VZCZCXRO0767
RR RUEHDU RUEHJO RUEHMR
DE RUEHSA #1657/01 1111351
ZNR UUUUU ZZH
R 211351Z APR 06
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC 2995
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 1126

UNCLAS SECTION 01 OF 05 PRETORIA 001657 
 
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 April 21 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:  Monitoring South African AIDS Treatment Plan 
Difficult; Health Minister Emphasizes HIV Prevention; Business 
Conference Learns About Possible AIDS Impacts; Survey:  AIDS 
Has no Major Impacts on Small and Medium Firms; TAC 
Representative Invited but will not Attend UN AIDS Conference; 
South African Women to test New Microbicides that Reduce HIV 
Transmission; South African Contributions to ARV Side Effects 
Research; South African Health Worker Shortage; Outline of 
Health Human Resource Plan; Eastern Cape Health MEC Replaced; 
South African Birth Defects; SA Highest Rate of Femicide; and 
SA to Develop new Malaria Drug.    End Summary. 
 
Monitoring South African AIDS Treatment Plan Difficult 
--------------------------------------------- --------- 
 
¶2.  The Joint Civil Society Monitoring Forum (JCSMF) reports on 
obstacles towards successful implementation of South Africa's 
treatment plan.  JCSMF considers that the most serious problems 
are:  severe human resource shortages, provincial divergences 
in implementing the government's treatment plan, gaps in 
communication and information sharing, uneven treatment of 
children needing ARV treatment, no disaggregated HIV and AIDS 
expenditure reporting by provinces available, and lack of 
clarity on the extent to which provinces are using conditional 
grants allocated by National Treasury or using funds from 
provincial budgets (including equitable share funding) to 
implement the ARV treatment plan.  The JCSMF has sponsored 
seven workshops starting in September 2004, with the latest on 
March 6, 2006.  All meetings have identified information 
inaccessibility as being a major challenge to monitoring the 
Operational Plan.  In addition, various JCSMF forums emphasized 
the lack of detailed provincial expenditure on HIV and AIDS 
activities as a major obstacle to evaluating the Operational 
Plan's success, especially in the areas of nutrition support 
and child services.  JCSMF is an organization composed of civil 
society organizations, research institutes, health workers and 
private sector members and its aims are to monitor and support 
the implementation of the Operational Plan for Comprehensive 
HIV and AIDS Care for South Africa.  Source:  IDASA Budget 
Brief 161, Monitoring AIDS Treatment Rollout in South Africa: 
Lessons from the Joint Civil Society Monitoring Forum, April 
¶13. 
 
Health Minister Emphasizes HIV Prevention 
----------------------------------------- 
 
¶3.  Speaking at the start of the African Union's Acceleration 
of Prevention of HIV Initiative, South African Health Minister 
Tshabalala-Msimang asserted that HIV prevention campaign has 
 
SIPDIS 
suffered at the expense of emphasis on treatment and that 
prevention has to be accelerated.  According to the minister, 
policies addressing poverty, underdevelopment and gender 
inequalities which make women more vulnerable to HIV infection 
have to be implemented.  She stressed the importance of condom 
distribution, basic health care, and nutrition and abstinence 
programs.  Source:  Business Day and The Star, April 12. 
 
Business Conference Learns About Possible AIDS Impacts 
--------------------------------------------- --------- 
 
¶4.  At a private sector conference on HIV/AIDS sponsored by 
Business Unity SA, various study results of HIV/AIDS impacts 
were used to illustrate the disease's possible negative impacts 
on South African business.  According to an SA Business 
Coalition Against HIV/AIDS survey for July to September 2005, 
40% of the manufacturing and transport companies, and 60% of 
the mining companies surveyed reported a tangible loss of 
experience and vital skills as a result of HIV/AIDS.  Peter 
Doyle, the chief executive of Metropolitan, said that while 
treatment was important, it was equally important to halt new 
infections.  Metropolitan is completing an extensive study on a 
20-year outlook for HIV/AIDS.  It expects to release the study 
to the public later in 2006.  Of the four scenarios presented 
 
PRETORIA 00001657  002 OF 005 
 
 
at the conference, the worst case showed about 8 million new 
infections by 2025.  This could be reduced by 2.8 million, by 
3.8 million, or by 5.9 million in the best case.  Source: 
Business Report, April 6. 
 
