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RR RUEHDU RUEHJO RUEHMR
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ZNR UUUUU ZZH
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FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 0907
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 0961

UNCLAS SECTION 01 OF 03 PRETORIA 000142 
 
SIPDIS 
 
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 JANUARY 13 2006 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:  Children's Bill Approved by NCOP; 
Resignations of South African AIDS Experts; South African Study 
Reports High Mortality Rate Waiting for Treatment Upon 
Enrollment; New Study Highlights Social Costs of AIDS on South 
Africa; Malaria Cases Reported in Limpopo Province; and Initial 
Human Trials May Start to Test AIDS Herbal Treatment.  End 
Summary. 
 
Children's Bill Approved by NCOP 
-------------------------------- 
 
¶2.  The National Council of Provinces (NCOP) has approved the 
first section of the Children's Bill that will outlaw virginity 
testing and male circumcision under the age of 16, both 
controversial issues provoking much cultural debate within 
South Africa.  The Bill allows virginity testing for girls over 
the age of 16, if they have proper counseling, that the results 
are not publicized and that the girl's body is not marked. 
Male circumcision was also forbidden unless the boy is 16 years 
or older and receives counseling, or is for religious or 
medical purposes.  Once the bill becomes law, anyone who 
performs a virginity test or a circumcision on a child under 
the age of 16 could face legal action.  Earlier in 2005, when 
the Children's Bill was passed by the National Assembly, 
virginity testing was banned, while male circumcision was not. 
The National Assembly's decision to ban virginity testing 
raised concern from the National House of Traditional Leaders, 
which deemed it a violation of cultural rights.  The NCOP 
amended the National Assembly's decisions to allow some testing 
and circumcision. 
 
¶3.  Under the new bill, a child can consent to medical 
treatment, including HIV testing and the purchase of 
contraceptives, at 12 years of age.  Previously, under the 
Child Care Act, the minimum age had been 14. 
 
¶4.  There are contradictions in the new bill.  Having sex with 
a child aged 15 or younger is considered statutory rape, but 
the new law assumes a 12-year-old is mature enough to purchase 
condoms.  Another concern is that, at 14 years old, children 
can now consent to surgical procedures, including abortion. 
However under the new bill, a girl can consent to giving up her 
baby for adoption only at 18, whereas previously, a 16-year-old 
could make that decision.  The Children's Bill updates the 
Child Care Act of 1983 and amends a section of the Bill of 
Rights that refers to children.  It is divided into two 
sections: section 75 and section 76. Section 75 focuses on 
provisions for children while section 76 will concentrate on 
Child Welfare services.  Section 76 will be presented before 
parliament in 2006.  New features of the Children's Bill 
include:  (1) establishment of a National Child Protection 
Register, which will allow all employers to check whether their 
employees are suitable to work with children; (2) barring 
anyone who has been found guilty of an offence against children 
to work in an environment that involves children; (3) 
establishment of a Register of Adoptable Children and 
Prospective Adoptive Parents, aiding social workers in matching 
children and adoptive parents; and (4) allowing children to 
remain with their siblings under the care of an adult 
designated by the court.  Source:  The Star, December 24 2005. 
 
Resignations of South African AIDS Experts 
------------------------------------------ 
 
¶5.  Fareed Abdullah has resigned from his position as deputy 
director-general of health of the Western Cape AIDS department, 
and will begin a three-year job at the International HIV and 
AIDS Alliance, based in Brighton, England.  Abdullah has been 
responsible for the province's HIV and AIDS program for 11 
years during which he played a crucial role in expanding access 
to anti-retroviral therapy (ART) and prevention of mother-to- 
child HIV transmission program, which has seen a reduction of 
the transmission rate from mothers on ART from 30% to 5%.  As 
 
PRETORIA 00000142  002 OF 003 
 
 
head of the International HIV and Aids Alliance's technical 
division, Abdullah will be in charge of program design and 
evaluation in 20 developing countries most of which are in 
Africa.  Earlier in December, Dr. Chris Jack, head of the 
HIV/AIDS program in KwaZulu-Natal resigned to work as a 
consultant in Durban.  KZN officials recently announced that Dr 
Busi Nyembezi would be the new head of the province's Health 
Department, following the retirement of Professor Ronald Green- 
Thomson as the Superintendent-General.  Source:  The Cape 
Times, January 9; Sunday Times January 8 2006. 
 
South African Study Reports High Mortality Rate Waiting for 
Treatment Upon Enrollment 
--------------------------------------------- -------------- 
 
¶6.  A prospective operational study of a community-based 
antiretroviral treatment (ART) program in Cape Town, South 
Africa has reported a very high rate of mortality among 
patients waiting to go on treatment after enrolling.  According 
to the study, published in AIDS in December 2005, nearly half 
of the observed deaths occurred in patients who had recently 
enrolled in the ART program but who were not yet on treatment. 
The vast majority of deaths occurred in patients with CD4 cell 
counts below 50 and advanced symptomatic disease (WHO stage 3 
and 4).  A number of studies have previously reported on the 
survival benefit observed after the ART rollout in resource- 
limited settings, but this is the first to report on the 
mortality rates among patients during the time between 
enrollment into the program and the actual start of treatment. 
 
