Identifier
Created
Classification
Origin
08PRETORIA1396
2008-06-26 15:38:00
UNCLASSIFIED//FOR OFFICIAL USE ONLY
Embassy Pretoria
Cable title:  

SCENE-SETTER FOR CODEL BERMAN'S JULY 1-6 VISIT TO

Tags:  OREP AMGT PREL PGOV SF 
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VZCZCXRO4010
PP RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHSA #1396/01 1781538
ZNR UUUUU ZZH
P 261538Z JUN 08
FM AMEMBASSY PRETORIA
TO RUEHC/SECSTATE WASHDC PRIORITY 4892
INFO RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHUJA/AMEMBASSY ABUJA 1167
RUEHLS/AMEMBASSY LUSAKA 3642
RUEHMV/AMEMBASSY MONROVIA 0224
RUEHOS/AMCONSUL LAGOS 1273
UNCLAS SECTION 01 OF 07 PRETORIA 001396 

SENSITIVE
SIPDIS

FOR CONGRESSMAN BERMAN FROM AMBASSADOR BOST
DEPT FOR H AMACDERMOTT, AF/S MARBURG
DEPT PLEASE PASS TO HILL STAFFERS RKING, P-AMARSH, DBERAKA

E.O. 12958: N/A
TAGS: OREP AMGT PREL PGOV SF
SUBJECT: SCENE-SETTER FOR CODEL BERMAN'S JULY 1-6 VISIT TO
SOUTH AFRICA

REF: A. STATE 62586

B. STATE 68515

UNCLAS SECTION 01 OF 07 PRETORIA 001396 SENSITIVE SIPDIS FOR CONGRESSMAN BERMAN FROM AMBASSADOR BOST DEPT FOR H AMACDERMOTT, AF/S MARBURG DEPT PLEASE PASS TO HILL STAFFERS RKING, P-AMARSH, DBERAKA E.O. 12958: N/A TAGS: OREP AMGT PREL PGOV SF SUBJECT: SCENE-SETTER FOR CODEL BERMAN'S JULY 1-6 VISIT TO SOUTH AFRICA REF: A. STATE 62586 ¶B. STATE 68515 ¶1. (SBU) I warmly welcome the visit of your delegation to South Africa. My staff and I stand ready to do everything we can to make your trip a success. You are visiting South Africa at a particularly interesting time, only seven months after Jacob Zuma defeated incumbent Thabo Mbeki as leader of the ruling African National Congress (ANC). Because the ANC has overwhelming support in the country (70 percent in the last election),Zuma is now the leading candidate to become the next national president following parliamentary elections expected in March/April 2009. ¶2. (SBU) South Africa is an anchor country in U.S. Africa policy. Since the end of apartheid in 1994, the ANC-led South African Government (SAG) has made major progress toward establishing a vibrant democracy and market-based economy. The SAG has focused on political and economic transformation: reducing the gap between the historically privileged and disadvantaged communities -- primarily through government-provided housing, electricity, and water to the poor -- and creating educational, skills development, employment and business opportunities. South Africa, however, continues to face daunting challenges, including a lack of public sector operational capacity, a thirty percent shortfall in mid-to-upper-level public sector managers, skills shortages in all sectors of the economy, growing infrastructure bottlenecks, energy shortages, income inequality between haves and have-nots, less than adequate educational opportunities, massive unemployment, entrenched poverty in both rural and urban areas, violent and widespread crime, and a severe HIV/AIDS pandemic. These problems are intensifying political tensions within the ANC-led ruling coalition and with other political, civil society, and private sector groups. The tense debate at the party's December 16-20, 2007 national conference and defeat of incumbent Mbeki reflected the growing impatience with the pace of socio-economic change particularly for those who have not benefited sufficiently from the modest economic growth. The recent xenophobic and inter-ethnic violence -- which resulted in more than 60 deaths and tens of thousands of �
0A;displaced persons around the country -- is also in large part a reflection of the growing restlessness and dissatisfaction with the ANC's inability to deliver a better life for everyone, especially when it comes to employment and housing (which was constitutionally promised to everyone). ¶3. (SBU) Despite its many challenges, South Africa remains the continent's best prospect for establishing a successful democratic society with expanding prosperity. South Africa is a leader of aid-recipient countries in their dialogue with donor nations, plays a key role in promoting peace and stability in Africa, and is an important voice on global trade, human rights, conflict resolution, and nonproliferation issues. U.S.