SOUTH AFRICA PUBLIC HEALTH SEPTEMBER 9 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: Drug-Resistant TB Threat to SA; Most of SA
Accepts Euthanasia; Public Hospital Fees to Decline; Inquiry
Launched to Determine if Ineffective AIDS Cure Still Sold; Rath
Foundation Conducts Illegal Experiments; Release of Two Studies
Delayed; Decline in 2005 SA Human Development Rating; and AIDS
Infections still Increasing in Corporate Sector. End Summary.

Drug-Resistant TB Threat to SA


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2. Research shows that the threat of drug-resistant TB is
greater than previously thought. The Center of Excellence for
Biomedical Tuberculosis Research at Stellenbosch University
released a study showing that TB strains causing drug-resistant
disease may be even more resistant to drugs than previously
believed. People with drug-resistant strains of TB are freely
passing on the dangerous bacteria, because diagnosis is too
slow. More than half of patients with drug-resistant TB tested
in two of the Western Cape Province's four health districts
were resistant to Pyrazinamide (PZA), one of the four drugs
included in the main single-dose treatment of TB in the
country. The researchers said urgent efforts were needed to
diagnose TB quickly. If first-line treatment failed, the risk
of multi drug-resistant TB grew in patients already infected
with drug-resistant strains. The university's Dr Tommie
Victor, professor of medical biochemistry, said some patients
in South Africa were already showing resistance to as many as
five of the six frontline anti-TB drugs.



3. The second part of the threat is fear of the creation of
new strains of TB, which become increasingly resistant and
continue to spread among people. New research by Dr. Rob
Warren, also a professor of medical biochemistry at
Stellenbosch, shows that two different strains of TB could be
found in a single patient's lungs, implying infection more than
once. His latest research has challenged another common
belief, that multidrug-resistant TB in a patient already being
treated must be the result of the person not taking the
prescribed drugs. Instead, Warren found, some patients had
both drug-sensitive and the drug-resistant strains of TB at the
same time. As the patient starts treatment with antibiotics,
the therapy kills the drug-sensitive strain, allowing the
resistant strain to emerge as the dominant strain. Poor
diagnosis means the multidrug-resistant strain is likely to be
diagnosed only when the original treatment fails - and in the
meantime whole communities are put at risk. It usually takes
six to eight weeks to identify whether a TB strain is
resistant. Drug-resistant TB is also expensive to treat - as
much as R20,000 per year ($3,200 using 6.3 rands per dollar) a
patient, compared to about R200 per year ($32) a patient for
drug-susceptible TB. In South Africa, 1,000 people die from TB
every day. Source: Cape Times, August 29.

Most of SA Accept Euthanasia


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4. Seventy percent of adults agree that family members should
be allowed to switch off the life support system of a brain-
dead person, according to a Research Surveys telephone survey
of 493. However half opposed active euthanasia. Religion
played a significant role in responses. Seventy percent of
Christians, 89 percent of Muslims, and 65 percent of Ancestral
believers, thought that families should turn off life support
systems if the individual was brain-dead. Gender had no impact
on the responses.



5. On the issue of the right to die when terminally ill,
people were sharply divided. Half of those questioned agreed
people should never be allowed to take their own life, even if
they were terminally ill and in considerable pain. Forty-four
percent of respondents disagreed with the statement.
Differences between the race groups are very strong; however,
differences between different religions are not evident.



6. Another statement asked of respondents was that a
terminally ill person had the right to die with medical
assistance from doctors. Forty-six percent of the respondents
agreed with this, while 51 percent disagreed. Differences in
response between religions are not evident nor are there any
age or gender differences. Source: SAPA, IOL, August 30.

Public Hospital Fees to Decline


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7. The Department of Health announced that patient fees at
public hospital rates will decrease by up to 70% once a new fee
structure has been approved by provincial hospitals. Revised
rates have been sent to all provincial health departments and
will be implemented immediately after endorsement by provinces.
The Department of Health wants the current uniform patient fees
system (UPFS) to support its efforts to increase access to
quality health care, saying that unless a more sustainable
means of health care financing is introduced, the challenges of
affordable health care will not be eliminated. The main
challenge is that users of public facilities come from poor
communities and are not covered by any form of health insurance
or medical aid. The most affected are people with some income,
who do not qualify for free health services. These users are
charged at various rates depending on their income, and they
usually pay these debts out of pocket from a very limited
disposable monthly income. Public hospitals are not allowed to
refuse patients who cannot settle their hospital bills. The
UPFS was first introduced in 1993 and has not been revised
since. Hospitals were instructed that patients should be
charged a full consultation fee for every single hospital visit
-- even if they had to be treated several times a week over the
course of several years. Source: SAPA, Mail&Guardian, August


31.

