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RUEAIIA/CIA WASHINGTON DC
RUCPDC/DEPT OF COMMERCE WASHDC

UNCLAS SECTION 01 OF 07 PRETORIA 000001 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
FOR CONGRESSWOMAN JOHNSON AND DELEGATION FROM AMBASSADOR 
ERIC BOST 
 
E.O. 12958: N/A 
TAGS: ECON SENV PREL PGOV SF
SUBJECT: SCENE-SETTER FOR CODEL LED BY CONGRESSWOMAN EDDIE 
BERNICE JOHNSON 
 
 
¶1. (SBU) I warmly welcome the visit of your congressional 
delegation to South Africa.  My staff and I stand ready to do 
everything we can to make your trip a success.  You are 
visiting South Africa at a particularly interesting time, 
only two weeks after Jacob Zuma defeated incumbent Thabo 
Mbeki as leader of the ruling African National Congress 
(ANC).  Because the ANC has overwhelming support in the 
country (70 percent in the last election), Zuma is now the 
leading candidate to become the next national president 
following parliamentary elections expected in March/April 
¶2009.  However, the December 28 indictment of Zuma on 
corruption and fraud charges complicates his political 
future.  Zuma,s trial is scheduled to begin August 14, 2008, 
and a conviction would derail his bid for the national 
presidency.  With Zuma in charge of the ruling party, his 
rival Mbeki in control of government, and the court case 
looming, the upcoming year will test South Africa,s young 
democracy. 
 
¶2. (SBU) South Africa is an anchor country in U.S. Africa 
policy.  Since the end of apartheid in 1994, the ANC-led 
South African Government (SAG) has made major progress toward 
establishing a vibrant democracy and market-based economy. 
The SAG has focused on political and economic transformation: 
 closing the gap between the historically privileged and 
disadvantaged communities -- primarily through 
government-provided housing, electricity, and water to the 
poor -- and creating employment and business opportunities. 
South Africa, however, continues to face daunting challenges, 
including skills shortages in all sectors of the economy, 
growing infrastructure bottlenecks, income inequality between 
haves and have-nots, massive unemployment, entrenched poverty 
in both rural and urban areas, violent crime, and a severe 
HIV/AIDS pandemic.  These problems are intensifying political 
tensions within the ANC-led ruling coalition.  The tense 
debate at the party's December 16-20, 2007 national 
conference and defeat of incumbent Mbeki reflected the 
growing impatience with the pace of socio-economic change. 
 
¶3. (SBU) Despite its challenges, South Africa remains the 
continent's best prospect for establishing a successful 
democratic society with widespread prosperity.  South Africa 
plays a key role in promoting peace and stability in Africa, 
and is an important voice on global trade and 
nonproliferation issues.  U.S.-South African relations are 
stable, as reflected by President Bush's July 2003 visit to 
South Africa and President Mbeki's June 2005 and December 
2006 trips to Washington.  We share objectives on the African 
continent and work together closely on many of them. 
 
------------------ 
POLITICAL OVERVIEW 
------------------ 
 
¶4. (SBU) The African National Congress (ANC) dominates the 
political scene in South Africa.  The ANC won 70 percent of 
the vote, and 279 of 400 seats in the National Assembly in 
the April 14, 2004 elections.  Subsequent "floor crossing" 
periods, in which parliamentarians were allowed to switch 
parties, boosted the ANC's total to 297.  The ANC also won 66 
percent of the vote nationally in the March 2006 local 
elections.  The Democratic Alliance (DA) is the largest of 
several opposition parties in parliament, with 47 seats.  The 
Qseveral opposition parties in parliament, with 47 seats.  The 
ANC leads the administrations in all nine of South Africa's 
provinces and in the vast majority of its municipalities. 
The most visible exception to this country-wide ANC 
domination is the DA's control of the Cape Town municipality 
where there have been multiple attempts to unseat the DA-led, 
multi-party municipal government. 
 
