US embassy cable - 05PRETORIA1507

UNCLAS SECTION 01 OF 04 PRETORIA 001507 
 
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 APRIL 15 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 African Teacher Shortage Blamed on 
Health, Low Pay and Morale; New AIDS Assistance Program for 
Teachers Launched; HIV Risk Exposure among Young Highlighted; 
Anti-clotting Drugs Cheaper than Conventional Treatment; South 
African Teen Alcoholism Increases; AIDS Treatment Centers Open 
in all Health Districts; KZN Health Department Faces Increasing 
Financial Burden; High Cost of Death Burden for Poor.  End 
Summary. 
 
South African Teacher Shortage Blamed on Health, Low Pay and 
Morale 
--------------------------------------------- ------------ 
 
2.  A national survey of South African teachers confirmed 
anecdotal reports that teachers have been leaving the 
profession due to low morale, job dissatisfaction and poor 
health.  Commissioned by the Education Labor Relations Council 
(ELRC), the two-year study consists of seven reports about the 
impact of HIV/AIDS on Education, done by the Human Sciences 
Research Council (HSRC), the Medical Research Council, and the 
University of KwaZulu-Natal's Mobile Task Team.  The study 
surveyed 21,358 teachers in more than 1,700 randomly selected 
schools.  In 2003/04, there were 368,548 public-school 
teachers. 
 
3.  More than half the country's teachers intend leaving the 
profession.  And as low morale, job dissatisfaction, HIV/AIDS 
and premature mortality impact public schools, the number of 
teachers has declined over the past seven years.  By 2002/03, 
21,000 teachers (about 6 percent) were leaving the system 
annually.  Of 55 percent of the respondents who intended to 
leave the profession, 25 percent considered leaving "from time 
to time" and nearly 30 percent considered it "very often". 
Likeliest to leave, the study found, are non-Africans, men, 
secondary school teachers, those aged between 25 and 49, the 
best-qualified teachers, those in the medium- to high-income 
group, and teachers of technology, economics and management, 
and natural sciences.  HIV-negative teachers are more likely 
than HIV-positive employees to want to leave.  Reasons teachers 
gave for wanting to quit were inadequate remuneration, 
increased workload, lack of career development and professional 
recognition, dissatisfaction with work policies, job 
insecurity, violence in schools and lack of choice about where 
they work. 
 
4.  The study measured the impact of HIV/AIDS using a 
nationally representative sample of 17,088 teachers who gave an 
oral fluid or blood specimen for testing.  Nearly 13 percent 
tested positive and 4,000 teachers died of AIDS in 2004.  HIV 
prevalence is highest (21 percent) among 25- to 34-year-olds, 
followed by 35- to 44-year-olds (13 percent tested positive). 
More than a fifth (22 percent) of the HIV-positive group, 
approximately 10,000 teachers, need immediate anti-retroviral 
therapy.  If the minimum CD4 count increased from 200 to the 
international standard of 350 to qualify for anti-retroviral 
treatment, approximately 23,500 teachers would be eligible for 
treatment.  However, teachers' overall health status was poor, 
with more than 10.6 percent having been hospitalized during the 
2003 compared to 7 percent of the general population.  The most 
frequently reported illnesses were high blood pressure and 
stomach ulcers, implying that stress has a leading role in 
keeping teachers out of the classroom.  The study found the 
teacher attrition rate had declined from 9.3 percent in 1997-98 
to 5.5 percent in 2000-01, before rising again to 5.9 percent 
in 2002-03.  Attrition due to mortality increased to 17.7 
percent in 2003-04 compared to 7 percent in 1997-98 and 
attrition due to illness grew to 8.7 percent compared to 4.6 
percent over the same period, reflecting the impact of 
HIV/AIDS. 
 
5.  In order to reduce teacher shortages, especially in poor 
provinces and rural areas, the study recommends the following 
actions:  (1) restructure remuneration packages, reduce 
workloads and manage teachers' job stress; (2) improve 
resources for poorer schools, especially African schools; (3) 
provide psychosocial support for teachers; (4) introduce a 
comprehensive workplace health-care program; and (5) implement 
HIV/AIDS-prevention and anti-retroviral programs for teachers. 
Source:  Pretoria News, Business Day, Health E-News, April 1; 
Mail & Guardian, April 1-7. 
 
New AIDS Assistance Program for Teachers Launched 
--------------------------------------------- ---- 
 
6.  Eight South African and U.S. non-governmental organizations 
began a new Prevention, Care and Treatment Access (PCTA) 
program aimed at South African teachers.  Its targets include 
providing anti-retroviral treatment to 1,000 infected teachers 
and their family members, access to care, counseling and 
testing for 150,000 teachers and families.  The PCTA program 
includes four South African teacher unions, the Solidarity 
Center, the American Federation of Teachers' Educational 
Foundation, the Tshepang Trust and the Academy for Educational 
Development.  The President's Emergency Plan for AIDS Relief is 
also providing $3.8 million for the two-year program.  Source: 
The Citizen, April 7. 
 
