VZCZCXRO7597
RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #0790/01 0551109
ZNR UUUUU ZZH
R 241109Z FEB 06
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 1811
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 1018

UNCLAS SECTION 01 OF 04 PRETORIA 000790 
 
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 FEBRUARY 24 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:  India and South African Joint Venture 
Announced; Aspen Will Supply Generic Atazanavir; HIV Test to 
Detect AIDS Resistance; SA Registers Tamiflu; New MCC Head; 
Budget 2006 Health Proposals; Antiretroviral Therapy Reduces 
High Incidence of TB in South African HIV-positive Children; 
Survey Reveals Church Youth Sexually Active; and Is There a 
Link Between Teenage Pregnancies and Social Grants?  End 
Summary. 
 
India and South African Joint Venture Announced 
--------------------------------------------- -- 
 
¶2.  India's largest pharmaceutical company Ranbaxy Laboratories 
announced a joint venture with South Africa's Community 
Investment Holdings to sell low-cost generic Aids drugs. 
Ranbaxy will own 70% of the joint venture, named Sonke 
Pharmaceuticals, which will market antiretroviral medicines 
under the trademark "Sonke" in South Africa, Namibia and 
Botswana.  C.I. Holdings, a black-owned company with 
investments in technology, logistics and health, will own the 
remaining 30%.  The government, retail pharmacies and aid 
groups will distribute the drugs.  CI Holding's executive 
chairwoman, Dr Anna Mokgokong, said the joint venture will 
provide Ranbaxy with new access to the markets in Botswana and 
Namibia.  The Medicines Control Council has yet to approve 
Ranbaxy's drugs, but the company hopes approval will come later 
in 2006.  Source:  Sapa, IOL, February 9; The Mercury, February 
¶19. 
 
Aspen Will Supply Generic Atazanavir 
------------------------------------ 
 
¶3.  South Africa's Aspen Pharmacare has reached agreement with 
U.S. firm Bristol Myers-Squibb to produce and distribute 
Atazanavir to about 70 countries, improving anti-retroviral 
drug supplies in sub-Saharan Africa.  Atazanavir is the second 
protease inhibitor offered for technology transfer.  The 
agreement will broaden the choice of second-line treatments 
available in poorer countries, but atazanavir use may be 
limited by the lack of access to the boosting agent ritonavir, 
another protease inhibitor manufactured by Abbott Laboratories. 
In Europe, atazanavir is only licensed for use in treatment- 
experienced patients when boosted by ritonavir, but ritonavir 
is vulnerable to high temperatures and should not be stored 
outside a refrigerator for more than a few days in a hot 
climate.  Although Abbott Laboratories has developed a heat 
stable tablet version of its own boosted protease inhibitor 
Kaletra (lopinavir/ritonavir), it has still to develop a heat 
stable version of ritonavir.  The heat stable version of 
Kaletra remains unlicensed outside the United States, and 
Medecins Sans Frontieres (MSF) wants Abbott Laboratories to 
register the new version in all countries eligible to receive 
the drug at the no-profit access price of approximately $500 a 
year.  Source:  BBC News and Health E-News, February 16; 
Business Day, February 17. 
 
HIV Test to Detect AIDS Resistance 
---------------------------------- 
 
¶4.  Medical testing firm Davies Diagnostics is planning to 
launch a new HIV test in South Africa that can identify the 
small minority of patients who take up to 20 years to develop 
AIDS.  Most HIV-positive people will develop AIDS-related 
illnesses within three to five years; however, some stay 
healthy for longer.  The test, developed by French firm Ivagen, 
enables doctors to identify patients who can safely delay in 
taking antiretroviral medicines.  The new test detects anti-R7V 
antibodies, which are present in the blood of long-term 
nonprogressors.  The test costs R200 ($33, using 6 rand per 
dollar).  Scientists believe these antibodies offer protection 
against the disease, although the exact mechanism is not yet 
understood, said Dr Alan Smith, chief specialist virologist for 
KwaZulu-Natal province.  President of the Southern Africa HIV 
 
PRETORIA 00000790  002 OF 004 
 
 
Clinicians Society Dr Francois Venter expressed doubts, saying 
he was unsure what extra value the test would add to 
conventional HIV monitoring.  Source:  Business Day, February 
¶16. 
 