-South African relations are stable, as reflected by President Bush's July 2003 visit to South Africa and President Mbeki's June 2005 and December 2006 trips to Washington. We share objectives in common on the African continent and beyond, and we work closely together on many of them. -------------- POLITICAL OVERVIEW QPOLITICAL OVERVIEW -------------- ¶4. (SBU) The African National Congress (ANC) dominates the political scene in South Africa. The ANC won 70 percent of the vote and 279 of 400 seats in the National Assembly in the April 14, 2004 elections. Subsequent "floor crossing" periods, in which parliamentarians were allowed to switch parties, boosted the ANC's total to 297. The ANC also won 66 percent of the vote nationally in the March 2006 local elections. The Democratic Alliance (DA) is the largest of several opposition parties in parliament, with 47 seats. The ANC leads the administrations in all nine of South Africa's provinces and in the vast majority of its municipalities. The most visible exception to this country-wide ANC domination is the DA's control of the Cape Town municipality where there have been multiple attempts by the ANC to unseat the DA-led, multi-party, municipal government coalition. ¶5. (SBU) The December 2007 ANC National Conference in PRETORIA 00001396 002 OF 007 Polokwane, Limpopo significantly shifted power within the ruling party. New ANC President Jacob Zuma defeated incumbent, national President Thabo Mbeki by a vote of 2,329 to 1,505. Zuma,s allies swept the other top five ANC leadership positions. The Zuma camp also dominated the elections for the ANC,s 86-member National Executive Council (NEC) with sixteen Mbeki Cabinet members (out of 28) losing their NEC seats. While Zuma,s victory makes him the frontrunner to become national President following the 2009 parliamentary elections, the December 28 indictment of Zuma on corruption and fraud charges complicates Zuma,s political future. Zuma,s political allies have alleged that the corruption case is politically-motivated, a charge prosecutors and Mbeki strongly deny. Zuma has stated he will step down as ANC President if convicted. If convicted and sentenced to more than 12 months imprisonment, Zuma would be constitutionally prohibited from running in the 2009 parliamentary elections, effectively blocking his succession to the national presidency. However, with the slow movement of the judicial process, it is highly unlikely that Zuma,s trial will begin prior to the 2009 parliamentary elections, practically assuring that he will become South Africa,s next president. ¶6. (SBU) It is too soon to tell whether the dramatic events at the ANC National Conference will result in any significant changes in South African Government policy. Mbeki remains in control of the government until 2009 and the ANC conference,s policy resolutions did not advocate any sweeping changes. New ANC President Zuma has stressed that he will not make any radical shifts and would respect the party,s previous policy traditions, statements, and consensus. However, many of the new ANC leaders - and Zuma,s strongest coalition supporters - come from the left wing of South African politics. The Congress of South African Trade Unions (COSATU) and South African Communist Party (SACP),formally members of the ANC-led tripartite alliance, will likely pressure Zuma to embrace more leftist or perhaps even populist positions in the interests of the poor and the working class. On issues like HIV/AIDS and Zimbabwe, this could lead to SAG policies more closely in line with U.S. interests, although on other issues like fiscal management, nationalization of industry/resource sectors, and trade liberalization, the shifts in policy might be less positive from a U.S. perspective. It is also possible that the newly elected ANC leaders might be more seized with domestic rather than continental or global issues, which could reduce the country,s current activist role in international affairs. -------------- -------------- APARTHEID ERA CRIMES AND VISA WAIVERS - A NEW WAY FORWARD -------------- -------------- ¶7. (SBU) Visa ineligibilities related to anti-apartheid activities pose a significant strain on the U.S.-S.A. bilateral relationship. South African leaders routinely raise the frustration and humiliation they associate with trying to travel to the U.S. despite what have been good faith efforts by the Consular Bureau (CA) and others to expedite their travel. These efforts include expedited Qexpedite their travel. These efforts include expedited waivers of ineligibility, including a multi-year and multiple-entry waiver for highly regarded former President Nelson Mandela, facilitated personally by Secretaries Rice and Chertoff. Other high profile persons such as businessman and anti-apartheid activist Tokyo Sexwale have also been affected. Legislation which placed high-level officials and heroes of the anti-apartheid movement into the category of "terrorist" undercuts our efforts to influence South African government policy on issues such as the designation of terrorist supporters and financiers at the United Nations Security Council. ¶8. (U) On April 9, 2008, Secretary Rice spoke before a Congressional hearing regarding the visa waiver issue and advocated the need to change the legislation. In May 2008, the House passed, and the Senate is currently considering, legislation lifting terrorism ineligibilities from certain South Africans. The new legislation allows the flexibility to end visa ineligibilities for anti-apartheid activists whose only crime was fighting the odious apartheid regime. It is important to note that the ineligibilities stemmed not from