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### Viewing cable 05PRETORIA1161, SOUTH AFRICA PUBLIC HEALTH MARCH 18 ISSUE

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
05PRETORIA1161 | 2005-03-18 11:19 | 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 05 PRETORIA 001161

    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 MARCH 18 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:  25% of Under-20s Using Drugs; Partial
    Victory for Dispensing Doctors; State to Supply AIDS Drugs for
    Less than R100; Debate in South Africa about Routine Testing;
    Survey Shows Durban Less Likely to Test for HIV; Survey Shows
    Youth Views of HIV/AIDS; AIDS Impacts on Agriculture; Another
    Study Confirms TB Increase; Constitutional Court will hear
    Medicine Pricing Case; The Impact of AIDS on Gauteng Province;
    MRC Points to Signs that HIV Pandemic might be abating.  End
    Summary.

    25% of Under-20s Using Drugs
    -----------------------------

    ¶2.  A Medical Research Council (MRC) survey of the prevalence
    of drug abuse among people under 20 years of age shows that in
    1996, one youth in 20 in the Western Cape was taking drugs and
    that now the figure is one in four.  The MRC collected
    information from 25 substance abuse treatment centers in the
    Western Cape and found that between 1996 and 2004, the number
    of young people using drugs had increased dramatically.   The
    drug of choice also changed over the eight years.  The demand
    for treatment of dagga, Mandrax, cocaine and heroin as primary
    drugs increased from one percent in 1996 to nine percent in
    ¶2004.  Methamphetamines (tik) became the most popular choice of
    drug, increasing from 121 treated cases in 2003 to 376 in the
    first half of 2004.  The number of people seeking treatment for
    the abuse of more than one drug had increased since the second
    half of 2003, with more than 10 percent of patients being
    reported as abusing four or more substances.  The length of
    time between a person's first using a drug and seeking
    treatment for abuse depends on the type of drug.  Treatment for
    tik begins, on average, 1.6 years after first use.  Heroin
    users enter treatment programs after three years on average,
    dagga users after 4.8 years, cocaine users after five years and
    Mandrax users after about 7.6 years.  Alcoholics tend to seek
    treatment much later.  Compared with other provinces, a greater
    proportion of young people in the Western Cape seem to have
    started drinking before the age of 13.  Half of the people
    whose unnatural deaths were recorded in Cape Town in 2003 had
    blood alcohol levels over the legal limit.   MRC researchers
    suggested a number of measures that could help curb drug and
    substance abuse.  These include:  (1) reducing the supply of
    drugs and taking steps to deter people from abusing alcohol,
    such as increasing the frequency of random breath tests for
    motorists; (2) passing provincial legislation on the retail
    sale of alcohol and bringing shebeens into the regulated
    market; (3) promoting and implementing effective prevention
    programs with community-based approaches; and (4) improving
    access to quality treatment by building strong partnerships
    between substance abuse treatment centers and mental health
    services.  Source:  The Cape Times, March 10.

    Partial Victory for Dispensing Doctors
    --------------------------------------

    ¶3.  The first constitutional challenge to new health laws left
    dispensing doctors and the Department of Health each claiming a
    partial victory.  In a unanimous judgment, the Constitution
    Court said that regulations that force doctors to get licenses
    to dispense drugs were not unconstitutional.  However, sections
    that tried to limit the number of pharmacies in an area were
    declared invalid.  The court said that laws requiring renewal
    of a dispensing license would stand.  The application to the
    Constitution Court was brought by a group of dispensing doctors
    under the umbrella of the Affordable Medicines Trust, which
    included the National Convention on Dispensing (NCD), and was
    opposed by the Department of Health.  NCD spokesperson Norman
    Mabasa said he did not consider it a partial victory. "It is a
    major victory," he said.  Mabasa claimed that NCD has never
    been against licenses and inspections, but was concerned about
    regulations that would have limited dispensing doctors on the
    basis of competition in an area.  Source:  Sapa, March 11.

