SOUTH AFRICA PUBLIC HEALTH FEBRUARY 10 2006 ISSUE

UNCLAS SECTION 01 OF 04 PRETORIA 000603

SIPDIS

STATE PASS TO AID

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 FEBRUARY 10 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: Transparency International Warns Against
Health Care Fraud; Study Shows Previous Blood Risk Management
Policies Led to Drop in HIV-infected Blood Supplies; MSF Starts
Handover of HIV/AIDS Treatment; New Head of HSRC HIV/AIDS
Research Unit; HSRC Study Details Impact of HIV/AIDS on
Teachers; South Africa to Test New HIV Treatment Strategy;
Plants used in Traditional Medicine Tested for AIDS Treatment;
Aspen Helps Affordable AIDS Treatment; and South Africa
Launches New Malaria Initiative. End Summary.

Transparency International Warns Against Health Care Fraud
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2. A new Transparency International report warns that health
care systems around the world are easy targets for fraud. The
report did not quantify the scale of corruption in health-care
systems, but said the complexity of health-related industries
and the vast sums of public money invested in medical care make
the sector an attractive target for fraud. The world spends
more than $3.1-trillion on health services each year, almost a
third of it in the U.S. Many of the cases in Transparency
International's report used examples from South Africa's health-
care systems. South Africa's vulnerability to increased fraud
was seen in several reports issued in 2005. One report on
provincial health departments highlighted problems in public
hospitals ranging from unpaid patient bills to poor staff
management and stock control. Last November, auditor-general
Shauket Fakie censured the national Health Department for a
consecutive second year due to poor management of conditional
grant transfers. Fakie found the Department had transferred
hospital revitalization grants to provinces without first
approving project implementation plans, as required by the
Division of Revenue Act, and HIV/AIDS grants had been paid to
two provinces before their business plans were approved. The
Public Service Accountability Monitor, a research organization
based in Eastern Cape, says that the provincial health
department is vulnerable to fraud and corruption because of a
lack of proper management systems. Two of the provincial
pharmaceutical storage depots have failed to submit proper
records for the past nine years, making it easy for drugs to be
misallocated, says the Monitor's advocacy head, Adrienne
Carlisle. The provincial health department has acknowledged
its weaknesses and privatized management of pharmaceutical
depots, but the department's inability to monitor the program
means it remains open to corruption, warns Carlisle.
Medscheme, one of South Africa's largest medical insurance
companies, has caught 62 vendors who admitted submitting
fraudulent claims worth R12 million ($2 million using 6 rands
per dollar) in the past 12 months, according to Medscheme Chief
Information Officer Kevin Right. Source: Business Day,
February 2.

Study Shows Previous Blood Risk Management Policies Led to Drop
in HIV-infected Blood Supplies
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3. According to a study published in the Journal of the
American Medical Association, the South African National Blood
Service's (SANBS) former race-based risk management policy,
which barred many blacks from donating blood between 1999 and
2005, led to a substantial drop in HIV-infected blood supplies.
Michael Busch with the Blood Systems Research Institute in San
Francisco collaborated with SANBS chief executive Anthon Heyns
and said the study underscored the dilemma of trying to
maintain a safe blood supply in the challenging arena of
epidemic infectious disease and social expectations. The
research looked at about 900,000 blood donations collected in
the inland region from the policy's first year, and compared
these with almost 800,000 donations collected from 2001 to
2002, when the policy was implemented. HIV was detected in
0.17% of donations in 1999-2000, but dropped 50 percent to

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0.08% in 2001-2002 after the implementation of the enhanced-
donor selection and education policy. The number of high-risk
donations collected decreased from 2.6% to 1.7%.


4. Under the old and new policies, prospective donors are
asked to answer a questionnaire about their medical history,
sexual practices and drug use. Using potential donors' race as
a marker of risk was the policy's most controversial component,
and in December 2004, the Department of Health declared that
race was not an acceptable risk indicator, and officials
decided in February2005 to test individual blood samples. More
recently, the SANBS's policy of excluding donations from
sexually active gay men also has generated criticism.
Officials say that, too, is now under review. Source: The
Star, February 6; Weekend Argus, February 4; "Blood safety
program in South Africa associated with decline in HIV-1 in
blood donations", JAMA and Archives Journals, 31 January, 2006,
p 519-526.


5. Comment. The U.S. government through the President's
Emergency Plan for AIDS Relief has been assisting the SANBS to
develop new blood screening methodologies. End comment.

