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### Viewing cable 04PRETORIA5334, SOUTH AFRICA PUBLIC HEALTH DECEMBER 10 ISSUE

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Reference ID | Created | Released | Classification | Origin
--- | --- | --- | --- | ---
04PRETORIA5334 | 2004-12-10 07:43 | 2011-08-24 01:00 | UNCLASSIFIED | Embassy Pretoria

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

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    UNCLAS SECTION 01 OF 05 PRETORIA 005334

    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 10 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:  South Africa's Response to HIV/AIDS Still
    Includes Denial and Ignorance; HIV/AIDS Places Burden on
    Elderly; Some Regions Fear HIV/AIDS, Others Cancer; Health
    Department Reports Increase in Number of Patients on ARV;
    Economic Cost of AIDS May Worsen; Telkom HIV/AIDS Prevalence
    Rate Expected to Peak at 11.4 Percent; Correctional Services
    Conducts HIV Survey in Prisons; HIV/AIDS Budgets for National
    and Provincial Government; Provincial Progress on Implementing
    Government's HIV/AIDS Treatment Plan; and SA's Labor Force
    Declines with HIV/AIDS, Discouragement Impacts.  End Summary.

    SA's Response to HIV/AIDS Still Includes Denial and Ignorance
    --------------------------------------------- ----------------

    ¶2.  The latest figures from the Actuarial Society of South
    Africa suggest that about one in nine South Africans is
    infected with HIV, the virus that causes AIDS, and about 5
    million people who are living with the disease, the largest
    case load in the world.  The Human Sciences Research Council's
    2002 household survey estimated that 6.2 percent of white South
    Africans were infected with HIV, the biggest middle class
    epidemic in the world. By comparison, an estimated 12.9 percent
    of black Africans were infected.  Many health care
    practitioners find that their patients know about HIV/AIDS but
    few are changing their behavior.  The same patients repeatedly
    ask for HIV tests. These are not sex workers for whom HIV is a
    hazard of their jobs, but people who refuse to accept that they
    need to protect themselves with condoms.  The point about an
    HIV test is to have it once, and if you are negative to keep it
    that way.  "There's a mistaken belief among many middle- to
    upper income professionals, particularly whites, that they are
    not at risk," says Mark Heywood of the Treatment Action
    Campaign.  The fact that HIV has disproportionately affected
    poor, black, young women is an indication that many of them
    think it cannot affect them, says Jonathan Berger, of the AIDS
    Law Project at the University of the Witwatersrand.  That
    denial is worsened by SA's HIV-prevention campaigns, which
    focus almost exclusively on young people.  "By telling part of
    the story as if it were the entire story, the vulnerability
    picture often painted is both inaccurate and misleading," he
    says in a paper accepted for publication by the journal
    Development Update.  Berger argues that SA's limited public
    education campaigns are deeply flawed, presenting a sanitized
    view of sex that bears little relation to people's lives. They
    focus on young men and women having heterosexual sex, and shy
    away from anything vaguely taboo, he says.  Very little
    research investigates what kind of sex people are having. And
    when research does shed light on potentially dangerous
    practices, Berger states that the findings are not incorporated
    in education campaigns.  Despite the frustration expressed by
    many HIV/AIDS experts, there is some encouraging evidence that
    young people are waiting longer before they have their first
    sexual encounters; are using condoms more consistently; and are
    more conscious of the dangers of HIV, says loveLife CEO David
    Harrision.  Source:  Business Day, December 1.

    HIV/AIDS Places Burden on Elderly
    ---------------------------------

    ¶3.  The Human Sciences Research Council (HSRC) released a study
    on the impact of HIV/AIDS on the elderly (aged 60 and older) in
    Mpumalanga that highlights the particularly heavy financial and
    care burden the elderly are paying.  The study found that 72
    percent of older people in the province are the main
    breadwinners in multi-generational households, spending most of
    their income on household necessities and the education of
    grandchildren.  Nine percent are caring for sick young adults
    living in the household, 22 percent are staying with
    grandchildren whose own parents are either dead or away in the
    cities on a long-term basis, 20 percent take care of children
    six years or younger, and 46 percent take care of children
    between the ages of six and 18.  With 60 percent of orphans in
    South Africa being cared for by their grandparents, bringing up
    a second generation weighed heavily on the elderly.  Funerals
    carry a substantial cost, often shouldered by the elderly as
    the main breadwinner, or receiver of a state pension. The
    majority of the elderly are female, according to census 2001
    there are 34 males to 100 females in Mpumalanga.  Most stay in
    rural areas, with even those who worked in the cities returning
    to rural areas when reaching retirement age to reunite with
    their extended families.  Source:  SAPA, Mail and Guardian,
    December 1.

