VZCZCXRO4251
RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #0320/01 0271217
ZNR UUUUU ZZH
R 271217Z JAN 06
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 1167
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 0987

UNCLAS SECTION 01 OF 04 PRETORIA 000320 
 
SIPDIS 
 
STTAE PASS TO USAID 
 
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 27 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:  More Agreement Regarding AIDS Statistics; 
Regular ARV Treatment Better than Intermittent Therapy; 2006 
South African Health Issues; South African Gay Men Banned from 
Giving Blood; Reactions; South Africans Show Genetic 
Vulnerability to TB; Cancer Could be Notifiable Disease; Spread 
of Disease by Rates Studied; Study Shows Clean Water's 
Importance in Treating AIDS.  End Summary. 
 
More Agreement Regarding AIDS Statistics 
---------------------------------------- 
 
¶2.  Two separate studies, using different techniques, have for 
the first time reached a similar conclusion about how many 
South Africans are infected with HIV.  The research has raised 
hopes of reconciling divergent estimates of HIV/AIDS 
prevalence.  The Actuarial Society of South Africa's (ASSA) 
computer model using data from a wide variety of sources, and a 
population survey by the Human Sciences Research Council 
(HSRC), indicate that five million South Africans, or about 
11%, carry the virus. 
 
¶3.  For the ASSA model, Rob Dorrington, of the Center for 
Actuarial Research at University Cape Town, analyzed surveys of 
HIV prevalence among pregnant women attending government 
clinics, but factored in the first HSRC household survey in 
2002, a youth survey, data from the most recent population 
census, and death registration records.  For the HSRC study, 
fieldworkers surveyed the country, taking HIV blood tests from 
15,800 of the nearly 23,300 people they interviewed.  Their 
work reveals widespread misunderstanding of the disease, with 
many South Africans -- particularly those over 50 years of age 
or in their early teens -- either uncertain of or denying any 
connection between the virus and the disease. 
 
¶4.  Confusion over South Africa's infection rate arose from the 
lack of information available at the start of the epidemic. 
For years the only consistent and reliable data came from 
government clinic blood tests on generally poor, pregnant 
women, issued yearly since 1990.  In 2005, Statistics SA 
estimated that 4.5 million South Africans were infected, while 
the Department of Health, has estimated that 6.3 million South 
Africans are HIV-positive based on the 2004 antenatal survey. 
Negotiations are under way to analyze the data and see if 
additional agreement can be found.  Source:  Mail and Guardian, 
January 20. 
 
Regular ARV Treatment Better than Intermittent Therapy 
--------------------------------------------- --------- 
 
¶5.  Findings from the Strategies for Management of Anti- 
Retroviral Therapy (SMART) trial, using South African 
participants, found that continuous anti-retroviral treatment 
is better than intermittent therapy, as regular treatment 
breaks can cause further health problems.  Taking regular 
breaks to avoid side effects and to save money was more than 
twice as likely to make people ill.  The study, conducted by 
the U.S.'s National Institute for Allergy and Infectious 
Diseases, compared levels of continuous ART with episodic drug 
treatment guided by levels of CD4+ cells, an indicator of the 
progression of AIDS.  Enrollment was stopped because those 
patients receiving episodic therapy had twice the risk of 
disease progression. 
 
¶6.  HIV-positive volunteers were assigned at random to either a 
viral suppression strategy, in which ART was taken on an 
ongoing basis to suppress HIV viral load, or a drug 
conservation strategy, in which ART was started only when the 
levels of key immune cells, called CD4+ cells, dropped below 
250 cells per cubic millimeter (mm3).  Volunteers in the drug 
conservation group were taken off ART with the aims of reducing 
drug side effects and preserving treatment options whenever 
 
PRETORIA 00000320  002 OF 004 
 
 
their CD4+ cells were above 350 cells/mm3.  The average follow- 
up was approximately 15 months. 
 
¶7.  The analysis showed that participants taking the treatment 
breaks faced more than twice the risk of disease progression 
than the participants on continuous ART.  There was an increase 
in major complications such as cardiovascular, kidney and liver 
diseases in the participants on the drug conservation program. 
These complications have been associated with ART, and it was 
hoped that they would be seen less frequently in those patients 
receiving less drugs.  Follow up visits will continue for all 
participants in the trial while the study team considers plans 
for a longer follow-up.  Source:  Sapa, Mail and Guardian, 
January 19. 
 
2006 South African Health Issues 
-------------------------------- 
 
¶8.  Two new health initiatives starting in 2006 will have cost 
implications for South African consumers:  new tax treatments 
for medical insurance contributions starting March 1 and 
revised pricing of medicines.  Only the first R500 ($83, using 
6 rands per dollar) in monthly medical insurance contributions 
will be tax exempt and those not covered by medical insurance 
will get tax relief when medical expenses are more than 7.5% of 
annual income, compared to the current tax threshold of 5%.  In 
addition, government is renegotiating the markups permitted on 
medicine sales, with a new dispensing fee unlikely before mid- 
¶2006. 
 