Inquiry Launched to Determine if Ineffective AIDS Cure Still
Sold


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8. The Medicine Control Council (MCC) has been ordered by the
Department of Health to see if the industrial solvent,
Virodene, is being openly sold on the internet as a cure for
AIDS. The MCC would establish whether any of the South African
medicine regulatory requirements had been broken and recommend
appropriate action. The Democratic Alliance charged that
Virodene Pharmaceutical Holdings' website was claiming the drug
was "safe and efficacious" in treating HIV/AIDS, and approved
by the MCC in July 1996. Initially thought as a major
breakthrough in the search for a cure for HIV/AIDS, Virodene
was denied clinical trials by the MCC after a 22-month inquiry.
It was reported on the internet that two South African
employees of Virodene Pharmaceutical (Pty) Limited of SA were
ordered to leave Tanzania in September 2001 over their alleged
implication in clinical trials of Virodene PO 58. They were
arrested in 2000 for allegedly importing Virodene PO58 and four
other drugs, PO 59, PO 60, PO 61 and PO 62, without official
approval, raising fears that Tanzanians were being used as
guinea pigs. Source: SAPA, September 7.

Rath Foundation Conducts Illegal Experiments


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9. The Dr Rath Health Foundation, led by German national Dr
Matthias Rath, claims that its vitamin products can reverse the
course of AIDS and says on its website that it is conducting a
"clinical trial" in the township. However, the Foundation does
not have the approval of the Medicines Control Council (MCC) to
conduct a trial, has not registered its products with the MCC
and makes unsubstantiated claims about their healing powers --
all in violation of the Medicines and Related Substances
Control Act. The MCC has been investigating the Rath
Foundation since April 2005. SA National Civic Organization
(SANCO) members have been acting as agents for the Rath
Foundation, and have set up "clinics" throughout the township.
SANCO street committee members target people in their areas
known to have HIV or to be sick, and encourage them to attend
one of the "clinics" where they are prescribed up to 20 vitamin
tablets a day.

The Rath Foundation and SANCO have also been holding public
meetings in Khayelitsha where a group of patients testify to
the healing properties of the vitamins. SANCO says it is
"honored" to work with Rath, but the Congress of SA Trade
Unions (COSATU), South African Communist Party (SACP) and local
health workers have condemned the Foundation for conducting
human experiments. The Foundation's products, Vitacor Plus,
Epican Forte, Lysin C Drink Mix and Vita Cell, contain
vitamins, minerals and lesser known ingredients such as Green
Tea Leaf extract and Bioflavonoids. Patients at the "clinics"
are being told to take doses that far exceed the recommended
daily allowance for vitamins. In interviews on Cape Town radio
stations P4 and 786, Rath admits to running a clinical pilot
study and doing blood tests. The Dr Rath Foundation website
states that: "In Khayelitsha, a township of Cape Town, South
Africa, we conducted a clinical pilot study in HIV positive
patients with advanced AIDS who had never taken any ARV drugs.
The goal of the study was to show that a combination of
micronutrients can reverse the course of AIDS. Rath Foundation
spokesperson Khaya Buthelezi declined to comment on any of the
allegations and said "just go ahead without our response".
Source: Health e Newsletter, September 6; Sunday Times,
September 4.

Release of Two Studies Delayed


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10. Release of two research reports commissioned by provincial
governments about HIV/AIDS in the Eastern Cape and rape
management in the Western Cape has been delayed. The Eastern
Cape Health Department wants a full investigation of the
statistics, while the National Prosecuting Authority states
that the rape management report was never intended for public
use and that it will be released to public prosecutors once the
results have been presented to the Danish government, who
funded the study along with UNICEF.



