US embassy cable - 04PRETORIA5119

UNCLAS SECTION 01 OF 04 PRETORIA 005119 
 
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 APETERSON 
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 AND NIH,HFRANCIS 
CDC FOR SBLOUNT AND EMCCRAY 
 
E.O.  12958: N/A 
TAGS: ECON, KHIV, SOCI, TBIO, EAID, SF 
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH NOVEMBER 26 ISSUE 
 
Summary 
------- 
 
1.  Summary.  Every two weeks, USEmbassy 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:  2004 National HIV/AIDS Survey launched; 
South African survey highlights problem of gender violence; 
Anti-ADIS seaweed vaginal gel tested in South Africa; Diabetes 
Common among youngest South Africans; antibiotic may help 
children with AIDS; South African Government devising plan for 
health care staffing shortages; one million orphans in South 
Africa by 2006; KZN Progress in HIV/AIDS; metropolitan 
Tshwane's fight against HIV/AIDS; and update on Gauteng's HIV 
 
SIPDIS 
treatment.  End Summary 
 
2004 National HIV/AIDS Survey Launched 
-------------------------------------- 
 
2.  Nelson Mandela Foundation and the Human Sciences Research 
Council are launching the 2004 national HIV/AIDS survey, the 
second national survey undertaken.  Results of the study will 
determine the prevalence of HIV/AIDS based on national data, 
rather than extrapolation of data from public antenatal 
clinics.  The survey will also concentrate on social and 
economic factors related to HIV infection.  A total of 15 000 
households have been selected throughout the country to 
participate in the survey, cutting across all races, economic 
standing and geographical location.  Participation was not 
compulsory, but co-operation would enable the study group to 
calculate informed information critical in fighting the 
pandemic.  The information gathered would assist in developing 
effective strategies and campaigns to combat HIV and Aids. All 
persons in the study will remain anonymous and personal 
information will not be released.  Source:  Pretoria News, 
November 8. 
 
SA Survey Highlights Problem of Gender Violence 
--------------------------------------------- -- 
 
3.  South Africa has the highest rate of rape and spousal abuse 
in the world, with one in four women beaten by their partners, 
according to a gender survey by the University of Cape Town's 
Unilever Institute of Strategic Marketing.  The survey found 
that at least one woman is raped every minute somewhere in 
South Africa and about one third of South African women will be 
raped in their lifetime.  The survey involved 3,500 people in a 
weighted sample representative of major city and rural areas. 
Gender was likely to replace race as the big issue facing South 
African marketers in the future.  Other survey results 
included:  (1) 61 percent believe men and women are equal; (2) 
66 percent say men and women should earn the same amount; (3) 
41 percent believe it is acceptable that society favors men; 
(4) 32 percent believe a woman's place is in the home; (5) 73 
percent believe men should be the head of the household; and 
(6) 64 percent believe men should be the primary breadwinner. 
Source:  Cape Times, November 15. 
 
Anti-AIDS Seaweed Vaginal Gel Tested in SA 
------------------------------------------ 
 
4.  The final phase three testing of Carraguard, a seaweed- 
based vaginal microbicide that could help prevent the spread of 
AIDS, is currently underway in three South African locations. 
The study is particularly important in societies where women 
have difficulty persuading partners to use condoms.  The final 
phase three testing of the Carraguard gel is currently underway 
at Soshanguve in Pretoria, Isipingo in KwaZulu-Natal and 
Gugulethu in Cape Town.  The final phase three testing involves 
a larger sample of 6,200 women and began in March 2004 and is 
expected to end in three years.  If proven to be efficacious, 
plans will be made to mass-produce and market the product. 
Carrageenan - the active ingredient in Carraguard - is found in 
seaweed and generally regarded as a safe product, and is 
already found in ice cream and lotions.  The Carraguard gel had 
a negative charge, while the human immunodeficiency virus had a 
positive charge.  Carraguard may work by binding to the 
positively charged regions of the virus and by inhibiting cell- 
to-cell transmission of the virus, by acting as a barrier 
between infected and non-infected cells.  Carraguard would be 
feasible and cost effective to mass-produce because the seaweed 
was readily available, a benefit for developing countries 
having high AIDS prevalence rates.  Research goals look for a 
33 percent difference in seroconversions between the placebo 
and the Carraguard samples. However, we only expect the entire 
rate of seroconversion - from HIV negative to HIV positive - 
across the trial to be about 3.5 percent.  Among the major 
challenges for the trial was to retain all the women 
participants and the possibility of prevalence rates 
increasing, which would mean that less women would be eligible 
and therefore requiring more screening.  According to Dr Lydia 
Altini, the principal investigator at the Gugulethu site, 
researchers had enrolled about 800 out of a targeted 2,100 
women since March.  Some of the criteria needed for women to 
participate included being over the age of 16, sexually active, 
HIV negative, living in the area for the past two years and not 
planning to fall pregnant.  Women were expected to visit the 
clinic about 10 times for the duration of the trial.  They were 
also provided with a compensation fee for traveling and 
incidentals.  Vice-president of the Population Council's Center 
for Biomedical Research, Dr Elof Johansson, said Carraguard was 
the first generation of microbicides under development.  The 
first generation microbicide does not kill the virus, but only 
binds the virus.  The South African site costs are in the 
region of R40 million to R60 million ($6.7 to $10 million using 
6 rand per dollar) and funded by the United States Agency for 
International Development and the Bill and Melinda Gates 
Foundation.  Source:  SAPA November 18. 
 
