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### Viewing cable 04PRETORIA5509, SOUTH AFRICA PUBLIC HEALTH DECEMBER 24 ISSUE

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
04PRETORIA5509 | 2004-12-23 12:19 | 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 03 PRETORIA 005509

    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 DECEMBER 24 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:  Blood Bank Drops Race as a Risk Factor;
    Genetic Discovery Brings AIDS Vaccines Closer; South African
    Vaccine Search; Study Focuses on Human Cost of AIDS; AIDS
    Infections Peaking in KZN; South African Children Victim of
    Fire; and Court Rules Against Pharmaceutical Pricing
    Regulations.  End Summary.

    Blood Bank Drops Race as a Risk Factor
    --------------------------------------

    ¶2.  The South African National Blood Service said that it would
    revise its controversial profiling system to enable it to risk-
    rate donors without using race.  To ensure patient safety, the
    current system would remain in place until the new model was
    developed, said the organization's CEO, Prof Anthon Heyns.  The
    developments follow a politicized row that the organization
    found itself embroiled in last week, after it emerged that it
    used race as one factor to risk-rate blood donors for possible
    HIV infection.  It was reported that blood donated by black and
    coloured donors was routinely discarded; although it later
    emerged that the organization destroyed only some of the blood
    products from those donors. The organization used low-risk
    blood products such as plasma, which can be treated to destroy
    HIV and discarded high-risk components such as red cells, from
    which the virus cannot be eradicated.  It said race-based risk
    rating was necessary as there was a higher incidence of HIV
    among blacks than other races in SA.  Although all donated
    blood is screened for HIV, the tests are unable to detect it in
    someone who has been recently infected.  Following a meeting
    with officials from the Health Department on Friday, the
    organization issued a statement saying it had agreed that it
    was unacceptable to use race as a risk-determinant.  It said
    its risk model was flawed because it was too heavily weighted
    for race, and would be "appropriately modified to identify the
    profile of a safe donor without taking race into account".  The
    new risk model would be developed by a committee of experts
    from the SA Blood Service, the Health Department, the Medical
    Research Council, the Council for Scientific and Industrial
    Research, and National Health Laboratory Services.  The
    committee has been given until the end of January to devise the
    new risk-rating system.  Source:  Business Day, December 14.

    Genetic Discover Brings AIDS Vaccines Closer
    --------------------------------------------

    ¶3.  An international study, involving South African scientists
    published in Nature shows which category of immune cells are
    actually fighting the HIV virus, which may be the first step
    towards finding ways of circumventing the virus's ability to
    avoid vaccines by rapid mutation.  Professor Coovadia and Dr.
    Kiepiela from the University of KwaZulu-Natal worked with the
    Partners Aids Research Center at Massachusetts General Hospital
    on the study.  The researchers found that the human leukocyte
    antigen B molecules (HLA-B), which send an alarm to the T cells
    when a virus or foreign body is present, were important in
    fighting the HIV virus, while the HLA-A and HLA-C were
    ineffective.  Patients who had particular HLA-B molecules coped
    better with HIV infection and had a lower viral load.  Infected
    pregnant mothers with a protective version of HLA-B were more
    likely to survive and less likely to pass the infection to
    their infant at birth.  The three-year research program was
    conducted in communities hardest hit by the HIV epidemic, most
    of which are in Africa.  Source:  The Sunday Independent,
    Sunday Times, December 12.

    South African Vaccine Search
    ----------------------------

    ¶4.  In South Africa, efforts to find a HIV/AIDS vaccine are led
    by the South African AIDS Vaccine Initiative (SAAVI), operating
    with a budget of $15 million per year, focusing on molecular
    biology engineering.  SAAVI was formed in 1999 by the
    government and Eskom (an electricity parastatal) in a public-
    private partnership to coordinate the research, development and
    testing of a HIV/AIDS vaccine in South Africa.  The Departments
    of Health and Science and Technology along with Eskom, Transnet
    (a transportation parastatal) and Impala Platinum have
    contributed its major funding.  SAAVI focuses on the
    development of subtype C HIV/AIDS vaccines, as this subtype
    accounts for more than 90 percent of infections in Southern
    Africa.  Globally, most HIV vaccines that have been tested to
    date have been developed for the subtype B virus.  There is no
    conclusive evidence as yet showing that a vaccine based on one
    subtype of HIV will or will not protect against infection with
    another HIV subtype.  There are two phase-one trials of
    possible HIV/AIDS vaccines started in South Africa last year.
    There are another two products that are in the ethics and
    regulatory approval processes preceding phase one and could
    possible go into trials soon.  Estimates are that there are
    more than two dozen different designs for a preventive AIDS
    vaccine currently on trial internationally.  The two current
    South African trial sites, enrolling only volunteers, are at
    the University of the Witwatersrand HIV/AIDS Vaccine Division
    of the Perinatal HIV Research Unit at the Chris Hani
    Baragwanath Hospital in Johannesburg, and the SAAVI Clinical
    Trial Unit at the Medical Research Council in Durban.  Two
    additional trial locations in Cape Town and Orkney (North West
    Province) will be added to future sites.  Source:  Engineering
    News, December 3-9.