11. Some of the statistics that needed confirmation in the
HIV/AIDS study include: (1) One in ten people in the Eastern
Cape is HIV-positive, (2) 96,000 people currently need ARV
treatment, yet the Eastern Cape's Health Department 2005/6 goal
is to register 15,169 people for treatment by the end of the
current financial year, (3) The number of people on ARV
treatment will have to increase by 20 times in order to serve
the people who need treatment by 2006, (4) The Eastern Cape
Health Department failed to account for the use of 73% of its
HIV/ADIS budget between 2000 and 2003, while 27% went unspent,
(5) 7 million Eastern Cape residents will die of AIDS by 2015
if there is no effective intervention, and (6) 120,000 orphans
are currently eligible for foster care, rising to 328,000 by


2010. Rhodes University's Center for AIDS Research and
Evaluation performed the study.



12. The Western Cape rape management study, Reflections on
Integrated Rape Case Management, was conducted between January
2001 and May 2003 by the Gender Health and Justice Research
Unit at the University of Cape Town. The report shows very
poor handling of rape cases by both the police and public
prosecutors. Among its findings include: (1) 61% of rape
cases in Manenberg (a Cape Town township) were dismissed on the
basis of there being no prima facie case; (2) 13% of rape cases
in Khayelitsha and 33% in Guguletu (both Cape Town townships)
were unsolved; the Khayelitsha figure rose from 23% to 44%
between January and April 2003; (3) 30% of rape cases in
Khayelitsha were withdrawn at the request of the complainant;
and (4) a 2002 report found that 40% of all reported rapes in
the country were child rapes and only 8.9% of these resulted in
convictions. The data was collected from the Thuthuzela Care
Center, which uses a centralized multi-disciplinary team of
police investigators, social workers, and prosecutors and
receives rape cases from Khayelitsha, Manenberg and Guguletu
police stations. Source: Mail&Guardian, September 2.

Decline in 2005 SA Human Development Rating


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13. South Africa's United Nations Human Development Index
(HDI) reached 120 out of 177 countries, slightly lower than
2004's HDI of 119, largely due to a fall in life expectancy
because of HIV/AIDS and high levels of inequality. The HDI
index tracks indicators including life expectancy, equality of
income and education, based on 2003 data. South Africa was
rated higher than India and most African countries, and lower
than the occupied Palestinian territory, Mongolia and
Indonesia. Positive trends include increasing real income and
advances in gender rights. However, South Africa has an
average HIV/AIDS prevalence rate of 21% for people aged 15-49.
Largely due to HIV/AIDS, life expectancy dropped from 53 years
in the period 1995-2000 to 49 years in the past five years.
South Africa's income inequality was also problematic. The
richest 10% of the population took 44% of the income, while the
poorest 10% got 1.4%. South Africa was assigned an inequality
rating worse than Zimbabwe or Niger, even though South African
per capita income was much higher. On a Human Poverty Index of
developing countries, South Africa ranked in the middle, at 56
out of 103 countries. South Africa's GDP per capita of $3,489
was higher than many of the countries of similar rank, growing
faster than Russia and the United Arab Emirates. Source:
SAPA, Business Day, September 8.

AIDS Infections Still Increasing in Corporate Sector


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14. The HIV/AIDS prevalence rate in the corporate sector has
risen to 19.4% compared to 15% in 2003, suggesting prevalence
of the disease has not yet peaked, according to a survey by Old
Mutual. Old Mutual's health-care survey, whose sample
contained 100 companies, provides the most up-to-date snapshot
of HIV infections among workers, and is one of the only studies
on prevalence in the corporate sector. The study showed most
companies were not even aware of the level of infection in
their organizations. Only 25 of the 100 companies had done
prevalence testing. Even though companies' anonymity was
guaranteed, only 12 of the 25 that had tested agreed to release
their prevalence figures. Extrapolating prevalence figures
from this limited sample could be distorted since companies
that did prevalence testing were likely to be those most
worried about AIDS, such as those in high-risk sectors like
mining or transport. Several factors, including objections
from trade unions fearing persecution of their members, mean
many companies still did not do prevalence testing. According
to Statistics SA, 16.7% of all people in SA aged 15-49 are
infected, while the United Nations puts it closer to 21%. Old
Mutual's figures for the corporate sector, despite their
limitations, suggest the UN figures are more accurate. Source:
Business Day, September 9.

TEITELBAUM