Diabetes Common Among Youngest South Africans 
--------------------------------------------- 
 
5.  More South African youth are diagnosed with Diabetes type 
1, the disease that occurs when the pancreas stops production 
of blood sugar-controlling insulin.  One in 500 children in 
South Africa have type 1 diabetes.  "Twenty years ago our 
youngest patients were between seven and 10 years old, now 
toddlers and babies of barely five months come in," said 
Professor Francois Bonnici of the diabetes education centre at 
the Red Cross Children's Hospital.  Bonnici states that he 
knows of no clear explanation why younger patients are 
diagnosed with diabetes now.   There is a genetic tendency of 
susceptibility of diabetes and treatment involves three to four 
insulin injections per day.  Short-term effects of the disease 
include are extreme thirst, nausea, vomiting, dehydration, 
dizziness, and coma.  Source:  Cape Times, November 17. 
 
Antibiotic May Help Children with AIDS 
-------------------------------------- 
 
6.  The positive results of a study of children in Zambia, 
carried out by the British Medical Research Council (MRC) and 
funded by the Department for International Development, suggest 
that deaths among children infected with HIV in Africa could be 
almost halved if the antibiotic co-trimoxazole were widely 
used.  While co-trimoxazole will not prevent children 
eventually developing AIDS, it could give extra years of 
healthy life before they need the powerful and toxic anti- 
retroviral drugs that suppress HIV in the blood.  The results 
of the trial, published in this week's Lancet medical journal, 
have persuaded the World Health Organization and UNICEF to 
change their policies and recommend the use of co-trimoxazole 
in all children with HIV.  In the study, 541 children aged 
between one and 14 were given the antibiotic or a placebo. The 
trial was stopped early when it became clear that substantially 
fewer children on the antibiotic were dying. After 19 months, 
74 (28 percent) children on co-trimoxazole had died, compared 
with 112 (42 percent) of those on the placebo.  All those who 
took part are now taking co-trimoxazole.  No severe side 
effects were reported.  Source:  Guardian Newspapers, November 
19. 
 
SA Government Devising Plan for Health Care Staffing Shortages 
--------------------------------------------- ----------------- 
 
7.  During a two-day workshop of government, health care 
workers and university representatives, Percy Mahlathi, the 
Health Department's Deputy Director-general, announced plans 
for a comprehensive human resource strategy for the public 
health sector, hoping to begin implementation by March 2005. 
The proposed plan will help respond to weaknesses caused to the 
system by HIV/AIDS, infrastructure challenges and the exodus of 
professionals from public service.  Delegates at the workshop 
have been divided into several working groups to deliberate on 
human resource challenges in health, and make contributions 
towards the department's envisaged master plan. About 14 health 
workers' organizations are represented, including the 
Democratic Nursing Organization of South Africa (DENOSA). 
Source:  SABC, November 18. 
 
