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UNCLAS SECTION 01 OF 07 PRETORIA 000584 
 
SIPDIS 
 
SENSITIVE 
SIPDIS 
 
FOR CONGRESSMAN FRANK AND DELEGATION FROM AMBASSADOR ERIC 
BOST 
 
E.O. 12958: N/A 
TAGS: ECON OTRA PGOV PREL SENV SF GH CV
SUBJECT: SCENE-SETTER FOR CODEL LED BY CONGRESSMAN BARNEY 
FRANK 
 
PRETORIA 00000584  001.2 OF 007 
 
 
¶1. (SBU) I warmly welcome the visit of your 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 a few months 
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 educational, skills development, 
employment and business opportunities.  South Africa, 
however, continues to face daunting challenges, including a 
lack of public sector operational capacity, a thirty percent 
shortfall in mid-to-upper level public sector managers, 
skills shortages in all sectors of the economy, growing 
infrastructure bottlenecks, energy shortages, income 
inequality between haves and have-nots, less than adequate 
educational opportunities, 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 and 
with other political, civil society and private sector 
groups.  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 
particularly for those who have not benefited sufficiently 
from the modest economic growth. 
 
¶3. (SBU) Despite its challenges, South Africa remains the 
continent's best prospect for establishing a successful 
democratic society with expanding prosperity.  South Africa 
is a leader of aid-recipient countries in their dialogue with 
donor nations, plays a key role in promoting peace and 
stability in Africa, and is an important voice on global 
trade, human rights, conflict resolution 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 common objectives on the African 
continent and beyond, and we work together 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 
Qpolitical 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 
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 by the ANC to unseat 
the DA-led, multi-party municipal government coalition. 
 
¶5. (SBU) The December 16-20, 2007 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 ANC 
leadership positions.  The Zuma camp also dominated the 
 
PRETORIA 00000584  002.2 OF 007 
 
 
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 
front-runner to become national President following the 2009 
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 
traditions, statements and consensus.  However, many of the 
new ANC leaders - and Zuma,s strongest coalition 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 in 
the interests of the poor and the working class.  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. It is also possible that the newly elected ANC 
leaders might be more seized with domestic rather than 
continental or global issues, which could alter the country's 
current activist role in international affairs. 
 
------------------------------------------ 
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 based on international best 
practices and continental peer review 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 African 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 
Qpersonnel are deployed in UN, African Union and bilateral 
peace support operations in Sudan, Burundi, DRC, 
Ethiopia/Eritrea, and Comoros.  The U.S. has a strong 
interest in seeing South Africa expand and enhance its 
peacekeeping and disaster assistance capabilities.  South 
Africa participates in the African Contingency Operations 
Training and Assistance program (ACOTA) to enhance the 
capacity of the South African National Defense Force (SANDF) 
for participation in multilateral peace support operations. 
We are using International Military Education and Training 
(IMET) funds to support professional military education and 
technical training of future military leaders and to assist 
the SANDF in improving management of its defense 
establishment.  In light of the January 2008 repeal of ASPA 
prohibitions on provision of military assistance, we hope 
soon to resume Foreign Military Financing (FMF) programs 
aimed at enhancing the South African Air Force's strategic 
airlift capability by funding C-130 annual maintenance, 
upgrades, technical support and flight simulator training. 
 
¶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 
 
PRETORIA 00000584  003.2 OF 007 
 
 
Zimbabwean President Robert Mugabe and the opposition 
Movement for Democratic Change (MDC) with the goal of 
leveling the playing field in advance of March 2008 
elections.  Negotiations 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 stability with reform in Zimbabwe, SAG 
officials argued that additional pressure, such as public 
criticism or additional sanctions, would have little positive 
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.  In the 
elections scheduled for March 2008, there is a limited 
possibility that the two challengers could attract sufficient 
support to erode Mugabe's ruling ZANU-PF overall majority in 
parliament.  However, it is not likely that the conditions 
for free and fair elections will be in place to produce a 
truly competitive poll.  Some critical analysts and observers 
contend that the election may have been stolen before any 
votes were cast. 
 
¶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 $5,670 (2007), 
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 of 0.6 
percent in 2006-07 and a projected 0.8 percent in 2007-08. 
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 8.8 
percent in January 2008.  Real GDP growth was 5.1 percent in 
¶2007.  The South African Department of Finance expects growth 
to slow to 4.0 percent in 2008-7 and 4.2 percent in 2009. 
However, this growth is measured against an increasingly 
strained energy supply which has led to power shortages. 
 