SA Registers Tamiflu 
-------------------- 
 
¶5.  The Medicines Control Council has registered Swiss 
pharmaceutical firm Roche's antiviral drug Tamiflu as part of 
its plans for combating the threat of avian flu.  Although as 
yet unproven, the drug is considered the best weapon for 
treating people should the deadly H5N1 avian flu mutate into a 
form easily transmitted between people.  While registration of 
Tamiflu means government and the private sector can import and 
prescribe the drug, it remains to be seen how swiftly South 
Africa can obtain supplies.  The Department of Health had not 
yet decided how much Tamiflu to stockpile, and planned to 
discuss its potential needs with Roche soon, according to 
Health Department's spokesman Solly Mabotha. He declined to 
discuss how quickly SA would be able to obtain supplies. 
According to Mabotha, the Health Department has finalized its 
flu preparedness plan, and submitted it to the cabinet for 
approval at its next meeting in March.  Orders for Tamiflu 
would be fulfilled on a first-come, first-serve basis, and the 
lead time for such orders is 15-18 months.  At least 11 
countries have reported bird-flu outbreaks over the past three 
weeks, an indication the virus is spreading faster.  Source: 
Reuters and Sapa, February 21. 
 
New MCC Head 
------------ 
 
¶6.  Health Minister Tshabalala-Msimang has appointed Mandisa 
Hela the new registrar of medicines who oversees the Medicines 
Control Council (MCC), responsible for evaluating new medicines 
and drug trials.  Hela takes over from the department's 
director-general, Thami Mseleku, who held the post as a 
temporary measure after the departure of former registrar 
Humphry Zokufa last November.  Zokufa quit to work with the 
Board of Healthcare Funders, a body representing medical 
schemes and their administrators.  MCC has had three heads in 
the past 14 months, since Precious Matsoso left in December 
¶2004.  The council is currently an independent body charged 
with ensuring that all medicines used in South Africa are safe, 
effective, and of high quality.  The MCC has been criticized by 
the pharmaceutical industry for the length of time it takes to 
approve new medicines.  Source:  Business Day, February 21. 
 
Budget 2006 Health Proposals 
---------------------------- 
 
¶7.  Finance Minister Trevor Manuel presented South Africa's 
2006 Budget, which outlined revenue and expenditures programs 
over the next three years.  Education and health spending 
remain key expenditure priorities.  Changed tax treatments of 
medical expenses, helping primarily lower income groups, and 
retirement savings are additional important revenue proposals 
impacting the health industry. 
 
¶8.  The revised tax treatment of medical expenses was announced 
in November 2005 and will be implemented in March 2006.  Up 
until now, employers have been allowed to pay two-thirds of 
their medical insurance contributions as a tax-free benefit. 
Now, monthly monetary caps for medical insurance contributions 
are introduced and individual tax deductible medical expenses 
will be raised from 5% to 7.5% of income.  Taxpayers 65 and 
older can deduct all their medical expenses.  Only 5% of South 
African population earning between R2,000-R5,000 ($333-$833) 
per month are covered by medical insurance. 
 
¶9.  Savings for retirement received a tax break, as taxes on 
retirement funds were cut to 9% from the previous tax rate of 
18%.  Reductions in retirement taxes should increase South 
Africa's relatively low savings rates. 
 
¶10.  As a result of providing more anti-retroviral treatment, 
real (adjusted for inflation) health expenditures will increase 
7.3%, 3.6%, and 3.1% in fiscal years 2006/07, 2007/08, and 
2008/09, respectively.  A substantial amount of total 2006/07 
health spending of R54.5 billion ($9.1 billion) is targeted at 
 
PRETORIA 00000790  003 OF 004 
 
 
improving health care infrastructure and service delivery.  The 
hospital revitalization program received an additional R900 
million ($150 million), increasing the national budget funding 
for improvements to provincial hospitals from R1.2 billion 
($200 million) in 2005/06 to R2 billion ($330 million) in 
2008/09. 
 
¶11.  National Treasury estimated that 112,000 patients were 
enrolled in the HIV/AIDS antiretroviral program.  Total 
spending for HIV/AIDS in 2006/07 is R1.9 billion ($320 
million), up from R1.5 billion ($250 million) last year. 
HIV/AIDS spending is expected to reach R2.1 billion ($350 
million) in 2008.  Funding for condoms has increased from R70.8 
million in 2002/03 to R147.9 million in 2008.  Treasury 
Minister Manuel allocated R40 million ($6.7 million) to manage 
and monitor the government's national HIV and AIDS plan and an 
additional R 52.7 million ($8.8 million) will go to non- 
governmental organizations.  The HIV/AIDS program consumes 94% 
of the total budget available for Strategic Health Programs in 
2006/07, up from 64% in 2002/03's budget.  The national 
government plans to spend R6.7 billion ($1.1 billion) in grants 
to provinces over the next three fiscal years.  Approximately 
80% of the total HIV budget is spent on health, with relatively 
little on education and social aspects. 
 
¶12.  Spending on social security grants will increase by a 
total of R80.6 billion ($13 billion).  Disability and old age 
grants rise to R820 ($137) per month, an increase of R40.  The 
foster care grant is now R590 ($98) per month, an increase of 
R30.  Finally, the child support grant (reaching children up to 
the age of 14) increases by R10 to reach R190 ($32) per month. 
Source:  Business Report and Business Day, February 16; 
Financial Mail, February 17. 
 