¶7.  The trial, conducted at the Gugulethu Community Health 
Centre on the outskirts of Cape Town between September 2002 and 
February 2005, involved 712 patients referred to clinic for 
ART.  After referral to the ART service, patients had to make 
at least three visits to the clinic before they could actually 
receive treatment.  Of the 712 patients included in the 
analysis, the median CD4 count was 94 cells and the median 
plasma viral load was 72 349 copies/ml.  The vast majority of 
patients had advanced disease, WHO clinical stage 3 for 354 
(50%) and stage 4 for 215 (30%). 
 
¶8.  A total of 578 patients (81%) started ART, a median of 29 
days after enrollment (96% within 90 days).  The most frequent 
reasons that the remaining 134 patients (19%) did not go on ART 
were 1) death, 2) decision to access treatment elsewhere, 3) 
failure to attend follow-up clinic appointments, 4) moving out 
of the area and 5) psychosocial reasons, such as denial of HIV 
infection status.  The median period of observation for the 
patients who didn't go on ART was 28 days.  Sixty-eight (9.5%) 
of the patients who enrolled into the program died during the 
course of the study.  The high mortality rate of 35.6 
deaths/100 person years before treatment fell to 2.5/100 person- 
years at one year among those on ART.  Within the first three 
months of enrollment, 29 of 44 (66%) deaths occurred among 
patients not yet on ART. 
 
¶9.  The authors suggest that reducing pre-treatment intervals 
may well decrease mortality.  However, a balance needs to be 
established between minimizing the pre-treatment interval 
(potentially reducing early mortality risk) and allowing 
adequate time to prepare patients for treatment (promoting high 
rates of treatment adherence and reducing long-term mortality 
rates).  They also suggest that a fast-track system could be 
developed to speed treatment of patients at the highest risk of 
death (those with stage 4 disease, a CD4 count < 50 cells/ml or 
an AIDS-defining illness).  Source:  AIDSMAP December 23, 2005, 
AIDS. 19(18): 2141-2148, 2005. 
 
New Study Highlights Social Costs of AIDS on South Africa 
--------------------------------------------- ------------ 
 
¶10.  The Center for the Study of AIDS, at the University of 
Pretoria, published a new report, "Buckling: The impact of AIDS 
in South Africa", by South African writer and journalist Hein 
Marais.  Marais presents an alternative analysis of AIDS impact 
in South Africa, and proposes a minimum social package to 
reduce the damage.  According to Marais, most projections of 
how the AIDS epidemic will affect society are vastly 
oversimplified and policies based on conventional conceptions 
of the societal effects of AIDS are likely to fail, or may even 
further aggravate existing inequities.  Marais argues that 
 
PRETORIA 00000142  003 OF 003 
 
 
analysis of AIDS' impacts has to explicitly take into account 
South Africa's economic and social inequities as well as the 
interplay of the epidemic with local resources and existing 
social arrangements.  Marais argues that the least privileged 
sections of society will disproportionately bear the brunt of 
the AIDS and that this could undermine South Africa's attempts 
to become a more just and equitable society, deepening the 
structural crisis in South Africa which is already fuelling the 
epidemic.  He calls on South Africa to improve its social 
security net by developing a comprehensive package of social 
services including job creation and workers' rights protection, 
safe-guarded food security, and the affordable provision of 
essential services.  "Overcoming the epidemic," writes Marais 
"therefore coincides with the overarching need to bring about a 
much more just society, one in which all South Africans have at 
least the basic means to a secure livelihood and the realistic 
prospect of improving their lives and those of their children." 
Source:  AIDSMAP, December 23, 2005. 
 
Malaria Cases Reported in Limpopo Province 
------------------------------------------ 
 
¶11.  Over 100 cases of malaria were reported in Limpopo 
Province in 2005 with 53 reported cases since December, despite 
South Africa's aggressive malarial control programs.  The 
recent increase in malaria has been attributed to increased 
rains providing stagnant pools of water.  South Africa sprays 
DDT in the affected areas, with the last Limpopo spraying in 
September and October 2004.  In the past several years, most of 
Limpopo districts have experienced drought conditions. 
National Health officials are meeting with their provincial 
health counterparts to discuss anti-malarial measures.  Source: 
City Press, January 8, 2006. 
 
Initial Human Trials May Start to Test AIDS Herbal Treatment 
--------------------------------------------- --------------- 
 
¶12.  An herbal mixture, known as Ubhejane, may become the first 
traditional medicine to be tested on humans.  Pre-clinical 
tests on the safety and activity against bacteria and fungi 
were conducted by the University of KwaZulu-Natal's Nelson 
Mandela School of Medicine and human trials on its efficacy are 
scheduled to begin at the end of 2006.  Dr. Nceba Gqaleni of 
the Nelson Mandela School said that Ubhejane had a `potent 
activity' against opportunistic infections associated with 
HIV/AIDS and is currently conducting a second phase metal 
analysis and antiviral tests with the compound, due to be 
completed in April 2006.  Up to 80 herbs collected throughout 
Africa composes Ubhejane.  Individual instances of improvement 
in CD4 counts and reduction in viral loads have been documented 
in patients using Ubhejane; however, the Medical University of 
South Africa's Patrick Maduna emphasized the need for more 
research before any more favorable expectations were created. 
Source:  City Press, January 8. 
 
TEITELBAUM