SOUTH AFRICA PUBLIC HEALTH DECEMBER 23 ISSUE

UNCLAS SECTION 01 OF 05 PRETORIA 004971

SIPDIS

DEPT PASS AID WASH DC

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 DECEMBER 23 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: African Women More Vulnerable to HIV/AIDS;
HIV Treatment Reduces Risk of TB in South Africa More than
Previously Thought; Mozambique and SA to Sign Health Agreement;
Eastern Cape Struggling with AIDS; SA Still Losing Health Care
Professionals; Awareness of South African HIV/AIDS Media
Strategy; Global Fund Withdraws Support for loveLife; HAART
Found Cost Effective in South Africa; and Cape Town Conference
Highlights Links between Poverty and HIV/AIDS. End Summary.

African Women More Vulnerable to HIV/AIDS
--------------


2. Not only are women biologically more prone to HIV/AIDS
infection than men, but for a variety of social, cultural and
economic reasons they also have a harder time coping with the
illness once infected, particularly in Africa, according to
Helen Jackson, HIV/AIDS Advisor for Southern Africa with the UN
Population Fund. The physiological data seem to indicate it is
twice as easy for women to become infected as for men. African
women are particularly hard hit. Of women affected worldwide,
77% are Africans, according to Michel Sidibe, deputy director
of UNAIDS. In southern Africa, young women aged between 15 and
24 are at least three times more likely to be HIV-positive than
men of the same age. Infection often occurs between older men
and young women. There is a greater chance of the women's
partners being HIV-positive and the immature vaginal tract is
more easily infected. An UNAIDS study pointed out that among
women surveyed in Harare (Zimbabwe),Durban and Soweto (South
Africa),66% reported having one lifetime partner, 79% had
abstained from sex at least until the age of 17; yet 40% of the
young women were HIV-positive. Source: Sapa-AFP, IOL,
December 8.

HIV Treatment Reduces Risk of TB in South Africa More than
Previously Thought
-------------- --------------


3. Antiretroviral therapy appears to reduce the risk of
developing tuberculosis (TB) to a greater extent than was
previously thought, according to a South African study
published in a recent edition of AIDS. Investigators found
that the incidence of new cases of tuberculosis fell to just
one case per 100 patient years after five years of
antiretroviral therapy.


4. Doctors in Cape Town studied the incidence of new cases of
tuberculosis in individuals during their first five years of
antiretroviral therapy. A total of 346 individuals who
received HIV therapy between 1996 and 2005 were included in the
analysis. The majority (55%) were men, the median age was 33
years, and just over half were assessed as having a low
socioeconomic status. Before HIV therapy was initiated, the
median CD4 cell count was 242 cells/mm3 and median viral load
was 80,000 copies/ml. A total of 51% of individuals had
symptoms of HIV/AIDS and 14% had a previous history of
tuberculosis. During a total of 1108 person years of follow-
up, 27 new diagnoses of tuberculosis were made. All but five
cases affected the lungs (extra-pulmonary tuberculosis is
normally much more common in HIV-positive individuals) and
three people with tuberculosis died.


5. The overall incidence of tuberculosis was 2.44 cases per
100 person years of follow-up. However, there was a significant
decline in incidence from 3.35 cases per 100 person years in
the first year to just 1.01 case per 100 person years in year
five. Development of tuberculosis was found to be
significantly associated with the following baseline
characteristics: age under 33 years; a CD4 cell count below
100 cells/mm3; and symptomatic HIV/AIDS. Source: AIDS 19:
2109 - 2116, 2005AIDSMAP, December 8


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Mozambique and SA to Sign Health Agreement
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6. Senior health officers from South Africa and Mozambique
will sign an agreement formalizing the treatment of Mozambicans
in health facilities along South Africa's borders. The
initiative was part of the Health Department's efforts to
address Mozambicans' use of South African resources in those
rural and underdeveloped areas. The agreement would take into
account the daily movement of people across the countries'
borders and the hospitals affected would be identified. So
far, the Tonga District Hospital has been earmarked for
referrals from Mozambique. Health professionals would record
the number of Mozambicans being treated and a patient referral
system between the two countries would be established.
Mozambique would then be billed when their citizens were
treated in South African facilities. Source: Sapa and Mail
and Guardian, December 7.