    Study Focuses on Human Cost of AIDS
    ------------------------------------

    ¶5.  "The Demographic Impact of HIV/AIDS in South Africa:
    National Indicators for 2004", compiled by the Medical Research
    Council's Burden of Disease Research Unit, the Center for
    Actuarial Research and the Actuarial Society of South Africa,
    highlights on the human costs of the HIV/AIDS pandemic.  The
    study was based on the latest antenatal clinic results, death
    register information and data on HIV/AIDS interventions.  In
    2004, HIV/AIDS related diseases have killed 311,000 people and
    5 million out of 46 million South Africans were HIV-positive.
    By the end of 2004, 600,000 children under 18 will have lost
    their mothers to AIDS, and by 2015, 2 million children will be
    maternal orphans.  The estimate of 5 million infected people
    was about a third lower than previous estimates, because
    condoms, voluntary testing and ARV treatment are starting to
    impact infections.  The incidence of HIV infections passed its
    peak in all age and gender groups between 1997 and 2001, except
    for males in the 15-24 age group, which is projected to peak
    around 90,000 new infections in 2006.  According to the 2004
    ASSA model, the national average life expectancy is just under
    50 years old.  The model also suggests that in 2005, around
    500,000 people need ARV treatment.  Currently 19,500 HIV-
    positive people are on public sector provided treatment and
    45,000 are on private sector dispensed treatment.  Women from
    the ages of 15-49 account for 2.55 million of all HIV
    infections to date, while HIV prevalence peaks between the ages
    of 25-29 for females and 30-34 for males.  The HIV virus is
    responsible for a declining annual population growth rate, from
    a high of 2.7 percent in 1994-96 to 0.8 percent in 2004; and a
    projected 0.3 percent by 2015.  The most economically active
    segment of the population, aged 35 to 49 will not grow by 2015.
    By 2015, 743,000 South Africans will need ARV treatment.
    Source:  The Star, December 4.

    AIDS Infections Peaking in KZN
    ------------------------------

    ¶6.  The rate of new HIV and Aids infections appears to have
    peaked in KwaZulu-Natal, according to Professor Alan Whiteside,
    the head of the Health, Economics and HIV and Aids Division at
    the University of KwaZulu-Natal.  The latest research showed an
    increase in the number of orphans, and a greater burden on
    provincial health care.  Whiteside's department had been
    conducting a four-year study into the effects of HIV and Aids
    on orphans in the Newcastle area.  He said that while the
    incidence of orphans in the area was growing, research had
    shown that the community was coping with the problem.  He
    commended the quality of the care given to HIV/AIDS patients in
    KZN provincial hospitals.  Whiteside said the South African
    authorities would have to formulate a "new agenda" to deal with
    the effects of HIV/Aids by the time of the next election in
    ¶2009.  By then, the government would have a better idea of the
    impact of HIV/Aids.  Source:  The Mercury, December 13.

    South African Children Victim of Fire
    -------------------------------------

    ¶7.  An estimated 1,100 children younger than five are burnt to
    death each year, most dying in their own homes.  A Medical
    Research Council study found fires account for about two
    percent of deaths in children aged one and four.  In the five
    to nine age group, fire accounts for four percent of all
    deaths.  The Fire Protection Association of SA reports that
    more than 10 percent of fire emergency calls involve homes.
    Open flames, electrical faults and cooking are the most common
    causes, says the association.  Burns specialist Dr Ian Thompson
    says most child-burn patients are injured at home due to not
    being supervised. Often, in the case of informal dwellings, a
    sleeping child is burnt when the structure catches fire.
    Sepsis, or the infection of burn wounds, causes up to 85
    percent of deaths.  Serious burn injuries not only result in
    physical trauma but in severe psychological trauma.  Source:
    Cape Argus, December 11.

    Court Rules Against Pharmaceutical Pricing Regulations
    --------------------------------------------- ---------

    ¶8.  The Supreme Court of Appeal ruled against the Department of
    Health's pharmaceutical pricing regulations by stating that the
    dispensing fees proposed by the regulations were not
    appropriate because they did not consider the viability of the
    dispensing industry and that the regulations relating to the
    single exit price introduced a price control mechanism, which
    the Act had not intended.  The Department of Health raised
    jurisdictional issues since the Cape High Court denied the
    industry a chance of appeal.  The Court of Appeal dismissed
    these issues of jurisdiction by ruling that the Cape High
    Court's delay in granting leave to appeal was so unreasonable
    as to breach the constitutional right to a fair hearing.  The
    regulations provided for a pricing system that defined a single
    exit price of manufacturers and a dispensing fee, which, for
    pharmacists, amounted to R16 without a medical prescription and
    R26 with a prescription.  The court did not challenge
    government's right to administer prices but stated that the
    lack of any document describing how dispensing fees were
    calculated meant that the government did not consider the long-
    term viability of the retail drug sector. The Health Department
    was ordered to pay the court costs.  Source:  Independent
    Foreign Service, December 20.

    ¶9.  Comment.  The Health Department has signaled that it would
    file an appeal against this court judgment in the
    Constitutional Court (equivalent to the U.S. Supreme Court),
    stating that international experts regarded the pricing
    regulations as reasonable and beneficial to consumers.
    According to the department, the single exit price set by drug
    manufacturers since June 2004 reduced the price of medicines by
    19 percent.  Drug retailers have long argued that the
    dispensing fee set by the government was so low that many
    retailers would be forced to close.  Until the Constitutional
    Court rules, the existing price regulations have been rescinded
    and pharmacists are again entitled to charge varied dispensing
    fees, while manufacturers can charge different prices to
    different buyers. End comment.

    FRAZER

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