US embassy cable - 05PRETORIA4834

UNCLAS SECTION 01 OF 04 PRETORIA 004834 
 
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 DECEMBER 9 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:  HSRC Releases HIV Survey; UN Report Shows 
Large Increase in HIV Prevalence; Profits of Mining Sector Most 
Impacted by HIV/AIDS; ASSA Model Shows Increase in HIV 
Infections; Stem-cell Therapy for South African Cardiac 
Patients; Tik Abuse by Cape Teens Shows Sharp Increase; Rath 
Generates Legal Fees.  End Summary. 
 
HSRC Releases HIV Survey 
------------------------ 
 
2.  Over one in 10 South Africans are HIV-positive, with young 
African women living in informal settlements having the highest 
risk of HIV infection.  The country's overall HIV prevalence 
rate has dropped slightly from 11.4% in 2002, when the first 
household survey was conducted, to 10.8%.  However, there has 
been a 5% jump in HIV infection among young women aged 15 to 
24, with 17% of whom are now living with HIV in comparison to 
12% three years ago. This is four times the rate of HIV- 
positive men in the same age group at 4.4%.  The incidence rate 
(new infections) of females aged 15 to 24 is eight times that 
of males, reaching 6.5% compared to the males' new infection 
rate of 0.8%, an indication of the increased vulnerability of 
women towards HIV/AIDS.  Six percent of all recent HIV 
infections in South Africa occurred in children aged 2 to 14, 
possibly attributed to mother-to-child transmission and child 
abuse. 
 
3.  KwaZulu-Natal, ranked fourth in the 2002 survey, now has 
the highest provincial HIV prevalence rate at 16.5%, followed 
by Mpumalanga (15.2%), Free State (12.6%) with North West 
(10.9%) and Gauteng (10.85%) almost tied.  The Western Cape has 
the lowest infection rate of 1.9%. 
 
4.  South Africans continue to believe that they are not at 
risk of contracting HIV.  Sixty-six percent of respondents 
thought that they were not at risk.  Fifty one percent of 
respondents found to be HIV-positive thought they would 
probably not (or definitely not) get infected with HIV.  Close 
to 80% knew where counseling and testing services were located. 
Of those who had never been tested for HIV, 12.8% tested HIV- 
positive; and of those ever tested, over one third were tested 
in the past year.  The main reason for not testing was a 
perception of low risk to HIV infection. 
 
5.  The HIV prevalence among Africans is 13.3% in 2005.  In 
African adults aged 15-49 years, almost 20% of men and 24.4% of 
women are HIV-positive.  People living in informal settlements 
aged between 15 and 49 have the highest HIV-prevalence at 
25.8%.  Men living in informal areas had more multiple partners 
than those living in formal urban areas.  For females aged 15- 
19 years, HIV prevalence was 29% among those who had a partner 
who was five or more years older than themselves. The figure is 
also high among females aged 20-24 years (34.9%).  About a 
third of men had partners at least five years younger than they 
were.  HIV prevalence for males aged 50-45 was over double that 
of females at 14.2% (males) compared to 6.4% of females, with 
few AIDS prevention programs aimed at the older male 
population. 
 
6.  About 14.4% of the children aged 2-18 years reported that 
they were orphans, with 2.6% maternal orphans, 10.0% paternal 
orphans and 2.0% double orphans.  Total orphans number 
2,531,810 in South Africa in 2005.  The overwhelming majority 
(92.8%) of orphans were African, followed by 4.8% who were 
coloured (an official South African racial category).  KwaZulu- 
Natal (19.8%) and Eastern Cape (18.1%) had the highest number 
of orphans, while the Western Cape (7.5%) had the lowest. 
Orphans were most likely to live in rural informal areas 
(19.6%) and least likely in urban formal areas, an indication 
that most live in poverty.  Source:  Health E-News, November 
30, City Press, December 4, South African National HIV 
Prevalence, HIV Incidence, Behavior and Communication Survey, 
2005, HSRC Press. 
 
7.  Comment.  The HSRC 2005 household survey interviewed 23,275 
individuals with 15,851 agreeing to be tested for HIV.  The 
2005 survey sample is more than two times the HSRC 2002 sample 
of 9,963.  Estimates of incidence in this year's survey used 
blood HIV tests that allow for identification of recent 
infection (infection from past 180 days) compared to 2002's use 
of oral specimens.   The HSRC surveys are population based, 
providing direct measures of HIV prevalence and incidence by 
sex, province, residence, age and race.  Other surveys used to 
estimate HIV prevalence are based on antenatal surveys 
(pregnant women using public health facilities) and with 
further modeling of estimate HIV prevalence in other groups.  A 
limitation of population-based surveys is reliance on perhaps 
low and differing response rates.  End comment. 
 
