SOUTH AFRICA PUBLIC HEALTH May 4 2006 ISSUE

UNCLAS SECTION 01 OF 03 PRETORIA 001821

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 May 4 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: Study Points to Benefits of Providing ARV
Treatment, Survey Shows HIV/AIDS a Growing Problem for
Microfinance, Microbicides 2006 Conference Emphasize Women's
Vulnerability to HIV Infection, Research Reports that High
Concentration of Lime Juice can kill HIV but too Caustic,
Obesity in South Africa Increasing, Chronic Disease Mortality
Will Increase by 2010, South Africa Intends to Strengthen
Smoking, and National Survey Shows 12% of SA's Adolescents
Regularly Gamble Bill. End Summary.

Study Points to Benefits of Providing ARV Treatment
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2. A recent study from the Bureau for Economic Research (BER)
at the University of Stellenbosch found that the macroeconomic
impacts of HIV/AIDS in South Africa would amount to a 0.44%
annual loss in GDP between 2005 and 2010. The study entitled,
"The Macroeconomic Impact of HIV/AIDS under Alternative
Intervention Scenarios (With Specific Reference to
Antiretroviral Treatment) on the South African Economy," also
found that providing antiretroviral treatment would mitigate
the estimated GDP loss of 0.44% to 0.4%. The BER study
described three model-based scenarios: no AIDS; AIDS with
prevention programs but no antiretroviral treatment program;
and AIDS with prevention programs and a large-scale
antiretroviral treatment program with a take-up rate of 50%.
The results from the different scenarios indicated the epidemic
would have a negative impact on overall economic growth and, in
the absence of antiretroviral treatment, the rate of GDP growth
could fall from a projected average of 4.4% over 2002 to 2015
to 4% a year due to the epidemic. Providing antiretroviral
treatment could reduce the impact of HIV/AIDS on economic
growth by on average 17% between 2000 and 2020. Per capita GDP
was projected to be about 8% higher in real terms by 2020
because the reduction in population would be larger than the
negative impact on GDP. Certain sectors of the economy would
experience higher negative impacts from HIV/AIDS. The general
government, water and electricity, mining, metals and
machinery, and electrical machinery sectors were more exposed
to the supply-side risk and demand-side risks. The supply-side
risk was due to high HIV prevalence and relatively high skills
intensity, while the demand-side risk stemmed from the impact
of HIV/AIDS on intermediate and final demand and exports.
Sectors with low overall risk included community, social and
personal services, clothing and textiles, agriculture and
construction. Source: Business Report, April 24.

Survey Shows HIV/AIDS a Growing Problem for Microfinance
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3. According to a study by Africap Micro Ventures, more than
50% of microfinance institutions across Africa viewed HIV/AIDS
as a growing problem due to rising default rates. The study
focused on 10 types of microfinance institutions including non-
governmental organizations, commercial banks, and licensed and
unlicensed financial institutions. Results showed that, as a
rule, repayment rates were high at 98%, although one bank
reported a 50% default rate. Only a third of the companies in
the survey had adjusted products to client needs, making
changes such as flexibility in loan repayments and adjusting
loan amounts. At an Africap conference in Cape Town, an
HIV/AIDS Risk Management Task Force Working Group, composed of
more than 20 organizations, is trying to finalize an HIV/AIDS
code of conduct for microfinance institutions. Source:
Business Report, April 25.

Microbicides 2006 Conference Emphasize Women's Vulnerability to
HIV Infection
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4. The international Microbicides conference in Cape Town
focused on the vulnerability to HIV infection of women in
Africa and the need to find better ways so that they can

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protect themselves from infection. Microbicides are products
that could reduce the transmission of HIV and other sexually
transmitted infections when used in the vagina or rectum.
Microbicides can be formulated in a variety of ways, such as a
gel, foam, cream, sponge, or intravaginal ring. Since they can
be applied by women before and, in some cases, even after sex
without the man being present, they have more control over this
prevention method. In southern Africa over 60% of the infected
adults are women. One in four South African women aged 15-24
is infected with HIV, compared to one in fourteen of the young
men of that age. Currently, over six products are in advanced
clinical studies in Africa involving over 25,000 participants
(five are being studied in South Africa in at least 12,000
women). The Microbicides 2006 Conference, attended by over
1300 researchers and public health workers, examined four
issues: (1) basic science research looking at issues such as
mucosal immunology, transmission models, microbicide discovery
and delivery mechanisms; (2) clinical research, including
preliminary data from some of the large scale studies, (3)
social and bioethical challenges conducting this type of
research in vulnerable populations, and (4) a community and
advocacy issues. Source: AIDSMAP, April 26.

