US embassy cable - 05PRETORIA4593

UNCLAS SECTION 01 OF 03 PRETORIA 004593 
 
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 18 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:  Increased Risk of Malaria for HIV-positive 
Individuals; Nearly Half of SA Nurses Report Abuse; Survey 
Shows South Africans Continue Risky Behavior; SA to Ban 
Asbestos; Study Highlights HIV Impacts on Children; New HIV 
Vaccine to be Tested in SA; High Medical Costs in South Africa; 
and New Malaria Cure Possible.  End Summary. 
 
Increased Risk of Malaria for HIV-positive Individuals 
--------------------------------------------- --------- 
 
2.  South African research demonstrated that HIV-positive 
individuals have a significantly increased risk of severe 
malaria.  Investigators working at a hospital in Soweto showed 
that the risk of severe malaria was almost three times greater 
for HIV-positive individuals than HIV-negative ones. 
Researchers offered two possible explanations:  (1) HIV 
infection could impair immune responses to malaria parasites, 
or (2) HIV-infected patients may develop excessive or aberrant 
immune responses that lead to increased disease severity. 
 
3.  A total of 336 patients were included in the investigators' 
analysis.  Of these individuals, 110 (33%) were HIV-positive. 
Two-thirds of patients had semi-immunity to malaria.  The 
researchers found that HIV-positive individuals were 
significantly more likely to have a distinct pattern of illness 
caused by malaria, including kidney failure, severe anemia, and 
that people with HIV were more likely to be admitted to 
intensive care than HIV-negative malaria patients.  In 
multivariate analysis, the investigators found that the risk 
factors for severe malaria were non-immunity, HIV infection, a 
high malaria parasite count, and an elevated white blood count. 
Overall, the investigators noted that HIV-positive patients 
with a CD4 cell count below 200 cells/mm3 were significantly 
more likely than HIV-negative individuals to have severe 
malaria.  The investigators also observed that non-immune HIV- 
positive patients with severe malaria had significantly lower 
CD4 cell counts (134 cells/mm3 vs 190 cells/mm3, p = 0.007) 
than semi-immune HIV-positive individuals.  Source:  Cohen C et 
al., Increased prevalence of severe malaria in HIV-infected 
adults in South Africa, Clinical Infectious Diseases, 41, 
online edition, 2005;AIDSMAP, November 10. 
 
Nearly Half of SA Nurses Report Abuse 
------------------------------------- 
 
4.  More than half of all nurses polled report suffering at 
least one incident of physical or psychological violence in a 
single year, according to a study published in the Health 
Annals 2005 of the Hospital Association of South Africa. 
Approximately 80% of nurses blamed abuse, largely by male 
doctors, for nurses leaving the profession.  Almost half the 
respondents cited abuse by patients as a reason for nurses 
leaving the profession.  The definition of abuse in the study 
ranged from harassment and bullying to aggression and assault, 
both physical and psychological, with the perpetrators being 
patients, patients' families and visitors, other nurses and 
other healthcare professionals, such as doctors.  Psychological 
violence was more likely from healthcare workers, and physical 
violence was usually perpetrated by patients and their 
relatives.  Source:  The Cape Argus, November 10. 
 
Survey Shows South Africans Continue Risky Behavior 
--------------------------------------------- ------ 
 
5.  According to the 2005 Durex Global Sex Survey, sixty-four 
percent of South Africans have had unprotected sex without 
knowing their partner's sexual history, higher than last year's 
results.  The survey, conducted online, found that 10 percent 
of South Africans have had unprotected sex when they thought 
they may have had a sexually transmitted infection like HIV. 
Nineteen percent of South Africans are too scared to test for 
HIV and Aids, even though they suspect they may have the 
disease.  The survey also found that 59 percent of South 
Africans have had sex with a stranger and 30 percent of men 
admit to having had an extra-marital affair compared with 20 
percent of South African women. 
 