    Some Regions Fear HIV/AIDS, Others Cancer
    -----------------------------------------

    ¶4.  A global survey has found that Africans, West Asians and
    Latin Americans believe that HIV/AIDS is the most important
    disease confronting them -- while people elsewhere fear cancer.
    The Gallup International/Markinor poll interviewed more than
    50,000 people in over 60 countries between June and August for
    their annual Voice of the People survey.  They were asked for
    their views of the most important disease in their country.
    Overall, four out of every 10 (42 percent) citizens in the
    countries polled around the world mentioned cancer as the most
    threatening disease -- a concern shared in most countries, but
    not unanimously.  Twenty-seven percent rated HIV/AIDS as the
    top disease and 15 percent heart attacks and strokes.  Three
    percent rated tuberculosis highest, two percent malaria and one
    percent Severe Acute Respiratory Syndrome, while eight percent
    rated other illnesses and four percent did not know or would
    not answer.  All five African countries included in the survey
    are amongst the first 11 that regard HIV/AIDS as the most
    important disease.  In the five African countries polled, two
    thirds of interviewees believed that HIV/AIDS was the most
    important disease facing them.  Malaria was the second most
    frequently mentioned disease in Africa and was of particular
    concern for Nigerians (35 percent) and the people of Cameroon
    (31 percent).  Source:  SAPA, December 1.

    Health Department Reports Increase in Number of Patients on ARV
    --------------------------------------------- ------------------

    ¶5.  The number of people receiving anti-retroviral therapy in
    accredited government facilities increased from 11,250 at the
    end of August to 19,500 in October, Health Minister Manto
    Tshabalala-Msimang reported.  Treatment is available in at

    SIPDIS
    least one facility in 50 of the 53 districts in the country. A
    total of 103 facilities have been accredited and are providing
    care and treatment for people with HIV and AIDS.  Three centers
    have been established to detect, assess, and prevent adverse
    reaction to anti-retroviral drugs.  A center at the Medical
    University of SA focuses on the use of anti-retroviral drugs
    and traditional medicine between adolescent and adults with HIV
    and AIDS.  The second center at the Free State University deals
    with the use of anti-retroviral drugs among pregnant women and
    infants.  The University of Cape Town also serves as a
    reference center for adverse reaction to all types of medicines
    registered in the country.  At least 67 percent of all public
    health clinics were providing voluntary counseling and testing
    (VCT) services, which had increased the coverage rate. The
    number of people using VCT services had increased from 412,696
    in 2002/2003 to 690,537 in 2003/4.  The Health Department
    reported that there were now 10,000 counselors at service
    points throughout the country at the end of March 2004. Rapid
    HIV test kits were widely available at the service points to
    ensure people received results immediately.  In addition, more
    than R9.4 million ($1.6 million, using 5.7 rands per dollar)
    had been spent on communication, including newspaper, radio and
    billboard advertising, and production of information and
    educational material to support the implementation of the
    comprehensive plan.  Source:  SAPA, Health Dept Health News
    Release, November 25.

