SOUTH AFRICA PUBLIC HEALTH APRIL 15 ISSUE

UNCLAS SECTION 01 OF 04 PRETORIA 001507

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 APRIL 15 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 African Teacher Shortage Blamed on
Health, Low Pay and Morale; New AIDS Assistance Program for
Teachers Launched; HIV Risk Exposure among Young Highlighted;
Anti-clotting Drugs Cheaper than Conventional Treatment; South
African Teen Alcoholism Increases; AIDS Treatment Centers Open
in all Health Districts; KZN Health Department Faces Increasing
Financial Burden; High Cost of Death Burden for Poor. End
Summary.

South African Teacher Shortage Blamed on Health, Low Pay and
Morale
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2. A national survey of South African teachers confirmed
anecdotal reports that teachers have been leaving the
profession due to low morale, job dissatisfaction and poor
health. Commissioned by the Education Labor Relations Council
(ELRC),the two-year study consists of seven reports about the
impact of HIV/AIDS on Education, done by the Human Sciences
Research Council (HSRC),the Medical Research Council, and the
University of KwaZulu-Natal's Mobile Task Team. The study
surveyed 21,358 teachers in more than 1,700 randomly selected
schools. In 2003/04, there were 368,548 public-school
teachers.


3. More than half the country's teachers intend leaving the
profession. And as low morale, job dissatisfaction, HIV/AIDS
and premature mortality impact public schools, the number of
teachers has declined over the past seven years. By 2002/03,
21,000 teachers (about 6 percent) were leaving the system
annually. Of 55 percent of the respondents who intended to
leave the profession, 25 percent considered leaving "from time
to time" and nearly 30 percent considered it "very often".
Likeliest to leave, the study found, are non-Africans, men,
secondary school teachers, those aged between 25 and 49, the
best-qualified teachers, those in the medium- to high-income
group, and teachers of technology, economics and management,
and natural sciences. HIV-negative teachers are more likely
than HIV-positive employees to want to leave. Reasons teachers
gave for wanting to quit were inadequate remuneration,
increased workload, lack of career development and professional
recognition, dissatisfaction with work policies, job
insecurity, violence in schools and lack of choice about where
they work.


4. The study measured the impact of HIV/AIDS using a
nationally representative sample of 17,088 teachers who gave an
oral fluid or blood specimen for testing. Nearly 13 percent
tested positive and 4,000 teachers died of AIDS in 2004. HIV
prevalence is highest (21 percent) among 25- to 34-year-olds,
followed by 35- to 44-year-olds (13 percent tested positive).
More than a fifth (22 percent) of the HIV-positive group,
approximately 10,000 teachers, need immediate anti-retroviral
therapy. If the minimum CD4 count increased from 200 to the
international standard of 350 to qualify for anti-retroviral
treatment, approximately 23,500 teachers would be eligible for
treatment. However, teachers' overall health status was poor,
with more than 10.6 percent having been hospitalized during the
2003 compared to 7 percent of the general population. The most
frequently reported illnesses were high blood pressure and
stomach ulcers, implying that stress has a leading role in
keeping teachers out of the classroom. The study found the
teacher attrition rate had declined from 9.3 percent in 1997-98
to 5.5 percent in 2000-01, before rising again to 5.9 percent
in 2002-03. Attrition due to mortality increased to 17.7
percent in 2003-04 compared to 7 percent in 1997-98 and
attrition due to illness grew to 8.7 percent compared to 4.6
percent over the same period, reflecting the impact of
HIV/AIDS.


5. In order to reduce teacher shortages, especially in poor
provinces and rural areas, the study recommends the following
actions: (1) restructure remuneration packages, reduce
workloads and manage teachers' job stress; (2) improve
resources for poorer schools, especially African schools; (3)
provide psychosocial support for teachers; (4) introduce a
comprehensive workplace health-care program; and (5) implement
HIV/AIDS-prevention and anti-retroviral programs for teachers.
Source: Pretoria News, Business Day, Health E-News, April 1;
Mail & Guardian, April 1-7.

New AIDS Assistance Program for Teachers Launched
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6. Eight South African and U.S. non-governmental organizations
began a new Prevention, Care and Treatment Access (PCTA)
program aimed at South African teachers. Its targets include
providing anti-retroviral treatment to 1,000 infected teachers
and their family members, access to care, counseling and
testing for 150,000 teachers and families. The PCTA program
includes four South African teacher unions, the Solidarity
Center, the American Federation of Teachers' Educational
Foundation, the Tshepang Trust and the Academy for Educational
Development. The President's Emergency Plan for AIDS Relief is
also providing $3.8 million for the two-year program. Source:
The Citizen, April 7.

