US embassy cable - 04PRETORIA5334

UNCLAS SECTION 01 OF 05 PRETORIA 005334 
 
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 DECEMBER 10 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:  South Africa's Response to HIV/AIDS Still 
Includes Denial and Ignorance; HIV/AIDS Places Burden on 
Elderly; Some Regions Fear HIV/AIDS, Others Cancer; Health 
Department Reports Increase in Number of Patients on ARV; 
Economic Cost of AIDS May Worsen; Telkom HIV/AIDS Prevalence 
Rate Expected to Peak at 11.4 Percent; Correctional Services 
Conducts HIV Survey in Prisons; HIV/AIDS Budgets for National 
and Provincial Government; Provincial Progress on Implementing 
Government's HIV/AIDS Treatment Plan; and SA's Labor Force 
Declines with HIV/AIDS, Discouragement Impacts.  End Summary. 
 
SA's Response to HIV/AIDS Still Includes Denial and Ignorance 
--------------------------------------------- ---------------- 
 
2.  The latest figures from the Actuarial Society of South 
Africa suggest that about one in nine South Africans is 
infected with HIV, the virus that causes AIDS, and about 5 
million people who are living with the disease, the largest 
case load in the world.  The Human Sciences Research Council's 
2002 household survey estimated that 6.2 percent of white South 
Africans were infected with HIV, the biggest middle class 
epidemic in the world. By comparison, an estimated 12.9 percent 
of black Africans were infected.  Many health care 
practitioners find that their patients know about HIV/AIDS but 
few are changing their behavior.  The same patients repeatedly 
ask for HIV tests. These are not sex workers for whom HIV is a 
hazard of their jobs, but people who refuse to accept that they 
need to protect themselves with condoms.  The point about an 
HIV test is to have it once, and if you are negative to keep it 
that way.  "There's a mistaken belief among many middle- to 
upper income professionals, particularly whites, that they are 
not at risk," says Mark Heywood of the Treatment Action 
Campaign.  The fact that HIV has disproportionately affected 
poor, black, young women is an indication that many of them 
think it cannot affect them, says Jonathan Berger, of the AIDS 
Law Project at the University of the Witwatersrand.  That 
denial is worsened by SA's HIV-prevention campaigns, which 
focus almost exclusively on young people.  "By telling part of 
the story as if it were the entire story, the vulnerability 
picture often painted is both inaccurate and misleading," he 
says in a paper accepted for publication by the journal 
Development Update.  Berger argues that SA's limited public 
education campaigns are deeply flawed, presenting a sanitized 
view of sex that bears little relation to people's lives. They 
focus on young men and women having heterosexual sex, and shy 
away from anything vaguely taboo, he says.  Very little 
research investigates what kind of sex people are having. And 
when research does shed light on potentially dangerous 
practices, Berger states that the findings are not incorporated 
in education campaigns.  Despite the frustration expressed by 
many HIV/AIDS experts, there is some encouraging evidence that 
young people are waiting longer before they have their first 
sexual encounters; are using condoms more consistently; and are 
more conscious of the dangers of HIV, says loveLife CEO David 
Harrision.  Source:  Business Day, December 1. 
 
HIV/AIDS Places Burden on Elderly 
--------------------------------- 
 
3.  The Human Sciences Research Council (HSRC) released a study 
on the impact of HIV/AIDS on the elderly (aged 60 and older) in 
Mpumalanga that highlights the particularly heavy financial and 
care burden the elderly are paying.  The study found that 72 
percent of older people in the province are the main 
breadwinners in multi-generational households, spending most of 
their income on household necessities and the education of 
grandchildren.  Nine percent are caring for sick young adults 
living in the household, 22 percent are staying with 
grandchildren whose own parents are either dead or away in the 
cities on a long-term basis, 20 percent take care of children 
six years or younger, and 46 percent take care of children 
between the ages of six and 18.  With 60 percent of orphans in 
South Africa being cared for by their grandparents, bringing up 
a second generation weighed heavily on the elderly.  Funerals 
carry a substantial cost, often shouldered by the elderly as 
the main breadwinner, or receiver of a state pension. The 
majority of the elderly are female, according to census 2001 
there are 34 males to 100 females in Mpumalanga.  Most stay in 
rural areas, with even those who worked in the cities returning 
to rural areas when reaching retirement age to reunite with 
their extended families.  Source:  SAPA, Mail and Guardian, 
December 1. 
 
