SOUTH AFRICA PUBLIC HEALTH NOVEMBER 18 ISSUE

UNCLAS SECTION 01 OF 03 PRETORIA 004593

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 KHILL
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, NIH/HFRANCIS
CDC FOR SBLOUNT AND DBIRX

E.O. 12958: N/A
TAGS: ECON KHIV SOCI TBIO EAID SF
SUBJECT: SOUTH AFRICA PUBLIC HEALTH NOVEMBER 18 ISSUE

Summary
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1. Summary. Every two weeks, Embassy 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: Increased Risk of Malaria for HIV-positive
Individuals; Nearly Half of SA Nurses Report Abuse; Survey
Shows South Africans Continue Risky Behavior; SA to Ban
Asbestos; Study Highlights HIV Impacts on Children; New HIV
Vaccine to be Tested in SA; High Medical Costs in South Africa;
and New Malaria Cure Possible. End Summary.

Increased Risk of Malaria for HIV-positive Individuals
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2. South African research demonstrated that HIV-positive
individuals have a significantly increased risk of severe
malaria. Investigators working at a hospital in Soweto showed
that the risk of severe malaria was almost three times greater
for HIV-positive individuals than HIV-negative ones.
Researchers offered two possible explanations: (1) HIV
infection could impair immune responses to malaria parasites,
or (2) HIV-infected patients may develop excessive or aberrant
immune responses that lead to increased disease severity.


3. A total of 336 patients were included in the investigators'
analysis. Of these individuals, 110 (33%) were HIV-positive.
Two-thirds of patients had semi-immunity to malaria. The
researchers found that HIV-positive individuals were
significantly more likely to have a distinct pattern of illness
caused by malaria, including kidney failure, severe anemia, and
that people with HIV were more likely to be admitted to
intensive care than HIV-negative malaria patients. In
multivariate analysis, the investigators found that the risk
factors for severe malaria were non-immunity, HIV infection, a
high malaria parasite count, and an elevated white blood count.
Overall, the investigators noted that HIV-positive patients
with a CD4 cell count below 200 cells/mm3 were significantly
more likely than HIV-negative individuals to have severe
malaria. The investigators also observed that non-immune HIV-
positive patients with severe malaria had significantly lower
CD4 cell counts (134 cells/mm3 vs 190 cells/mm3, p = 0.007)
than semi-immune HIV-positive individuals. Source: Cohen C et
al., Increased prevalence of severe malaria in HIV-infected
adults in South Africa, Clinical Infectious Diseases, 41,
online edition, 2005;AIDSMAP, November 10.

Nearly Half of SA Nurses Report Abuse
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4. More than half of all nurses polled report suffering at
least one incident of physical or psychological violence in a
single year, according to a study published in the Health
Annals 2005 of the Hospital Association of South Africa.
Approximately 80% of nurses blamed abuse, largely by male
doctors, for nurses leaving the profession. Almost half the
respondents cited abuse by patients as a reason for nurses
leaving the profession. The definition of abuse in the study
ranged from harassment and bullying to aggression and assault,
both physical and psychological, with the perpetrators being
patients, patients' families and visitors, other nurses and
other healthcare professionals, such as doctors. Psychological
violence was more likely from healthcare workers, and physical
violence was usually perpetrated by patients and their
relatives. Source: The Cape Argus, November 10.

Survey Shows South Africans Continue Risky Behavior
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5. According to the 2005 Durex Global Sex Survey, sixty-four
percent of South Africans have had unprotected sex without
knowing their partner's sexual history, higher than last year's
results. The survey, conducted online, found that 10 percent
of South Africans have had unprotected sex when they thought
they may have had a sexually transmitted infection like HIV.
Nineteen percent of South Africans are too scared to test for
HIV and Aids, even though they suspect they may have the
disease. The survey also found that 59 percent of South
Africans have had sex with a stranger and 30 percent of men
admit to having had an extra-marital affair compared with 20
percent of South African women.

South African individuals have sex about 109 times a year -
above the global average of 103. Greece had the highest number
of sexual encounters at 138, while Japan reported the lowest at
45 times a year. For South Africans, the most common places
for sex outside the bedroom are: the car (74%),followed by
toilets (47%),the garden (46%),parties (44%),nightclubs
(37%) and in planes (4%). Nearly a third of the South African
respondents also admitted to having had sex at their place of
employment. Forty-one countries were included in the survey,
with more than 300,000 participants. Source: SAPA, IOL,
November 8.

SA to Ban Asbestos
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6. Draft regulations will be published to ban the import and
export of all asbestos products, along with new measures to
phase out the local manufacture and use of asbestos-containing
products. The decision to publish the regulations, which
provide for hefty fines and a maximum jail term of 10 years for
offenders, was approved by the cabinet in October 2005. From
an economic perspective, the new South African ban is not
expected to lead to major job losses, with government
statistics suggesting that fewer than 200 people remain
directly employed in the domestic asbestos manufacturing
industry. According to the department of environmental
affairs, alternative fibres and materials are available to
replace most asbestos-containing products. Everite, the
biggest South African producer of asbestos roof sheeting,
switched over completely to a new tree-based fiber product
called Nutec in 2002. Federal-Mogul, the largest local
supplier of brake and clutch linings, also stopped using
asbestos nearly 10 years ago, according to Johnny Frankiskos,
Managing Director of the Friction Products Division.


