SOUTH AFRICA PUBLIC HEALTH OCTOBER 15 ISSUE

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: a new survey on youth risk
behavior; vaccine research struggles in finding trial
participants; criticism by auditor of Health Department for
lax funds allocation; lack of vitamins in Africa; results of
Western Cape's HIV/AIDS antenatal survey; an outline by the
Health finance chief on health funds; the HIV crisis among
health workers; and risk behavior in South Africa. End
Summary

South African National Youth Risk Behavior Survey Released


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2. The 2002 South African National Youth Risk Behavior
Survey, using results from 10,699 students in grades 8-11,
highlighted sexual practices of students in South African
high schools. The findings include: (1) 40 percent of
South African high school pupils are sexually active; (2)
more than 14 percent of these students had their first
sexual experience before the age of 14, and some of them had
already had more than two sexual partners by the age of 14,
and (3) in a sampling of 4,182 students, 8.1 percent has had
an abortion or had a partner who has had an abortion.
Provincially, in KwaZulu-Natal, of 1,151 students sampled,
15.6 percent admitted to having had sex before the age of
14; in Gauteng of the 1,129 sampled, 19.1 percent answered
positively; in the Western Cape of the 1,390 sampled, 12.5
percent answered positively. In the Eastern Cape, 12.5
percent of students admitted to having had sex before the
age of 14 (1,108 sampled); in the Free State, 18.8 percent
of the 1,101 students sampled; in the Limpopo province 11.5
percent of the 964 students sampled; in Mpumalanga 15.7
percent of the 1,220 sampled; in the Northern Cape 10.8
percent of the 1 041 sampled; and in the North West province
9.9 percent of the 1,162 sampled. The survey, which
consisted of a sampling of 23 schools per province, was
conducted for the purpose of providing nationally and
provincially representative data on the prevalence of key
risk behaviors, namely: intentional and unintentional
injuries, violence and traffic safety, suicide-related
behavior, behaviors related to substance abuse, sexual
behavior, nutrition and dietary behaviors, physical
activity, and hygiene-related behaviors. Source: The Star,
October 2.

South Africa: Vaccine Research Struggles to Find Trial
Participants


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3. South African HIV vaccine research efforts are being
threatened by the low number of people willing to
participate in trials, said the Medical Research Council
(MRC). According to researchers from the MRC in Durban, the
fear of stigma and discrimination from their communities
prevented people from taking part in the trials. The country
began conducting vaccine trials in November 2003. The
stringent eligibility criteria also saw many potential study
participants being rejected. Although more than 400 people
have attended the MRC's HIV vaccine information sessions in
the past two years, only 90 have returned for the screening
process - a medical check-up that establishes eligibility.
Of these 90, only 18 have been enrolled in Phase I vaccine
trials. The MRC has managed to find a further 30 eligible
candidates during the past twelve months. Eighteen
volunteers is the minimum amount required to proceed with
the trials at the Durban site, as the first phase needs a
small number of participants. But the vaccine trials could
be at risk if the existing participants drop out. The MRC's
HIV Vaccine Research Unit, based in Durban and the Perinatal
HIV Research Unit at the Chris Hani Baragwanath Hospital in
Soweto, Johannesburg are the only two trial sites. Two more
sites are expected to start vaccine testing in the next few
months. Despite ongoing education campaigns, misconceptions
and myths about the trials and the vaccine present another
obstacle. A large number of people believed they could be
infected with the HI virus by being inoculated with a test
vaccine, researchers said. Such fears were unfounded, "as
no live viruses are injected," explained MRC senior clinical
research nurse Armstrong Makhofola. The stigma associated
with joining an HIV vaccine trial remains a big challenge.
In addition, many willing volunteers also do not meet the
stringent eligibility criteria, such as belonging to a
certain age group, being in good health, having a good level
of education, being HIV-negative and at low risk of
contracting HIV, as well as not planning a pregnancy in the
near future. Phase I trials in Durban and Soweto will end
in mid-2005. These results will dictate whether the research
can move into its second and third phases. The main
objective of Phase I trials is to test the safety of the
vaccine prototype. They will also determine its possible
side effects. Despite being in the early stages of the
first phase of trials, "so far, the [test] vaccine appears
to have strengthened immune response," Makhofola said. The
candidate-vaccine had also not shown any unexpected side
effects so far. The next phase will focus on maintaining
the safety level of the vaccine, as well as finding the best
dosage and method of administering the vaccine. The third
phase involves tens of thousands of participants to assess
whether the vaccine pre-vents natural infection from HIV.
Source: UN Integrated Regional Information Networks, October


5.

