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FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC PRIORITY 4892
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHUJA/AMEMBASSY ABUJA 1167
RUEHLS/AMEMBASSY LUSAKA 3642
RUEHMV/AMEMBASSY MONROVIA 0224
RUEHOS/AMCONSUL LAGOS 1273

UNCLAS SECTION 01 OF 07 PRETORIA 001396 
 
SENSITIVE 
SIPDIS 
 
FOR CONGRESSMAN BERMAN FROM AMBASSADOR BOST 
DEPT FOR H AMACDERMOTT, AF/S MARBURG 
DEPT PLEASE PASS TO HILL STAFFERS RKING, P-AMARSH, DBERAKA 
 
E.O. 12958: N/A 
TAGS: OREP AMGT PREL PGOV SF
SUBJECT: SCENE-SETTER FOR CODEL BERMAN'S JULY 1-6 VISIT TO 
SOUTH AFRICA 
 
REF: A. STATE 62586 
     ¶B. STATE 68515 
 
¶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 seven 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. 
 
¶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: 
reducing 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 and widespread 
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. 
The recent xenophobic and inter-ethnic violence -- which 
resulted in more than 60 deaths and tens of thousands of 
displaced persons around the country -- is also in large part 
a reflection of the growing restlessness and dissatisfaction 
with the ANC's inability to deliver a better life for 
everyone, especially when it comes to employment and housing 
(which was constitutionally promised to everyone). 
 
¶3. (SBU) Despite its many 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 objectives in common on 
the African continent and beyond, and we work closely 
together on many of them. 
 
------------------ 
POLITICAL OVERVIEW 
QPOLITICAL 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 
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 2007 ANC National Conference in 
 
PRETORIA 00001396  002 OF 007 
 
 
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 
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 
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.  However, with the slow movement 
of the judicial process, it is highly unlikely that Zuma,s 
trial will begin prior to the 2009 parliamentary elections, 
practically assuring that he will become South Africa,s next 
president. 
 
¶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,s 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, nationalization of industry/resource 
sectors, 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 reduce the country,s current activist 
role in international affairs. 
 
--------------------------------------------- ------------ 
APARTHEID ERA CRIMES AND VISA WAIVERS - A NEW WAY FORWARD 
--------------------------------------------- ------------ 
 
¶7. (SBU) Visa ineligibilities related to anti-apartheid 
activities pose a significant strain on the U.S.-S.A. 
bilateral relationship.  South African leaders routinely 
raise the frustration and humiliation they associate with 
trying to travel to the U.S. despite what have been good 
faith efforts by the Consular Bureau (CA) and others to 
expedite their travel.  These efforts include expedited 
Qexpedite their travel.  These efforts include expedited 
waivers of ineligibility, including a multi-year and 
multiple-entry waiver for highly regarded former President 
Nelson Mandela, facilitated personally by Secretaries Rice 
and Chertoff. Other high profile persons such as businessman 
and anti-apartheid activist Tokyo Sexwale have also been 
affected.  Legislation which placed high-level officials and 
heroes of the anti-apartheid movement into the category of 
"terrorist" undercuts our efforts to influence South African 
government policy on issues such as the designation of 
terrorist supporters and financiers at the United Nations 
Security Council. 
 
¶8. (U) On April 9, 2008, Secretary Rice spoke before a 
Congressional hearing regarding the visa waiver issue and 
advocated the need to change the legislation.  In May 2008, 
the House passed, and the Senate is currently considering, 
legislation lifting terrorism ineligibilities from certain 
South Africans.  The new legislation allows the flexibility 
to end visa ineligibilities for anti-apartheid activists 
whose only crime was fighting the odious apartheid regime. It 
is important to note that the ineligibilities stemmed not 
from membership in the ANC (they affected non-ANC members 
 
PRETORIA 00001396  003 OF 007 
 
 
also), but from activities occurring during the apartheid 
era. 
 
