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RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #0603/01 0411326
ZNR UUUUU ZZH
R 101326Z FEB 06
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 1506
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 1000

UNCLAS SECTION 01 OF 04 PRETORIA 000603 
 
SIPDIS 
 
STATE PASS TO AID 
 
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 FEBRUARY 10 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:  Transparency International Warns Against 
Health Care Fraud; Study Shows Previous Blood Risk Management 
Policies Led to Drop in HIV-infected Blood Supplies; MSF Starts 
Handover of HIV/AIDS Treatment; New Head of HSRC HIV/AIDS 
Research Unit; HSRC Study Details Impact of HIV/AIDS on 
Teachers; South Africa to Test New HIV Treatment Strategy; 
Plants used in Traditional Medicine Tested for AIDS Treatment; 
Aspen Helps Affordable AIDS Treatment; and South Africa 
Launches New Malaria Initiative.  End Summary. 
 
Transparency International Warns Against Health Care Fraud 
--------------------------------------------- ------------- 
 
¶2.  A new Transparency International report warns that health 
care systems around the world are easy targets for fraud.  The 
report did not quantify the scale of corruption in health-care 
systems, but said the complexity of health-related industries 
and the vast sums of public money invested in medical care make 
the sector an attractive target for fraud.  The world spends 
more than $3.1-trillion on health services each year, almost a 
third of it in the U.S.  Many of the cases in Transparency 
International's report used examples from South Africa's health- 
care systems.  South Africa's vulnerability to increased fraud 
was seen in several reports issued in 2005.  One report on 
provincial health departments highlighted problems in public 
hospitals ranging from unpaid patient bills to poor staff 
management and stock control.  Last November, auditor-general 
Shauket Fakie censured the national Health Department for a 
consecutive second year due to poor management of conditional 
grant transfers.  Fakie found the Department had transferred 
hospital revitalization grants to provinces without first 
approving project implementation plans, as required by the 
Division of Revenue Act, and HIV/AIDS grants had been paid to 
two provinces before their business plans were approved.  The 
Public Service Accountability Monitor, a research organization 
based in Eastern Cape, says that the provincial health 
department is vulnerable to fraud and corruption because of a 
lack of proper management systems.  Two of the provincial 
pharmaceutical storage depots have failed to submit proper 
records for the past nine years, making it easy for drugs to be 
misallocated, says the Monitor's advocacy head, Adrienne 
Carlisle.  The provincial health department has acknowledged 
its weaknesses and privatized management of pharmaceutical 
depots, but the department's inability to monitor the program 
means it remains open to corruption, warns Carlisle. 
Medscheme, one of South Africa's largest medical insurance 
companies, has caught 62 vendors who admitted submitting 
fraudulent claims worth R12 million ($2 million using 6 rands 
per dollar) in the past 12 months, according to Medscheme Chief 
Information Officer Kevin Right.  Source:  Business Day, 
February 2. 
 
Study Shows Previous Blood Risk Management Policies Led to Drop 
in HIV-infected Blood Supplies 
--------------------------------------------- ----------------- 
 
¶3.  According to a study published in the Journal of the 
American Medical Association, the South African National Blood 
Service's (SANBS) former race-based risk management policy, 
which barred many blacks from donating blood between 1999 and 
2005, led to a substantial drop in HIV-infected blood supplies. 
Michael Busch with the Blood Systems Research Institute in San 
Francisco collaborated with SANBS chief executive Anthon Heyns 
and said the study underscored the dilemma of trying to 
maintain a safe blood supply in the challenging arena of 
epidemic infectious disease and social expectations.  The 
research looked at about 900,000 blood donations collected in 
the inland region from the policy's first year, and compared 
these with almost 800,000 donations collected from 2001 to 
2002, when the policy was implemented.  HIV was detected in 
0.17% of donations in 1999-2000, but dropped 50 percent to 
 
PRETORIA 00000603  002 OF 004 
 
 
0.08% in 2001-2002 after the implementation of the enhanced- 
donor selection and education policy.  The number of high-risk 
donations collected decreased from 2.6% to 1.7%. 
 
¶4.  Under the old and new policies, prospective donors are 
asked to answer a questionnaire about their medical history, 
sexual practices and drug use. Using potential donors' race as 
a marker of risk was the policy's most controversial component, 
and in December 2004, the Department of Health declared that 
race was not an acceptable risk indicator, and officials 
decided in February2005 to test individual blood samples.  More 
recently, the SANBS's policy of excluding donations from 
sexually active gay men also has generated criticism. 
Officials say that, too, is now under review.  Source:  The 
Star, February 6; Weekend Argus, February 4; "Blood safety 
program in South Africa associated with decline in HIV-1 in 
blood donations", JAMA and Archives Journals, 31 January, 2006, 
p 519-526. 
 
¶5.  Comment.  The U.S. government through the President's 
Emergency Plan for AIDS Relief has been assisting the SANBS to 
develop new blood screening methodologies.  End comment. 
 
