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### Viewing cable 05PRETORIA4441, SOUTH AFRICA PUBLIC HEALTH NOVEMBER 4 ISSUE

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
05PRETORIA4441 | 2005-11-04 07:33 | 2011-08-24 01:00 | UNCLASSIFIED | Embassy Pretoria

`

    This record is a partial extract of the original cable. The full text of the original cable is not available.

` `

    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

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