¶5. (SBU) The recently-concluded December 16-20 ANC National 
Conference in Polokwane, Limpopo significantly shifted power 
within the ruling party.  New ANC President Jacob Zuma 
defeated incumbent, national President Thabo Mbeki, by a vote 
of 2,329 to 1,505.  Zuma,s allies swept the other top five 
leadership positions.  The Zuma camp also dominated the 
elections for the ANC,s 86-member National Executive Council 
(NEC), with sixteen Mbeki Cabinet members (out of 28) losing 
their NEC seats.  While Zuma,s victory makes him the 
frontrunner to become national President following the 2009 
 
PRETORIA 00000001  002 OF 007 
 
 
parliamentary elections, the December 28 indictment of Zuma 
on corruption and fraud charges complicates Zuma,s political 
future.  Zuma,s political allies have alleged that the 
corruption case is politically-motivated, a charge 
prosecutors and Mbeki strongly deny.  Zuma has stated he will 
step down as ANC President if convicted.  If convicted and 
sentenced to more than 12 months imprisonment, Zuma would be 
constitutionally prohibited from running in the 2009 
parliamentary elections, effectively blocking his succession 
to the national presidency. 
 
¶6. (SBU) It is too soon to tell whether the dramatic events 
at the ANC National Conference will result in any significant 
changes in South African Government policy.  Mbeki remains in 
control of the government until 2009, and the ANC conference 
policy resolutions did not advocate any sweeping changes. 
New ANC President Zuma has stressed that he will not make any 
radical shifts and would respect the party,s previous policy 
statements.  However, many of the new ANC leaders - and 
Zuma,s strongest supporters - come from the left wing of 
South African politics.  The Congress of South African Trade 
Unions (COSATU) and South African Communist Party (SACP), 
formally members of the ANC-led tripartite alliance, will 
likely pressure Zuma to embrace more leftist or perhaps even 
populist positions.  On issues like HIV/AIDS and Zimbabwe, 
this could lead to SAG policies more closely in line with 
U.S. interests, although on other issues like fiscal 
management and trade liberalization the shifts in policy 
might be less positive from a U.S. perspective. 
 
------------------------------------------ 
FOREIGN POLICY - FOCUS ON PROMOTING AFRICA 
------------------------------------------ 
 
¶7. (U) South Africa has taken a high-profile role in 
promoting Africa's development.  South Africa served as the 
first chair of the African Union until July 2003 and helped 
establish continental institutions such as the Pan-African 
Parliament (which sits in South Africa) and the AU Peace and 
Security Council.  President Mbeki is the driving force 
behind the New Partnership for Africa's Development (NEPAD), 
an African-developed program to strengthen economic and 
political governance across the continent and a framework for 
productive partnership with the international community. 
 
¶8. (SBU) South Africa recognizes that, by virtue of its 
regional political, economic, and military clout, it has a 
responsibility to participate in conflict resolution and 
peace support operations.  South Africa played a leading role 
in negotiations that ended the conflicts in Burundi and the 
Democratic Republic of Congo.  Approximately 3,000 personnel 
are deployed in UN, African Union and bilateral peace support 
operations in Sudan, Burundi, DRC, Ethiopia/Eritrea, and 
Comoros.  While the U.S. has a strong policy interest in 
seeing South Africa expand and enhance its peace support 
capabilities, our ability to support these efforts has been 
limited by the suspension of FMF military assistance because 
of the lack of an Article 98 agreement with South Africa. 
South Africa participates in the African Contingency 
Operations Training and Assistance program (ACOTA) to enhance 
the capacity of the South African National Defence Force 
Qthe capacity of the South African National Defence Force 
(SANDF) for participation in multilateral peace support 
operations. 
 
¶9. (SBU) Zimbabwe remains a continuing challenge and 
increasing concern for South Africa.  In March 2007, regional 
SADC leaders appointed Mbeki as official mediator between 
Zimbabwean President Robert Mugabe and the opposition 
Movement for Democratic Change (MDC) with the goal of 
leveling the playing field in advance of 2008 elections. 
Negotiations are ongoing and have made some progress, but 
human rights abuses against the opposition continue.  Mugabe 
has shown little willingness to open the political 
environment and allow free and fair elections.  While South 
Africa wants political and economic reform in Zimbabwe, SAG 
officials argue that additional pressure, such as public 
criticism or additional sanctions, would have little effect 
on President Mugabe and could destabilize Zimbabwe with 
spillover effects in South Africa.  South Africa already 
hosts between 1 and 2 million Zimbabwean refugees. 
 
PRETORIA 00000001  003 OF 007 
 
 
 
¶10. (SBU) Overall U.S.-South African relations are positive, 
but South Africa sometimes takes positions on global issues 
that run counter to U.S. interests.  As a non-permanent UN 
Security Council member, and former chair of the G-77 and the 
Non-Aligned Movement (NAM), South Africa has taken up the 
cause of a greater "South" voice in international 
institutions, increased development assistance, an expanded 
UN Security Council, and lower trade barriers (for 
manufactured and agricultural exports to developed countries). 
 