membership in the ANC (they affected non-ANC members PRETORIA 00001396 003 OF 007 also),but from activities occurring during the apartheid era. -------------- FOREIGN POLICY - FOCUS ON PROMOTING AFRICA -------------- ¶9. (U) South Africa has taken a high-profile role in promoting Africa's development - the African Renaissance. South Africa served as the first chair of the African Union until July 2003 and helped establish continental institutions such as the Pan-African Parliament (which sits in South Africa) and the AU Peace and Security Council. President Mbeki is the driving force behind the New Partnership for Africa's Development (NEPAD),an African-developed program based on international best practices and continental peer review to strengthen economic and political governance across the continent and a framework for productive partnership with the international community. These initiatives have not progressed beyond talk-shop stages and have not advanced to become effective mechanisms for development. ¶10. (SBU) South Africa recognizes that, by virtue of its regional political, economic, and military clout, it has a responsibility to participate in African conflict resolution and peace support operations. South Africa is playing a leading role in negotiations to end the conflicts in Burundi and the Democratic Republic of Congo. Approximately 3,000 personnel are deployed in UN, African Union, and bilateral peace support operations in Sudan, Burundi, DRC, Ethiopia/Eritrea, and the Comoros. The U.S. has a strong interest in seeing South Africa expand and enhance its peacekeeping and disaster assistance capabilities. South Africa participates in the African Contingency Operations Training and Assistance program (ACOTA) to enhance the capacity of the South African National Defence Force (SANDF) for participation in multilateral peace support operations. We are using International Military Education and Training (IMET) funds to support professional military education and technical training of future military leaders and to assist the SANDF in improving management of its defense establishment. In light of the January 2008 repeal of ASPA prohibitions on provision of military assistance, we hope soon to resume Foreign Military Financing (FMF) programs aimed at enhancing the South African Air Force,s strategic airlift capability by funding C-130 annual maintenance, upgrades, technical support, and flight simulator training. ¶11. (SBU) Zimbabwe remains a continuing challenge and increasing concern for South Africa. In March 2007, regional SADC leaders appointed Mbeki as official mediator between Zimbabwean President Robert Mugabe and the opposition Movement for Democratic Change (MDC) with the goal of leveling the playing field in advance of March 2008 elections. Negotiations made some progress, but human rights abuses against the opposition continued. Mugabe has shown little willingness to open the political environment and allow free and fair elections. While South Africa wants political and economic stability with reform in Zimbabwe, SAG officials argued that additional pressure, such as public criticism or additional sanctions, would have little positive effect on President Mugabe and could destabilize Zimbabwe Qeffect on President Mugabe and could destabilize Zimbabwe with spillover effects in South Africa. South Africa already hosts between 1 and 2 million Zimbabwean refugees. In the March 29, 2008 elections, the MDC won a small majority of seats in the Parliament, and its leader Morgan Tsvangirai officially won a majority of the vote (47 percent) but not enough to avoid a runoff with incumbent president Robert Mugabe. Presidential runoff elections planned for June 27, 2008 have been preceded by a terrible campaign of state-sponsored violence and intimidation that has undermined the prospects for a free and fair electoral contest. Some critical analysts and observers contend that the election may have been stolen before any votes were cast. As a result of the political instability, Tsvangirai dropped out of the race on June 22. ¶12. (SBU) Overall U.S.-South African relations are positive, but South Africa sometimes takes positions on global issues that run counter to U.S. interests. As a non-permanent UN Security Council member, and former chair of the G-77 and the Non-Aligned Movement (NAM),South Africa has taken up the cause of a greater voice for the "South" relative to the PRETORIA 00001396 004 OF 007 "North" in global finance, international institutions, increased development assistance, an expanded and reformed UN Security Council, and lower trade barriers (for manufactured and agricultural exports to developed countries). -------------- THE ECONOMY AND THE STRUGGLE TO TRANSFORM -------------- ¶13. (SBU) As the dominant and most developed economy in sub-Saharan Africa, South Africa is markedly different from other countries of the region. It is a middle-income, emerging