Eastern Cape Struggling With AIDS
--------------


7. The Public Service Accountability Monitor (PSAM) reported
to the Joint Civil Society Monitoring Forum (made up of
organizations including the Aids Law Project, the Health
Systems Trust and the Institute for Democracy in South Africa,
meeting regularly to assess the progress of Government's
treatment plan) that during the 2004/5 financial year the
Eastern Cape Health Department under spent its overall budget
by R50.8 million ($8 million, using 6.3 rands per dollar). The
department also recorded under spending across all eight
programs, including the HIV/AIDS program which failed to spend
12.7% or R16.8 million ($2.6 million) of its overall budget.
Over the past four years, the Eastern Cape Health Department
has failed to spend R172 million ($27 million) on HIV/AIDS
programs. However, there are signs of progress. There are now
26 accredited antiretroviral sites, with 20 providing treatment
at the end of September. They were treating almost 10,000
patients, including almost 1,000 children. The patient target
by March 2006 is 15,000 patients. According to a report by the
International Treatment Preparedness Coalition, called "Missing
the Target - A Report on HIV/AIDS Treatment Access from the
Frontlines", lack of effective national political leadership as
well as denialism and pseudoscience were barriers to AIDS
treatment in South Africa. Specific recommendations for South
Africa include launching an international campaign to hold
government accountable and expanding human resources. Latest
figures show that at least six million South Africans are
currently living with HIV/AIDS, while 600,000 need
antiretroviral treatment. According to South African
government figures, 86,000 people are currently accessing
treatment in the public health system. Source: Health-e News
Service, December 13.

SA Still Losing Health Care Professionals
--------------


8. Despite an agreement to stop active recruitment for the
national public service in the United Kingdom, South Africa is
still losing healthcare professionals as the agreement does not
include the private sector whose recruitment agencies continue
to recruit South African staff. The recruitment process
involves large-scale distribution of circulars and printed
advertisements of foreign posts in monthly journals such as one
from the Democratic Nurses Organization of South Africa, which
relies on revenue from those ads to fund the publication of
their magazine. Although the national public service of the
United Kingdom, which takes in the largest number of health
care professionals from South Africa out of all receiving
countries, can no longer actively recruit in South African, the
United States, Canada, Australia and New Zealand are locations
where an increasing number of South African health care workers
are going. Source: The Pretoria News, December 12.

Awareness of South African HIV/AIDS Media Strategy
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9. Part of the 2005 South African National HIV Prevalence, HIV
Incidence, and Behavior Communication Survey focuses on the

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awareness of HIV/AIDS national media campaigns in South Africa.
These campaigns use a variety of media, such as television,
radio, outdoor media, or some combination of all. Certain
campaigns focus only on particular age groups. Seven media
campaigns were highlighted in the 2005 Survey: Soul City, Soul
Buddyz and Takalani Sesame (both aimed at children),Khomanani,
loveLife, Gazlam and Tsha Tsha. Khomanani, loveLife and Soul
City use broadcast, print and outdoor media, while Gazlam and
Tsha Tsha use television and Takalani Sesame use television and

SIPDIS
radio. The campaigns receiving the most funding are Khomanani
and loveLife.


10. The Khomanani: Caring Together for Life campaign is the
government's main communication initiative on HIV/AIDS.
(Khomanani is a Tsonga word meaning caring together.) The
South African government spent approximately R165million ($26
million) for the 2004-to-2006 period on the campaign. Yet, the
2005 South African National HIV Prevalence, HIV Incidence,
Behavior and Communication Survey showed that of all the AIDS
information campaigns underway, Khomanani reached the fewest
people. Only 33.8% of teenagers aged between 12 and 14, and
46.7% of young people between 15 and 24, were aware of the
campaign. For those aged 25 to 49, the figure was 41.7%.
According to Nathan Geffen, spokesperson for the Treatment
Action Campaign, Khomanani's message is acceptable, but there
isn't enough of it. Even more importantly, high-level
officials need to become more vocal about safe sex and
ascertaining HIV status.


11. loveLife, South Africa's best-funded campaign, receives
R200 million ($32 million),although less than R26-million ($4
million) comes from the South African government. The Global
Fund, one of loveLife's major supporters recently announced
withdrawal in their support (see next article). loveLife
produces weekly radio programs and works to ensure that anti-
AIDS messages are communicated in all 11 official languages.
About 72% of young people aged 15 to 24 are aware of loveLife,
according to the South African National HIV Prevalence, HIV
Incidence, Behavior and Communication Survey. However, critics
point to loveLife's unclear messages and lack of accountability
in demonstrating its campaign's effectiveness.


