SOUTH AFRICA PUBLIC HEALTH JANUARY 13 2006 ISSUE

UNCLAS SECTION 01 OF 03 PRETORIA 000142

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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 JANUARY 13 2006 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: Children's Bill Approved by NCOP;
Resignations of South African AIDS Experts; South African Study
Reports High Mortality Rate Waiting for Treatment Upon
Enrollment; New Study Highlights Social Costs of AIDS on South
Africa; Malaria Cases Reported in Limpopo Province; and Initial
Human Trials May Start to Test AIDS Herbal Treatment. End
Summary.

Children's Bill Approved by NCOP
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2. The National Council of Provinces (NCOP) has approved the
first section of the Children's Bill that will outlaw virginity
testing and male circumcision under the age of 16, both
controversial issues provoking much cultural debate within
South Africa. The Bill allows virginity testing for girls over
the age of 16, if they have proper counseling, that the results
are not publicized and that the girl's body is not marked.
Male circumcision was also forbidden unless the boy is 16 years
or older and receives counseling, or is for religious or
medical purposes. Once the bill becomes law, anyone who
performs a virginity test or a circumcision on a child under
the age of 16 could face legal action. Earlier in 2005, when
the Children's Bill was passed by the National Assembly,
virginity testing was banned, while male circumcision was not.
The National Assembly's decision to ban virginity testing
raised concern from the National House of Traditional Leaders,
which deemed it a violation of cultural rights. The NCOP
amended the National Assembly's decisions to allow some testing
and circumcision.


3. Under the new bill, a child can consent to medical
treatment, including HIV testing and the purchase of
contraceptives, at 12 years of age. Previously, under the
Child Care Act, the minimum age had been 14.


4. There are contradictions in the new bill. Having sex with
a child aged 15 or younger is considered statutory rape, but
the new law assumes a 12-year-old is mature enough to purchase
condoms. Another concern is that, at 14 years old, children
can now consent to surgical procedures, including abortion.
However under the new bill, a girl can consent to giving up her
baby for adoption only at 18, whereas previously, a 16-year-old
could make that decision. The Children's Bill updates the
Child Care Act of 1983 and amends a section of the Bill of
Rights that refers to children. It is divided into two
sections: section 75 and section 76. Section 75 focuses on
provisions for children while section 76 will concentrate on
Child Welfare services. Section 76 will be presented before
parliament in 2006. New features of the Children's Bill
include: (1) establishment of a National Child Protection
Register, which will allow all employers to check whether their
employees are suitable to work with children; (2) barring
anyone who has been found guilty of an offence against children
to work in an environment that involves children; (3)
establishment of a Register of Adoptable Children and
Prospective Adoptive Parents, aiding social workers in matching
children and adoptive parents; and (4) allowing children to
remain with their siblings under the care of an adult
designated by the court. Source: The Star, December 24 2005.

Resignations of South African AIDS Experts
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5. Fareed Abdullah has resigned from his position as deputy
director-general of health of the Western Cape AIDS department,
and will begin a three-year job at the International HIV and
AIDS Alliance, based in Brighton, England. Abdullah has been
responsible for the province's HIV and AIDS program for 11
years during which he played a crucial role in expanding access
to anti-retroviral therapy (ART) and prevention of mother-to-
child HIV transmission program, which has seen a reduction of
the transmission rate from mothers on ART from 30% to 5%. As

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head of the International HIV and Aids Alliance's technical
division, Abdullah will be in charge of program design and
evaluation in 20 developing countries most of which are in
Africa. Earlier in December, Dr. Chris Jack, head of the
HIV/AIDS program in KwaZulu-Natal resigned to work as a
consultant in Durban. KZN officials recently announced that Dr
Busi Nyembezi would be the new head of the province's Health
Department, following the retirement of Professor Ronald Green-
Thomson as the Superintendent-General. Source: The Cape
Times, January 9; Sunday Times January 8 2006.

South African Study Reports High Mortality Rate Waiting for
Treatment Upon Enrollment
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6. A prospective operational study of a community-based
antiretroviral treatment (ART) program in Cape Town, South
Africa has reported a very high rate of mortality among
patients waiting to go on treatment after enrolling. According
to the study, published in AIDS in December 2005, nearly half
of the observed deaths occurred in patients who had recently
enrolled in the ART program but who were not yet on treatment.
The vast majority of deaths occurred in patients with CD4 cell
counts below 50 and advanced symptomatic disease (WHO stage 3
and 4). A number of studies have previously reported on the
survival benefit observed after the ART rollout in resource-
limited settings, but this is the first to report on the
mortality rates among patients during the time between
enrollment into the program and the actual start of treatment.