market economy with GNI per capita of $5,670 (2007), akin to Chile, Malaysia, or Thailand. The South African government's fiscal and monetary policies are excellent, but have been criticized as being too conservative by the increasingly influential COSATU, SACP, and ANC Youth League. The ANC government steadily reduced the fiscal deficit from nearly 6 percent of GDP in 1994-95 to a small surplus of 0.6 percent in 2006-07 and 0.9 percent in 2007-08. The South African Reserve Bank (SARB) is independent and committed to returning CPIX inflation (CPI excluding mortgage interest costs) within a target band of 3.0 to 6.0 percent. Inflation fell from 12.4 percent at the beginning of 2003 to 4.8 percent in June 2006, but has recently crept back up to 10.4 percent (April 2008). The SARB now does not believe inflation will return to within the maximum level of the target band until the end of 2010. Real GDP growth was 5.1 percent in 2007. The South African National Treasury expects growth to slow to 4.0 percent in 2008 and 4.2 percent in ¶2009. However, this growth is measured against an increasingly strained energy supply which has led to power shortages. Because of this, rising inflation and higher interest rates, some local economists expect growth to slow to as little as 3.0 to 3.5 percent. ¶14. (SBU) South Africa's single greatest economic challenge is to accelerate growth. GDP growth averaged 3.0 percent per year between 1994 and 2004 and was not sufficient to address widespread unemployment and reduce poverty. The official unemployment rate, currently 23.0 percent, has only recently begun to decline and is significantly higher among black South Africans than among whites. Income inequality between haves and have-nots remains one of the highest rates in the world. Poverty is widespread. Fifty-six percent of black South Africans, but only four percent of whites, live in poverty. The lack of capacity and service delivery at the provincial and municipal levels has fueled the recent xenophobic attacks as South Africans from lower socioeconomic strata feared that jobs, houses, and other services were being given to refugees from neighboring countries. Other obstacles exacerbating South Africa,s unemployment and economic problems are skill shortages and education system weaknesses. The media reports regularly about a growing brain-drain of technically skilled workforce professionals, including medical staff, to other countries. Nevertheless, the government has made strides in the areas of transfer payments and public services to close the gap. Nearly 2.5 million low-cost homes have been built to provide shelter to 7.6 million people, 3.5 million homes have been provided with Q7.6 million people, 3.5 million homes have been provided with electricity, and nine million people have been connected to clean water. Almost 12.4 million people were benefiting from social grants in 2007 (compared to the country's five million individual taxpayers). The government's broad-based Black Economic Empowerment (BEE) program provides ownership and employment opportunities to blacks and has helped the black middle class double to an estimated two million since 1994. The black middle class has expanded appreciably over the last year, increasing by 30 percent. Of the approximately 48 million person population, 6.0 million belong to the middle class, with 3.4 million being whites and 2.6 million being blacks. ¶15. (U) The success in preparing for and carrying off the FIFA 2010 Soccer World Cup to be held in South Africa is regarded by many as a bellwether of the country's commitment to continued progress in a variety of social and economic areas, among these being the fight against crime, expanding and improving infrastructure, providing services, and developing tourism. -------------- -------------- TRANSPORTATION - WELL DEVELOPED, RELIANT ON STATE PRETORIA 00001396 005 OF 007 -------------- -------------- ¶16. (U) South Africa's transport infrastructure is well developed and is the best in Africa. There are sizeable and efficient ports, a road network that is mostly excellent, and good air links, particularly to Europe and the U.S. and increasingly to Asia and the rest of Africa. The network of rural secondary roads is less well-developed. Transport policy has led to a shift from rail to road since the liberalization of transport in the mid-1980s and a relative lack of investment in rail. Lack of control over heavy-vehicle overloading has led to significant damage to the road network and substantial backlogs in maintenance. ¶17. (U) State-owned Transnet owns and operates port facilities, including the Port of Durban, the largest in Africa. Transnet Freight Rail (formerly known as Spoornet) runs an extensive rail network, including spurs to transport coal from Mpumalanga coal-fields to the Richards Bay Coal Terminal and iron ore from the Western Cape to the port of Saldanha. The government has not