SOUTH AFRICA PUBLIC HEALTH MARCH 24 2006 ISSUE

UNCLAS SECTION 01 OF 03 PRETORIA 001195

SIPDIS

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 MARCH 24 2006 ISSUE


Summary
--------------


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: SA Health Department Short of its Goals;
Traditional Cure Advocated However Still in Research Stages;
New Pharmaceutical Dispensing Fees Proposed; Heart Drug
Introduced in South Africa; Rapid Increase of Youth in Drug
Treatment Centers; North West Province Begins TB Information
Campaign; and Survey Results of Workplace Peer Educators. End
Summary.

SA Health Department Short of its Goals
--------------


2. More than 500,000 South Africans require antiretroviral
(ARV) treatment, according to Fatima Hassan of the Aids Law
Project at the University of the Witwatersrand. Less than half
are receiving the medication, despite substantial increases in
public funding for ARV treatment. A government fact sheet
issued in November 2005 titled "Implementation of the
Comprehensive Plan on Prevention, Treatment and Care of HIV and
AIDS" noted that 85,000 people were receiving ARV treatment in
the public health sector by September of 2005. Hassan
estimated that an additional 70,000 to 80,000 persons were
being treated privately by August 2005. In November 2003, the
Operational Plan for Comprehensive HIV and Aids Care,
Management and Treatment for South Africa, noted that 381,177
persons were supposed to be on government-funded ARV treatment
in the 2005/2006 period. According to the Treasury Department,
112,000 were enrolled for ARV therapy by end December 2005. In
addition, not many children are on treatment, according to
Hassan. At least 50,000 children need ARV treatment now, but
currently only about 10,000 are receiving ARV treatment.
Shortages of doctors and nurses also pose a problem. According
to Rotimi Sankore, from the Center for Research, Education and
Development of Freedom of Expression and Associated Rights,
about 100,000 health professionals, half of them doctors, had
left Africa since the 1990s for global employment. Source:
Sapa-IPS IOL, March 15.

Traditional Cure Advocated However Still in Research Stages
-------------- --------------


3. Recent press reports have portrayed ubhejane as both a
possible cure and unproved treatment in combating HIV/AIDS.
Zeblon Gwala, who makes ubhejane from a mixture of 89 African
herbs, has claimed that the pre-clinical assessment tests
conducted by the University of KwaZulu-Natal, Dr. Nceba
Gqaleni, have shown that ubhejane has potent activity against
opportunistic infections associated with HIV/AIDS. KwaZulu-
Natal (KZN) Health Minister Piggy Nkonyeni, eThekwini (Durban)
mayor Obed Mlaba and Professor Herbert Vilakazi, special
advisor to KZN's premier, have encouraged ubhejane's use,
saying that it improved conditions of HIV/AIDS patients.
Professor Salim Abdool Karim, UKZN Pro Vice-Chancellor for
Research, said while the university supported research on
traditional medicines, it would not allow its reputation to be
abused through false claims. According to Karim, new
procedures were being enforced at the university to prevent
people making false claims from its research findings. Dr.
Gqaleni asserted that claims of effective treatment of ubhejane
for AIDS are unfounded and misrepresent findings of preliminary
research. His research on the activity of ubhejane on cell-
lines only used test tubes and could not conclude about the
potential action of Ubhejane in humans.


4. Gwala, the manufacturer of ubhejane, claims that the recipe
came from his traditional healer grandfather in dreams and that
he personally mixes 89 African herbs manually. Initial
treatments are 2 two-liter bottles costing R 342 ($60),which
lasts four weeks. According to Gwala, he offers patients a
choice between using his product and antiretroviral drugs.
While Gwala keeps patient records, he could not supply details
of those who had improved their CD4 counts and decreased their
viral loads since taking ubhejane. Source: Sapa, Sunday
Tribune, City Press, March 19; Mail & Guardian, March 17.

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New Pharmaceutical Dispensing Fees Proposed
--------------


5. Health Minister Manto Tshabalala Msimang announced new
draft regulations for pharmacies' dispensing fees. The
dispensing fees will be on a sliding scale. Under the draft
regulations, where the manufacturer's price (or single exit
price of medicine) is less than R75 ($12),the maximum
dispensing fee that may be charged is R7 plus 28% of the price.
Where the single exit price is more than R75, the dispensing
fee would be R23 plus 7% of the price. Where the exit price is
between R150 and R250, the fee would be R26 plus 5% of the
single exit price. Where the exit price is more than R250 the
fee would be R31 plus 3%. These dispensing fees would serve as
a ceiling on drug prices, where lower dispensing fees could be
charged at the discretion of the pharmacist. In October 2005,
the Constitutional Court upheld the government's medicine
pricing regulation, but ordered a review of the previous
proposed dispensing fee of a maximum of R26 for medicines
priced over R100 and 26% for those under R100. A final
dispensing fee would only be announced after the comments have
been considered. Consumers would receive an invoice that gave
the single exit price of a medicine and the dispensing fee.
According to Anban Pillay of the Health Department, the
department relied on information submitted by pharmacies to
determine the dispensing fee ceilings. The department had sent
questionnaires to all 2,532 pharmacies in South Africa,
receiving only 162 analyzable questionnaires back. The
questionnaires revealed that some pharmacies would close, no
matter what the level of the price ceiling. Source: Sapa,
March 9; Cape Times, March 10.