¶9.  Another new health initiative likely to impact the health 
industry is the proposed government employee health plan, GEMS. 
GEMS is expected to consolidate the medical insurance industry 
as civil servants change from their current insurance plans. 
Unions representing civil servants will continue negotiating 
with government on the fine details of GEMS' implementation, 
hoping to postpone mandatory membership until the proposed plan 
has proved to be value for money for civil servants. 
 
¶10.  Far-reaching industry talks will focus on negotiations for 
the new health-care charter.  Businesses were highly critical 
of the initial approach to the charter in 2005.  The second 
draft of the health charter was more favorably received. 
 
¶11.  HIV/AIDS will continue to be a major health concern. 
Doctors and AIDS activists are already on a collision course 
with entrepreneur Matthias Rath over his anti-AIDS drug 
campaign and controversial vitamin-based therapies, and have 
drawn the Department of Health into their legal challenge to 
his activities.  Government is expected to come under renewed 
pressure to improve the provision of AIDS drugs at its clinics 
and hospitals. 
 
¶12.  The Health Department also has plans to finalize and 
implement a human resources strategy.  Without a plan to 
recruit and retain adequate numbers of doctors, nurses and 
other health professionals, health-care services are expected 
to continue to deteriorate as staff emigrates for better jobs. 
 
¶13.  Implementing and finalizing already passed regulations 
will be another priority for the Department of Health, 
including implementing the Nursing Bill (once President Mbeki 
has signed it), tightening legislation controlling tobacco and 
alcohol, finalizing regulations for traditional and 
complementary medicines, and implementing the most 
controversial aspects of the National Health Act.  Doctors and 
private hospitals are awaiting the regulations spelling out how 
government plans to introduce the "certificate of need", a new 
system designed to control the location of doctors and 
hospitals. 
 
¶14.  Finally, health experts say South Africa cannot afford to 
focus all its attention on immediate health-care needs at the 
expense of planning its response to a possible global avian flu 
epidemic.  Source:  Business Day, January 11. 
 
South African Gay Men Banned from Giving Blood 
--------------------------------------------- - 
 
 
PRETORIA 00000320  003 OF 004 
 
 
¶15.  South Africa's blood donor service has banned blood from 
sexually active homosexual men due to a higher risk of HIV, 
provoking an angry response from gay activists.  A man who has 
had sex with another man within the last five years, whether 
oral or anal sex, with or without a condom is not permitted to 
donate blood, according to the head of the South African 
National Blood Service, Dr. Robert Crookes.  The South African 
Gay and Lesbian Rights Advocacy Group said blood donors should 
be screened according to whether they used a condom, not their 
sexuality.  Crookes said the blood service's position was based 
on international practice and research that showed sexually 
active gay men were more likely to be infected with HIV than 
their heterosexual counterparts.  Source:  Reuters, January 12. 
 
Reactions 
--------- 
 
¶16.  The Gay and Lesbian Alliance's (GLA) claimed that it 
recruited more than 100 gay men to donate blood to the SA 
National Blood Services (SANBS) without disclosing their sexual 
activities.  However, SANBS Chief Executive Officer Anthon 
Heyns said the organization was not able to find any record of 
the people the GLA claimed had donated blood.  The South 
African Human Rights Commission (SAHRC) said that gay men could 
not be excluded from donating blood based upon identity or 
status, but rather on the basis of epidemiological data.  The 
SAHRC also said it had met with the SANBS previously to discuss 
the possibility of SANBS undertaking an epidemiological study, 
along with the Medical Research Council and the Council for 
Scientific Industrial Research (CSIR), to determine if 
homosexuals were a high-risk group for contracting HIV in South 
Africa.  According to SAHRC, negotiations broke down because 
SANBS did not want to conduct the study under their auspices. 
The SANBS asserts that it does not exclude gay men from 
donating blood, just those who have sexual relations.  SANBS 
publicity manager Gail Nothard said the SANBS has just received 
research about the gay male community in South Africa, which it 
will examine in the next few months.  For now the SANBS still 
goes by available international data in order to "ensure the 
safety of the blood supply," Nothard said. 
 
¶17.  This is the second time that SANBS has been accused of 
discrimination.  In 2005, the SANBS was asked to change its 
blood exclusion policy that had been based upon information 
that some races were perceived as a higher risk for HIV 
contraction than others.  After discussions with the Department 
of Health, SANBS introduced a new blood-screening process 
called Nucleic acid Amplification Testing (NAT), which can 
detect the presence of the virus earlier. 
 
¶18.  On January 17, the Health Department announced that SANBS 
will begin discussions with interested parties to resolve the 
challenges posed by its policy of excluding gay male donors. 
SANBS may modify their donor criteria to identify potential 
donors who engage in anal sex, regardless of if they are 
homosexual.  Source:  Sunday Independent, January 15; Sapa and 
IOL, January 17; The Star January 21. 
 