    State to Supply AIDS Drugs for less than R100
    ---------------------------------------------

    ¶4. Government will be able to supply state patients with three
    antiretroviral drugs (triple therapy) for around R100 ($17,
    using 5.85 rands per dollar) a month, according to prices
    agreed in the government antiretroviral drug tender.  Local
    generic drug producer Aspen is the main beneficiary of the
    tender, while Indian generic producer Cipla will supply one of
    the drugs needed.  Brand name drugs from the large
    pharmaceutical companies, GlaxoSmithKline, Boehringer
    Ingleheim, Bristol Meyers Squibb, MerckSharpe&Dohme and
    Abbott, are only included where there are no generic
    alternatives.  Concern has been expressed about price increases
    during the tender period.  Boehringer Ingleheim is the only
    company to guarantee that it will not increase the price of the
    drug it is supplying, nevirapine, over the tender period.
    Aspen's prices rise by 6 percent after 18 months.  Abbott is
    providing its drug, lopinavir, to the state at the same price
    as in the private sector.  However, it has pegged its prices
    for Kaletra and Norvir at $500 per patient per year for the
    duration of the tender, which ends in August 2007.  It says
    increases will only come about in relation to currency
    fluctuation.  GlaxoSmithKline's price for 3TC is almost a third
    of the private sector cost, while AZT is almost half the
    private sector price.  First line treatment of the drugs d4T
    (stavudine), 3TC (Lamivudine) and nevirapine for an adult
    weighing 70kg will be about R97.26 a month.  Where efavirenz is
    substituted for nevirapine, the drug the price rises to R269.96
    ($46).  Second line treatment of AZT, ddI and lopinavir will
    cost R534.98 ($91). This treatment will be resorted to if
    patients fail to respond to the first regimen, perhaps because
    they have been on antiretroviral drugs in the past and
    developed resistance, or because of side-effects.  Three
    different classes of antiretroviral drugs, called triple
    therapy, are needed because the virus mutates rapidly, and can
    develop resistance to a single drug with relative ease. Each of
    the three drugs is from a different class and interacts with
    the virus at a different stage of its lifecycle.  Source:
    Health E-News and Business Day, March 4.

    Debate in South Africa about Routine HIV Testing
    --------------------------------------------- ---

    ¶5.  Only 850,000 South Africans have actually been tested for
    HIV in the past four years, while 1.2 million people have had
    pre-test counseling.  The low rate of testing is a common
    problem worldwide, which has led to countries such as Botswana
    and the US making the HIV test a routine service available at
    primary health facilities.  Debate about South Africa's
    voluntary approach to HIV Testing and Counseling involves
    government officials and interested community organizations.
    The article summarizes different viewpoints on testing.  The
    Department of Health has concerns about making HIV testing a
    routine practice, stating that they operate within the
    parameters of the Bill of Rights of the Constitution, whereby
    mandatory testing would violate the rights of those who are HIV-
    infected, so testing should be voluntary.  In addition, they
    feel that mandatory testing will increase stigma associated
    with the infection, saying that their approach is to educate
    communities about the importance of getting to know their
    status early, and also, educating them as to how to live
    positive, healthy, longer lives.  Jonathan Berger of the AIDS
    Law Project asserts that offering the HIV test as a routine
    service would not conflict with South Africa's human rights
    principles.  According to Berger, the routine offer of HIV
    testing should be introduced in South Africa as long as it is
    not introduced in a way that dispenses with the need for pre-
    and post-counseling and proper informed consent.  Advocates of
    routine testing emphasize that an environment where treatment
    is being offered as a real option to the patient and
    confidentiality is respected is essential.  Confidentiality is

    SIPDIS
    different from disclosure.  Disclosure is the choice of the
    patient.  In addition, legal and Constitutional guarantees of
    non-discrimination are essential as well.  With these
    guarantees in place, HIV testing can become routine.  Proposals
    for increased mandatory testing have been recently introduced,
    with the latest recommendation of pre-marital testing proposed
    by Ruth Rabinowitz, an IFP Member of Parliament.  Source:
    Health E-News, March 4, The Witness, March 14.