HIV Risk Exposure among Young Highlighted 
----------------------------------------- 
 
7.  The Nelson Mandela Foundation released a study "HIV Risk 
Exposure among Young Children:  A study of 2-9 Year Olds", 
found that breastfeeding of babies by a non-biological HIV- 
positive caregiver was the single most important factor 
associated with HIV infection in children and there is a 
potential for health-care acquired transmission of HIV in the 
maternity, pediatric, and dental facilities in the Free State 
health institutions.  The study, conducted by the Human 
Sciences Research Council (HSRC), the University of 
Stellenbosch, the Medical Research Council and the Centre for 
Aids Development, Research and Evaluation, aimed to identify 
all other possible sources of HIV transmission, besides mother- 
to-child transmission, among children aged 2 to 9 in the Free 
State public health sector.  More than 4,000 mother-and-child 
pairs took part in the study which involved 25 public 
hospitals, three community health centers and 54 primary health 
care clinics between April and July of 2004.  Almost 15 percent 
of the children in the study were HIV-positive, while just over 
29 percent of mothers were infected with the virus. 
Researchers sampled expressed breast milk destined for baby 
feeding at the health facilities and found that almost 30 
percent of the milk tested positive for HIV, while six samples 
contained high viral loads.  Ninety-two percent of HIV-positive 
mothers breastfed their children - 60 percent of them for more 
than a year.  The study also found that children were being 
exposed to possible HIV infection because of poor infection 
controls at the facilities.  Healthcare workers were also not 
taking the necessary precautions, with the study finding that 
44 percent of nurses did not use gloves during the delivery of 
babies.  The study also found risks in hospitals in the 
management of expressed breast milk, where bottles were labeled 
by cot numbers, not the name of the baby, and seldom checked, 
which allowed milk to be fed to the wrong baby if the cot was 
moved.  Findings included that 24.6 percent of dental 
instruments ready to be used in patients' mouths, and 24 
percent of instruments to be used for maternity and pediatric 
patients were contaminated with invisible blood, and 17.5 
percent had visible blood on them.  Recommendations included 
discouraging prolonged breastfeeding, better control of 
expressed milk and a campaign to educate patients to demand 
better hygiene practices by health workers.  Source:  The 
Citizen, Health E-News, April 4; Business Day, April 6. 
 
Anti-clotting Drugs Cheaper than Conventional Treatment 
--------------------------------------------- ---------- 
 
8.  According to a medical research company, Health Monitor, 
anti-platelet drugs for sufferers of arterial disease are 
cheaper than bypass surgery or treatment after heart attacks 
and strokes.  The research, requested by medical insurance 
companies, funded by pharmaceutical group Sanofi Aventis and 
conducted by independent South African medical researcher 
Health Monitor Company, found that new-generation anti-platelet 
drugs, which prevent excessive clotting in patients at 
heightened risk of suffering a "coronary event", increase 
lifespan and cost less than conventional hospital treatment in 
both the short and long term.  More than 8,000 insured patients 
who had suffered conditions such as unstable angina, heart 
bypass surgery, heart attack or stroke, and were at increased 
risk of experiencing more, were included in the year-long 
study.  The study compared the cost of treating patients on 
anti-platelet therapy with those who were not and suffered 
subsequent strokes and heart attacks or who needed bypass 
surgery.  These costs included initial and follow-up 
hospitalization, medication and further treatment for recurring 
and related events.  Health Monitor Company's Dr Tienie 
Stander, who will present the findings at the 2nd South African 
Atherothrombosis Summit, cites the benefits of administering 
these new drugs, not only for patients who will gain extended 
life years but to medical insurers who will pay lower costs. 
Source:  Business Day, April 5. 
 