----------------------------------------- 
THE ECONOMY AND THE STRUGGLE TO TRANSFORM 
----------------------------------------- 
 
¶11. (SBU) As the dominant and most developed economy in 
sub-Saharan Africa, South Africa is markedly different from 
other countries of the region.  It is a middle income, 
emerging market economy with GNI per capita of $5,209 (2006), 
akin to Chile, Malaysia, or Thailand.  The South African 
government's fiscal and monetary policies are excellent.  The 
ANC government steadily reduced the fiscal deficit from 
nearly 6 percent of GDP in 1994-95 to a small surplus (0.3 
percent of GDP) in 2006-07.  The South African Reserve Bank 
(SARB) is independent and committed to CPIX inflation (CPI 
excluding mortgage interest costs) within a target band of 
3.0 to 6.0 percent.  Inflation fell from 12.4 percent at the 
beginning of 2003 to 4.8 percent in June 2006, but has 
recently crept back up to 7.9 percent (November 2007).  Real 
GDP growth in 2006 fell slightly to 5.0 percent from 5.1 
percent in 2005.  The South African Department of Finance 
expects growth to slow to 4.9 percent in 2007 and 4.5 percent 
in 2008. 
 
¶12. (SBU) South Africa's single greatest economic challenge 
is to accelerate growth.  GDP growth averaged 3.0 percent per 
year between 1994 and 2004, and was not sufficient to address 
widespread unemployment and reduce poverty.  The official 
unemployment rate, currently 25.5 percent, has only recently 
begun to decline, and is significantly higher among black 
South Africans than among whites.  Income inequality between 
haves and have-nots remains high.  Poverty is widespread. 
Fifty-six percent of black South Africans, but only four 
percent of whites, live in poverty.  Nevertheless, the 
government has made strides in the areas of transfer payments 
and public services to close the gap.  Nearly 1.9 million 
low-cost homes have been built to provide shelter to 7.6 
million people, 3.5 million homes have been provided with 
electricity, and nine million people have been connected to 
clean water.  Almost twelve million people were benefiting 
from social grants in 2006 (compared to the country's five 
million individual taxpayers).  The government's broad-based 
Black Economic Empowerment (BEE) program provides ownership 
and employment opportunities to blacks and has helped the 
black middle class double to an estimated two million since 
¶1994.  The black middle class now exceeds the size of the 
white middle class and is driving consumer demand. 
 
¶13. (U) The success in preparing for and carrying off the 
FIFA 2010 Soccer World Cup to be held in South Africa is 
regarded by many as a bellwether of the country's commitment 
to continued progress in a variety of social and economic 
Qto continued progress in a variety of social and economic 
areas, among these being the fight against crime, expanding 
and improving infrastructure, providing services, and 
developing tourism. 
 
--------------------------------------------- ----------- 
Environment, Science and Technology - A Delicate Balance 
--------------------------------------------- ----------- 
 
¶14. (U) South Africa currently spends 0.6 percent of its GDP 
on science and technology and the South African government 
wants to increase that figure to 1.0 percent within the next 
five to ten years.  South Africa has channeled its S&T focus 
in the last decade, concentrating on science for development 
and on areas of traditional strength, such as paleontology, 
astronomy, social science and biodiversity. 
 
¶15. (U) The Department of Science and Technology (DST) is the 
major funder of S&T research, including most S&T 
 
PRETORIA 00000001  004 OF 007 
 
 
infrastructure projects, such as the Hermanus Magnetic 
Observatory.  The National Research Foundation (NRF), a DST 
agency, provides funding for research and for students. 
Research Councils throughout the country fund specialized 
research and student scholarships.  NRF has just completed a 
major strategic planning exercise and is focusing its efforts 
on: research and innovation; astro/space/geoscience 
infrastructure; biodiversity/conservation infrastructure, 
including the South African Environmental Observatory Network 
(SAEON); and nuclear science. 
 
¶16. (U) Capacity building remains a major challenge.  The NRF 
has instituted a new program aimed at increasing the number 
of PhDs fivefold by 2018.  Nevertheless, a lack of capacity 
continues to hamper scientific research.  Scientists across 
the country also note that the lack of broadband and other 
computing connections impede scientific advancement. 
 