    Survey Shows Durban less likely to Test for HIV
    --------------------------------------------- --

    ¶6.  According to a survey by Khulisa Management Services,
    people living in Durban are less likely to test for HIV than
    people in Cape Town and Johannesburg.  The survey of 892
    households in the Durban area found that 72 percent of
    respondents had no intention of getting tested for HIV in the
    next 12 months, compared with 42 percent of people in Cape Town
    and 53 percent of Johannesburg residents.  Overall, 33 percent
    of the respondents aged between 18 and 35 had been tested for
    HIV and 43 percent intended to go for tests in the next 12
    months.  Walk-in centers, independent of any established clinic
    or hospital are being established by the government and U.S.
    Center for Disease Control, to serve people who prefer not to
    use government testing facilities.  According to Treasury's
    estimated 2005 expenditure, 3,369 public health care facilities
    are already providing voluntary counseling and testing, with
    the number expected to increase to 5,000 by the end of 2005.
    KwaZulu-Natal province has the highest estimated HIV prevalence
    in South Africa.  Source:  Business Day, March 7.

    Survey Shows Youth Views of HIV/AIDS
    ------------------------------------

    ¶7.  The University of Cape Town's Center for Social Research's
    AIDS and Society Research Unit recently published a study
    "Measuring HIV/AIDS Stigma" based on a survey of 4,800 Cape
    Town youths aged 14 to 22.  Respondents in the Cape Area Panel
    Study were interviewed repeatedly between 2002 and late 2003.
    The study will track the youths' changing circumstances and
    views until 2008.  Initial results highlight the importance of
    awareness campaigns in reducing stigma, showing that the more
    adolescents know about how HIV/AIDS is transmitted, the less
    likely they are to stigmatize people living with the virus.
    Fear of infection is the dominant cause of discrimination among
    81 percent of respondents, followed by `some negative moral
    judgments' cited by 73 percent of survey participants.  Almost
    all respondents believed HIV-positive people should be treated
    equally with regard to government services such as free health
    services, job training, and welfare grants.  The research also
    found that respondents aged 15 to 18 are more likely to
    stigmatize people living with HIV/AIDS than the older
    participants.  Males are more likely to be prejudiced than
    women, while coloured youths are more likely to discriminate
    against those with the virus and African youths the least
    likely to discriminate.  Christian and Muslim youth are more
    likely to discriminate against HIV-infected people than those
    with no religious affiliation.  Source:  Mail&Guardian, March
    ¶11.

    AIDS Impacts on Agriculture
    ---------------------------

    ¶8.  Based on forecasts of Agri AIDS, an HIV/AIDS awareness
    initiative directed at farm workers, between 35 and 40 percent
    of South Africa's agricultural workers are infected with the
    HIV/AIDS virus.  The pilot program of Agri AIDS brings AIDS
    treatment to agricultural workers, with 200 treatment centers
    treating 1000 workers.  According to the latest Statistics SA
    employment report, the agricultural sector employs
    approximately 1 million workers and more severe impacts on the
    agricultural sector production would be felt in the next
    several years.  Source:  Business Day, March 15.

    Another Study Confirms TB Increase
    ----------------------------------

    ¶9.  A National Tuberculosis Control Program (NTBCP) study shows
    that the prevalence of TB has increased from 188,695 patients
    diagnosed in 2001 to 256,000 diagnosed in 2003.  In addition,
    an estimated 55 percent of TB patients are also HIV-positive.
    On a provincial level, KwaZulu-Natal showed the highest TB and
    HIV prevalence, with almost 80,000 TB cases recorded in 2003
    and 37.5 percent of its population infected with HIV.
    Statistics SA, in its 2005 Mortality Report, found that TB
    accounted for 11.3 percent of all deaths in 2001.  NTBCP cited
    a cure success rate of nearly 54 percent although multi-drug
    resistant cases had increased by almost 2 percent and re-
    treatment cases by about 7 percent.  The NTBCP estimates that
    about 10,000 patients currently suffered from multi-drug
    resistant TB.  Source:  Pretoria News, March 15.