Survey:  AIDS has no Major Impacts on Small and Medium Firms 
--------------------------------------------- --------------- 
 
¶5.  According to a report on a Joint Economic AIDS and Poverty 
Program commissioned study done by Patrick Connelly and Sydney 
Rosen, HIV/AIDS was ranked ninth among a list of 10 concerns 
affecting small and medium enterprises (SMEs).  Productivity of 
workers, demand for product, cost of labor, cost of materials, 
regulations, crime, taxes and a shortage of skilled labor were 
all ranked as more important concerns than HIV/AIDS.  Only the 
availability of capital or financing was ranked as being of 
less concern than HIV/AIDS by SMEs, with 62% of the companies 
surveyed confirming that they had never even discussed HIV/AIDS 
as a business issue.  The study results were based on data 
collected through a survey of managers of 80 randomly selected 
SMEs in KwaZulu-Natal and Gauteng.  The study found that about 
a quarter of the sampled companies were providing some HIV/AIDS 
service to employees, but fewer than half of them incurred any 
direct costs to provide these services, which were usually 
limited to condom distribution, education and awareness of 
HIV/AIDS, and the development of a workplace policy on 
HIV/AIDS.  Employee turnover was about 13% annually but only 
10% of this was due to illness or death.  Roughly 29% of SMEs 
surveyed expected the epidemic to have a large impact, 25% a 
moderate impact and 43% little or no impact, with 4% not 
responding.  Source:  Business Report, April 13. 
 
TAC Representative Invited but will not be Official 
Representative at UN AIDS Conference 
--------------------------------------------- ------ 
 
¶6.  The Health Ministry issued a list of groups invited to take 
part in the United Nations General Assembly Special Session on 
Aids (UNGASS) which now includes a representative from the 
previously excluded Treatment Action Campaign (TAC).  The 
Health Department extended an invitation to Sipho Mthathi, the 
secretary-general of TAC.  Earlier the Health Department said 
 
SIPDIS 
that the TAC would not be invited because of a concern over 
TAC's position on the government's HIV program, sparking 
criticism from AIDS activists.  TAC announced that it will not 
be part of the official South African delegation because of the 
exclusion of the Aids Law Project, another non-governmental 
organization associated with the University of Witwatersrand 
and focuses on human rights developments of HIV/AIDS in South 
Africa.  The Health Department objected to the accreditation of 
both TAC and ALP because they felt that these organizations 
would only disparage government policies.  Source:  Reuters IOL 
April 13; The Sunday Independent, April 16; Cape Times and Cape 
Argus, April 20. 
 
South African Women to test New Microbicides that Reduce HIV 
Transmission 
--------------------------------------------- --------------- 
 
¶7.  More than 5,000 Durban women have volunteered for the 
world's largest microbicides clinical trials that will test its 
efficacy.  Microbicides are products that are applied to the 
vagina to reduce HIV transmission during sexual intercourse and 
can take the form of a gel, cream, suppository or sponge that 
contains an active ingredient which can kill or inactivate HIV 
cells.  Six clinical efficacy trials are being conducted in 
Africa, India and the United States, four of which are underway 
in South Africa.  Microbicides can help women who do not have 
the power to negotiate condom use with their partners.  The 
major route of HIV transmission in sub-Saharan Africa is 
through heterosexual contact.  The first set of results should 
be available by late 2008, and the second set of results by 
late 2009 or early 2010.  Source:  Health Systems Trust and The 
Mercury, April 12. 
 
South African Contributions to ARV Side Effects Research 
--------------------------------------------- ----------- 
 
¶8.  Now that antiretroviral therapy is available on a large 
scale, and across a wide range of populations in Africa and 
Asia, evidence is beginning to emerge about the variations in 
 
PRETORIA 00001657  003 OF 005 
 
 
side-effects and tolerability between different populations. 
Drug toxicity is one of the major obstacles to good adherence, 
so observation of toxicity, education of patients and timely 
response to their concerns is a necessary part of HIV 
management.  Toxicities most commonly reported in cohort 
studies from resource-limited settings include:  (1) Peripheral 
neuropathy (damage to the nerves in the feet and legs, caused 
by d4T, universally reported as the most common serious 
toxicity); (2) Lactic acidosis (a build-up of lactate in the 
body); (3) Rash (caused by nevirapine); (4) Anemia (caused by 
zidovudine (AZT)) and (4) Lipoatrophy (loss of fat from the 
limbs and face, chiefly caused by d4T, more prominently a 
problem in reports from Rwanda and India than from Uganda, 
South Africa or Kenya). 
 
South African Studies on Side Effects 
------------------------------------- 
 
¶9.  Peripheral Neuropathy 
In Khayelitsha, South Africa, a study of 1,700 patients treated 
for up to 36 months found that the rate of switching from d4T 
due to peripheral neuropathy was 17 cases per 1,000 years of 
patient follow-up.  These rates are similar to those seen in 
the developed world.  Neuropathy may be more likely when d4T 
and isoniazid are used together - which is an argument for 
closer communication between the TB and HIV clinic, and also a 
cause for concern as more patients on ART are put on isoniazid 
preventative therapy for latent TB. 
 