South Africans Show Genetic Vulnerability to TB 
--------------------------------------------- -- 
 
¶19.  South African blood samples have helped identify a new 
genetic link to people's susceptibility to tuberculosis (TB). 
Tuberculosis is caused by a bacterium that is so widespread in 
South Africa that most people have been exposed to it.  Yet, 
only ten per cent of those infected develop the disease. 
Researchers at South Africa's Stellenbosch University spent 
years collecting blood samples from local communities.  The 
study revealed that people who had been exposed to the virus 
but did not fall ill were more likely to have a variant of one 
particular gene than those who did become ill.  The gene 
produces a chemical called DC-SIGN, which is known to affect 
other diseases including HIV/AIDS, Ebola, hepatitis C and 
dengue fever.  But, until now, variation in DC-SIGN had never 
been linked to TB.  The study director, Eileen Hoal, stated 
that additional research on the immunological response to the 
TB bacteria is needed since the immune system's response is 
important to developing a more effective TB treatment.  The 
research is published in January 2006's issue of PLoS Medicine. 
 
PRETORIA 00000320  004 OF 004 
 
 
Source:  SciDev.Net, January 11. 
 
Cancer Could be Notifiable Disease 
---------------------------------- 
 
¶20.  In order to improve data collection, the Health Department 
wants to make cancer a `notifiable' disease, with health 
institutions required to submit cancer diagnosis to the Health 
Department.  Currently, incidents of cancer are voluntarily 
supplied to the National Cancer Registry (NCR) by pathology 
laboratories.  Officials from the NCR, Health Department, 
pathology laboratories, medical schools and the South African 
Oncology Society agreed to set up a working group assigned to 
develop a way of collecting accurate data on cancer without 
compromising patient confidentiality.  NCR figures for 1999 
(the most recent available) show that 30,000 cases of cancer 
were diagnosed among South African women, mostly breast, 
cervical and colorectal cancer.  The leading cancers among the 
29,000 newly diagnosed men that year were prostate, lung and 
esophageal cancer.  Source:  Business Day, January 24. 
 
Spread of Disease by Rats Studied 
--------------------------------- 
 
¶21.  Nearly 200 blood samples from Durban shack dwellers are 
being analyzed amid fears that rats are spreading potentially 
fatal diseases to humans.  Because some of the symptoms are 
similar to flu, fever and malaria, officials say that cases of 
rat-borne illness could go untreated because of misdiagnosis by 
clinic staff and poor public awareness of the risks.  Blood and 
tissue samples from four species of rats and mice collected in 
Durban during the past two years all came up negative for 
bubonic plague, but in some parts of the city more than 30% of 
rats were found to be carrying leptospirosis and about 10% were 
carrying toxoplasmosis.  Both diseases can be passed from rats 
to humans.  Newborn infants and developing embryos also face 
very grave risks if the mother contracts toxoplasmosis during 
pregnancy.  As a follow-up to the rat blood tests, more than 
200 human blood samples were taken from volunteers in the Cato 
Crest informal settlement late 2005.  The results are expected 
to be published soon.  The recent surveys would be very useful 
to prepare more effective treatment and control strategies in 
Durban, other South African cities and the rest of Africa. 
This research project is part of a larger international study 
investigating rodent-related disease hot spots in four African 
countries.  Known as "Ratzooman", the project is being funded 
by the European Union to check the re-emergence of zoonotic 
diseases (sicknesses which can be spread from animals to 
humans).  Source:  The Mercury, January 23. 
 
Study Shows Clean Water's Importance in Treating AIDS 
--------------------------------------------- -------- 
 
¶22.  Researchers from Denmark and Zimbabwe found evidence that 
treating bilharzias or schistosoma (microscopic worms usually 
in stagnant water) can improve the immune systems of HIV/AIDS 
patients.  The study used two groups of patients, some of whom 
also had HIV.  One group was immediately treated for bilharzias 
and the other had to wait three months for treatment.  In HIV- 
infected patients, the number of CD4 cells rose.  In those HIV 
patients waiting for treatment, the CD4 count did not improve 
and the amount of HIV increased.  The results suggest that the 
parasitic worm suppresses the immune system, leaving people 
more vulnerable to viral infections such as HIV.  The precise 
extent to which bilharzias increased the development of AIDS is 
still unknown.  Bilharzias is responsible for 2.5 million 
people being ill in South Africa, with approximately 10% 
developing severe infections.  Bilharzias contributes to slow 
mental and physical growth in children as well as anemia in 
adults.  It is found primarily in the eastern half of South 
Africa and is particularly prevalent in the KwaZulu-Natal 
province.  Source:  The Witness, January 23. 
 
TEITELBAUM