¶12. (SBU) South Africa's single greatest economic challenge 
is to accelerate growth.  GDP growth averaged 3.0 percent per 
year between 1994 and 2003 and 5.0 percent between 2004 and 
2007, but 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 
Qdecline, 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 2.5 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 12.4 million people were benefiting from 
social grants in 2007 (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 has expanded appreciably over the last 
year, increasing by 30 percent.  Of the approximately 48 
million person population, 6 million belong to the middle 
class, with 3.4 million being whites and 2.6 million being 
blacks.  Of course, with the white middle class migrating out 
in record numbers, and the black middle class growing 
 
PRETORIA 00000584  004.2 OF 007 
 
 
rapidly, the black middle class will continue to increase 
both in size and as a percent of the total middle class. 
 
¶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 
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 
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) walk 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.  In 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 
Qlaws, 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. 
 
------------------------------ 
KEY SECTORS - WATER AND ENERGY 
------------------------------ 
 
 
PRETORIA 00000584  005.2 OF 007 
 
 
¶19.  (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 sustainable 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. 
 
¶20.  (SBU) South Africa now faces electricity supply 
shortages and load-shedding, given strong demand growth and 
delays in the construction 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 power plants over the next twenty 
years.  The Government seeks to augment use of renewable 
energy and energy efficiency.  South Africa is a oil importer 
and has built up a significant coal-to-liquids technology 
capability to reduce its reliance on oil imports. 
Automobiles in the interior of South Africa run on 
coal-derived fuel. 
 
--------------------------------------------- ----- 
TRANSPORTATION - WELL DEVELOPED, RELIANCE ON STATE 
--------------------------------------------- ----- 
 
¶21.  (U) South Africa's transport infrastructure is 
well-developed and is the best in Africa.  There are sizable 
and efficient ports, a road network that is mostly excellent, 
and good 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. 
 
¶22.  (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 Richard's Bay Coal 
Terminal and iron ore from the Western Cape to 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 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. 
 
----------------------------- 
Q----------------------------- 
U.S. SUPPORT FOR SOUTH AFRICA 
----------------------------- 
 
¶23. (U) The United States Government has contributed 
approximately $1.2 billion toward South Africa's development 
since 1994, including $201 million in credit guarantees.  Our 
development assistance program currently focuses on 
strengthening the healthcare system, addressing unemployment 
through job-skills training and education, creating models 
for efficient service delivery, reducing gender-based 
violence as part of the President's Women's Justice and 
Empowerment Initiative (WJEI), and responding to HIV/AIDS 
through PEPFAR.  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 
 
PRETORIA 00000584  006.2 OF 007 
 
 
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 provides regional 
services 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 22 percent in 2007, 
totaling $14.3 billion.  U.S. exports were up 23 percent at 
$5.2 billion, while South African exports to the United 
States increased 22 percent at $9.1 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 2007, and the 
largest beneficiary of non-oil exports to the U.S under AGOA. 
 South Africa's AGOA exports totaled 25 percent of the 
country's total exports to the U.S. in 2007.  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 replaced Japan as the largest export 
market in 2007.  The U.S. is the third most important two-way 
trade partner, after Germany and China.  Over 600 U.S. firms 
have a presence in South Africa with 85 percent of these 
companies using the country as a regional or continental 
center.  South Africa's stable government, sound fiscal and 
monetary policy management and, by African standards, 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: high unit labor costs, labor regulations, skills 
shortages, crime, HIV/AIDS, regulatory uncertainty and the 
impact of Black Economic Empowerment policies.  The U.S. was 
the second largest portfolio investor and source of foreign 
direct investment in South Africa ($5.1 billion at year-end 
2005), after the U.K. 
 
¶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 2006 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). 
Discussions 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 number of HIV-infected 
Q27. (U) South Africa has the largest number 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 5.4 million 
South Africans are HIV-positive, including 2.7 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, 350,000 adults and children died from 
AIDS.  An estimated 2-3 million children, or approximately 15 
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 percent of all deaths in the 15-41 year old 
age group being due to AIDS.  Continued AIDS-related 
 
PRETORIA 00000584  007.2 OF 007 
 
 
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, and 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 
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 South Africa the largest recipient of Emergency Plan 
resources.  The Emergency Plan directly supported 204,692 
people in ARV treatment through programs in all nine 
provinces as of September 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 HIV and tuberculosis (TB) epidemics 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 a 
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 
Qlinked to substantially higher fatality rates, even in the 
presence of effective TB chemotherapy. 
BOST