Some Regions Fear HIV/AIDS, Others Cancer 
----------------------------------------- 
 
4.  A global survey has found that Africans, West Asians and 
Latin Americans believe that HIV/AIDS is the most important 
disease confronting them -- while people elsewhere fear cancer. 
The Gallup International/Markinor poll interviewed more than 
50,000 people in over 60 countries between June and August for 
their annual Voice of the People survey.  They were asked for 
their views of the most important disease in their country. 
Overall, four out of every 10 (42 percent) citizens in the 
countries polled around the world mentioned cancer as the most 
threatening disease -- a concern shared in most countries, but 
not unanimously.  Twenty-seven percent rated HIV/AIDS as the 
top disease and 15 percent heart attacks and strokes.  Three 
percent rated tuberculosis highest, two percent malaria and one 
percent Severe Acute Respiratory Syndrome, while eight percent 
rated other illnesses and four percent did not know or would 
not answer.  All five African countries included in the survey 
are amongst the first 11 that regard HIV/AIDS as the most 
important disease.  In the five African countries polled, two 
thirds of interviewees believed that HIV/AIDS was the most 
important disease facing them.  Malaria was the second most 
frequently mentioned disease in Africa and was of particular 
concern for Nigerians (35 percent) and the people of Cameroon 
(31 percent).  Source:  SAPA, December 1. 
 
Health Department Reports Increase in Number of Patients on ARV 
--------------------------------------------- ------------------ 
 
5.  The number of people receiving anti-retroviral therapy in 
accredited government facilities increased from 11,250 at the 
end of August to 19,500 in October, Health Minister Manto 
Tshabalala-Msimang reported.  Treatment is available in at 
 
SIPDIS 
least one facility in 50 of the 53 districts in the country. A 
total of 103 facilities have been accredited and are providing 
care and treatment for people with HIV and AIDS.  Three centers 
have been established to detect, assess, and prevent adverse 
reaction to anti-retroviral drugs.  A center at the Medical 
University of SA focuses on the use of anti-retroviral drugs 
and traditional medicine between adolescent and adults with HIV 
and AIDS.  The second center at the Free State University deals 
with the use of anti-retroviral drugs among pregnant women and 
infants.  The University of Cape Town also serves as a 
reference center for adverse reaction to all types of medicines 
registered in the country.  At least 67 percent of all public 
health clinics were providing voluntary counseling and testing 
(VCT) services, which had increased the coverage rate. The 
number of people using VCT services had increased from 412,696 
in 2002/2003 to 690,537 in 2003/4.  The Health Department 
reported that there were now 10,000 counselors at service 
points throughout the country at the end of March 2004. Rapid 
HIV test kits were widely available at the service points to 
ensure people received results immediately.  In addition, more 
than R9.4 million ($1.6 million, using 5.7 rands per dollar) 
had been spent on communication, including newspaper, radio and 
billboard advertising, and production of information and 
educational material to support the implementation of the 
comprehensive plan.  Source:  SAPA, Health Dept Health News 
Release, November 25. 
 