Research Reports that High Concentration of Lime Juice can kill
HIV but too Caustic
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5. Using high concentrations of lime juice as a vaginal douche
to prevent HIV or other sexually transmitted infections (STIs)
can cause severe abrasions to the vaginal epithelium, and would
probably only increase the risk of HIV transmission, according
to a safety study presented at the Microbicides 2006
conference. Although another study suggested that using lower
concentrations (up to 20%) may be safer, laboratory studies
have found such concentrations are too low to kill HIV. A
laboratory study of lime juice presented at the Conference
found that it does indeed kill HIV. At a 10% concentration,
lime juice can inactivate HIV within five minutes. But in the
presence of semen, it takes a 50% concentration at least 30
minutes to kill the virus. But the study also found some
suggestions that lime juice might damage mucosal tissues,
particularly if the tissue was already irritated. A second
preclinical study, which also looked at lemon juice, found that
both juices were markedly toxic to a variety of human cells,
and concluded that while the juice might kill HIV in the
cultures, it killed everything in the culture. Source:
AIDSMAP, April 27.

Obesity in South Africa Increasing
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6. According to a Medical Research Council (MRC) report
"Dietary Changes and the Health Transition in South Africa:
Implications for Health Policy", South Africans are eating more
saturated fats, sugars and refined carbohydrates, resulting in
a high prevalence of obesity. The average South African
consumed 12% more kilojoules between 1962 and 2001, increasing
consumption of fat, proteins and carbohydrates. In the black
community there was a movement, particularly in cities, away
from traditional high fiber, high carbohydrate diet to a diet
richer in saturated fats and refined carbohydrates. Findings
in the report indicate that men consume alcohol far more
frequently than women. In addition, 17% of children between
the ages of one and nine were either overweight or obese.
Fifty-six percent of South African women and 29% of South
African men were considered overweight. Source: Sapa, IOL,
May 2.

Chronic Disease Mortality Will Increase by 2010
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7. Chronic diseases such as hypertension, high cholesterol and
diabetes are expected to kill 666 South Africans daily by the
year 2010, according to the South Africa Medical Research
Council (MRC). A new MRC report titled "Chronic Diseases of
Lifestyle in South Africa: 1995-2005" reported that there are
about six million South Africans with hypertension, five
million with high blood cholesterol, 1.5 million with diabetes
and more than seven million smokers. According to the report,
chronic diseases killed 565 people daily in 2000. Lifestyle-
related cancers had been increasing in the country. The report

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found that increasing urbanization was a factor behind
hypertension and diabetes. The report highlights the need for
proper health care in South Africa for people with chronic
diseases of lifestyle, particularly at primary care level.
Challenges facing developing countries include trying to treat
chronic diseases, lasting the patient's lifetime and needing
complex health care systems, and acute diseases on limited
resources devoted to health care. Very little international
research and policy activities have addressed the question of
how poorer developing countries, with multiple burdens of
disease, can address both acute and chronic conditions.
Source: Sapa and IOL, May 2.

South Africa Intends to Strengthen Smoking Bill
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8. A draft of the Tobacco Products Control Amendment Bill,
tabled in Parliament, proposes new fines and tougher
enforcement of smoking laws for individuals and businesses who
ignore anti-smoking laws. For example, parents who sit with
children in the smoking area of a restaurant will, with the
business owner, be subject to higher fines. If the Health
Department's proposals are accepted, individuals caught
breaking the law will have to fork out a minimum of R300 ($50,
using 6 rands per dollar) or an amount determined by the
courts. The draft proposals also suggest an increase in fines
from R200 ($33) to a minimum of R200,000 ($33,333) for
restaurant owners who do not enforce the law. There is also a
minimum fine of R100,000 ($16,666) for those who sell
cigarettes to minors or who fail to comply with vending machine
legislation. Those who illegally advertise or give away
tobacco products could be fined R1 million ($166,666). The
Health Department wants Parliament to approve the new bill in
time for implementation by early 2007. According to Zanele
Mthembu, the Department's Director of Health Services, 25,000
South Africans died of smoking-related deaths every year. The
proposed bill would close loopholes in existing regulations and
bring legislation in line with international laws, in
particular the World Health Organization's framework convention
on tobacco control. Source: The Sunday Independent, April 30.

National Survey Shows 12% of SA's Adolescents Regularly Gamble
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9. At the Fourth Biennial Gambling Conference in Cape Town,
Philip Frankel, the Head of the Department of Political Studies
at Wits University, described results from the first nationally-
based survey on risk behaviors of adolescents. The survey
found that more than one third of high school students gambled
more than R200 per session and that 12% gambled regularly with
3-5% showing signs of serious gambling addiction. In addition,
over one third surveyed believed people should enjoy life and
stop worrying about condoms, HIV and AIDS. A quarter believed
that an understanding of mathematical trends led to a better
chance of winning the lottery, while almost 37% believed that
staying at the same slot machine improved their chances of
winning. According to the report: (1) South Africans spent
R11.6 billion ($1.9) on gambling in 2005, (2) the majority of
South Africans gambled by buying lottery tickets (45.8%),with
7.8% buying scratch cards and 7.1% gambling at casinos, (3) of
those who bought lottery tickets, 72.7% bought Lotto tickets at
least once a week while one in every 10 people visited a casino
at least once a week, (3) 1.7% of household budgets in South
Africa is spent on gambling, and (4) The gaming industry has
created almost 100,000 direct and indirect jobs in the past 10
years. The survey is based on a sample of 40 schools, ranging
in locations from rural KwaZulu-Natal to Cape Town and
Johannesburg. Source: The Mercury, April 21.

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