MSF Starts Handover of HIV/AIDS Treatment 
----------------------------------------- 
 
¶6.  After five years of work in the treatment of HIV/AIDS, 
Medecins Sans Frontiers (MSF) is preparing to withdraw from the 
antiretroviral treatment program in the Cape Town township of 
Khayelitsha.  MSF began offering antiretroviral therapy (ART) 
in Khayelitsha in 2001, when the provision of anti-AIDS drugs 
in the public sector was still illegal.  At that time, the 
South African government considered provision of ART too 
complex and expensive to implement.  MSF committed to a five- 
year plan to treat 180 patients in Khayelitsha, which had the 
largest concentration of HIV/AIDS patients in South Africa. The 
organization estimated that 70,000 of Khayelitsha's half a 
million population are infected with HIV.  A national HIV 
treatment and prevention plan was eventually approved by the 
government in 2003.  With extra financial support from the 
Global Fund to fight HIV/AIDS, Tuberculosis and Malaria, and a 
reduction in the cost of anti-AIDS drugs, MSF was able to 
enroll more patients in ART.  The organization established 
three dedicated HIV/AIDS clinics in Khayelitsha's public health 
facilities, where they now treat close to 3,000 people.  MSF 
figures showed there were fewer than 500 HIV tests taken in 
2000 while in 2005 that figure increased to 28,000.  MSF has 
reduced their role in providing drugs, staff and other 
resources to the Khayelitsha clinics.  The provincial health 
authority for the Western Cape expects to take full control of 
these projects by mid-2007.  MSF intends giving the Treatment 
Action Campaign a prominent role to act as a permanent 
monitoring body over treatment and will put pressure on the 
provincial health authority to maintain quality of service. 
Source:  IRIN News and PLUS News, January 24. 
 
New Head of HSRC HIV/AIDS Research Unit 
--------------------------------------- 
 
¶7.  Laetitia Rispel, former head of the Gauteng health 
department, has been appointed as the executive director of the 
Social Aspects of HIV/AIDS and Health (SAHA) program at the 
Human Sciences Research Council (HSRC).  She succeeds Olive 
Shisana, who took over as President and CEO of the HSRC in 
August 2005.  Rispel has worked for the Gauteng health 
department for nine years, first as a senior manager, and for 
the past five years as head of the department.  She also worked 
for eight years at the Center for Health Policy, a research 
unit within the Wits University Department of Community Health. 
She obtained a PhD in Health Systems and a Masters in Community 
Health from the University of the Witwatersrand.  In 2002, she 
completed a senior executive program at Harvard University in 
conjunction with Wits University.  The SAHA program conducts 
research on the social determinants of health, not only on 
HIV/AIDS, but also for public health in general.  Source: 
SAPS, January 30. 
 
HSRC Study Details Impact of HIV/AIDS on Teachers 
--------------------------------------------- ---- 
 
PRETORIA 00000603  003 OF 004 
 
 
 
¶8.  South Africa needs 90% anti-retroviral coverage for 
teachers with HIV, or the country could be losing more than 5 
000 teachers to AIDS annually within the next four years. 
According to an HSRC study by Thomas Rehle and Olive Shisana, 
one in nearly every 10 teachers with HIV was dying of AIDS, a 
loss of more than 1% of the total teacher population in 2005. 
Published in a recent edition of the Journal of Social Aspects 
of HIV/AIDS, the study pointed to the precarious health status 
of a large percentage of HIV-positive teachers.  The study 
found that nearly one in every three HIV-positive teachers 
participating in their survey had a CD4 count of less than 200. 
More than half had a CD4 count lower than 350 (the U.S. 
standard for when people start ARV treatment).  Their survey 
results suggested that more than one-fifth of HIV-positive 
teachers needed ARVs, if healthcare providers used South 
African national criteria for the start of this treatment.  The 
percentage of HIV-positive teachers with a CD4 count lower than 
200 (22%), was higher than those previously reported in 
population-based studies in sub-Saharan Africa.  B 2005, nearly 
11,000 teachers needed treatment.  If the U.S. treatment 
standard of a CD4 count of 350 was applied, 25,000 teachers 
should have started ARV treatment last year.  Within the study 
group of approximately17,000 teachers, the authors expected 
more than 4,000 to die in 2005 if there was no intervention, 
and nearly half of those deaths were among teachers aged 35 to 
¶44.  But by 2010, 90% antiretroviral coverage could result in a 
50% reduction in AIDS deaths, according to Shisana and Rehle. 
Source:  IOL, The Cape Argus, IRIN, January 30; 
www.hsrcpres.ac.za. 
 
South Africa to Test New HIV Treatment Strategy 
--------------------------------------------- -- 
 
¶9.  South African sites will be participants in the Spartac 
study, which will test a new treatment strategy of providing 
ART treatment during the early months of HIV infection, rather 
than in the later stages of the disease.  The researchers hope 
that early treatment will block the virus before it damages the 
immune system and thus delay the onset of lifelong therapy. 
Trials will occur in Durban, which as already enrolled 11 
volunteers with hopes of 100.  The researchers want to enroll a 
total of 360 including sites at University of Cape Town, and 
the Reproductive Health and HIV Research Unit at Wits 
University.  Recruitment is difficult as volunteers need to be 
in the early stage of the infection, when typically there are 
no clear symptoms.  Volunteers will be divided into three 
groups:  one is receiving ARV drugs for three months; the 
second receiving ARV drugs for one year; and the third getting 
a placebo.  This will be one of the last international HIV 
trials including a placebo.  The South African Spartac 
investigator is Dr. Francois Venter.  Source:  Sunday Times, 
February 5. 
 
