SOUTH AFRICA PUBLIC HEALTH DECEMBER 24 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: 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


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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


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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


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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


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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


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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


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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


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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