Africa.  Little direct 
evidence was shown of the link between poverty and HIV/AIDS, 
although much discussion centered around the problems and 
interpretations of using panel data for empirical 
investigations.  Most of the studies used Demographic Health 
Surveys, household-based national surveys having little 
detailed information concerning income.  The studies had to 
impute assets using either type of flooring or house or other 
type of asset information having little direct income 
information, making the analysis of the interaction of poverty 
and HIV/AIDS subject to possible measurement and 
misspecification errors. 
 
¶18.  The South African studies used provincial surveys, making 
generalized national observations difficult.  The South African 
studies examined the socio-economic impacts of HIV/AIDS on 
household in the Free State; impacts of parental death on 
school enrollment in KZN; and orphans and HIV Risk Behaviors 
among adolescents in KZN.  The Free State study grouped HIV 
affected and non-affected by liquid and illiquid assets and 
found the assets to be similar among groups, although since 40% 
of people had no income in both groups, one could argue that 
poverty impacted the results.  The study of orphans in KZN 
found that that there was no link between socio economic status 
(SES) if the mother died, and a negative association if the 
father died; however children without mothers are behind in 
school relative to other children.  Source:  iussp.org, 
 
PRETORIA 00004971  005 OF 005 
 
 
December 12-14. 
 
TEITELBAUM