UN Report Shows Large Increase in HIV Prevalence 
--------------------------------------------- --- 
 
8.  The UNAIDS Global AIDS Epidemic Update Report highlighted 
the speed at which HIV is impacting South Africa, with HIV- 
prevalence rates at 1% in 1990, now reaching close to 30%. 
According to the UNAIDS report, 29.5% of South African pregnant 
women attending public clinics were HIV-positive in 2004.  The 
UN report estimated 6 million HIV-positive individuals are 
living in South Africa, with approximately 15% in need of anti- 
retroviral treatment (135,000 out of 900,000) receiving ARV 
drugs.  The UN report said HIV/AIDS was responsible for a 62% 
increase in deaths of South Africans aged 15 and older between 
1997 and 2002 and a more than 50% increase in deaths in the 25- 
44 age group.  Sub-Saharan Africa has 25.8 million HIV-positive 
people, more than 60% of HIV-positive individuals worldwide, 
with only 10% of the world's population.  HIV-prevalence rates 
have declined in Zimbabwe, Kenya and Uganda between 1999 and 
2004.  Source:  Business Day and Pretoria News, November 22; 
City Press, November 27. 
 
9.  Comment.  The UN report relies on antenatal survey results, 
which are the only surveys available over a long period of 
time.  Sampling representation have repeatedly been questioned, 
as well as key assumptions, such as total fertility rate and 
fertility rates by age and race, which would give different 
estimates of HIV prevalence.  End comment. 
 
Profits of Mining Sector Most Impacted by HIV/AIDS 
--------------------------------------------- ----- 
 
10.  According to a survey sponsored by the South Africa 
Business Coalition on HIV and AIDS (SABCOHA), more than half 
the mining sector had suffered a drop in profitability because 
of the effect of HIV/AIDS on its workforce.  The profit of 
about 55 percent of mines, 46 percent of transport firms and 38 
percent of manufacturers polled had declined due to the 
pandemic.  The survey, which covered 1,032 companies in eight 
industries, was conducted by the Bureau for Economic Research. 
According to SABCOHA, most of the companies surveyed had 
indicated that the effect on profit was less than 2.5%, similar 
to the 2004 survey.  In terms of the impact on production 
costs, it appears as though HIV/AIDS has had the largest impact 
on labor productivity and worker absenteeism, followed by 
employee benefit costs.  The survey was carried out between 
July and August 2005, covering the mining, manufacturing, 
retail, wholesale, motor trade, financial services, building 
and construction sectors.  It found that 40% of manufacturers 
and transport firms, and 60% of mines had lost experienced and 
skilled workers because of HIV/AIDS.  Firms employing 
semiskilled and unskilled workers were the worst affected.  The 
vast majority of small companies have yet to conduct a single 
awareness campaign.  Source:  Business Day, December 1. 
 
ASSA Model Shows Increase in HIV Infections 
------------------------------------------- 
 
11.  According to the Actuarial Society of South Africa (ASSA), 
the number of HIV infections in South Africa would increase to 
5.8 million by 2010, despite significant interventions already 
introduced to limit the spread of infection.  ASSA's 2003 model 
estimated 5.2 million South Africans were living with HIV/AIDS 
now, 530,000 of them infected between 2004 and 2005 when 
340,000 people died of HIV/AIDS.  As the number of new HIV 
infections exceeds the number of HIV/AIDS deaths, the HIV 
prevalence is still growing in South Africa.  According to the 
model, just 120,000 of the country's 520,000 HIV/AIDS needing 
anti-retroviral treatment were receiving the drugs. About 1.5 
million South Africans had died of AIDS-related illnesses since 
the start of the epidemic.  It found KwaZulu-Natal the worst 
affected province, with the highest rates of HIV prevalence and 
the lowest life expectancy.  Other severely affected provinces 
were Gauteng, the Free State, Mpumalanga and the North West. 
Last year, the ASSA model was the first to take into account 
the government's integrated AIDS plan.  Source:  Pretoria News, 
November 30. 
 