¶10.  Lactic acidosis 
Lactic acidosis is the condition caused by over accumulation of 
lactate in the bloodstream and tissues, which the body is 
unable to clear.  In South Africa, lactic acidosis is more 
common.  A South African study found that lactic acidosis is 
occurring at an unusually high frequency in patients receiving 
either d4T or AZT-based antiretroviral therapy.  The South 
African study found an incidence of 15 cases per 1000 years of 
patient follow-up (almost as high a frequency as that reported 
for peripheral neuropathy in the same study).  The risk of 
developing lactic acidosis seemed to be greater in women with a 
higher body weight - which is much more common in South Africa 
than in most other settings.  Multivariate analysis found that 
women weighing 75 kilograms or more had an adjusted hazard 
ratio (AHR) of 25 for lactic acidosis when compared with males, 
while women weighing between 60 and 75 kilograms had an AHR of 
5.6 for lactic acidosis. 
 
¶11.  Rash 
Severe rash is a potential side effect of nevirapine.  It 
occurs during the first month of treatment in 16-20% of 
patients, but is usually mild and self-limiting, passing within 
a few weeks.  Its frequency does not appear to be any greater 
in African populations than in developed world cohorts.  In the 
Khayelitsha study, 8.9% of patients had switched from 
nevirapine after 24 months of treatment.  Most switches from 
nevirapine occurred in the first six months of treatment. 
 
¶12.  Anemia 
Anemia is a frequent condition in resource-limited settings and 
is a major risk factor for death in the first year of 
treatment.  Anemia can also be caused or worsened by AZT.  The 
Khayelitsha study, in which AZT was used as the basis of a 
first-line regimen in the early years of treatment, found that 
8.2% of AZT-treated patients had switched from the drug after 
24 months of treatment, 82% of whom switched due to anemia. 
Source:  HIV &AIDS Treatment in Practice, April 13. 
 
South African Health Worker Shortage 
------------------------------------ 
 
¶13.  The World Health Organization's World Health Report 2006 
revealed that 37% of doctors trained in South Africa are 
working in either Australia, Canada, Finland, France, Germany, 
Portugal, the United Kingdom or America.  South African trained 
nurses working in these countries made up 13,496 of the local 
workforce of 184,459.  Both the South African doctor and nurse 
migration figures were higher that any of the other sub-Saharan 
countries.  The report also revealed that South Africa has 
35,000 registered nurses who are either inactive or unemployed 
despite 32,000 vacancies. Many of these nurses are thought to 
be working in non-nursing occupations.  According to the WHO 
 
PRETORIA 00001657  004 OF 005 
 
 
report, more than four million additional doctors, nurses, 
midwives, managers and public health workers are urgently 
needed to fill the gap in 57 countries, 36 of which are in sub- 
Saharan Africa.  According to South African research, nurses 
working in maternal health services were asked about the most 
important characteristics of the workplace and presented with 
16 theoretical workplace profiles.  The most significant 
finding was that nurses ranked good management, including 
clearly defined responsibilities, supportive attitude when 
mistakes are made and reward for ability, not length of 
service, higher than improved salaries, unless the remuneration 
was dramatically higher.  A recent study from Cameroon, South 
Africa, Uganda and Zimbabwe points to both push and pull 
factors being significant.  Workers' concerns about lack of 
promotion prospects, poor management, heavy workload, lack of 
facilities, a declining health service, inadequate living 
conditions and high levels of violence and crime are among the 
push factors for migration.  Prospects for better remuneration, 
upgrading qualification, gaining experience, a safer 
environment and family-related matters are among the pull 
factors.  Source:  Health E-News, April 10. 
 
Outline of Health Human Resource Plan 
------------------------------------- 
 
¶14.  The Health Department released its human resource plan 
designed to address the shortage of health care workers in 
South Africa.  The human resource plan focuses attention on 
training and has set targets for increased health professionals 
working in the public sector by areas of specialization.  By 
2009, the planned targets are:  (1) to double the number of 
clinical psychologists to 150; (2) to almost double the number 
of professional nurses to 3,000, up from 1,896; (3) to increase 
the number of nursing assistants to 10,000 from 7,368.  By 
2010, the number of pharmacists trained annually should reach 
600 from 400 trained currently.  By 2014, the number of trained 
doctors should reach 2,400.  In addition, a staff retention 
policy based on better pay, a package of incentives and 
improved working conditions will help prevent trained health 
professionals from taking better jobs overseas after 
graduation.  Foreign health professionals will be used as a 
last resort.  The Health Department plans to use foreign 
workers primarily through government-to-government agreements 
as it had with Cuba, and it will not actively recruit people 
from African countries.  In addition, employment contracts for 
foreign health professionals will be a maximum of three years 
and be non-renewable.  Source:  Health-e News and Pretoria 
News, April 7. 
 