¶17. (U) South Africa remains committed to conservation and is 
a recognized world leader in wildlife management.  For 
example, South Africa's elephant herds are so numerous that 
the government recently announced that culling might become 
necessary.  Major conservation NGOs such as the World 
Wildlife Fund/South Africa and TRAFFIC supported this 
decision because the South African government's management 
and decision-making policies are science-based and 
transparent.  However, economic and social pressures can play 
a role in environmental decisions.  The government recently 
rescinded a ban on endangered abalone fishing after numerous 
protests from disadvantaged fishing communities. 
 
¶18. (U) The Department of Environment and Tourism Affairs 
(DEAT) walks a delicate balance between promoting climate 
change/adaptation policies and advocating economic growth. 
South Africa would like to play a role as a green leader 
within the developing world.  However, it recognizes that its 
coal-based energy systems (95 percent of the country's 
electric power comes from coal-fired power stations) preclude 
certain decisions/actions.  With the past 10 years, South 
Africa has enacted a series of well-regarded environmental 
laws, many based on U.S. EPA criteria or standards and on 
principles found in international agreements.  Over the past 
four years, South Africa has begun to enact implementation 
legislation to enforce these statutes.  One key enforcement 
tactic has been the establishment of the Environmental 
Management Inspectorate (EMI) also known as the "Green 
Scorpions".  Prosecutors from the U.S. Department of Justice 
and investigators from the U.S. Environmental Protection 
Agency (EPA) developed and presented training programs for 
the initial cadre of EMIs.  That program has now been 
replicated throughout the country and EMIs are found not only 
at the national level, but also in provincial and 
metropolitan environmental agencies. 
 
--------------------------------------------- ----- 
TRANSPORTATION - WELL DEVELOPED, RELIANCE ON STATE 
--------------------------------------------- ----- 
 
¶19.  (U) South Africa's transport infrastructure is well 
developed and is the best in Africa.  There are sizeable and 
efficient ports, a road network that is mostly excellent, and 
good air links, particularly to Europe and the U.S., and 
Qgood air links, particularly to Europe and the U.S., and 
increasingly to Asia and the rest of Africa.  The network of 
rural secondary roads is less well developed.  Transport 
policy has led to a shift from rail to road since the 
liberalization of transport in the mid-1980's and a relative 
lack of investment in rail.  Lack of control over 
heavy-vehicle overloading has led to significant damage to 
the road network and substantial backlogs in maintenance. 
 
¶20.  (U) State-owned Transnet owns and operates port 
facilities, including the Port of Durban, the largest in 
Africa.  Transnet Freight Rail (formerly known as Spoornet) 
runs an extensive rail network, including spurs to transport 
coal from Mpumalanga coal-fields to the Richards Bay Coal 
Terminal and iron ore from the Western Cape to the coast at 
the port of Saldanha.  The government has not allowed private 
investment in rail lines.  There has been substantial 
under-investment in locomotives and rolling stock.  South 
Africa Airways has direct flights to the U.S., Europe, and 
 
PRETORIA 00000001  005 OF 007 
 
 
Asia, and is a world-class airline.  It cannot effectively 
position itself as an international hub, because of its 
location at the end of the African continent, so it has 
focused more recently on travel within Africa. 
 
------------------------------ 
KEY SECTORS - WATER AND ENERGY 
------------------------------ 
 
¶21.  (U)  South Africa is a water-scarce country given that 
much of the country is semi-arid, but nevertheless subject to 
periodic flooding.  South Africa's water policy is based on 
managing scarce water resources to ensure that water is used 
to support equitable and sustainable social and economic 
transformation.  The government aims to ensure provision of 
water services - potable water and safe sanitation - to all 
people, but especially to the poor and previously 
disadvantaged.  The National Water Act of 1998 transformed 
the way water is controlled, from a system of rights based on 
land ownership to a system designed to allocate water 
equitably, efficiently, and sustainably in the public 
interest.  The National Water Resource Strategy targets 
progressive decentralization of responsibility and authority 
for water resources management to catchment management 
agencies and local water user associations. 
 
¶22.  (SBU) South Africa now faces electricity supply 
shortages and load-shedding, given strong demand growth and 
delays in the government planning for addition of sufficient 
new supply.  State-owned electricity supplier Eskom has now 
embarked on the building of new coal-fired plants.  The 
Government has undertaken a plan to diversify its energy mix 
by greatly expanding its portfolio of nuclear power plants. 
Westinghouse and Areva of France are competing for up to 
20,000 MW of new nuclear build over the next twenty years. 
The Government seeks to augment use of renewable energy and 
energy efficiency.  South Africa is a significant oil 
importer and has built up a significant coal-to-liquids 
techology capability to reduce its reliance on oil imports. 
Automobiles in the interior of South Africa run on 
coal-drived fuel. 
 
