US embassy cable - 05PRETORIA4441

UNCLAS SECTION 01 OF 04 PRETORIA 004441 
 
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 KHILL 
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, NIH/HFRANCIS 
CDC FOR SBLOUNT AND DBIRX 
 
E.O.  12958:  N/A 
TAGS: ECON, KHIV, SOCI, TBIO, EAID, SF 
SUBJECT:  SOUTH AFRICA PUBLIC HEALTH NOVEMBER 4 ISSUE 
 
 
Summary 
------- 
 
1.  Summary.  Every two weeks, Embassy 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:  Health Department Underspent R39.7 Million 
on HIV/AIDS; HIV/AIDS Expenditures in 2005 MTBPS; South 
Africa's Response to Avian Flu; Health Sector Charter Eases BEE 
Requirements; Mental Illnesses Increase in SA; Vaginal Gel 
Trials Start in Africa; Large Firms to Help Smaller in HIV/AIDS 
Prevention; TB Study Begins in SA Gold Mines; University of 
Western Cape to Study Medicinal Plants.  End Summary. 
 
Health Department Underspent R39.7 Million on HIV/AIDS 
--------------------------------------------- --------- 
 
2.  The Health Department did not spend R39.7 million ($6.1 
million, using 6.5 rands per dollar) of its total R 1.2 billion 
($185 million) allocated to HIV/AIDS in financial year 2004/05, 
with the major reason cited for the under-expenditure being 
delays in issuing tenders and required reports.  Components of 
the R39.7 million rollover into next financial year's budget 
include:  (1) R15 million in conditional grants to provinces 
due to problems in reporting; (2) R11 million for an inventory 
managements tracking system due to delays in advertising the 
tenders; (3) R10 million for condoms because of the high volume 
and delay in initial ordering; (4) R2.2 million for training in 
monitoring and evaluation due to the late award (issued late 
December 2004) of the bid; and (5) R1.5 million for development 
of antiretroviral equipment, training and networks.  Health 
Minister Tshabalala-Msimang cited local and provincial 
government's failure of not providing regular reports on how 
allocated funds were being used as the main reason for the 
under-expenditures.  Health policy analysts cite the low 
priority of monitoring and evaluation systems placed by 
government, resulting in a lack of emphasis on reporting.  The 
Department of Health has failed to brief the Parliament's 
health committee on the ARV treatment plan after many 
cancellations.  Recent provincial treatment numbers are hard to 
obtain.  The latest known treatment numbers by province are: 
KwaZulu-Natal, 19,000 in mid-August; Gauteng at 20,000 by end 
of July; Limpopo at 5,000 by end of July; North West at 7,578; 
Free State at 2,500; Western Cape at 11,474 (all three by mid- 
September) and Mpumalanga at 936 in January.  Source:  Mail and 
Guardian and The Star, October 28; Adjusted Estimates of 
National Expenditure, 2005, National Treasury. 
 
HIV/AIDS Expenditures in 2005 MTBPS 
----------------------------------- 
 
3.  The 2005 Medium Term Budget Policy Statement (MTBPS) 
provided little direct information on HIV/AIDS spending.  The 
MTBPS did, however, indicate a shift of some HIV/AIDS spending 
through the Department of Social Development from conditional 
grants (money that can be spent only on a designated purpose) 
towards provincial equitable share financing, allowing the 
provinces to decide the spending priorities.  Since 1999, the 
National Integrated Plan for HIV/AIDS provided conditional 
grants to the Health, Education, and Social Development 
Departments.  The Health Department has spent the money on 
prevention, treatment and care, the Education Department has 
funded HIV/AIDS life skills and prevention education, and the 
Department of Social Development has implemented HIV/AIDS 
community home-based care services (CHBCS), primarily through 
non-governmental organizations. 
 
4.  According to the 2005 MTBPS, from 2006/7 onwards, the 
Department of Social Development will no longer receive a 
conditional grant for its CBHCS spending.  Since 2001, the 
Department of Social Development has depended upon the 
conditional grant to fund community and home based care 
services.  In FY2004/5, the provincial Social Development 
programs spent 103% of the CHBCS grant.  The previously 
estimated amount for FY2005/6 CHBCS grants was R139 million 
($21 million).  In the future, Social Development will not be 
able to rely upon this funding mechanism.  Rather CHBCS 
programs will be incorporated into the equitable share funding 
mechanism.  Provincial treasuries will now have the 
responsibility to ensure that sufficient CHBCS funds are 
allocated.  Monitoring of CHBCS funding will be harder unless 
provincial social development departments make CHBCS funding a 
separate line item in their budgets.  In addition, since 
provinces have their own spending priorities, there is no 
guarantee that sufficient CHBCS spending will be available 
using equitable funds.  Source:  Budget Brief 157, HIV and AIDS 
Expenditures in the 2005 MTBPS, IDASA, October 28. 
 