Stem-Cell Therapy for South African Cardiac Patients 
--------------------------------------------- ------- 
 
12.  Lazaron Biotechnologies, the company that established 
South Africa's first stem-cell bank, is now planning to offer 
stem-cell therapy to patients with failing hearts. 
Cardiologists in the U.S., Europe and South America report 
improvements in cardiac patients treated using stem cell 
therapy, promising an alternative to heart transplants.  In 
most cases the cells are harvested from the patient's own body, 
and injected into their heart tissue to rejuvenate the failing 
organ.   Stem cells are immature cells that can be coaxed into 
becoming many different kinds of cells.  Scientists are 
exploring their potential to combat a host of degenerative 
conditions, such as Parkinson's or Alzheimers, or repairing 
damaged tissue.  Lazaron is planning to begin South Africa's 
first cardiac clinic that will include experimental stem-cell 
therapy among its treatment options.  Lazaron's cardiac clinic 
would not be limited to stem-cell therapy, but would provide 
the full spectrum of accepted treatments for patients with 
different kinds of heart problems.  Source:  Business Day, 
November 18. 
 
Tik Abuse by Cape Teens Shows Sharp Increase 
-------------------------------------------- 
 
13.  New figures released by the Medical Research Council show 
that methamphetamine (or tik) abuse in Cape Town has shot up 
dramatically since the end of 2004.  Two-thirds of persons 
under the age of 20 who come to local treatment centers for 
substance abuse have tik as either their primary or secondary 
drug.  About a third of substance abusers of all ages, in the 
first half of 2005, had tik as their primary drug of abuse, 
compared with 19% at the same time last year and 4.7% in the 
first half of 2003.  Of the more than 600 patients under the 
age of 20 treated in 2005 for all types of substance abuse at 
25 treatment centers in Cape Town, 49% primarily abused tik, 
compared with 42% in the second half of 2004, 25% in the first 
half of 2004, 5% and 4% in the second and first half of 2003, 
respectively.  Of substance abusers of all ages, 34% primarily 
abuse alcohol, 2% mainly abuse tik, 10% mainly do heroin and 
9.7% are treated primarily for the abuse of dagga (marijuana). 
According to Professor Charles Parry, who led the study, it was 
the first time that heroin had passed dagga as the primary drug 
that patients had sought treatment for.  According to Parry, 
within 10 years, alcohol abuse dropped from around 80% to 34%, 
not because people started drinking less, but rather because 
alcoholics had to start making way for abusers of other 
substances.  On average, tik users would enroll for 
rehabilitation within 1.9 years of starting the habit, which is 
sooner than any other substance abusers.  Heroin addicts would 
typically seek treatment within 2.9 years, while cocaine 
addicts on average would take 5.1 years to enroll for 
rehabilitation.  Dagga smokers would seek treatment on average 
about five and a half years after addiction started, while 
Mandrax addicts would typically take more than 10 years to seek 
help.  Source:  The Cape Times, November 18. 
 
Rath Generates Legal Fees 
------------------------- 
 
14.  The Treatment Action Council (TAC) and the South African 
Medical Association have asked the Cape High Court to grant 
them an interdict that would stop Rath's selling and 
distributing medicines which are not registered, making false 
statements claiming that their medicines were effective in 
treating or preventing Aids, and making false statements about 
antiretrovirals.  According to Health Minister Manto Tshabalala- 
Msimang, the government will continue to support the use of 
vitamins by HIV and Aids patients until the courts have decided 
otherwise.  Minister Tshabalala-Msimang said: "We believe that 
there is no one solution to improve the wellness of those who 
are HIV-positive or have full blown Aids. Therefore, we have a 
multi-pronged approach. The use of vitamins is part of that 
plan."  Rath brought a R1.6 million ($250 million, using 6.5 
rands per dollar) defamation suit against Health E-News and 
three of its employees over a series of articles describing the 
Rath Foundation's campaign against ARV drugs in two of Cape 
Town's townships.  The Rath Foundation has pending suits 
against many of South Africa's leading media organizations, 
former educational minister Kader Asmal and HIV/AIDS expert 
Professor Jerry Coovadia.  TAC, the Congress of South African 
Trade Unions and the South African Council of Churches are 
uniting to denounce the Rath Foundation's attempts to conduct 
unauthorized HIV trials in South Africa.  Source:  Business 
Day, November 22 and 24; The Daily News, December 1. 
 
TEITELBAUM