MSF Starts Handover of HIV/AIDS Treatment
--------------


6. After five years of work in the treatment of HIV/AIDS,
Medecins Sans Frontiers (MSF) is preparing to withdraw from the
antiretroviral treatment program in the Cape Town township of
Khayelitsha. MSF began offering antiretroviral therapy (ART)
in Khayelitsha in 2001, when the provision of anti-AIDS drugs
in the public sector was still illegal. At that time, the
South African government considered provision of ART too
complex and expensive to implement. MSF committed to a five-
year plan to treat 180 patients in Khayelitsha, which had the
largest concentration of HIV/AIDS patients in South Africa. The
organization estimated that 70,000 of Khayelitsha's half a
million population are infected with HIV. A national HIV
treatment and prevention plan was eventually approved by the
government in 2003. With extra financial support from the
Global Fund to fight HIV/AIDS, Tuberculosis and Malaria, and a
reduction in the cost of anti-AIDS drugs, MSF was able to
enroll more patients in ART. The organization established
three dedicated HIV/AIDS clinics in Khayelitsha's public health
facilities, where they now treat close to 3,000 people. MSF
figures showed there were fewer than 500 HIV tests taken in
2000 while in 2005 that figure increased to 28,000. MSF has
reduced their role in providing drugs, staff and other
resources to the Khayelitsha clinics. The provincial health
authority for the Western Cape expects to take full control of
these projects by mid-2007. MSF intends giving the Treatment
Action Campaign a prominent role to act as a permanent
monitoring body over treatment and will put pressure on the
provincial health authority to maintain quality of service.
Source: IRIN News and PLUS News, January 24.

New Head of HSRC HIV/AIDS Research Unit
--------------


7. Laetitia Rispel, former head of the Gauteng health
department, has been appointed as the executive director of the
Social Aspects of HIV/AIDS and Health (SAHA) program at the
Human Sciences Research Council (HSRC). She succeeds Olive
Shisana, who took over as President and CEO of the HSRC in
August 2005. Rispel has worked for the Gauteng health
department for nine years, first as a senior manager, and for
the past five years as head of the department. She also worked
for eight years at the Center for Health Policy, a research
unit within the Wits University Department of Community Health.
She obtained a PhD in Health Systems and a Masters in Community
Health from the University of the Witwatersrand. In 2002, she
completed a senior executive program at Harvard University in
conjunction with Wits University. The SAHA program conducts
research on the social determinants of health, not only on
HIV/AIDS, but also for public health in general. Source:
SAPS, January 30.

HSRC Study Details Impact of HIV/AIDS on Teachers
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8. South Africa needs 90% anti-retroviral coverage for
teachers with HIV, or the country could be losing more than 5
000 teachers to AIDS annually within the next four years.
According to an HSRC study by Thomas Rehle and Olive Shisana,
one in nearly every 10 teachers with HIV was dying of AIDS, a
loss of more than 1% of the total teacher population in 2005.
Published in a recent edition of the Journal of Social Aspects
of HIV/AIDS, the study pointed to the precarious health status
of a large percentage of HIV-positive teachers. The study
found that nearly one in every three HIV-positive teachers
participating in their survey had a CD4 count of less than 200.
More than half had a CD4 count lower than 350 (the U.S.
standard for when people start ARV treatment). Their survey
results suggested that more than one-fifth of HIV-positive
teachers needed ARVs, if healthcare providers used South
African national criteria for the start of this treatment. The
percentage of HIV-positive teachers with a CD4 count lower than
200 (22%),was higher than those previously reported in
population-based studies in sub-Saharan Africa. B 2005, nearly
11,000 teachers needed treatment. If the U.S. treatment
standard of a CD4 count of 350 was applied, 25,000 teachers
should have started ARV treatment last year. Within the study
group of approximately17,000 teachers, the authors expected
more than 4,000 to die in 2005 if there was no intervention,
and nearly half of those deaths were among teachers aged 35 to

44. But by 2010, 90% antiretroviral coverage could result in a
50% reduction in AIDS deaths, according to Shisana and Rehle.
Source: IOL, The Cape Argus, IRIN, January 30;
www.hsrcpres.ac.za.

South Africa to Test New HIV Treatment Strategy
-------------- --


9. South African sites will be participants in the Spartac
study, which will test a new treatment strategy of providing
ART treatment during the early months of HIV infection, rather
than in the later stages of the disease. The researchers hope
that early treatment will block the virus before it damages the
immune system and thus delay the onset of lifelong therapy.
Trials will occur in Durban, which as already enrolled 11
volunteers with hopes of 100. The researchers want to enroll a
total of 360 including sites at University of Cape Town, and
the Reproductive Health and HIV Research Unit at Wits
University. Recruitment is difficult as volunteers need to be
in the early stage of the infection, when typically there are
no clear symptoms. Volunteers will be divided into three
groups: one is receiving ARV drugs for three months; the
second receiving ARV drugs for one year; and the third getting
a placebo. This will be one of the last international HIV
trials including a placebo. The South African Spartac
investigator is Dr. Francois Venter. Source: Sunday Times,
February 5.