Antiretroviral Therapy Reduces High Incidence of TB in South 
African HIV-positive Children 
--------------------------------------------- -------------- 
 
¶13.  According to a study by researchers at the University of 
Witwatersrand, HIV-positive children in South Africa have an 
extremely high incidence of tuberculosis (TB), but 
antiretroviral therapy (ART) substantially reduces TB suspected 
cases.  However, the benefit was not as clear-cut when looking 
at cases of confirmed TB.  This finding corresponds with 
another study showing a greater tendency to treat suspected TB 
in children who were going to receive ART.  Taken together, 
this may represent another benefit of the ART rollout. 
Community rates of TB in both adults and children are very high 
in South Africa with reported rates of over a thousand per 
hundred thousand.  An estimated 15% of the total TB case load 
is contributed by children up to 14 years of age in regions 
with a high burden of HIV and TB; however, pediatric TB is 
relatively under-reported in South Africa and sub-Saharan 
Africa. 
 
¶14.  With the national rollout of ART in South Africa, a 50-80% 
reduction in the incidence of TB has been observed in ART- 
treated adults with HIV.  Since about 10% of those on ART in 
South Africa now are children, the University of Witwatersrand 
study examines if there has been a similar reduction in the 
incidence of TB diagnosis and the incidence of confirmed TB in 
children treated with ART when compared to those who have not 
received ART. 
 
¶15.  The study used reviews from records of ART-treated and 
untreated children attending four South African ART clinics: 
three in Johannesburg and one in Cape Town.  992 children under 
15 years of age were included in the study.  Two thirds of the 
cohort received HAART for more than three months.  Children 
receiving ART tended to be more immune compromised.  However, 
despite this, they had fewer TB diagnoses.  The incidence of TB 
in all the patients not on ART was 16.3 per 100 child years, 
which was reduced to 6.3 per 100 child years for those on ART. 
When just looking at the children who received ART, reduction 
in TB incidence became 21.6 per 100 child years (before 
treatment) compared to 6.3 per 100 child years (after 
treatment).  According to reports from doctors, it appears that 
they are more willing to give TB treatment by itself when there 
is a suspected TB case than to wait till they are on 
antiretrovirals and then have to deal with treating children 
with both TB treatment as well as antiretrovirals.  Source: 
 
PRETORIA 00000790  004 OF 004 
 
 
AIDSMAP February 9. 
 
Survey Reveals Church Youth Sexually Active 
------------------------------------------- 
 
¶16.  Anglican teenagers in the Western Cape are almost as 
sexually active as their peers outside the church, according to 
a survey reported in the latest issue of the South African 
Medical Journal.  The survey, in which 1 306 youngsters were 
questioned, was carried out by researchers from the Cape Town- 
based Fiklela AIDS project and the University of Stellenbosch's 
theology department.  A total of 31% of the Anglicans aged 12 
to 19 were sexually active, compared with a figure of 38% 
reported for Western Cape youth in general by the South Africa 
Youth Risk Behavior (SAYB) Survey.  The sexually active church- 
based youngsters appeared to have a higher rate of multiple 
partners (66%) than the 48% reported in the SAYB survey.  Sixty 
five percent of the Anglican youngsters had not used a 
contraceptive during their first sexual encounter.  Only 33% of 
them believed that oral sex was actually sex, and only half 
that anal sex was indeed sex.  Source:  Sapa, February 10 and 
IRIN News, February 13. 
 
Is There a Link Between Teenage Pregnancies and Social Grants? 
--------------------------------------------- ----------------- 
 
¶17.  Minister of Social Development Zola Skweyiya announced 
that the government is sponsoring research to investigate 
whether teenage pregnancies are being driven by people who want 
access to the Child Support Grant and a final report would be 
presented to the Cabinet.  The minister declined to comment on 
reports that some people living with HIV/AIDS were reluctant to 
start on anti-retroviral drugs as they feared that, once their 
health improved, they would no longer be eligible for a 
disability grant.  Skweyiya stated that the government depends 
only on the on the medical report when approving or continuing 
a grant.  The minister confirmed that a total of 516 cases of 
social grants fraud were brought to court by December 22 with 
128 convictions.  At least half the 12,000 public servants 
found to have defrauded the system are expected to be 
prosecuted by the end of March 2007 and the remainder by 2008, 
once investigations were completed.  The total number of poor 
households in the country is estimated at 5,682,272 out of a 
national household total of 12,701,572.  Two-million households 
(8.2-million people) have been provided with basic sanitation 
since 1994.  Source:  Health-E News, February 8. 
 
TEITELBAUM