South African individuals have sex about 109 times a year - 
above the global average of 103.  Greece had the highest number 
of sexual encounters at 138, while Japan reported the lowest at 
45 times a year.  For South Africans, the most common places 
for sex outside the bedroom are: the car (74%), followed by 
toilets (47%), the garden (46%), parties (44%), nightclubs 
(37%) and in planes (4%).  Nearly a third of the South African 
respondents also admitted to having had sex at their place of 
employment.  Forty-one countries were included in the survey, 
with more than 300,000 participants.  Source:  SAPA, IOL, 
November 8. 
 
SA to Ban Asbestos 
------------------ 
 
6.  Draft regulations will be published to ban the import and 
export of all asbestos products, along with new measures to 
phase out the local manufacture and use of asbestos-containing 
products.  The decision to publish the regulations, which 
provide for hefty fines and a maximum jail term of 10 years for 
offenders, was approved by the cabinet in October 2005.  From 
an economic perspective, the new South African ban is not 
expected to lead to major job losses, with government 
statistics suggesting that fewer than 200 people remain 
directly employed in the domestic asbestos manufacturing 
industry.  According to the department of environmental 
affairs, alternative fibres and materials are available to 
replace most asbestos-containing products.  Everite, the 
biggest South African producer of asbestos roof sheeting, 
switched over completely to a new tree-based fiber product 
called Nutec in 2002.  Federal-Mogul, the largest local 
supplier of brake and clutch linings, also stopped using 
asbestos nearly 10 years ago, according to Johnny Frankiskos, 
Managing Director of the Friction Products Division. 
 
7.  The new government measures are not aimed at removing or 
replacing existing asbestos products.  Removing asbestos roof 
sheets and gutters without adequate safety precautions could 
create bigger health risk exposures than leaving them in place, 
said senior Environmental Affairs Department official Joanne 
Yawitch.  The regulations aim to ban any further manufacture of 
such products and to ensure much stricter safety standards for 
workers when old buildings are demolished.  Those companies 
which continue to stock asbestos-containing products will be 
allowed a four-month grace period once the ban takes effect, 
while a limited number of companies will be granted exemptions 
on condition that they submit phase-out plans to the 
government.  South Africa, a major world supplier of asbestos 
for nearly a century, closed its last asbestos mine in 2001 and 
has been under increasing pressure to ban asbestos completely. 
Total asbestos usage in South Africa had declined by about 40 
percent between 2000 and 2002, while a National Economic 
Development and Labor Council study estimated that by banning 
asbestos, South Africa could save nearly R27 million ($4.2 
million using 6.5 rands per dollar) every year in disease 
compensation and health costs.  Source:  The Mercury, November 3. 
 
Study Highlights HIV Impacts on Children 
---------------------------------------- 
 
8.  Almost half the world's orphans and vulnerable children 
whose parents died of AIDS are in southern Africa, according to 
Human Sciences Research Council study sponsored by WK Kellogg 
Foundation (WKKF).  The study began in 2002, when the WKKF 
contributed about R35 million ($5.4 million) to launch a pilot 
project to combat the growing number of orphans and vulnerable 
children in South Africa, Botswana and Zimbabwe.  Researchers 
from HSRC interviewed government representatives, caregivers 
and management of projects providing support services to 
children in HIV-impacted households.  According to the study, 
rural communities must bear the human and financial costs of 
the disease because many HIV-infected urban dwellers return to 
their rural communities when they become ill.  In addition, the 
study recommends more focus on prevention of HIV infection, 
with increased attention placed on prevention of sexual abuse. 
Income generating projects are needed to encourage skills 
development.  Finally, there has to be more advocacy work on 
legal issues related to orphans and vulnerable children to 
publicize and protect their legal rights.  Source:  The Star, 
November 11; hsrc.ac.za. 
 