    Economic Costs of AIDS May Worsen
    ---------------------------------

    ¶6.  Although data on the extent of HIV/AIDS and its impact on
    the South African economy vary, analysts agree that government
    and businesses need to take urgent action to combat the virus.
    Already HIV/AIDS is estimated to be reducing South Africa's
    growth rate by a minimum of 0.3 to 0.4 percent per year.
    Forecasts of future growth show large discrepancies, however,
    as financial experts have created different mathematic models
    to calculate the consequences.  Analysts at Apt Associates
    estimated that the country's gross domestic product (GDP) will
    be 17 percent lower by 2010 than it would have been without
    AIDS, leading to a loss of $22 billion.  Financial analysts at
    ABSA bank, in contrast, estimate the shrinkage of GDP at 9.6
    percent by 2015, while ING Barings put the figure at only 2.8
    percent.  One of the paradoxes of the HIV epidemic in sub-
    Saharan Africa is that in the past 10 years it has not made a
    huge dent on standard macroeconomic yardsticks, such as GDP.
    This is due, in part, to the labor situation in South Africa.
    The country's labor surplus means that workers removed by AIDS
    can be replaced without much loss of productivity.  The World
    Bank analysis emphasizes the long-term impact of the disease on
    human capital, arguing that the damage in terms of accumulated
    loss of GDP per capita will be large, if left untreated.  This
    suggests that a country like South Africa could face
    progressive economic decline over several generations, unless
    it combats its AIDS epidemic more urgently.  By mainly taking
    the lives of young adults, AIDS seriously weakens a country's
    tax base; as a result, national finances will come under
    increasing pressure.  Less income from taxes will reduce the
    government's ability to finance public expenditures, including
    those aimed at accumulating human capital, such as education
    and public health services.  It will also have to handle severe
    financial strain in other social spending categories, such as
    grants for AIDS orphans. To balance these, the government is
    likely to raise taxes.  AIDS will create significant costs to
    business. At the company level, the pandemic poses a serious
    threat to profitability as well as competitiveness. Firms will
    have to face increasing absenteeism due to illness, funeral
    attendances and care taking of family members.  Businesses will
    also see rising expenditure on medical and pension benefits,
    loss of skilled manpower leading to disruption of production,
    as well as increases in training, recruitment and personnel
    turnover costs.  Old Mutual Healthcare, for example, estimated
    that additional healthcare costs as a result of HIV/AIDS could
    reach $3.8-billion per year by 2009.  By 2010 life expectancy
    will be 43 years, 17 years less than it would have been without
    AIDS. Analysts estimate the South African labor force will
    decline by up to 23.5 percent by 2015.  To what degree
    enterprises are affected varies between business sectors. The
    mining sector has been worst hit by the pandemic, with an AIDS
    prevalence rate among its workforce of 25 percent, closely
    followed by manufacturing with a prevalence rate of up to 19
    percent. Construction, retail and wholesale count as medium- to
    low-risk sectors.  The effects of AIDS on businesses will also
    depend on a company's location.  In provinces with high
    prevalence rates, such as KwaZulu-Natal and Gauteng, close to
    40 percent of firms indicated that AIDS already had a negative
    impact on their profits, according to Bureau for Economic
    Research. In the Western Cape and Eastern Cape, the numbers
    were 25 percent and 27 percent respectively.  HIV/AIDS is a
    risk of doing business in South Africa, right next to asset
    security, crime and exchange rate volatility, besides political
    and infrastructural risk.  Only about a quarter of the
    country's businesses -- mainly large corporations -- have
    workplace policies in place. Small and medium-sized firms often
    the lack human and financial resources to implement an AIDS
    plan.  Source:  Mail and Guardian, November 26.

    Telkom HIV/AIDS Prevalence Rate Expected to Peak at 11.4
    Percent
    --------------------------------------------- ------------

    ¶7.  Telkom, the telecommunications parastatal, expects its
    HIV/AIDS rate among employees to peak at 11.4 percent in 2006,
    with the company's current HIV/AIDS prevalence rate at 9.6
    percent.  Telkom's introduction of antiretroviral treatment,
    which started in October, is part of an integrated health
    management strategy to manage health risks and invest in human
    capital.  Telkom had allocated R8 million ($1.4 million) in the
    current financial year for the management of HIV/AIDS.  The
    company is offering a voluntary counseling, testing and
    treatment (VCT) program, which offers employees around the
    country access to a range of HIV/AIDS related services in
    absolute privacy and confidentiality.  Telkom does not have
    access to details of an employee's HIV and AIDS status unless
    he or she voluntarily discloses the information. The first
    phase of Telkom's VCT program ended in October, during which
    2,504 employees were tested. The second phase is currently
    running until March next year with a target of 10,000.  Source:
    SAPA, December 1.