------------------------------------------ 
FOREIGN POLICY - FOCUS ON PROMOTING AFRICA 
------------------------------------------ 
 
¶9. (U) South Africa has taken a high-profile role in 
promoting Africa's development - the African Renaissance. 
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. These initiatives have not 
progressed beyond talk-shop stages and have not advanced to 
become effective mechanisms for development. 
 
¶10. (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 is playing a 
leading role in negotiations to end 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 the 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 Defence 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. 
 
¶11. (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 March 2008 
elections.  Negotiations made some progress, but human rights 
abuses against the opposition continued.  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 
Qeffect 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 
March 29, 2008 elections, the MDC won a small majority of 
seats in the Parliament, and its leader Morgan Tsvangirai 
officially won a majority of the vote (47 percent) but not 
enough to avoid a runoff with incumbent president Robert 
Mugabe.  Presidential runoff elections planned for June 27, 
2008 have been preceded by a terrible campaign of 
state-sponsored violence and intimidation that has undermined 
the prospects for a free and fair electoral contest.  Some 
critical analysts and observers contend that the election may 
have been stolen before any votes were cast.  As a result of 
the political instability, Tsvangirai dropped out of the race 
on June 22. 
 
¶12. (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 voice for the "South" relative to the 
 
PRETORIA 00001396  004 OF 007 
 
 
"North" in global finance, international institutions, 
increased development assistance, an expanded and reformed UN 
Security Council, and lower trade barriers (for manufactured 
and agricultural exports to developed countries). 
 
----------------------------------------- 
THE ECONOMY AND THE STRUGGLE TO TRANSFORM 
----------------------------------------- 
 
¶13. (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, but 
have been criticized as being too conservative by the 
increasingly influential COSATU, SACP, and ANC Youth League. 
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 0.9 percent in 2007-08.  The South 
African Reserve Bank (SARB) is independent and committed to 
returning 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 10.4 
percent (April 2008).  The SARB now does not believe 
inflation will return to within the maximum level of the 
target band until the end of 2010.  Real GDP growth was 5.1 
percent in 2007.  The South African National Treasury expects 
growth to slow to 4.0 percent in 2008 and 4.2 percent in 
¶2009. However, this growth is measured against an 
increasingly strained energy supply which has led to power 
shortages.  Because of this, rising inflation and higher 
interest rates, some local economists expect growth to slow 
to as little as 3.0 to 3.5 percent. 
 
¶14. (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 23.0 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 one of the highest rates in the 
world.  Poverty is widespread.  Fifty-six percent of black 
South Africans, but only four percent of whites, live in 
poverty.  The lack of capacity and service delivery at the 
provincial and municipal levels has fueled the recent 
xenophobic attacks as South Africans from lower socioeconomic 
strata feared that jobs, houses, and other services were 
being given to refugees from neighboring countries.  Other 
obstacles exacerbating South Africa,s unemployment and 
economic problems are skill shortages and education system 
weaknesses.  The media reports regularly about a growing 
brain-drain of technically skilled workforce professionals, 
including medical staff, to other countries.  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 
Q7.6 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, 6.0 million belong to the middle 
class, with 3.4 million being whites and 2.6 million being 
blacks. 
 
¶15. (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. 
 
--------------------------------------------- ----- 
TRANSPORTATION - WELL DEVELOPED, RELIANT ON STATE 
 
PRETORIA 00001396  005 OF 007 
 
 
--------------------------------------------- ----- 
 
¶16.  (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 
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-1980s 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. 
 
¶17.  (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 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, however, because of its location at 
the end of the African continent, so it has focused more 
recently on travel within Africa. 
 
----------------------------- 
U.S. SUPPORT FOR SOUTH AFRICA 
----------------------------- 
 
¶18. (U) Since 1994, the United States Government has 
contributed approximately $1.2 billion toward South Africa's 
development, including $201 million in credit guarantees. 
Currently, our development assistance program 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), as well as 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). 
 
¶19. (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 318 approved U.S. positions (only 241 are 
filled) and 570 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.  In FY 2009, the Mission will complete a new 
consulate building in Johannesburg and in FY 2010 intends to 
break ground on a new 155-desk office annex in Pretoria. 
 