New HIV Vaccine to be Tested in SA 
---------------------------------- 
9.  Seventy-eight healthy South Africans are to test a new 
candidate HIV vaccine over the next 18 months, according to the 
International AIDS Vaccine Initiative (IAVI).  The trials will 
test the safety of tgAAC09, a vaccine candidate that is based 
on the HIV sub-type most prevalent in southern and eastern 
Africa.  The trial will be conducted in three sites in South 
Africa:  (1) the Perinatal HIV Research Unit, Chris Hani- 
Baragwanath Hospital in Soweto with Dr Eftyhia Vardas as the 
principal investigator; (2) the Desmond Tutu Institute for HIV 
Research, University of Cape Town, with Dr Linda-Gail Bekker as 
the principal investigator; and (3) the Medunsa Campus of the 
University of Limpopo with Professor Anwar Hoosen as the 
principal investigator.  The IAVI also plans to test the 
vaccine in Zambia and Uganda, pending regulatory approval in 
those countries. The vaccine candidate, tgAAC09, uses a 
recombinant adeno-associated viral vector (rAAV) that was 
developed with and manufactured by Targeted Genetics 
Corporation, based in Seattle, Washington.  The South African 
trial follows positive safety data received from "Phase I" 
tests conducted over the past two years in Belgium, Germany and 
India.  Candidate vaccines that are proven to be safe in Phase 
I trials move on to Phase II trials, allowing investigators to 
test the immune response and acquire more data on safety.  This 
is the first Phase II HIV vaccine trial to be held in South 
Africa.  Sub-Saharan Africa is the region hardest hit by AIDS, 
with more than 25 million people estimated to be infected with 
HIV, the virus that leads to the disease.  Source:  SAPA, IOL, 
November 14. 
 
High Medical Costs in South Africa 
---------------------------------- 
 
10.  South Africans are leading unhealthy lifestyles, forcing 
companies and government to pay more for health coverage. 
Currently 8.6% of South African GDP is spent on healthcare, 
compared to 7.7% in the UK and 14.6% in the U.S.  Insurance 
coverage for chronic drugs has increased by 27.5% per year 
between 1999 and 2003.  According to the South Africa Health 
Review, Non-communicable diseases are the leading cause of 
death in South Africa, with cardiovascular diseases (CVDs) 
killing 14% of men and 19% of women.  CVDs comprise Ischaemic 
heart disease, diabetes mellitus, and hypertensive heart 
disease. The Medical Research Council estimates that 318,083 
years of life are lost because of strokes and 284,438 because 
of Ischaemic heart disease.  According to World Health 
Organization Mortality Statistics, South Africa ranks first in 
CVD deaths ahead of Brazil, China, India, the U.S., and 
Portugal.  Source:  The Citizen, November 10; hst.org.za. 
 
New Malaria Cure Possible 
------------------------- 
 
11.  A new malaria cure, based on an Asian medicinal herb 
artmisinine, is to be presented to the African market in 2006. 
Dafra Pharma, a Belgian company specializing in malaria 
medicines since 1997, announced the new cure.  The new single- 
day cure for malaria has already been widely tested on several 
locations in Africa, making it ready for marketing in 2006. 
After the initial treatment, which takes one day, patients 
suffered no subsequent relapses, and after 28 days after the 
start of treatment, no parasites were left in the patients' 
blood.  Dafra asserts that its new cure is simpler, more 
effective and cheaper than any other malaria cures on the 
market.  It is a fixed-dose combination (FDC) of two active 
ingredients in a single tablet.  The company has developed 
three different FDC's for patients of different weights, 
including one for children, infants or pregnant women. In 
Africa, in particular children are very affected by malaria, 
causing very high mortality rates.  According to Dafra, the 
recommended price for government purchases of the drug will be 
just 1 euro per adult patient and 50 cent per child, making the 
new one-day therapy the cheapest anti-malarial treatment of all 
Artemisinin based Combination Therapies (ACT's).  Dafra Pharma 
has subsidiaries in Mali, South Africa and Kenya where it also 
produces generic drugs.  Source:  AfroNews, November 11. 
 
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