Auditor Criticizes Health Department for Lax Funds
Allocation


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4. Auditor-General Shauket Fakie has criticized the Health
Department for paying out billions of rands in conditional
grants to provinces and then failing to follow up on how
these funds were spent. Fakie qualified the department's
annual report tabled in Parliament yesterday, saying there
were fundamental deficiencies, and noncompliance with the
law, particularly the Division of Revenue Act. Fakie said
the health department did not verify or follow up on all of
the payments it made to provincial departments amounting to
R7 billion ($1.1 billion using 6.5 rands per dollar), or
91.4 percent of the department's budget for conditional
grants to the provinces. "The act requires funds to be
withheld when significant under spending and the no
achievement of objectives occurs. It was noted that, in
spite of the grants being under spent, transfers were still
made. In 18 instances, under spending of conditional grants
amounting to R279 million occurred in the provinces on the
various programs," he said. On-site monitoring of the
Health Professions Training and Development conditional
grant of R1.8 billion was inadequate in Gauteng, Free State,
Eastern Cape, North West and Limpopo. The Health Department
transfers conditional grants to the provinces for combating
HIV/AIDS, hospital revitalization, integrated nutrition and
hospital management, among other things. Fakie also said
the department transferred R110 million to non-governmental
organizations and failed to ensure that audited statements
for the use of the money were provided, or even that there
were effective financial management and control systems in
place at the organizations. Source: Business Day, October


8.

Africa's Countries Lack Vitamins


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5. It is estimated that vitamin and mineral deficiencies
are costing sub-Saharan economies more than $2.3 billion a
year in lost productivity. Iron deficiency alone costs South
Africa 0.4% of its gross domestic product. A report
released by the World Health Organization, the Macronutrient
Initiative, the United Nations Children's Fund, the Global
Alliance for Improved Nutrition and the Development Bank of
Southern Africa (DBSA) finds that adding essential vitamins
and minerals to foods regularly consumed by a significant
proportion of the population can cost as little as a few
cents per person per year. In South Africa, it is estimated
that 37 percent of children under the age of five suffer
iron deficiency; 160,000 children are born each year with
severe mental impairments; and about 26 percent of women
between the ages of 15 and 49 have iron-deficiency anemia.
Also, 6,000 children under the age of six die each year
because they lack vitamin A. In May 2002 the United Nations
General Assembly agreed that the elimination or reduction of
vitamin deficiencies should be one of the principal goals of
development to be achieved early this century. Almost two
years ago South Africa joined a global initiative to fortify
flour with iron and folic acid and vitamin A, investing $11
million a year over the next five years. South Africa
iodizes 62 percent of salt sold, hoping to save the lives of
5800 children and prevent 3400 birth defects a year. In
South Africa, 33% of children under the age of six have
subclinical vitamin A deficiency. Source: Business Day,
October 8.