One Million Orphans in South Africa by 2006 
------------------------------------------- 
 
8.  The Actuarial Society of South Africa's (ASSA) 2000 
demographic model predicts that almost one million children 
will be orphaned nationally due to the AIDS epidemic by the 
year 2006.  By 2006 the model projects that 857,000 will be 
orphaned nationally - in KwaZulu-Natal more than 252,000, in 
Gauteng 133,204, Eastern Cape 99,227, Free State 47,062, 
Limpopo 75,487, Mpumalanga 72,995, Northern Cape 7,331, North 
West Province 57,956 and Western Cape 19,648.  By the year 
2015, more than 1,854,462 will be orphaned because of the Aids 
epidemic.  The case study definition of an orphan is any child 
under 15 whose mother has died of HIV and Aids.  According to 
child care workers poverty, depression and HIV and Aids are 
some of the major factors that contribute to mothers abandoning 
their babies.  Source:  Pretoria News, November 20. 
 
KZN Progress in HIV/AIDS 
------------------------ 
 
9.  In March, KwaZulu-Natal did not have a government program 
for getting HIV-positive people on to anti-retroviral 
treatment.  In the past seven months, the province has made 
good progress.  As of November 5, the department had 3,247 
adults and 167 children (aged from three to 15 years) on anti- 
retroviral treatment, while 25,036 people had been screened for 
the treatment program.  The World Health Organization released 
a report this year which said that 5.3 million people were 
living with HIV and Aids in South Africa. The report estimated 
that 370,000 people would die from Aids-related illnesses in 
South Africa this year.   In KwaZulu-Natal, the province 
reputed to have the highest prevalence of HIV and Aids in the 
country, anti-retroviral treatment involves more than just 
taking medication.  Patient education and building health 
infrastructure are crucial elements to the comprehensive 
treatment plan.  Patient literacy involves education about the 
disease, its implications, clinical and dietary assessments and 
anti-retrovirals.  Hospitals have to be equipped with all the 
necessary resources before getting accreditation to administer 
anti-retroviral treatment. In the province's 11 health 
districts, at least two hospitals in each district have been 
accredited for the anti-retroviral treatment plan.  Districts 
like Uthungulu (near Richards Bay) has six hospitals and 
eThekwini (Durban metropolitan area) have eight.  Source:  IOL, 
November 21. 
 
Metropolitan Tshwane's Fight Against HIV/AIDS 
--------------------------------------------- 
 
10.  The Tshwane (greater Pretoria) Metropolitan Council has 
adopted a HIV/AIDS treatment strategy encompassing anti- 
retroviral treatment, treatment of sexually transmitted 
infections, behavior change, and voluntary testing and 
counseling.  Based on research commissioned by the Council, an 
estimated 6 percent of the municipality's employees are HIV- 
positive and one percent have AIDS-related diseases.  The risk 
profile of the metropolitan's employees is lower than that of 
the general South African population.  Despite the lower HIV 
prevalence rates, progression to AID-related sicknesses is over 
half that of the general population and there is a higher 
proportion of employees who are at ages where progression to 
AIDS is likely (30 - 50 years) than the case in the general 
population.  The research states that by beginning the broad 
strategy for treatment immediately, the council could reduce 
the general mortality of its employees by more than half and 
the AIDS-related deaths from six out of 10 to one out of 10 
within 12 months.  Source:  Pretoria News, November 18. 
 
Update on Gauteng's HIV Treatment 
--------------------------------- 
 
10.  On November 19, 2003, the South African government 
announced its HIV/AIDS comprehensive treatment plan with the 
plans to provide anti-retroviral treatment to 53,000 by March 
2005.  Several of the provinces only began providing treatment 
until August and September 2004, however Gauteng began its 
program in April 2004.  Both the Western Cape and Gauteng 
provinces have more developed health infrastructure and 
political leadership in providing HIV/AIDS treatment and these 
provinces are crucial so that South Africa can meet its stated 
goal of 53,000 on treatment.  Gauteng health care facilities 
are experiencing the same sort of capacity problems that other 
provinces endure.  Large inner-city research hospitals have 
been able to start programs relatively efficiently; however, 
most clinics located in former township areas and opened during 
the second wave of accreditation during July 2004 have similar 
staffing and equipment shortages experienced by the health care 
facilities located in poorer provinces.   Gauteng's Department 
of Health has been able to recruit 70 percent of the 214 
additional staff needed to implement the comprehensive 
treatment plan although it admits that filling staff 
requirements for former township areas has been especially 
difficult.  Source:  Sunday Independent, November 21. 
 
FRAZER