----------------------------- 
U.S. SUPPORT FOR SOUTH AFRICA 
----------------------------- 
 
¶23. (U) Since 1994, the United States Government has 
contributed approximately $1.217 billion toward South 
Africa's development, plus $201 million in credit guarantees. 
 Currently, our development assistance program focuses on 
HIV/AIDS and strengthening the healthcare system, addressing 
unemployment through job-skills training and education, 
creating models for efficient service delivery, and reducing 
gender-based violence as part of the President's Women's 
Justice and Empowerment Initiative (WJEI).  A wide range of 
U.S. private foundations and NGOs are also at work in South 
Africa.  Among them are the Gates Foundation (HIV/AIDS), the 
Ford Foundation (higher education), and the Rockefeller 
Foundation (adult education). 
 
¶24. (U) Twenty-eight U.S. government entities are represented 
at the U.S. Mission in South Africa (Embassy Pretoria and the 
three Consulates in Cape Town, Durban, and Johannesburg). 
The Mission has 281 U.S. employees and 564 local employees. 
More than 40 percent of Mission staff provide regional 
services to other U.S. embassies in Africa.  The Mission has 
Qservices to other U.S. embassies in Africa.  The Mission has 
embarked on an ambitious program to build safe office 
facilities.  In FY 2005, the Mission completed the new 
Consulate compound in Cape Town, and in FY 2006 broke ground 
on a new Consulate building in Johannesburg.  In FY 2009, the 
Mission intends to break ground on a new 155-desk office 
annex in Pretoria. 
 
------------------------------ 
U.S.-S.A. TRADE AND INVESTMENT 
------------------------------ 
 
¶25. (SBU) U.S.-South Africa trade grew 23 percent in 2006, 
totaling $11.7 billion.  U.S. exports were up 16 percent at 
$4.2 billion, while South African exports to the United 
 
PRETORIA 00000001  006 OF 007 
 
 
States increased 28 percent at $7.5 billion.  In 2006, South 
Africa was the 37th largest trading partner of the United 
States, equivalent to Turkey or Chile.  It is the largest 
U.S. export market in sub-Saharan Africa, twice the size of 
Nigeria and equal to Russia or Argentina.  South Africa was 
the third largest beneficiary of AGOA in 2006, and the 
largest beneficiary of non-oil exports.  Its AGOA exports 
totaled 21 percent of the country's total exports in 2006. 
An impressive 99.6 percent of South Africa's exports entered 
the U.S. with zero import duties in 2005 as a result of 
normal trading relations (NTR), GSP and AGOA benefits.  Only 
0.4 percent of the value of South Africa's exports to the 
U.S. was subject to duty, or $26 million out of $5.9 billion 
in exports in 2005.  The U.S. also became South Africa's 
largest export market in 2007.  Over 600 U.S. firms have a 
presence in South Africa with 85 percent using the country as 
a regional or continental center.  South Africa's stable 
government, sound fiscal and monetary policy management and, 
by African standards, its large market are the primary 
attractions for U.S. businesses.  South Africa has, however, 
failed to attract a proportionate share of foreign direct 
investment since 1994.  Reasons include: slow growth, high 
unit labor costs, crime, regulatory uncertainty and the 
impact of Black Economic Empowerment policies, labor 
regulations, HIV/AIDS, and the slow process of privatization. 
 The U.S. was the largest portfolio investor and the second 
largest foreign direct investor in South Africa ($5.1 billion 
at year-end 2005). 
 
¶26. (SBU) Following six rounds of negotiations over three 
years, the U.S. and the Southern African Customs Union (SACU: 
 South Africa, Botswana, Lesotho, Namibia, and Swaziland) 
agreed in April that they could not conclude negotiations on 
a free trade agreement (FTA) by their target date of December 
¶2006.  Negotiators subsequently agreed to deepen the 
bilateral relationship through a Cooperative Agreement on 
Trade, Investment and Development (TIDCA).  Negotiations are 
currently underway for the signing of a framework agreement 
for the TIDCA. 
 