Plants used in Traditional Medicine Tested for AIDS Treatment 
--------------------------------------------- ---------------- 
 
¶10.  Two African plants used in traditional medicine are 
research subjects of an initial $4.4 million research grant 
collaboration between the Mandela School of Medicine at the 
University of KwaZulu-Natal, the Center for HIV/AIDS Vaccine 
Immunology at Duke University, and University of Missouri. 
Cancer bush (Sutherlandia Frutescens) and African wormwood 
(Artemisia Afra) have had a long history of treatment use in 
Africa.  Sutherlandia is known as the cancer bush because of 
its anecdotal reputation as a cure for certain cancers. 
According to the South Africa National Biodiversity Institute, 
eating or drinking Sutherlandia leaf improves the appetite and 
allows weight gain, possibly delaying the progression of HIV 
into AIDS.  In traditional medicine, the African Artemesia 
plants have been used to treat coughs, colds, fever, intestinal 
worms and malaria.  According to Ben-Erik van Wyk, professor of 
botany at Rand Africaans University, natural products and their 
derivatives make up more than 50% of all drugs in clinical use. 
The first part of the project will monitor AIDS patients at 
Edendale Hospital in Pietermaritzburg being treated with 
extracts of the cancer bush.  Further pre-clinical studies will 
be done on African wormwood for possible use in treating AIDS, 
tuberculosis, and cervical cancer.  Similar work will be done 
 
PRETORIA 00000603  004 OF 004 
 
 
in Malawi, Gambia, Tanzania and Uganda as part of a 7-year 
project costing $300 million.  Source:  The Mercury, Cape 
Times, Pretoria News, January 26. 
 
Aspen Helps Affordable AIDS Treatment 
------------------------------------- 
 
¶11.  Over the past five years, the cost of a year's supply of 
antiretroviral (ARV) drugs in South Africa has dropped from 
over R95,000 ($13,690, using 6.94 rands per dollar, the 2000 
average rate of exchange) to around R1,200 ($190, using 6.36, 
the 2005 average rate of exchange) for the standard first-line 
package of three drugs a day, largely because generic ARV drugs 
are now available.  Second-line drugs for people who develop 
side-effects or resistance to the first-line drugs are still 
significantly more expensive as they tend to be newer drugs 
still under patent protection.  Aspen Pharmacare, the largest 
pharmaceutical company listed on the Johannesburg Stock 
Exchange, has played a key role in securing voluntary licenses 
from pharmaceutical companies to enable Aspen to make cheap 
generic versions of brand name drugs.  Aspen senior executive 
Stavros Nicolau is convinced that voluntary licenses have been 
responsible for South Africa's successful provision of generic 
drugs because acrimonious relations with pharmaceutical 
companies were avoided.  By 2001, Aspen had secured its first 
voluntary license from GlaxoSmithKline to manufacture AZT and 
3TC.  Since then, it has secured voluntary licenses from 
Bristol-Myers Squibb (for stavudine and didanosine), Boehringer 
Ingleheim (for nevirapine) and Merck Sharp & Dohme (for 
efavirenz).  According to Nicolau, Aspen's 2005 achievements 
include:  (1) becoming the first generic manufacturer to get US 
Food and Drug Administration approval for drug supply; (2) 
becoming the main supplier for the South African Health 
Department's provision of antiretroviral drugs, providing eight 
out of 15 categories of drugs; (3) securing a non-exclusive 
licensing and distribution arrangement with Gilead Sciences to 
make generic versions of the ARVs, Truvada (a combination of 
emtricitabine and tenofovir) and Viread (tenofovir); and (4) 
entering into a joint venture with India's Matrix, one of the 
world's largest manufacturers of active pharmaceutical 
ingredients (APIs) for ARVs, which ensures Aspen's continued 
supply of ARVs.  Aspen is beginning to focus on the U.S. and 
U.K. market for additional sales since it had received 
manufacturing approval from both regulatory authorities. 
Source:  Financial Mail, December 2005; Health E-News, January 
18 2006; Business Day, February 7, 2006. 
 
South Africa Launches New Malaria Initiative 
-------------------------------------------- 
 
¶12.  Science and Technology Minister Mangena officially 
launched the South African Malaria Initiative (SAMI), an R11.5 
million ($1.9 million, using 6 rands per dollar) research grant 
whose aim is to focus on three areas:  developing new 
antimalarial compounds; better malarial diagnostics; and 
examining the interaction between the malaria parasite and its 
carriers.  SAMI intends to develop a national and regional 
capacity for treatment and diagnostics of malaria.  There are 
on average 10,000 cases of malaria a year in South Africa, 
mostly impacting rural populations of Mpumalanga, Limpopo and 
northern KwaZulu-Natal provinces.  Source:  Pretoria News, 
Business Day, February 8. 
 
TEITELBAUM