Economic Costs of AIDS May Worsen 
--------------------------------- 
 
6.  Although data on the extent of HIV/AIDS and its impact on 
the South African economy vary, analysts agree that government 
and businesses need to take urgent action to combat the virus. 
Already HIV/AIDS is estimated to be reducing South Africa's 
growth rate by a minimum of 0.3 to 0.4 percent per year. 
Forecasts of future growth show large discrepancies, however, 
as financial experts have created different mathematic models 
to calculate the consequences.  Analysts at Apt Associates 
estimated that the country's gross domestic product (GDP) will 
be 17 percent lower by 2010 than it would have been without 
AIDS, leading to a loss of $22 billion.  Financial analysts at 
ABSA bank, in contrast, estimate the shrinkage of GDP at 9.6 
percent by 2015, while ING Barings put the figure at only 2.8 
percent.  One of the paradoxes of the HIV epidemic in sub- 
Saharan Africa is that in the past 10 years it has not made a 
huge dent on standard macroeconomic yardsticks, such as GDP. 
This is due, in part, to the labor situation in South Africa. 
The country's labor surplus means that workers removed by AIDS 
can be replaced without much loss of productivity.  The World 
Bank analysis emphasizes the long-term impact of the disease on 
human capital, arguing that the damage in terms of accumulated 
loss of GDP per capita will be large, if left untreated.  This 
suggests that a country like South Africa could face 
progressive economic decline over several generations, unless 
it combats its AIDS epidemic more urgently.  By mainly taking 
the lives of young adults, AIDS seriously weakens a country's 
tax base; as a result, national finances will come under 
increasing pressure.  Less income from taxes will reduce the 
government's ability to finance public expenditures, including 
those aimed at accumulating human capital, such as education 
and public health services.  It will also have to handle severe 
financial strain in other social spending categories, such as 
grants for AIDS orphans. To balance these, the government is 
likely to raise taxes.  AIDS will create significant costs to 
business. At the company level, the pandemic poses a serious 
threat to profitability as well as competitiveness. Firms will 
have to face increasing absenteeism due to illness, funeral 
attendances and care taking of family members.  Businesses will 
also see rising expenditure on medical and pension benefits, 
loss of skilled manpower leading to disruption of production, 
as well as increases in training, recruitment and personnel 
turnover costs.  Old Mutual Healthcare, for example, estimated 
that additional healthcare costs as a result of HIV/AIDS could 
reach $3.8-billion per year by 2009.  By 2010 life expectancy 
will be 43 years, 17 years less than it would have been without 
AIDS. Analysts estimate the South African labor force will 
decline by up to 23.5 percent by 2015.  To what degree 
enterprises are affected varies between business sectors. The 
mining sector has been worst hit by the pandemic, with an AIDS 
prevalence rate among its workforce of 25 percent, closely 
followed by manufacturing with a prevalence rate of up to 19 
percent. Construction, retail and wholesale count as medium- to 
low-risk sectors.  The effects of AIDS on businesses will also 
depend on a company's location.  In provinces with high 
prevalence rates, such as KwaZulu-Natal and Gauteng, close to 
40 percent of firms indicated that AIDS already had a negative 
impact on their profits, according to Bureau for Economic 
Research. In the Western Cape and Eastern Cape, the numbers 
were 25 percent and 27 percent respectively.  HIV/AIDS is a 
risk of doing business in South Africa, right next to asset 
security, crime and exchange rate volatility, besides political 
and infrastructural risk.  Only about a quarter of the 
country's businesses -- mainly large corporations -- have 
workplace policies in place. Small and medium-sized firms often 
the lack human and financial resources to implement an AIDS 
plan.  Source:  Mail and Guardian, November 26. 
 
Telkom HIV/AIDS Prevalence Rate Expected to Peak at 11.4 
Percent 
--------------------------------------------- ------------ 
 
7.  Telkom, the telecommunications parastatal, expects its 
HIV/AIDS rate among employees to peak at 11.4 percent in 2006, 
with the company's current HIV/AIDS prevalence rate at 9.6 
percent.  Telkom's introduction of antiretroviral treatment, 
which started in October, is part of an integrated health 
management strategy to manage health risks and invest in human 
capital.  Telkom had allocated R8 million ($1.4 million) in the 
current financial year for the management of HIV/AIDS.  The 
company is offering a voluntary counseling, testing and 
treatment (VCT) program, which offers employees around the 
country access to a range of HIV/AIDS related services in 
absolute privacy and confidentiality.  Telkom does not have 
access to details of an employee's HIV and AIDS status unless 
he or she voluntarily discloses the information. The first 
phase of Telkom's VCT program ended in October, during which 
2,504 employees were tested. The second phase is currently 
running until March next year with a target of 10,000.  Source: 
SAPA, December 1. 
 