    Constitutional Court Will Hear Medicine Pricing Case
    --------------------------------------------- -------

    ¶10.  The Constitutional Court will hear an application by the
    Department of Health relating to its controversial medicine
    pricing regulations.  Part of the regulations, which were
    introduced last May to make medicines more affordable and
    accessible, includes formulas to set the manufacturer price of
    medicine and cap the amount that pharmacists may make from
    selling the medicines.  Pharmacists believe this will put them
    out of business and have waged a prolonged court battle with
    the Department of Health to alter the dispensing fee maximum of
    R26 or 26 percent of the cost of the medicine.  While waiting
    for word of an appeal of a Cape High Court ruling in favor of
    the Department of Health, the pharmacists decided to approach
    the Supreme Court of Appeal (SCA) directly.  The SCA declared
    the regulations invalid and the Department of Health will ask
    the Constitutional Court for leave to appeal this.  The court
    is also expected to be asked to make a declaratory order on
    which laws are currently in force.  The Health Department
    believes their application to the Constitutional Court revives
    the regulations, but the pharmacists believe that because there
    is no clear rule over what happens to an order when it is
    appealed from the SCA, the SCA order stands until the
    Constitutional Court makes a ruling.  Meanwhile, pharmacists
    have chosen their own pricing structures pending the outcome of
    the application.  Source:  Sapa, March 14.

    The Impacts of AIDS on Gauteng Province
    ---------------------------------------

    ¶11.  Gauteng commissioned a study in 2003/04 to investigate the
    impact of the HIV epidemic on hospitals in 2002.  In 2002, 64
    percent of hospital admissions for the age group 25 to 34 were
    people with HIV, with the most common cause of admission being
    TB.  The major costs for the province's hospitals in HIV/AIDS-
    related illnesses were antibiotic drugs and laboratory
    investigations.  The province has had a sharp rise in the
    prevalence of HIV among pregnant women during the period from
    1997 to 2001.  About 80 percent of the population of the
    province does not have medical insurance and depends on public
    health facilities for health services.  To date, 20 health care
    facilities are providing HIV/AIDS treatment in the province,
    with a total of 88,415 people tested, and 9,413 adults and
    1,308 children receiving ARV treatment.  In 2004/05, the total
    provincial HIV/AIDS budget allocation is R334.231 million
    ($57.6 million) of which R200 million is from the provincial
    budget and an additional R134.231 million is from a conditional
    grant from the national Department of Health.  Source:
    Mail&Guardian, March 11.

    MRC Points to Signs that HIV Pandemic Might be Abating
    --------------------------------------------- ---------

    ¶12.  According to Medical Research Council (MRC) interim
    president Dr. Anthony Mbewu, recent surveys signal that the
    demographic impact of HIV/AIDS might be changing.   Using data
    from the annual HIV-prevalence survey of pregnant women
    attending government clinics, Mbewu said there were indications
    that the pandemic was reaching a plateau.  The survey,
    conducted every year since 1990, found that 28 percent of the
    pregnant women surveyed in 2003 were HIV-positive; in 1990 the
    figure was just 0.7 percent.  The prevalence rate rose sharply
    during the mid-1990s, but year-on-year increases have slowed
    since 2000.  In earlier surveys, the highest prevalence rates
    were seen among women aged between 15 and 25, but in 2003 the
    survey showed the highest HIV burden among those aged 25-35.
    In addition, a decline in other sexually transmitted diseases
    such as syphilis, and the increased use of condoms, had helped
    limit the spread of HIV/AIDS.  The prevalence of syphilis among
    pregnant women attending government clinics declined from 8
    percent in 1998 to about 2 percent in 2000.   The MRC estimated
    that HIV was the leading cause of death in 2000, responsible
    for 29.8 percent of all reported deaths.  Cardiovascular
    disease was also a major problem in SA, and Mbewu suggested
    that its economic repercussions might be of the same order as
    those of HIV/AIDS. Referring to Statistics SA's latest
    mortality report, released last month, he said AIDS-related
    deaths were clearly under-reported.   The report detailed the
    causes of deaths recorded on death certificates between 1997
    and 2003, and found that only 2.8 percent of reported deaths in
    2001 were described as being due to HIV.  On the impact of the
    disease on the local economy, Mbewu cited most studies
    predicted a reduction in GDP of between 0.3 percent and 0.6
    percent, based on a decline in the population growth rate of
    1.3 percent.  However, he emphasized the uncertainties in the
    capability of the health system and the extent of the reduction
    in labor force due to HIV/AIDS and suggested that econometric
    models used to estimate HIV/AIDS impacts be refined.  Source:
    Sapa, Business Day, March 16)

    FRAZER

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