12. Previous research indicated that the media had virtually
no effect on behavior and that more emphasis should be placed
on face-to-face programs, such as those in clinics and youth
centers. However, the South African National HIV Prevalence,
HIV Incidence, Behavior and Communication Survey found that of
those who were being reached by the campaigns, a large
proportion saw the information as useful. The survey also
noted that work still needs to be done in reaching rural areas
and informal settlements. As newspapers and television sets
are luxuries in many South African homes, radio remains an
important means for communicating with such audiences. The
government also funds a number of other campaigns, such as Soul
City, which uses television and radio dramas to warn people
about HIV. The South African National HIV Prevalence, HIV
Incidence, Behavior and Communication Survey noted that
awareness of Soul City, the longest-running campaign operating
since 1992, was the highest across all age groups. Note: Soul
City receives PEPFAR funding. Source: Mail and Guardian,
December 19; South African National HIV Survey,
hsrcpress.ac.za.

Global Fund Withdraws Support for loveLife
--------------


13. The Global Fund to fight HIV/AIDS, Tuberculosis and
Malaria has refused to fund any additional activities of
loveLife, a South African youth-targeted HIV/AIDS campaign.
The Global Fund board stated that loveLife "was deemed to not
have sufficiently addressed weaknesses in its implementation".
Global Fund spokesman Jon Liden said it had become difficult to
measure how the prevention campaign was contributing to the
reduction of HIV/AIDS among young people. Global Fund had
repeatedly requested loveLife to revise its proposals and
address concerns regarding performance, financial and
accounting procedures, and the need for an effective governance
structure. In 2003, loveLife received about US $12 million
from the Fund, a third of its operating budget. Citing other

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less expensive programs that show effective results, Liden
stated that the Global Fund needs to see evidence of loveLife's
effectiveness before spending more money. However, loveLife's
Deputy CEO, Grace Matlhape, stressed that loveLife is working,
citing a 2004 study conducted by the University of
Witwatersrand's Reproductive Health Research Unit study of more
than 11,000 young people aged between 15 and 24. Those who had
participated in a number of loveLife programs were less likely
to be HIV-positive, and were also more likely to report using
condoms and be tested for HIV. However, the study did not show
whether the project had caused these differences. Source: UN
Integrated Regional Information Networks, December 19.

HAART Found Cost Effective in South Africa
--------------


14. A recent study investigating the cost effectiveness of the
highly active antiretroviral therapy (HAART) in South Africa
found that the cost savings of treating patients with AIDS
using HAART ranged between $209 and $2,116 per patient.
Patients on HAART required fewer hospital admissions and
depending on how long the patient survived and the price of
antiretrovirals, it costs less to treat the HAART patients with
AIDS.


15. During the study period (January 1995 to the end of
December 2000),HAART was not available in the publicly funded
South African health care system. The study took place in HIV
clinics affiliated with the University of Cape Town.
Researchers compared the cost of services for 292 patients who
were given HAART with the costs for a comparison group (with
the same number of patients) who were not given any
antiretroviral drugs. There were 27 patients in each group
that had AIDS; the others were HIV-infected but did not have
AIDS. Researchers calculated costs per patient year and per
life-year gained (the total cost divided by the number of extra
years the treated patients lived).


16. HAART proved to be a more cost-effective way for South
African hospitals to treat HIV infection than simply to wait
for patients to come and be treated for HIV symptoms. Indirect
costs were not addressed in this study. Source: Plos
Medicine, January 2006, Volume 3, Issue 1.

Cape Town Conference Highlights Links Between Poverty and
HIV/AIDS
-------------- --------------


17. In December 2005, a Cape Town conference sponsored by the
International Union for the Scientific Study of Population
(IUSSP) presented demographic studies that highlighted the
interactions between poverty and HIV/AIDS in Southern African
nations of Malawi, Zambia, and South Africa. Little direct
evidence was shown of the link between poverty and HIV/AIDS,
although much discussion centered around the problems and
interpretations of using panel data for empirical
investigations. Most of the studies used Demographic Health
Surveys, household-based national surveys having little
detailed information concerning income. The studies had to
impute assets using either type of flooring or house or other
type of asset information having little direct income
information, making the analysis of the interaction of poverty
and HIV/AIDS subject to possible measurement and
misspecification errors.


18. The South African studies used provincial surveys, making
generalized national observations difficult. The South African
studies examined the socio-economic impacts of HIV/AIDS on
household in the Free State; impacts of parental death on
school enrollment in KZN; and orphans and HIV Risk Behaviors
among adolescents in KZN. The Free State study grouped HIV
affected and non-affected by liquid and illiquid assets and
found the assets to be similar among groups, although since 40%
of people had no income in both groups, one could argue that
poverty impacted the results. The study of orphans in KZN
found that that there was no link between socio economic status
(SES) if the mother died, and a negative association if the
father died; however children without mothers are behind in
school relative to other children. Source: iussp.org,

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December 12-14.

TEITELBAUM