    Correctional Services Conducts HIV Survey in Prisons
    --------------------------------------------- -------

    ¶8.  The Department of Correctional Services announced that a
    national survey of prison inmates to determine HIV/AIDS
    prevalence is now in the preparation phase, with a task team
    and steering committee established.  The prevalence of HIV/AIDS
    will be ascertained by extrapolation from a sample. The 2003/04
    annual report of the judicial inspectorate of prisons,
    described HIV/AIDS in prisons as a "major problem". The report
    noted that about 58 percent of prisoners were men below the age
    of 30, who were more sexually active and prone to take risks
    than older men.  The report found that natural deaths were
    rising and the increase could be "fairly attributed" to
    HIV/AIDS and the opportunistic diseases that followed. Natural
    deaths rose by 584 percent from 1995 to 2000, with 1087 deaths
    in 2000 and 1683 in 2003.  Seven months ago an AIDS directorate
    was established focusing on care and support, prevention and
    treatment.  The Department of Correctional Services was
    conducting a baseline study of the number of offenders
    currently using ARVs in prisons, with preliminary results
    expected in early December.  Source:  SAPA, December 1.

    HIV/AIDS Budgets for National and Provincial Government
    --------------------------------------------- ----------

    ¶9.  Government commitment to HIV/AIDS funding only really
    materialized in 2000 with the introduction of special
    conditional grants, according to Alison Hickey, manager of
    Idasa's AIDS Budget Unit.  Before 2000, the AIDS budget was
    minimal.  The 2004/5 national budget shows a serious commitment
    to making financial resources available for the new ARV
    treatment programs.  National Treasury has specifically
    allocated R1.439 billion ($250 million) for HIV/AIDS programs
    and services in this year.  This is seven times what was set
    aside to fight HIV/AIDS in 2000/1. However, HIV/AIDS funds
    still constitute less than 1 percent of the total budget.
    Money for ARV treatment is sent to provinces via conditional
    grants. However, Hickey is concerned that provinces such as the
    Eastern Cape and Mpumalanga may struggle to spend their grants.
    "For those provinces with weaker financial and project
    management skills, absorption capacity could well be the
    primary obstacle to roll-out," she says.  One of the weaknesses
    in the national Department of Health identified by the Auditor
    General is its inability to monitor conditional grants
    properly.  A new clause in the Division of Revenue Bill allows
    unspent HIV/AIDS grants to be relocated to better-performing
    provinces.  Researcher Hein Marais found that the Western Cape,
    Eastern Cape and Mpumalanga did not allocate any funds
    specifically for HIV/AIDS in 1998.  Gauteng was the only
    province to allocate a substantial sum, with R49 million
    allocated across all its departments and R4 million set aside
    for NGOs.  Source:  Health E-News, November 28.

    Provincial Progress on Implementing Government's HIV/AIDS
    Treatment Plan
    --------------------------------------------- -----------