7. The new government measures are not aimed at removing or
replacing existing asbestos products. Removing asbestos roof
sheets and gutters without adequate safety precautions could
create bigger health risk exposures than leaving them in place,
said senior Environmental Affairs Department official Joanne
Yawitch. The regulations aim to ban any further manufacture of
such products and to ensure much stricter safety standards for
workers when old buildings are demolished. Those companies
which continue to stock asbestos-containing products will be
allowed a four-month grace period once the ban takes effect,
while a limited number of companies will be granted exemptions
on condition that they submit phase-out plans to the
government. South Africa, a major world supplier of asbestos
for nearly a century, closed its last asbestos mine in 2001 and
has been under increasing pressure to ban asbestos completely.
Total asbestos usage in South Africa had declined by about 40
percent between 2000 and 2002, while a National Economic
Development and Labor Council study estimated that by banning
asbestos, South Africa could save nearly R27 million ($4.2
million using 6.5 rands per dollar) every year in disease
compensation and health costs. Source: The Mercury, November 3.

Study Highlights HIV Impacts on Children
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8. Almost half the world's orphans and vulnerable children
whose parents died of AIDS are in southern Africa, according to
Human Sciences Research Council study sponsored by WK Kellogg
Foundation (WKKF). The study began in 2002, when the WKKF
contributed about R35 million ($5.4 million) to launch a pilot
project to combat the growing number of orphans and vulnerable
children in South Africa, Botswana and Zimbabwe. Researchers
from HSRC interviewed government representatives, caregivers
and management of projects providing support services to
children in HIV-impacted households. According to the study,
rural communities must bear the human and financial costs of
the disease because many HIV-infected urban dwellers return to
their rural communities when they become ill. In addition, the
study recommends more focus on prevention of HIV infection,
with increased attention placed on prevention of sexual abuse.
Income generating projects are needed to encourage skills
development. Finally, there has to be more advocacy work on
legal issues related to orphans and vulnerable children to
publicize and protect their legal rights. Source: The Star,
November 11; hsrc.ac.za.

New HIV Vaccine to be Tested in SA
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9. Seventy-eight healthy South Africans are to test a new
candidate HIV vaccine over the next 18 months, according to the
International AIDS Vaccine Initiative (IAVI). The trials will
test the safety of tgAAC09, a vaccine candidate that is based
on the HIV sub-type most prevalent in southern and eastern
Africa. The trial will be conducted in three sites in South
Africa: (1) the Perinatal HIV Research Unit, Chris Hani-
Baragwanath Hospital in Soweto with Dr Eftyhia Vardas as the
principal investigator; (2) the Desmond Tutu Institute for HIV
Research, University of Cape Town, with Dr Linda-Gail Bekker as
the principal investigator; and (3) the Medunsa Campus of the
University of Limpopo with Professor Anwar Hoosen as the
principal investigator. The IAVI also plans to test the
vaccine in Zambia and Uganda, pending regulatory approval in
those countries. The vaccine candidate, tgAAC09, uses a
recombinant adeno-associated viral vector (rAAV) that was
developed with and manufactured by Targeted Genetics
Corporation, based in Seattle, Washington. The South African
trial follows positive safety data received from "Phase I"
tests conducted over the past two years in Belgium, Germany and
India. Candidate vaccines that are proven to be safe in Phase
I trials move on to Phase II trials, allowing investigators to
test the immune response and acquire more data on safety. This
is the first Phase II HIV vaccine trial to be held in South
Africa. Sub-Saharan Africa is the region hardest hit by AIDS,
with more than 25 million people estimated to be infected with
HIV, the virus that leads to the disease. Source: SAPA, IOL,
November 14.

High Medical Costs in South Africa
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10. South Africans are leading unhealthy lifestyles, forcing
companies and government to pay more for health coverage.
Currently 8.6% of South African GDP is spent on healthcare,
compared to 7.7% in the UK and 14.6% in the U.S. Insurance
coverage for chronic drugs has increased by 27.5% per year
between 1999 and 2003. According to the South Africa Health
Review, Non-communicable diseases are the leading cause of
death in South Africa, with cardiovascular diseases (CVDs)
killing 14% of men and 19% of women. CVDs comprise Ischaemic
heart disease, diabetes mellitus, and hypertensive heart
disease. The Medical Research Council estimates that 318,083
years of life are lost because of strokes and 284,438 because
of Ischaemic heart disease. According to World Health
Organization Mortality Statistics, South Africa ranks first in
CVD deaths ahead of Brazil, China, India, the U.S., and
Portugal. Source: The Citizen, November 10; hst.org.za.

New Malaria Cure Possible
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11. A new malaria cure, based on an Asian medicinal herb
artmisinine, is to be presented to the African market in 2006.
Dafra Pharma, a Belgian company specializing in malaria
medicines since 1997, announced the new cure. The new single-
day cure for malaria has already been widely tested on several
locations in Africa, making it ready for marketing in 2006.
After the initial treatment, which takes one day, patients
suffered no subsequent relapses, and after 28 days after the
start of treatment, no parasites were left in the patients'
blood. Dafra asserts that its new cure is simpler, more
effective and cheaper than any other malaria cures on the
market. It is a fixed-dose combination (FDC) of two active
ingredients in a single tablet. The company has developed
three different FDC's for patients of different weights,
including one for children, infants or pregnant women. In
Africa, in particular children are very affected by malaria,
causing very high mortality rates. According to Dafra, the
recommended price for government purchases of the drug will be
just 1 euro per adult patient and 50 cent per child, making the
new one-day therapy the cheapest anti-malarial treatment of all
Artemisinin based Combination Therapies (ACT's). Dafra Pharma
has subsidiaries in Mali, South Africa and Kenya where it also
produces generic drugs. Source: AfroNews, November 11.

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