Heart Drug Introduced in South Africa
--------------


6. Astra-Zeneca, a global pharmaceutical manufacturer, plans
to introduce Crestor, a drug that blocks the production of
cholesterol and reduces the amount of plaque in blood vessels,
in South Africa by the end of 2006. Jasvanti Bhana, the
medical adviser for Astra-Zeneca said Crestor also increased
the level of good cholesterol in the blood, thus helping to
reduce the risk of fatty deposits in the arteries, which can
lead to heart attacks, stroke and vascular disease. Launched
globally in 2003, Crestor is awaiting approval for registration
by South Africa's Medicines Control Council. Prof Abdul Mitha,
chairman of the Heart Association's KwaZulu-Natal branch, said
it would be premature to call Crestor a wonder drug. It lowers
cholesterol more than other drugs have done, however he sees no
evidence of better results in terms of deaths and recoveries.
Results of an international study released at the American
College of Cardiology annual conference in Atlanta show that
two years of treatment with Crestor, whose chemical name is
rosuvastatin, cut cholesterol levels by more than half and
reduced the thickness of the atheroma (or fat deposits in
arteries) by 6.8%. The research also showed four out of five
patients showed some form of reduction in atheroma. Crestor
has been the focus of controversy after evidence emerged that
it could cause a muscle-wasting disease.


7. Heart disease kills 200,000 people a year in South Africa
and affects more than two million. South Africa's Indian,
Jewish and Afrikaner communities are among the world's highest
risk populations when it comes to cardiovascular diseases.
Source: Sunday Tribune, March 19.

Rapid Increase of Youth in Drug Treatment Centers
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8. In the past five years, there has been a rapid increase in
the patterns of alcohol and other drug use in South Africa, and
significantly more young patients are being admitted to
treatment centers for drug-related problems. According to
statistics released by the Hospital Association of South Africa
(HASA) there was a growing number of patients younger than 20
being admitted to treatment centers, as well as an increase in
the number of young people, some as young as 14, dying from
substance-abuse-related causes. In Durban, East London and
Gauteng the average age of Mandrax users was 21. Across the
country, the mean age for dagga (marijuana) use ranged from 19
to 21. In the Western Cape Province, 42% of patients younger

PRETORIA 00001195 003 OF 003


than 20 used Tik (crystal meth) as their primary drug of abuse.
In KwaZulu-Natal Province, 50% of admitted patients in
treatment centers younger than 20 used dagga, while 25% used
alcohol, 20% used Mandrax (20 percent). Treatment and demand
for dagga and Mandrax-related problems across South Africa is
generally higher for people younger than 20 than for older
patients. Forty percent of children who are admitted for
substance abuse have a dual diagnosis: addiction which is the
primary illness and a secondary or underlying psychiatric
condition such as clinical depression or bipolar mood disorder.
In these cases, rehabilitation aimed at reducing the use of
drugs is only one component of the treatment. Claire Savage,
Senior Information Officer at the South African Council on
Alcoholism and Drug Dependency Center, asserted that their
center is admitting increasing numbers of younger patients for
rehabilitation. Between 2004 and 2005, more than 30% percent
of patients were under the age of 20. Source: The Mercury,
March 16.

North West Province Begins TB Information Campaign
-------------- --------------


9. The North West Health Department is beginning a
Tuberculosis (TB) information-sharing campaign aimed at the
media to inform communities about the disease. There has been
a significant increase in TB cases around the country since

1995. In 1995, just over 500 cases of TB were registered,
while by 2000, over 25,000 cases were noted. In the North West
province, 617 out of every 100,000 people had TB in 2005. The
North West currently ranks 5th in the national caseload of the
disease. Eighty percent of the TB case loads were reported in
Kwa Zulu-Natal, Western Cape, Eastern Cape and Gauteng
provinces. People aged between 35 and 44 years suffered from
TB the most. Health MEC Nomonde Rasmeni said organizing the
Media Open Day/TB Awareness Campaign was important, as it
equips journalists with information about the disease to help
educate communities. The mycobacterium tuberculosis, a germ
that causes the disease, is present in the sputum coughed up by
those that have TB of the lungs. The germ destroys the soft
tissue of the lungs, causing cavities and resulting breathing
difficulty. Source: BuaNews, March 12.

Survey Results of Workplace Peer Educators
--------------


10. Wits University's Business School conducted a study of
peer educators from five large companies involved in the
mining, retail, finance and the auto manufacturing sectors. The
companies have a workforce of over120,000. The number of peer
educators surveyed totaled 1,780. Dr David Dickinson, a Senior
Lecturer on HIV/AIDS in the workplace at University of
Witwatersrand Business School and author of the report, stated
that the study tried to establish who the peer educators are in
the workplace. The study found that the peer educators were
similar to the typical profile of the workforce with two
differences. African women are over-represented as peer
educators compared to their profile in the work-force and an
almost total absence of top and senior management amongst the
ranks of peer educators. Dr Dickinson gives two explanations
of women's over-representation. More Africans have HIV/AIDS
and there is a gendered concern about the disease's effects
taken from the home into the workplace along with peer
education. Dickinson gives supervisors' importance on
maintaining production as reasons for low senior management
participation in peer education programs. He asserts that peer
education programs must be given official recognition, with
formal opportunities provided by supervisors and materials, the
information and the resources to run education and training
programs. Researchers won't reveal the identities of the
companies involved in the survey. Source: Health E-News,
March 10.

TEITELBAUM