South African Teen Alcoholism Increases 
--------------------------------------- 
 
9.  Research by the Medical Research Council in 2002 showed 
that nationally, 49.1 percent of pupils had drunk one or more 
drinks of alcohol in their lifetime and almost one in eight 
pupils had drunk their first drink of alcohol before the age of 
13 years.  The research found that 23 percent of pupils had 
drunk five or more drinks of alcohol within a few hours on one 
or more days in the research month.  Claire Savage of South 
African National Council on Alcoholism and Drug Abuse (SANCA), 
said earlier MRC research conducted in the 1990s indicated that 
in certain areas 20 to 25 percent of high school males and 
about 15 percent of females were binge drinking at least once 
every two weeks.  On average, South Africans drink 20 liters of 
alcohol each year - a statistic that puts them among the 
worlds' biggest drinkers.  The average South African consumes 
the equivalent of several hundred bottles of beer every year, 
and with that comes the "extremely high" burden of alcohol- 
related death and trauma, record levels of fetal alcohol 
syndrome, and greater risk of contracting HIV and AIDS, says 
Professor Charles Parry, addiction specialist and director of 
the Medical Research Council's alcohol and drug abuse research 
unit.  About one in four South African men and one in 10 women 
displayed symptoms of alcohol problems and almost one in four 
high school pupils reported "binge-drinking" during the past 
month - five or more drinks on any given day.  Just less than 
half of all non-natural deaths in 2002 involved blood-alcohol 
concentrations equal to or more than 0.05g/100ml (the legal 
driving limit), and up to two-thirds of all cases tested 
annually at trauma units in three South African cities between 
1999 and 2001 showed breath-alcohol concentrations above that 
level.  Levels of fetal alcohol syndrome are the highest yet 
recorded.  The prevalence of the syndrome among Grade 1 
students in the Western Cape was 41 to 46 per 1,000 children in 
1997, rising to 65 to 74 per 1,000 two years later.  Almost one 
in five AIDS patients at a large infectious disease clinic in 
Cape Town in 2003 met criteria for an alcohol-use disorder. 
Source:  Cape Argus, April 5; Pretoria News, April 6. 
 
AIDS Treatment Centers Open in all Health Districts 
--------------------------------------------- ------ 
 
10.  As of March 31 2004 (the end of 2004 financial year), all 
53 health districts have a AIDS treatment center, completing 
one of the Department of Health's target objectives in its 
Comprehensive Plan for Management, Care and Treatment of HIV 
and AIDS.  250 laboratories and three centers have been 
established to monitor any adverse reaction to anti-retroviral 
treatment.  More than 1,060 health professionals now work on 
the comprehensive plan and 7,600 health personnel have been 
trained to treat AIDS patients.  An accreditation process 
evaluates the capacity of health facilities, including 
effective screening, diagnosis, treatment and monitoring of 
HIV/AIDS patients.  Through the accreditation process, the 
Health Department has identified challenges to the health 
system:  shortage of health personnel, especially doctors, 
pharmacists and dieticians; delays in obtaining laboratory 
results; and lack of safe medicine storage and training in AIDS- 
related treatment.  Source:  Pretoria News, April 5. 
 
KZN Health Department Faces Increasing Financial Burden 
--------------------------------------------- ---------- 
 
11.  The influx of people from Lesotho, Mozambique and 
Swaziland into the province's health institutions along the 
border has overstretched the provincial health department. 
Cross-border patients seeking better medical treatment are 
costing the KwaZulu-Natal Health Department at least R149 
million ($24 million using 6.1 rands per dollar) monthly.  Prof 
Ronald Green-Thompson, the KZN Superintendent-General, said 
that due to financial constraints, the province only had 400 
ambulances instead of the required full fleet of 1,000.  In 
some instances, the KZN Health Department rented military 
helicopters for use as ambulances to reach remote communities, 
costing more than R60,000 a day.  Provincial hospitals were 
flooded not only by foreigners, but also by people from nearby 
provinces such as the Eastern Cape and Mpumalanga.  Provincial 
security costs have declined since the Department spent more 
than R10 million in putting electronic security systems and 
trackers into ambulances, and incidents of hijacking have 
fallen.  Before the ambulances were fitted with the new 
security system, KwaZulu-Natal lost 59 vehicles to hijacking 
and 47 to theft.  Six ambulances were hijacked in 2003 alone. 
Source:  Daily News April 7. 
 
High Cost of Death Burden to Poor 
--------------------------------- 
 
12.  The Financial Diaries project, South Africa's first 
comprehensive look at the financial lives of poor families 
highlights the increasing economic toll that death of relatives 
places on their savings.  Financial Diaries fieldworkers 
interviewed 160 poor households in various townships in the 
Western Cape Province every two weeks for one year, recording 
savings transactions and determining how income gets spent. 
Financial Diaries research shows people being constantly asked 
for substantial amounts of money for the funerals of distant 
relatives.  Eighty percent of rural households in the sample 
contributed at least twice during the year-long study.  In the 
urban areas, people aren't asked to help out with funeral money 
as often but they are asked for larger contributions, 
interrupting their cash flow and savings plans.  South Africa's 
Financial Diaries research indicates that 60 percent of the 
cost of funeral expenses is spent to feed mourners, with the 
result that burial societies (an insurance system to pay for 
the cost of funerals) are specialized, with one covering 
undertaker costs and another providing food.  Many of the poor 
participants in the study put aside money into at least one 
burial society because they were concerned about the impact 
their own death would have on the family's already-stressed 
finances.  Nicoli Nattrass, of the AIDS and Society Research 
Unit (ASRU), is convinced that deaths from the AIDS epidemic 
are slicing increasingly deeply into the limited finances of 
poverty-stricken households.  Source:  All-africa.com, Inter- 
Press Service, April 8. 
 
 
FRAZER