7. The trial, conducted at the Gugulethu Community Health
Centre on the outskirts of Cape Town between September 2002 and
February 2005, involved 712 patients referred to clinic for
ART. After referral to the ART service, patients had to make
at least three visits to the clinic before they could actually
receive treatment. Of the 712 patients included in the
analysis, the median CD4 count was 94 cells and the median
plasma viral load was 72 349 copies/ml. The vast majority of
patients had advanced disease, WHO clinical stage 3 for 354
(50%) and stage 4 for 215 (30%).


8. A total of 578 patients (81%) started ART, a median of 29
days after enrollment (96% within 90 days). The most frequent
reasons that the remaining 134 patients (19%) did not go on ART
were 1) death, 2) decision to access treatment elsewhere, 3)
failure to attend follow-up clinic appointments, 4) moving out
of the area and 5) psychosocial reasons, such as denial of HIV
infection status. The median period of observation for the
patients who didn't go on ART was 28 days. Sixty-eight (9.5%)
of the patients who enrolled into the program died during the
course of the study. The high mortality rate of 35.6
deaths/100 person years before treatment fell to 2.5/100 person-
years at one year among those on ART. Within the first three
months of enrollment, 29 of 44 (66%) deaths occurred among
patients not yet on ART.


9. The authors suggest that reducing pre-treatment intervals
may well decrease mortality. However, a balance needs to be
established between minimizing the pre-treatment interval
(potentially reducing early mortality risk) and allowing
adequate time to prepare patients for treatment (promoting high
rates of treatment adherence and reducing long-term mortality
rates). They also suggest that a fast-track system could be
developed to speed treatment of patients at the highest risk of
death (those with stage 4 disease, a CD4 count < 50 cells/ml or
an AIDS-defining illness). Source: AIDSMAP December 23, 2005,
AIDS. 19(18): 2141-2148, 2005.

New Study Highlights Social Costs of AIDS on South Africa
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10. The Center for the Study of AIDS, at the University of
Pretoria, published a new report, "Buckling: The impact of AIDS
in South Africa", by South African writer and journalist Hein
Marais. Marais presents an alternative analysis of AIDS impact
in South Africa, and proposes a minimum social package to
reduce the damage. According to Marais, most projections of
how the AIDS epidemic will affect society are vastly
oversimplified and policies based on conventional conceptions
of the societal effects of AIDS are likely to fail, or may even
further aggravate existing inequities. Marais argues that

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analysis of AIDS' impacts has to explicitly take into account
South Africa's economic and social inequities as well as the
interplay of the epidemic with local resources and existing
social arrangements. Marais argues that the least privileged
sections of society will disproportionately bear the brunt of
the AIDS and that this could undermine South Africa's attempts
to become a more just and equitable society, deepening the
structural crisis in South Africa which is already fuelling the
epidemic. He calls on South Africa to improve its social
security net by developing a comprehensive package of social
services including job creation and workers' rights protection,
safe-guarded food security, and the affordable provision of
essential services. "Overcoming the epidemic," writes Marais
"therefore coincides with the overarching need to bring about a
much more just society, one in which all South Africans have at
least the basic means to a secure livelihood and the realistic
prospect of improving their lives and those of their children."
Source: AIDSMAP, December 23, 2005.

Malaria Cases Reported in Limpopo Province
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11. Over 100 cases of malaria were reported in Limpopo
Province in 2005 with 53 reported cases since December, despite
South Africa's aggressive malarial control programs. The
recent increase in malaria has been attributed to increased
rains providing stagnant pools of water. South Africa sprays
DDT in the affected areas, with the last Limpopo spraying in
September and October 2004. In the past several years, most of
Limpopo districts have experienced drought conditions.
National Health officials are meeting with their provincial
health counterparts to discuss anti-malarial measures. Source:
City Press, January 8, 2006.

Initial Human Trials May Start to Test AIDS Herbal Treatment
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12. An herbal mixture, known as Ubhejane, may become the first
traditional medicine to be tested on humans. Pre-clinical
tests on the safety and activity against bacteria and fungi
were conducted by the University of KwaZulu-Natal's Nelson
Mandela School of Medicine and human trials on its efficacy are
scheduled to begin at the end of 2006. Dr. Nceba Gqaleni of
the Nelson Mandela School said that Ubhejane had a `potent
activity' against opportunistic infections associated with
HIV/AIDS and is currently conducting a second phase metal
analysis and antiviral tests with the compound, due to be
completed in April 2006. Up to 80 herbs collected throughout
Africa composes Ubhejane. Individual instances of improvement
in CD4 counts and reduction in viral loads have been documented
in patients using Ubhejane; however, the Medical University of
South Africa's Patrick Maduna emphasized the need for more
research before any more favorable expectations were created.
Source: City Press, January 8.

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