Plants used in Traditional Medicine Tested for AIDS Treatment
-------------- --------------


10. Two African plants used in traditional medicine are
research subjects of an initial $4.4 million research grant
collaboration between the Mandela School of Medicine at the
University of KwaZulu-Natal, the Center for HIV/AIDS Vaccine
Immunology at Duke University, and University of Missouri.
Cancer bush (Sutherlandia Frutescens) and African wormwood
(Artemisia Afra) have had a long history of treatment use in
Africa. Sutherlandia is known as the cancer bush because of
its anecdotal reputation as a cure for certain cancers.
According to the South Africa National Biodiversity Institute,
eating or drinking Sutherlandia leaf improves the appetite and
allows weight gain, possibly delaying the progression of HIV
into AIDS. In traditional medicine, the African Artemesia
plants have been used to treat coughs, colds, fever, intestinal
worms and malaria. According to Ben-Erik van Wyk, professor of
botany at Rand Africaans University, natural products and their
derivatives make up more than 50% of all drugs in clinical use.
The first part of the project will monitor AIDS patients at
Edendale Hospital in Pietermaritzburg being treated with
extracts of the cancer bush. Further pre-clinical studies will
be done on African wormwood for possible use in treating AIDS,
tuberculosis, and cervical cancer. Similar work will be done

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in Malawi, Gambia, Tanzania and Uganda as part of a 7-year
project costing $300 million. Source: The Mercury, Cape
Times, Pretoria News, January 26.

Aspen Helps Affordable AIDS Treatment
--------------


11. Over the past five years, the cost of a year's supply of
antiretroviral (ARV) drugs in South Africa has dropped from
over R95,000 ($13,690, using 6.94 rands per dollar, the 2000
average rate of exchange) to around R1,200 ($190, using 6.36,
the 2005 average rate of exchange) for the standard first-line
package of three drugs a day, largely because generic ARV drugs
are now available. Second-line drugs for people who develop
side-effects or resistance to the first-line drugs are still
significantly more expensive as they tend to be newer drugs
still under patent protection. Aspen Pharmacare, the largest
pharmaceutical company listed on the Johannesburg Stock
Exchange, has played a key role in securing voluntary licenses
from pharmaceutical companies to enable Aspen to make cheap
generic versions of brand name drugs. Aspen senior executive
Stavros Nicolau is convinced that voluntary licenses have been
responsible for South Africa's successful provision of generic
drugs because acrimonious relations with pharmaceutical
companies were avoided. By 2001, Aspen had secured its first
voluntary license from GlaxoSmithKline to manufacture AZT and
3TC. Since then, it has secured voluntary licenses from
Bristol-Myers Squibb (for stavudine and didanosine),Boehringer
Ingleheim (for nevirapine) and Merck Sharp & Dohme (for
efavirenz). According to Nicolau, Aspen's 2005 achievements
include: (1) becoming the first generic manufacturer to get US
Food and Drug Administration approval for drug supply; (2)
becoming the main supplier for the South African Health
Department's provision of antiretroviral drugs, providing eight
out of 15 categories of drugs; (3) securing a non-exclusive
licensing and distribution arrangement with Gilead Sciences to
make generic versions of the ARVs, Truvada (a combination of
emtricitabine and tenofovir) and Viread (tenofovir); and (4)
entering into a joint venture with India's Matrix, one of the
world's largest manufacturers of active pharmaceutical
ingredients (APIs) for ARVs, which ensures Aspen's continued
supply of ARVs. Aspen is beginning to focus on the U.S. and
U.K. market for additional sales since it had received
manufacturing approval from both regulatory authorities.
Source: Financial Mail, December 2005; Health E-News, January
18 2006; Business Day, February 7, 2006.

South Africa Launches New Malaria Initiative
--------------


12. Science and Technology Minister Mangena officially
launched the South African Malaria Initiative (SAMI),an R11.5
million ($1.9 million, using 6 rands per dollar) research grant
whose aim is to focus on three areas: developing new
antimalarial compounds; better malarial diagnostics; and
examining the interaction between the malaria parasite and its
carriers. SAMI intends to develop a national and regional
capacity for treatment and diagnostics of malaria. There are
on average 10,000 cases of malaria a year in South Africa,
mostly impacting rural populations of Mpumalanga, Limpopo and
northern KwaZulu-Natal provinces. Source: Pretoria News,
Business Day, February 8.

TEITELBAUM