allowed private investment in rail lines. There has been substantial under-investment in locomotives and rolling stock. South Africa Airways has direct flights to the U.S., Europe, and Asia and is a world-class airline. It cannot effectively position itself as an international hub, however, because of its location at the end of the African continent, so it has focused more recently on travel within Africa. -------------- U.S. SUPPORT FOR SOUTH AFRICA -------------- ¶18. (U) Since 1994, the United States Government has contributed approximately $1.2 billion toward South Africa's development, including $201 million in credit guarantees. Currently, our development assistance program focuses on strengthening the healthcare system, addressing unemployment through job-skills training and education, creating models for efficient service delivery, reducing gender-based violence as part of the President's Women's Justice and Empowerment Initiative (WJEI),as well as HIV/AIDS through PEPFAR. A wide range of U.S. private foundations and NGOs are also at work in South Africa. Among them are the Gates Foundation (HIV/AIDS),the Ford Foundation (higher education),and the Rockefeller Foundation (adult education). ¶19. (U) Twenty-eight U.S. government entities are represented at the U.S. Mission in South Africa (Embassy Pretoria and the three Consulates in Cape Town, Durban, and Johannesburg). The Mission has 318 approved U.S. positions (only 241 are filled) and 570 local employees. More than 40 percent of Mission staff provides regional services to other U.S. embassies in Africa. The Mission has embarked on an ambitious program to build safe office facilities. In FY 2005, the Mission completed the new consulate compound in Cape Town. In FY 2009, the Mission will complete a new consulate building in Johannesburg and in FY 2010 intends to break ground on a new 155-desk office annex in Pretoria. -------------- U.S.-S.A. TRADE AND INVESTMENT -------------- ¶20. (SBU) U.S.-South Africa trade grew 22 percent in 2007, totaling $14.3 billion. U.S. exports were up 23 percent at $5.2 billion, while South African exports to the United Q$5.2 billion, while South African exports to the United States increased 22 percent at $9.1 billion. In 2007, South Africa was the 34th largest trading partner of the United States, equivalent to Turkey or Chile. It is the largest U.S. export market in sub-Saharan Africa, twice the size of Nigeria and equal to Russia or Argentina. South Africa was the third largest beneficiary of AGOA and the largest beneficiary of non-oil exports to the U.S. in 2007. Its AGOA exports totaled 25 percent of the country's total exports to the U.S. in 2007. An impressive 98.1 percent of South Africa's exports entered the U.S. with zero import duties in 2007 as a result of normal trading relations (NTR),GSP, and AGOA benefits. Only 1.9 percent of the value of South Africa's exports to the U.S. was subject to duty, or $174 million out of $9.1 billion in exports, in 2007. The U.S. also replaced Japan as the largest export market in 2007. The U.S. is the third-largest two-way trade partner, after PRETORIA 00001396 006 OF 007 Germany and China. Over 600 U.S. firms have a presence in South Africa with 85 percent using the country as a regional or continental center. South Africa's stable government, sound fiscal and monetary policy management, its transportation infrastructure, sophisticated financial sector, and, by African standards, its large market are the primary attractions for U.S. businesses. South Africa has, however, failed to attract a proportionate share of foreign direct investment since 1994. Reasons include high unit labor costs, labor regulations, skills shortages, crime, HIV/AIDS, regulatory uncertainty, and the impact of Black Economic Empowerment policies such as the mandatory sale of equity to previously disadvantaged persons. The U.S. was the second largest portfolio investor and the second largest foreign direct investor in South Africa after the U.K. ($5.5 billion at year-end 2006). ¶21. (SBU) Following six rounds of negotiations over three years, the U.S. and the Southern African Customs Union (SACU: South Africa, Botswana, Lesotho, Namibia, and Swaziland) agreed in April that they could not conclude negotiations on a free trade agreement (FTA) by their target date of December ¶2006. Negotiators subsequently agreed to deepen the bilateral relationship through a Cooperative Agreement on Trade, Investment and Development (TIDCA). A framework agreement for the TIDCA is scheduled to be signed at the annual AGOA Summit in Washington on July 14, 2008. The next steps will be to establish working groups in the areas of sanitary and phytosanitary measures (SPS),technical barriers to trade (TBT),customs, and trade promotion. -------------- HIV/AIDS: A CRISIS OF EPIC PROPORTIONS -------------- ¶22. (U) South Africa has the largest number of HIV-infected citizens in the world and HIV/AIDS