    ¶10.  North West Province
    Provincial Health Department has allocated close to R50 million
    for voluntary counseling and testing (VCT), prevention of
    mother-to-child transmission (PMTCT) and sexually transmitted
    infections.  The high AIDS prevalence rate (29.9 percent) has
    led to more rapid implementation of the treatment plan, with
    more than 5,000 new patients coming to the 3 available service
    points and more than 1,000 patients being treated.  The
    provincial health department was allocated R70 million for the
    HIV/AIDS program, including R29 million for ARVs.
    Gauteng
    Nineteen hospitals in the province are now providing ARV drugs
    and the province plans to expand the program to 80 facilities
    by 2009.  By November 5, 49,268 people have been assessed, of
    whom 5,588 adult and 800 children received ARVs.  2002 records
    indicate that 54 percent of people between 15 and 34 years of
    age admitted to state hospitals were infected with HIV.
    Limpopo
    Limpopo has the third lowest (17.5 percent) HIV prevalence rate
    in the country.  Since October, more than 2,000 patients have
    been assessed, with 300 adults and 40 children on ARV
    treatment.  The province has eight treatment sites and by April
    2005, will introduce the ARV treatment program to 30 district
    hospitals and 22 community health centers.  The province has
    R80 million for the AIDS program during the 2004 financial year
    and R120 million for next year.
    Northern Cape
    The provincial treatment program started three months ago and
    now has 1,200 patients qualified for ARV treatment with 250
    patients registered for treatment.  Approximately 500 patients
    with more than a CD4-count of 200 have been assessed.  R31.8
    billion has been allocated for the AIDS program this year.
    Eastern Cape
    The province launched its treatment program in May and 2,000
    patients, 135 of them children, are receiving treatment at 11
    sites.  R40 million has been allocated and about R22.6 million
    has been spent on ARV treatment in the 2004 fiscal year.  A
    regional training center, funded by the Department of Health,
    Columbia University and CDC, provides HIV/AIDS training to
    health care professionals.  So far, 1,000 have received
    training.
    Western Cape
    The province has 31 treatment sites, a total HIV/AIDS budget of
    R119 million, of which R29 million is a grant from the Global
    Fund.  The province estimates that about 12,000 people need ARV
    treatment and so far about 5,500, of which 1,000 are children,
    are receiving ARVs.  The Western Cape has the lowest HIV/AIDS
    prevalence rate of 13.1 percent.
    Free State
    In October, the number of patients on treatment was 250, much
    lower than the March 2005 target of 2,127; however its goals of
    providing 5 treatment sites have been reached.  A budget of R30
    million has been allocated for 2004 and R50 million for next
    year.  For next year, an additional 16 sites providing ARV
    treatment are planned.
    Mpumalanga
    The province currently has eight ARV treatment sites, though
    the national Department of Health declared in October that the
    province had 12.  R 67 million was allocated to the AIDS
    program this financial year and the province will likely not
    reach its target of 1,934 patients on ARV treatment by March
    ¶2005.  Currently Mpumalanga is treating 378 patients compared
    to 130 patients in July.
    KwaZulu-Natal
    KZN has the highest AIDS prevalence rate at 38 percent and will
    likely not meet its March 2005 target of 20,000 patients on
    treatment.  The province is currently treating 3,247 adults and
    167 children at 31 sites.  A further 16 sites have been
    recommended for accreditation by the national advisers.  A
    conditional grant of R64 million is available for the ARV
    treatment program.  Source:  Mail&Guardian, November 26 to
    December 2.

    SA's Labor Force Declines with HIV/AIDS, Discouragement Impacts
    --------------------------------------------- ------------------

    ¶10.  South Africa's labor force has declined over the past few
    years, probably because more people have given up looking for
    work or are infected with HIV, says a new report in the South
    African Reserve Bank's Labor Market Frontiers report.  South
    Africa's labor force participation rate, which counts the
    number of people working and actively seeking work as a
    proportion of the total population, has dropped to 54.1 percent
    in September 2003, down from 58.9 percent in September 2000.
    Official figures from Statistics SA show that unemployment
    dropped to 4.6 million in September 2003 from 5.3 million in
    March 2003, based on the narrow definition of unemployment,
    where an individual had been actively seeking work prior to the
    survey.  The drop in unemployment was not matched by an
    increase in total employment over that period, with more people
    dropping out of the labor market.  The number of discouraged
    job seekers increased the unemployed figure to more than 8
    million.  The Bank's report stated that job seekers were
    discouraged because of the slim chances of finding a job, or
    because they lacked funds to search actively for work.  Another
    likely cause for a drop in labor market participation was the
    effect of HIV/AIDS.  The report points to research that shows a
    drop in HIV/AIDS prevalence among younger people in their
    twenties, and an increase in higher age groups, making up most
    of the labor force.  The report also assesses whether social
    grants have a negative incentive on labor force participation,
    but found mixed results.  Some studies show that pension
    payments cause an indirect effect of withdrawal from the labor
    market.  However, other studies show that a child support grant
    could result in higher labor force participation.  Source:
    Business Day, December 3.

    FRAZER

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