HIV Risk Exposure among Young Highlighted
--------------


7. The Nelson Mandela Foundation released a study "HIV Risk
Exposure among Young Children: A study of 2-9 Year Olds",
found that breastfeeding of babies by a non-biological HIV-
positive caregiver was the single most important factor
associated with HIV infection in children and there is a
potential for health-care acquired transmission of HIV in the
maternity, pediatric, and dental facilities in the Free State
health institutions. The study, conducted by the Human
Sciences Research Council (HSRC),the University of
Stellenbosch, the Medical Research Council and the Centre for
Aids Development, Research and Evaluation, aimed to identify
all other possible sources of HIV transmission, besides mother-
to-child transmission, among children aged 2 to 9 in the Free
State public health sector. More than 4,000 mother-and-child
pairs took part in the study which involved 25 public
hospitals, three community health centers and 54 primary health
care clinics between April and July of 2004. Almost 15 percent
of the children in the study were HIV-positive, while just over
29 percent of mothers were infected with the virus.
Researchers sampled expressed breast milk destined for baby
feeding at the health facilities and found that almost 30
percent of the milk tested positive for HIV, while six samples
contained high viral loads. Ninety-two percent of HIV-positive
mothers breastfed their children - 60 percent of them for more
than a year. The study also found that children were being
exposed to possible HIV infection because of poor infection
controls at the facilities. Healthcare workers were also not
taking the necessary precautions, with the study finding that
44 percent of nurses did not use gloves during the delivery of
babies. The study also found risks in hospitals in the
management of expressed breast milk, where bottles were labeled
by cot numbers, not the name of the baby, and seldom checked,
which allowed milk to be fed to the wrong baby if the cot was
moved. Findings included that 24.6 percent of dental
instruments ready to be used in patients' mouths, and 24
percent of instruments to be used for maternity and pediatric
patients were contaminated with invisible blood, and 17.5
percent had visible blood on them. Recommendations included
discouraging prolonged breastfeeding, better control of
expressed milk and a campaign to educate patients to demand
better hygiene practices by health workers. Source: The
Citizen, Health E-News, April 4; Business Day, April 6.

Anti-clotting Drugs Cheaper than Conventional Treatment
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8. According to a medical research company, Health Monitor,
anti-platelet drugs for sufferers of arterial disease are
cheaper than bypass surgery or treatment after heart attacks
and strokes. The research, requested by medical insurance
companies, funded by pharmaceutical group Sanofi Aventis and
conducted by independent South African medical researcher
Health Monitor Company, found that new-generation anti-platelet
drugs, which prevent excessive clotting in patients at
heightened risk of suffering a "coronary event", increase
lifespan and cost less than conventional hospital treatment in
both the short and long term. More than 8,000 insured patients
who had suffered conditions such as unstable angina, heart
bypass surgery, heart attack or stroke, and were at increased
risk of experiencing more, were included in the year-long
study. The study compared the cost of treating patients on
anti-platelet therapy with those who were not and suffered
subsequent strokes and heart attacks or who needed bypass
surgery. These costs included initial and follow-up
hospitalization, medication and further treatment for recurring
and related events. Health Monitor Company's Dr Tienie
Stander, who will present the findings at the 2nd South African
Atherothrombosis Summit, cites the benefits of administering
these new drugs, not only for patients who will gain extended
life years but to medical insurers who will pay lower costs.
Source: Business Day, April 5.