Correctional Services Conducts HIV Survey in Prisons 
--------------------------------------------- ------- 
 
8.  The Department of Correctional Services announced that a 
national survey of prison inmates to determine HIV/AIDS 
prevalence is now in the preparation phase, with a task team 
and steering committee established.  The prevalence of HIV/AIDS 
will be ascertained by extrapolation from a sample. The 2003/04 
annual report of the judicial inspectorate of prisons, 
described HIV/AIDS in prisons as a "major problem". The report 
noted that about 58 percent of prisoners were men below the age 
of 30, who were more sexually active and prone to take risks 
than older men.  The report found that natural deaths were 
rising and the increase could be "fairly attributed" to 
HIV/AIDS and the opportunistic diseases that followed. Natural 
deaths rose by 584 percent from 1995 to 2000, with 1087 deaths 
in 2000 and 1683 in 2003.  Seven months ago an AIDS directorate 
was established focusing on care and support, prevention and 
treatment.  The Department of Correctional Services was 
conducting a baseline study of the number of offenders 
currently using ARVs in prisons, with preliminary results 
expected in early December.  Source:  SAPA, December 1. 
 
HIV/AIDS Budgets for National and Provincial Government 
--------------------------------------------- ---------- 
 
9.  Government commitment to HIV/AIDS funding only really 
materialized in 2000 with the introduction of special 
conditional grants, according to Alison Hickey, manager of 
Idasa's AIDS Budget Unit.  Before 2000, the AIDS budget was 
minimal.  The 2004/5 national budget shows a serious commitment 
to making financial resources available for the new ARV 
treatment programs.  National Treasury has specifically 
allocated R1.439 billion ($250 million) for HIV/AIDS programs 
and services in this year.  This is seven times what was set 
aside to fight HIV/AIDS in 2000/1. However, HIV/AIDS funds 
still constitute less than 1 percent of the total budget. 
Money for ARV treatment is sent to provinces via conditional 
grants. However, Hickey is concerned that provinces such as the 
Eastern Cape and Mpumalanga may struggle to spend their grants. 
"For those provinces with weaker financial and project 
management skills, absorption capacity could well be the 
primary obstacle to roll-out," she says.  One of the weaknesses 
in the national Department of Health identified by the Auditor 
General is its inability to monitor conditional grants 
properly.  A new clause in the Division of Revenue Bill allows 
unspent HIV/AIDS grants to be relocated to better-performing 
provinces.  Researcher Hein Marais found that the Western Cape, 
Eastern Cape and Mpumalanga did not allocate any funds 
specifically for HIV/AIDS in 1998.  Gauteng was the only 
province to allocate a substantial sum, with R49 million 
allocated across all its departments and R4 million set aside 
for NGOs.  Source:  Health E-News, November 28. 
 
Provincial Progress on Implementing Government's HIV/AIDS 
Treatment Plan 
--------------------------------------------- ----------- 
 