Western Cape's HIV/AIDS Antenatal Survey Results


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6. Western Cape's latest antenatal survey reveals that 13
percent of pregnant women attending public health facilities
have HIV (up from 12.4 percent in 2002) and that teenage
infection rates have been increasing by 1 percent annually,
with 8.5 percent of all pregnant 15-19 year olds having HIV.
52 percent of districts reported HIV prevalence rates of
greater or equal to 10 percent. There had been a rapid rate
of increase in urban settings, where over 65 percent of the
province's populations reside. The HIV prevalence rate in
the under 20 age group has continued to rise consistently
over the last eight years with the rate highest among
younger women. It continues to increase rapidly among 15 to
24 year old women. The district with the highest infection
rate is Gugulethu/ Nyanga, where 28 percent of pregnant
women are infected. The Western Cape has the lowest HIV
prevalence of all provinces and around one-third of that of
KwaZulu-Natal. To combat the rise among teenagers, the
Health Department is planning peer education programs in
every high school this year. Around a quarter already run
these programs. The survey showed that: (1) The districts
with the highest prevalence were Gugulethu/ Nyanga, with 28
percent prevalence, Khayelitsha (27.2 percent), Helderberg
(19 percent), Oostenberg (16 percent), and the Knysna-
Plettenberg Bay area (15.6 percent); (2) there were fewer
infections in rural (8.3 percent) than in urban (14.7
percent) areas, although infections were high along the N2
between Plettenberg Bay and Cape Town; (3) lowest infection
rates were found in the Klein Karoo (5.4 percent), the
Central Karoo (6.5 percent), Mitchells Plain (6.3 percent)
and Blaauwberg (4.4 percent); (4) the epidemic in the
Western Cape is around five years behind the national
epidemic; and (5) the HIV infection rate of the total
population in the Western Cape is probably half that of
pregnant women at around 6.5 percent. The evidence
indicates that the largest risk group in our province is the
under-20s. Source: Cape Times, October 8; Health E-News,
October 7.

Health Finance Chief Outlines Action on Health Funds


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7. The Health Department's chief financial officer, Gerrit
Muller, conceded that the department had failed to properly
oversee the spending of billions of rands given to provinces
as conditional grants, but said remedial steps had been
taken to address the problem. Muller's comments came after
auditor-general Shauket Fakie's damning report on the Health
Department's spending, which became public when its annual
report was tabled in Parliament (see above article). Muller
provided the parliamentary portfolio on health with details
of the department's R172 million under spending during the
2003-04 financial year, and said the department's staff
complement would be strengthened to improve financial
monitoring. Co-ordination with the provinces would also be
improved, he said, using forums such as the provincial chief
financial officers gathering, the meeting of the health
minister and the nine provincial ministers and meetings of
the provincial heads of health. Regarding the lack of
oversight for nongovernmental organizations (NGOs) that
received funding from government, Muller said it was
difficult to obtain financial statements from NGOs that
received once-off funding. Those requesting more funding had
to provide financial statements and audited reports.
Source: Business Day, October 13.

HIV Crisis Among South Africa's Health Workers


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8. October's issue of South African Medical Journal
published an article showing a high prevalence rate of
HIV/AIDS of health workers in KwaZulu-Natal, Free State,
Mpumalanga, and North West provinces. Out of 595
respondents, an estimated 15.7 percent of health workers in
the four provinces had HIV/AIDS in 2002. The authors said
the high HIV prevalence among health workers had serious
implications including increased absenteeism, and the fact
that non-infected workers had to compensate by working much
harder, leading to lower morale and burnout. The study used
a stratified cluster sample, drawn from 5% of health
facilities in the country that represented the public and
private health sectors in Free State, Mpumalanga, KwaZulu-
Natal and North West. The sample was designed to obtain a
representative, nation-wide sample of medical professionals
and nonprofessional health workers, with a sub-sample
comprising workers in four provinces tested for HIV. Among
younger health workers, the HIV prevalence rates were even
higher. The group, aged between 18 and 35, had an estimated
HIV prevalence rate of 20 percent. About 20.3 percent of
nonprofessionals were infected with HIV, while 13.7 percent
of professionals were HIV-positive. Black health workers
had a much higher HIV prevalence than other race groups,
however caution needed to be exercised in interpreting the
results, because the figures among the other race groups
were too small to yield meaningful results. Source:
Business Day, October 13.

South Africa's Risk Behavior


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9. Results from Durex's eighth annual online global sex
survey, in which more than 3,000 South Africans
participated, highlighted continuing South African risky
sexual behavior.
While 78 percent of South Africans are seriously concerned
about HIV-Aids, 58 percent are having unprotected sex with
partners whose sexual history they do not know. The survey
showed that of the South Africans who completed the
questionnaire, 21 percent have never received any formal sex
education. The survey is internet-based with 350,000 people
participating from 41 countries. Source: SAPA, October 12.

MILOVANOVIC