South Africa's Response to Avian Flu 
------------------------------------ 
 
5.  Over the past two weeks, South Africa has intensified its 
efforts to monitor and prepare for the possible appearance of 
the H5N1 version of the avian flu.  Coordination of researchers 
in Durban, Pretoria and Cape Town to collect bird droppings for 
testing has begun, with initial tests underway in Durban. 
Because of last year's outbreak of avian flu in ostriches at 
the Eastern Cape Province, South Africa has in place an 
extensive surveillance system.  The Department of Agriculture 
contained the ostrich outbreak and on September 13, South 
Africa was declared free from Notifiable Avian Influenza (NIA). 
To keep its NIA-free status, South Africa must conduct a 
surveillance program for commercial and non-commercial chickens 
and domestic ostriches as well as maintain strict import 
requirements, including tests in the country of origin, and 
quarantines and retesting in South Africa.  Imported poultry 
products must come from approved processing facilities that are 
free of avian flu.  Most feel that the major danger of H5N1 
landing in South Africa is from migrating birds.  For this 
reason, the Department of Agriculture has advised separation of 
commercial stock from wild birds.  Source:  Cape Argus, October 
20; Business Day, October 21; The Star and Pretoria News, 
October 25. 
 
Health Sector Charter Eases BEE Requirements 
-------------------------------------------- 
 
6.  The Department of Health issued a second draft of the 
health sector charter which eases the black ownership 
requirements to 31% by 2014, with the provision that 15% of the 
black ownership would lie with black women.  The initial draft 
health charter, released in July 2005, was roundly rejected by 
the industry, which felt the target of 51% black ownership by 
2014 was too high.  In addition, industry analysts felt the 
charter failed to differentiate between small practices, 
hospital groups and foreign-owned pharmaceutical firms.  In 
contrast, industry's response to the revised charter has been 
more supportive.  The Private Healthcare Forum, which 
represents more than 80% of private sector health companies, 
welcomed the "significant movement" in the targets.  Medscheme 
CEO Andre Meyer said it was "a lot more positive and far more 
realistic" than the draft charter released in July.  The 
Pharmaceutical Manufacturers Association said that it was 
pleased by the concessions relating to foreign-owned companies 
operating in SA.  The industry has a month to consult with the 
government before it is formally adopted on November.  Source: 
Business Day, October 31. 
 
Mental Illnesses Increase in SA 
------------------------------- 
 
7.  One in five South Africans suffers from a mental disorder 
severe enough to affect their lives significantly, according to 
the Medical Research Council.  Worldwide, psychiatric illnesses 
will rise to be the number one cause of disability within the 
next 15 years, according to the World Health Organization 
(WHO).  The WHO also estimates that 400 million people around 
the world currently suffer from mental or neurological 
disorders or from psychosocial problems such as those related 
to alcohol and drug abuse.  South African women suffer from 
depression in numbers far greater than men.  About 42% of 
women, compared to 24% of men, show signs of depression.  Other 
studies have shown that people wait for 11 months (on average) 
to see a doctor when they are not feeling well and they are 
only diagnosed after the fifth visit.  In South Africa, 150,000 
people commit suicide every year, with the rate among children 
aged between 10 and 14 having more than doubled in the past 15 
years.  Winnie de Roover, from the Mental Health Information 
Center at the University of Stellenbosch, said between one and 
three percent of South Africans suffered from a mental health 
problem, which required them to be admitted to hospital. 
According to Gloria Mhlaluka, head of Mental Health and 
Substance Abuse in the KwaZulu-Natal department of health, 
schizophrenia is the leading major mental illness in the 
province.  Unipolar depression, alcohol abuse, bipolar 
affective disorder, schizophrenia and obsessive-compulsive 
disorder are among the 10 leading causes of disability 
worldwide and major depression was ranked fifth in the 10 
leading causes of the global disease burden in 1998.  Source: 
The Mercury, October 27. 
 
Vaginal Gel Trials Start in Africa 
---------------------------------- 
 
8.  About 10,000 women in South Africa, Uganda, Tanzania and 
Zambia are expected to take part in the trial of PRO 2000, 
which could provide a physical barrier that prevents HIV from 
reaching target cells during sexual intercourse.  More than 
3,000 women in Orange Farm and Soweto in Gauteng have 
volunteered to take part in the trial, which is estimated to 
run for a three-year period at cost of about R210 million ($32 
million).  Two more research groups, in Durban and Mtubatuba, 
will soon join the trials.  The South African trial is part of 
a four-country project run by the international Microbicides 
Development Program.  Half of all adults HIV-positive are 
female, according to U.N. figures.  In sub-Saharan Africa, the 
figure is nearly 60%, with most new infections acquired through 
heterosexual intercourse.  Other microbicides under development 
enhance the natural vaginal defense mechanisms by maintaining 
an acidic pH, kill pathogens by stripping them of their outer 
covering, or prevent replication of the virus after it has 
entered the cell. 
 