-------------------------------------- 
HIV/AIDS: A CRISIS OF EPIC PROPORTIONS 
-------------------------------------- 
 
¶27. (U) South Africa has the largest mumber of HIV-infected 
citizens in the world and HIV/AIDS is the country's leading 
cause of death.  South Africa has a generalized, mature HIV 
epidemic and HIV-related care and treatment services are 
required across the population.  An estimated 5.5 million 
South Africans are HIV-positive, including 2.9 million women 
and approximately 300,000 children aged 14 or less.  An 
estimated 18.8 percent of the adults between 15 and 49 are 
infected.  Women in the age group 25-29 are the most 
seriously affected, with prevalence rates of up to 40 
percent.  In 2005, an estimated 800,000 more citizens became 
infected and in 2006, 346,000 adults and children died from 
AIDS.  An estimated 3.5 million children, or 18.6 percent of 
South Africa's children, have had at least one parent die. 
Sixty-six percent of these children had been orphaned as a 
result of AIDS.  The number of AIDS-related deaths since the 
start of the epidemic is estimated at 1.8 million, with 71 
Qstart of the epidemic is estimated at 1.8 million, with 71 
percent of all deaths in the 15-41 year old age group being 
due to AIDS.  Continued AIDS-related mortality will create 
millions of new orphans and generate additional social and 
economic disruption, including orphans being raised by 
extended family members or in child-headed households. 
 
¶28. (U) In April 2007, the South African Government released 
its National Strategic Plan for HIV, AIDS, & Sexually 
Transmitted Infections (STIs) for 2007-2011 (NSP).  The NSP 
has the goal of reducing new HIV infections by 50 percent by 
2011 and also aims to boost provision of anti-retroviral 
treatment (ART) in South Africa.  However, South African 
public health facilities suffer from an acute shortage of 
skilled personnel and laboratory and clinical infrastructure. 
 Considerable investment in human resources and 
infrastructure is necessary to meet the NSP's national 
anti-retroviral treatment targets.  Approximately 230,000 
people were receiving anti-retroviral (ARV) treatment as of 
2006, while a further 540,000 people needed, but were not 
 
PRETORIA 00000001  007 OF 007 
 
 
receiving, treatment.  The Global Fund has provided major 
grants to the Western Cape Health Department and a 
public-private consortium in KZN. 
 
¶29. (SBU) The President's Emergency Plan for AIDS Relief 
(PEPFAR) is in its fourth year of implementation working with 
public and private sector prevention, treatment, and care 
programs.  To date, the U.S. has provided $857.8 million 
through PEPFAR to support HIV/AIDS programs in South Africa, 
with an additional $590 million to be funded in FY 2008, 
making it the largest recipient of Emergency Plan resources. 
The Emergency Plan directly supported 172,400 people in ARV 
treatment through programs in all nine provinces as of June 
¶2007.  The USG PEPFAR team in South Africa includes U.S. 
Agency for International Development (USAID), Centers for 
Disease Control (CDC), Department of State, Department of 
Health and Human Services (HHS), Department of Defense, and 
Peace Corps.  The team works to ensure that the PEPFAR 
strategic plan is aligned with the goals of the NSP.  The 
South African military has expanded prevention programs and 
collaborates with the U.S. military and NIH on AIDS treatment 
research. 
 
¶30. (U) South Africa has the strongest research and training 
capacity of any country in the region, making it an important 
partner in the fight against HIV/AIDS.  USG agencies work 
with national and provincial health departments, the 
military, universities and NGOs to strengthen primary health 
care, prevention, disease surveillance and research. 
President Bush and President Mbeki confirmed a mutual 
commitment to expand HIV/AIDS collaboration, particularly 
through the Emergency Plan.  The U.S. Mission has prepared, 
in coordination with the government, a five-year strategic 
plan focused on treatment, prevention, palliative care, and 
the provision of care for orphans and other vulnerable 
children. 
 
¶31. (U) The epidemics of HIV and tuberculosis (TB) are 
interlinked.  TB is the most common infectious disease 
associated with HIV in sub-Saharan Africa and between 50 and 
88 percent of TB patients in Southern Africa are HIV 
positive.  A high overall prevalence rate for HIV and lack of 
continuity in treatment contributes to the increasing 
incidence of active TB disease, including multi-drug 
resistant (MDR) strains.  In conjunction with HIV, TB is 
linked to substantially higher fatality rates, even in the 
presence of effective TB chemotherapy. 
BOST