South African Teen Alcoholism Increases
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9. Research by the Medical Research Council in 2002 showed
that nationally, 49.1 percent of pupils had drunk one or more
drinks of alcohol in their lifetime and almost one in eight
pupils had drunk their first drink of alcohol before the age of
13 years. The research found that 23 percent of pupils had
drunk five or more drinks of alcohol within a few hours on one
or more days in the research month. Claire Savage of South
African National Council on Alcoholism and Drug Abuse (SANCA),
said earlier MRC research conducted in the 1990s indicated that
in certain areas 20 to 25 percent of high school males and
about 15 percent of females were binge drinking at least once
every two weeks. On average, South Africans drink 20 liters of
alcohol each year - a statistic that puts them among the
worlds' biggest drinkers. The average South African consumes
the equivalent of several hundred bottles of beer every year,
and with that comes the "extremely high" burden of alcohol-
related death and trauma, record levels of fetal alcohol
syndrome, and greater risk of contracting HIV and AIDS, says
Professor Charles Parry, addiction specialist and director of
the Medical Research Council's alcohol and drug abuse research
unit. About one in four South African men and one in 10 women
displayed symptoms of alcohol problems and almost one in four
high school pupils reported "binge-drinking" during the past
month - five or more drinks on any given day. Just less than
half of all non-natural deaths in 2002 involved blood-alcohol
concentrations equal to or more than 0.05g/100ml (the legal
driving limit),and up to two-thirds of all cases tested
annually at trauma units in three South African cities between
1999 and 2001 showed breath-alcohol concentrations above that
level. Levels of fetal alcohol syndrome are the highest yet
recorded. The prevalence of the syndrome among Grade 1
students in the Western Cape was 41 to 46 per 1,000 children in
1997, rising to 65 to 74 per 1,000 two years later. Almost one
in five AIDS patients at a large infectious disease clinic in
Cape Town in 2003 met criteria for an alcohol-use disorder.
Source: Cape Argus, April 5; Pretoria News, April 6.

AIDS Treatment Centers Open in all Health Districts
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10. As of March 31 2004 (the end of 2004 financial year),all
53 health districts have a AIDS treatment center, completing
one of the Department of Health's target objectives in its
Comprehensive Plan for Management, Care and Treatment of HIV
and AIDS. 250 laboratories and three centers have been
established to monitor any adverse reaction to anti-retroviral
treatment. More than 1,060 health professionals now work on
the comprehensive plan and 7,600 health personnel have been
trained to treat AIDS patients. An accreditation process
evaluates the capacity of health facilities, including
effective screening, diagnosis, treatment and monitoring of
HIV/AIDS patients. Through the accreditation process, the
Health Department has identified challenges to the health
system: shortage of health personnel, especially doctors,
pharmacists and dieticians; delays in obtaining laboratory
results; and lack of safe medicine storage and training in AIDS-
related treatment. Source: Pretoria News, April 5.

KZN Health Department Faces Increasing Financial Burden
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11. The influx of people from Lesotho, Mozambique and
Swaziland into the province's health institutions along the
border has overstretched the provincial health department.
Cross-border patients seeking better medical treatment are
costing the KwaZulu-Natal Health Department at least R149
million ($24 million using 6.1 rands per dollar) monthly. Prof
Ronald Green-Thompson, the KZN Superintendent-General, said
that due to financial constraints, the province only had 400
ambulances instead of the required full fleet of 1,000. In
some instances, the KZN Health Department rented military
helicopters for use as ambulances to reach remote communities,
costing more than R60,000 a day. Provincial hospitals were
flooded not only by foreigners, but also by people from nearby
provinces such as the Eastern Cape and Mpumalanga. Provincial
security costs have declined since the Department spent more
than R10 million in putting electronic security systems and
trackers into ambulances, and incidents of hijacking have
fallen. Before the ambulances were fitted with the new
security system, KwaZulu-Natal lost 59 vehicles to hijacking
and 47 to theft. Six ambulances were hijacked in 2003 alone.
Source: Daily News April 7.

High Cost of Death Burden to Poor
--------------


12. The Financial Diaries project, South Africa's first
comprehensive look at the financial lives of poor families
highlights the increasing economic toll that death of relatives
places on their savings. Financial Diaries fieldworkers
interviewed 160 poor households in various townships in the
Western Cape Province every two weeks for one year, recording
savings transactions and determining how income gets spent.
Financial Diaries research shows people being constantly asked
for substantial amounts of money for the funerals of distant
relatives. Eighty percent of rural households in the sample
contributed at least twice during the year-long study. In the
urban areas, people aren't asked to help out with funeral money
as often but they are asked for larger contributions,
interrupting their cash flow and savings plans. South Africa's
Financial Diaries research indicates that 60 percent of the
cost of funeral expenses is spent to feed mourners, with the
result that burial societies (an insurance system to pay for
the cost of funerals) are specialized, with one covering
undertaker costs and another providing food. Many of the poor
participants in the study put aside money into at least one
burial society because they were concerned about the impact
their own death would have on the family's already-stressed
finances. Nicoli Nattrass, of the AIDS and Society Research
Unit (ASRU),is convinced that deaths from the AIDS epidemic
are slicing increasingly deeply into the limited finances of
poverty-stricken households. Source: All-africa.com, Inter-
Press Service, April 8.


FRAZER