------------------------------ 
U.S.-S.A. TRADE AND INVESTMENT 
------------------------------ 
 
¶20. (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 
Q$5.2 billion, while South African exports to the United 
States increased 22 percent at $9.1 billion.  In 2007, South 
Africa was the 34th 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 and the largest 
beneficiary of non-oil exports to the U.S. in 2007.  Its AGOA 
exports totaled 25 percent of the country's total exports to 
the U.S. in 2007.  An impressive 98.1 percent of South 
Africa's exports entered the U.S. with zero import duties in 
2007 as a result of normal trading relations (NTR), GSP, and 
AGOA benefits.  Only 1.9 percent of the value of South 
Africa's exports to the U.S. was subject to duty, or $174 
million out of $9.1 billion in exports, in 2007.  The U.S. 
also replaced Japan as the largest export market in 2007. 
The U.S. is the third-largest two-way trade partner, after 
 
PRETORIA 00001396  006 OF 007 
 
 
Germany and China. 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, its 
transportation infrastructure, sophisticated financial 
sector, 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 high unit 
labor costs, labor regulations, skills shortages, crime, 
HIV/AIDS, regulatory uncertainty, and the impact of Black 
Economic Empowerment policies such as the mandatory sale of 
equity to previously disadvantaged persons.  The U.S. was the 
second largest portfolio investor and the second largest 
foreign direct investor in South Africa after the U.K. ($5.5 
billion at year-end 2006). 
 
¶21. (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).  A framework 
agreement for the TIDCA is scheduled to be signed at the 
annual AGOA Summit in Washington on July 14, 2008.  The next 
steps will be to establish working groups in the areas of 
sanitary and phytosanitary measures (SPS), technical barriers 
to trade (TBT), customs, and trade promotion. 
 
-------------------------------------- 
HIV/AIDS: A CRISIS OF EPIC PROPORTIONS 
-------------------------------------- 
 
¶22. (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 prevention, 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 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 some areas.  In 2005, an estimated 800,000 more citizens 
became infected, and in 2006, 350,000 adults and children 
died from AIDS.  An estimated 1.6 million children, or 
approximately 10 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 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. 
 
¶23. (U) In April 2007, the South African Government released 
its National Strategic Plan (NSP) for HIV, AIDS, and Sexually 
Transmitted Infections. The NSP has the goal of reducing new 
QTransmitted Infections. 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.  371,731 people 
were receiving anti-retroviral (ARV) treatment as of 2007, 
while a further 511,269 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. The Global Fund also provides funding to 
the National Department of Health to refurbish multi-drug 
resistant TB centers and other areas to strengthen the 
country,s approach to TB-HIV. 
 
¶24. (SBU) The President's Emergency Plan for AIDS Relief 
(PEPFAR) is in its fifth year of implementation working with 
public and private sector prevention, treatment, and care 
programs.  To date, the U.S. has provided $1.45 billion 
through PEPFAR to support HIV/AIDS programs in South Africa 
 
PRETORIA 00001396  007 OF 007 
 
 
including $591 million in FY 2008, making it the largest 
recipient of Emergency Plan resources.  The Emergency Plan 
directly supported 305,356 people in ARV treatment through 
programs in all nine provinces as of March 2008.  The USG 
PEPFAR team in South Africa includes U.S. Agency for 
International Development (USAID), Department of Health and 
Human Services (HHS) (which includes the Centers for Disease 
Control and Prevention (CDC) and the Office of International 
Health (OIH)), Department of State, 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, care, and 
treatment programs and collaborates with the U.S. military 
and NIH on AIDS treatment research. 
 
¶25. (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 South 
African government, a five-year strategic plan focused on 
treatment, prevention, palliative care, and the provision of 
care for orphans and other vulnerable children.  Currently, 
the U.S. Mission, in coordination with the South African 
Government, is defining new priorities, gaps, and needs that 
will shape our program for the coming year. 
 
¶26. (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 approximately 
50 percent of HIV patients in Southern Africa also have TB. 
A high overall prevalence rate for HIV, people co-infected 
with TB and 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. 
TEITELBAUM