10.  North West Province 
Provincial Health Department has allocated close to R50 million 
for voluntary counseling and testing (VCT), prevention of 
mother-to-child transmission (PMTCT) and sexually transmitted 
infections.  The high AIDS prevalence rate (29.9 percent) has 
led to more rapid implementation of the treatment plan, with 
more than 5,000 new patients coming to the 3 available service 
points and more than 1,000 patients being treated.  The 
provincial health department was allocated R70 million for the 
HIV/AIDS program, including R29 million for ARVs. 
Gauteng 
Nineteen hospitals in the province are now providing ARV drugs 
and the province plans to expand the program to 80 facilities 
by 2009.  By November 5, 49,268 people have been assessed, of 
whom 5,588 adult and 800 children received ARVs.  2002 records 
indicate that 54 percent of people between 15 and 34 years of 
age admitted to state hospitals were infected with HIV. 
Limpopo 
Limpopo has the third lowest (17.5 percent) HIV prevalence rate 
in the country.  Since October, more than 2,000 patients have 
been assessed, with 300 adults and 40 children on ARV 
treatment.  The province has eight treatment sites and by April 
2005, will introduce the ARV treatment program to 30 district 
hospitals and 22 community health centers.  The province has 
R80 million for the AIDS program during the 2004 financial year 
and R120 million for next year. 
Northern Cape 
The provincial treatment program started three months ago and 
now has 1,200 patients qualified for ARV treatment with 250 
patients registered for treatment.  Approximately 500 patients 
with more than a CD4-count of 200 have been assessed.  R31.8 
billion has been allocated for the AIDS program this year. 
Eastern Cape 
The province launched its treatment program in May and 2,000 
patients, 135 of them children, are receiving treatment at 11 
sites.  R40 million has been allocated and about R22.6 million 
has been spent on ARV treatment in the 2004 fiscal year.  A 
regional training center, funded by the Department of Health, 
Columbia University and CDC, provides HIV/AIDS training to 
health care professionals.  So far, 1,000 have received 
training. 
Western Cape 
The province has 31 treatment sites, a total HIV/AIDS budget of 
R119 million, of which R29 million is a grant from the Global 
Fund.  The province estimates that about 12,000 people need ARV 
treatment and so far about 5,500, of which 1,000 are children, 
are receiving ARVs.  The Western Cape has the lowest HIV/AIDS 
prevalence rate of 13.1 percent. 
Free State 
In October, the number of patients on treatment was 250, much 
lower than the March 2005 target of 2,127; however its goals of 
providing 5 treatment sites have been reached.  A budget of R30 
million has been allocated for 2004 and R50 million for next 
year.  For next year, an additional 16 sites providing ARV 
treatment are planned. 
Mpumalanga 
The province currently has eight ARV treatment sites, though 
the national Department of Health declared in October that the 
province had 12.  R 67 million was allocated to the AIDS 
program this financial year and the province will likely not 
reach its target of 1,934 patients on ARV treatment by March 
2005.  Currently Mpumalanga is treating 378 patients compared 
to 130 patients in July. 
KwaZulu-Natal 
KZN has the highest AIDS prevalence rate at 38 percent and will 
likely not meet its March 2005 target of 20,000 patients on 
treatment.  The province is currently treating 3,247 adults and 
167 children at 31 sites.  A further 16 sites have been 
recommended for accreditation by the national advisers.  A 
conditional grant of R64 million is available for the ARV 
treatment program.  Source:  Mail&Guardian, November 26 to 
December 2. 
 
SA's Labor Force Declines with HIV/AIDS, Discouragement Impacts 
--------------------------------------------- ------------------ 
 
10.  South Africa's labor force has declined over the past few 
years, probably because more people have given up looking for 
work or are infected with HIV, says a new report in the South 
African Reserve Bank's Labor Market Frontiers report.  South 
Africa's labor force participation rate, which counts the 
number of people working and actively seeking work as a 
proportion of the total population, has dropped to 54.1 percent 
in September 2003, down from 58.9 percent in September 2000. 
Official figures from Statistics SA show that unemployment 
dropped to 4.6 million in September 2003 from 5.3 million in 
March 2003, based on the narrow definition of unemployment, 
where an individual had been actively seeking work prior to the 
survey.  The drop in unemployment was not matched by an 
increase in total employment over that period, with more people 
dropping out of the labor market.  The number of discouraged 
job seekers increased the unemployed figure to more than 8 
million.  The Bank's report stated that job seekers were 
discouraged because of the slim chances of finding a job, or 
because they lacked funds to search actively for work.  Another 
likely cause for a drop in labor market participation was the 
effect of HIV/AIDS.  The report points to research that shows a 
drop in HIV/AIDS prevalence among younger people in their 
twenties, and an increase in higher age groups, making up most 
of the labor force.  The report also assesses whether social 
grants have a negative incentive on labor force participation, 
but found mixed results.  Some studies show that pension 
payments cause an indirect effect of withdrawal from the labor 
market.  However, other studies show that a child support grant 
could result in higher labor force participation.  Source: 
Business Day, December 3. 
 
FRAZER