9.  PRO 2000 has already been tested on small numbers of women 
to rule out serious side effects.  Clinical trials funded by 
the British government and coordinated by the Clinical Trials 
Unit of the British Medical Research Council will take place 
over three to four years in South Africa, Uganda, Tanzania and 
Zambia.  Researchers hope to enroll 50 new HIV-free 
participants a month and ensure that all receive proper 
counseling and clinical monitoring.  The women will be assigned 
at random to receive a placebo or the microbicide.  They will 
be asked to use it for one year but can drop out at any time. 
The volunteers will all be counseled to continue using a condom 
during intercourse.  Past experience has shown this advice is 
frequently ignored, so the trial has been designed to determine 
whether the gel offers additional protection. 
 
10.  The London School of Hygiene and Tropical Medicine 
calculated that if a microbicide, which is 60% effective 
against HIV and used by 20% of women in 73 developing countries 
over three years, could prevent 2.5 million infections. 
Researchers hope the first generation of microbicides with 50- 
60% effectiveness will be available over the counter in five 
years.  By 2012, second generation microbicides that are 
between 70-90% effective could be on the market, according to 
University of Witwatersrand Reproductive Health Research Unit. 
Source:  Mail and Guardian, October 24, Associated Press, 
October 28. 
 
Large Firms to Help Smaller in HIV/AIDS Prevention 
--------------------------------------------- ----- 
 
11.  An initiative to expand testing and treatment of HIV- 
infected workers in mid-sized companies in South Africa was 
launched, in conjunction with the World Economic Forum (WEF) 
and supported by larger companies with successful HIV/AIDS 
treatment and prevention programs.  South African subsidiaries 
of Volkswagen, Unilever, and state power utility Eskom are 
among the companies working with WEF's Global Health Initiative 
to try to expand HIV/AIDS care to their suppliers.  The larger 
companies will finance AIDS testing, counseling, awareness 
campaigns and treatment of infected workers in the smaller 
businesses.  Small and medium-sized firms provide more than 55 
percent of all South African jobs, according to the African 
Development Bank.  Only half of small business owners in the 
country had a formal strategy to tackle AIDS, and over a third 
of those had no one to oversee the policy, according to an 
April 2005 Grant Thornton Business Owners Survey.  Source: 
Reuters, October 28. 
 
TB Study Begins in SA Gold Mines 
-------------------------------- 
 
12.  The Johns Hopkins-based Consortium to Respond Effectively 
to the AIDS/TB Epidemic (CREATE) announced the start of three 
studies to evaluate novel techniques for controlling HIV- 
related TB in countries hard hit by the dual epidemics.  With 
the goal of reducing death and disease from TB in AIDS-endemic 
populations, consortium partners have designed three projects 
in South Africa, Zambia and Brazil.  All three studies have 
moved into implementation in recent weeks.  The World Health 
Organization's Global Tuberculosis Control 2005 report notes 
that global TB prevalence has declined by more than 20% since 
1990 and that incidence rates are now falling or stable in five 
of the six WHO regions of the world.  The exception is Africa, 
where TB incidence rates have tripled since 1990 in countries 
with high HIV prevalence and continue to rise across the 
continent at 3-4% annually.  CREATE includes, besides Hopkins, 
Aurum Health Research (South Africa), London School of Hygiene 
and Tropical Medicine, Municipal Health Secretariat 
Communicable Disease Program Rio de Janeiro and The World 
Health Organization - Stop TB Department.  Source:  Engineering 
News, October 24. 
 
University of Western Cape to Study Medicinal Plants 
--------------------------------------------- ------- 
 
13.  The U.S. National Institutes of Health has awarded $4.4 
million to a consortium of South African and US scientists to 
study local medicinal plants that are already being used by 
traditional healers to fight HIV and its associated infections. 
A new center at the University of Western Cape (UWC), The 
International Center for Indigenous Phyto-therapy Studies, will 
be established.  Four out of five South Africans use 
traditional medicines, according to the Health Department. 
Many of these medicines are derived from local plants and 
little scientific evidence supports their use.  The Center is a 
joint initiative between UWC and the University of Missouri. 
The South African institutes collaborating with the centre 
include the Medical Research Council, and the Medical Schools 
at the University of KwaZulu-Natal and the University of Cape 
Town.  The Center will focus its research on plants already in 
use, with at least 3,000 of South Africa's 21,000 unique plant 
species now used as traditional remedies.  Scientists have 
already begun assessing the safety of the Sutherlandia plant, 
which has traditionally been used as a tonic for a wide range 
of health problems.  Researchers hope to figure out whether the 
plant helped prevent weight loss in people suffering from the 
early stages of HIV.  The Center is not looking at substituting 
other medicines (such as antiretroviral AIDS drugs) with any of 
these plant remedies.  Source:  Business Day, October 24. 
 
HARTLEY