is the country's leading cause of death. South Africa has a generalized, mature HIV epidemic, and HIV-related prevention, care, and treatment services are required across the population. An estimated 5.4 million South Africans are HIV-positive including 2.7 million women and approximately 300,000 children aged 14 or less. An estimated 18.8 percent of adults between 15 and 49 are infected. Women in the age group 25-29 are the most seriously affected, with prevalence rates of up to 40 percent in some areas. In 2005, an estimated 800,000 more citizens became infected, and in 2006, 350,000 adults and children died from AIDS. An estimated 1.6 million children, or approximately 10 percent of South Africa's children, have had at least one parent die. Sixty-six percent of these children had been orphaned as a result of AIDS. The number of AIDS-related deaths since the start of the epidemic is estimated at 1.8 million, with 71 percent of all deaths in the 15-41 year old age group being due to AIDS. Continued AIDS-related mortality will create millions of new orphans and generate additional social and economic disruption, including orphans being raised by extended family members or in child-headed households. ¶23. (U) In April 2007, the South African Government released its National Strategic Plan (NSP) for HIV, AIDS, and Sexually Transmitted Infections. The NSP has the goal of reducing new QTransmitted Infections. The NSP has the goal of reducing new HIV infections by 50 percent by 2011 and also aims to boost provision of anti-retroviral treatment (ART) in South Africa. However, South African public health facilities suffer from an acute shortage of skilled personnel and laboratory and clinical infrastructure. Considerable investment in human resources and infrastructure is necessary to meet the NSP's national anti-retroviral treatment targets. 371,731 people were receiving anti-retroviral (ARV) treatment as of 2007, while a further 511,269 people needed but were not receiving treatment. The Global Fund has provided major grants to the Western Cape Health Department and a public-private consortium in KZN. The Global Fund also provides funding to the National Department of Health to refurbish multi-drug resistant TB centers and other areas to strengthen the country,s approach to TB-HIV. ¶24. (SBU) The President's Emergency Plan for AIDS Relief (PEPFAR) is in its fifth year of implementation working with public and private sector prevention, treatment, and care programs. To date, the U.S. has provided $1.45 billion through PEPFAR to support HIV/AIDS programs in South Africa PRETORIA 00001396 007 OF 007 including $591 million in FY 2008, making it the largest recipient of Emergency Plan resources. The Emergency Plan directly supported 305,356 people in ARV treatment through programs in all nine provinces as of March 2008. The USG PEPFAR team in South Africa includes U.S. Agency for International Development (USAID),Department of Health and Human Services (HHS) (which includes the Centers for Disease Control and Prevention (CDC) and the Office of International Health (OIH)),Department of State, Department of Defense, and Peace Corps. The team works to ensure that the PEPFAR strategic plan is aligned with the goals of the NSP. The South African military has expanded prevention, care, and treatment programs and collaborates with the U.S. military and NIH on AIDS treatment research. ¶25. (U) South Africa has the strongest research and training capacity of any country in the region, making it an important partner in the fight against HIV/AIDS. USG agencies work with national and provincial health departments, the military, universities, and NGOs to strengthen primary health care, prevention, disease surveillance, and research. President Bush and President Mbeki confirmed a mutual commitment to expand HIV/AIDS collaboration, particularly through the Emergency Plan. The U.S. Mission has prepared, in coordination with the South African government, a five-year strategic plan focused on treatment, prevention, palliative care, and the provision of care for orphans and other vulnerable children. Currently, the U.S. Mission, in coordination with the South African Government, is defining new priorities, gaps, and needs that will shape our program for the coming year. ¶26. (U) The epidemics of HIV and tuberculosis (TB) are interlinked. TB is the most common infectious disease associated with HIV in sub-Saharan Africa and approximately 50 percent of HIV patients in Southern Africa also have TB. A high overall prevalence rate for HIV, people co-infected with TB and HIV, and lack of continuity in treatment contributes to the increasing incidence of active TB disease, including multi-drug resistant (MDR) strains. In conjunction with HIV, TB is linked to substantially higher fatality rates, even in the presence of effective TB chemotherapy. TEITELBAUM

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