Eastern Cape MEC Replaced 
------------------------- 
 
¶15.  Eastern Cape Health MEC Dr Bevan Goqwana was fired as a 
result of long standing inadequacies in the Eastern Cape health 
system.  Under his tenure, the provincial health department 
failed to properly account for R18.1 billion out of a total 
budget of R22.6 billion.  The Public Service Accountability 
Monitor (PSAM), an independent monitoring and research 
institute based at Rhodes University, cited critical staff 
shortages, severe under spending, dilapidated hospitals and 
crumbling infrastructure, corruption charges, shortages of 
essential medical equipment and medicine as some of the 
characteristics of Goqwana's tenure as Eastern Cape's Health 
MEC since 1999.  Under Goqwana the health department has 
received five audit disclaimers between 2000 and 2005.  During 
his tenure, Goqwana was involved in corruption charges leading 
to nine months fully paid leave.  He was investigated by the 
Public Protector over allegations that he owned a private 
specialist practice and an ambulance service while in public 
office.  He faced over a thousand fraud charges in 2002. He was 
found not guilty on all charges.  In the last study that PSAM 
conducted it indicated that the Eastern Cape had one medical 
specialist for every 47,529 people, one professional nurse for 
every 1,278 patients, one pharmacist for every 53,662 people 
and one occupational therapist for every 554,507 people. 
Source:  Health E-News, April 10; Business Day, April 12. 
 
South African Birth Defects 
--------------------------- 
 
¶16.  According to a March of Dimes report on birth defects, 
 
PRETORIA 00001657  005 OF 005 
 
 
58,000 South African children are born with a serious genetic 
birth defect and another 14,000 born with fetal alcohol 
syndrome.  Professor Christianson, a clinical geneticist at 
Wits University, was the co-author of the "March of Dimes 
global report, and views teaching and training of primary care 
practitioners as the major challenge to reducing overall South 
African birth defects, as most defects in South Africa may be 
prevented.  According to Christianson, for children or people 
with birth defects, care is an absolute, prevention is the 
ideal.  Syphilis and fetal alcohol syndrome can be prevented. 
Increased education of primary health care workers as well as 
the population is needed.  Source:  Health E News, April 13. 
 
SA Highest Rate of Femicide 
--------------------------- 
 
¶17.  South Africa has the world's highest rate of female 
homicide (femicide) by an intimate partner, with a woman being 
killed every six hours by her partner, according to a Medical 
Research Council (MRC) report.  According to Dr Naeemah 
Abrahams from the MRC, females accounted for a third of all 
homicides globally, with a rate of four deaths per population 
of 100,000.  In 50.3% of cases the perpetrator was found to be 
an intimate partner. The femicide rate in South Africa was much 
higher, with about 28 such cases per 100,000, compared to about 
three per 100,000 in the U.S.  Statistics showed that the 
Western Cape had the highest number of femicide cases per 
100,000, with about 37 deaths, and KZN the lowest, with 21 
deaths.  Women between the ages of 14 and 29 accounted for 
about 39% of femicides, and African women accounted for about 
78%.  Almost 61% of femicides took place at the women's homes. 
Of those women killed in 1999, 33% were killed with a firearm, 
and about 50% were at the hands of an intimate partner.  About 
11% of the perpetrators died after the murder, most commonly by 
suicide.  Source:  IOL, April 5. 
 
SA to Develop New Malaria Drug 
------------------------------ 
 
¶18.  The Medical Research Council (MRC) has developed a drug to 
treat malaria using extracts from an indigenous plant of the 
Asteraceae family and is now seeking a partner to commercialize 
the drug.  Gilbert Matsabisa, the MRC's director of indigenous 
knowledge systems, said tests had shown promising results, 
indicating that the drug could eradicate the malaria infection 
from the bloodstream.  Matsabisa said the plant was indigenous 
to sub-Saharan Africa and was concentrated in central South 
Africa up to Zimbabwe and Zambia.  The Asteraceae family has 
more than 25,000 species worldwide with more than 2,300 species 
in southern Africa.  It is commonly known as the aster, daisy 
or sunflower family.  Well-known medicinal plants in this 
family include the African wormwood and the wild camphor bush. 
The MRC will not issue licenses but intends to retain the 
intellectual property in South Africa.  Matsabisa said the MRC 
had applied for a worldwide patent on the drug and wanted to 
develop it in South Africa.  Source:  Business Report, April 
¶19. 
 
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