Cablegate: South Africa Public Health November 26 Issue

This record is a partial extract of the original cable. The full text of the original cable is not available.




E.O. 12958: N/A


1. Summary. Every two weeks, USEmbassy 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: 2004 National HIV/AIDS Survey launched;
South African survey highlights problem of gender violence;
Anti-ADIS seaweed vaginal gel tested in South Africa; Diabetes
Common among youngest South Africans; antibiotic may help
children with AIDS; South African Government devising plan for
health care staffing shortages; one million orphans in South
Africa by 2006; KZN Progress in HIV/AIDS; metropolitan
Tshwane's fight against HIV/AIDS; and update on Gauteng's HIV

treatment. End Summary

2004 National HIV/AIDS Survey Launched

2. Nelson Mandela Foundation and the Human Sciences Research
Council are launching the 2004 national HIV/AIDS survey, the
second national survey undertaken. Results of the study will
determine the prevalence of HIV/AIDS based on national data,
rather than extrapolation of data from public antenatal
clinics. The survey will also concentrate on social and
economic factors related to HIV infection. A total of 15 000
households have been selected throughout the country to
participate in the survey, cutting across all races, economic
standing and geographical location. Participation was not
compulsory, but co-operation would enable the study group to
calculate informed information critical in fighting the
pandemic. The information gathered would assist in developing
effective strategies and campaigns to combat HIV and Aids. All
persons in the study will remain anonymous and personal
information will not be released. Source: Pretoria News,
November 8.

SA Survey Highlights Problem of Gender Violence
--------------------------------------------- --

3. South Africa has the highest rate of rape and spousal abuse
in the world, with one in four women beaten by their partners,
according to a gender survey by the University of Cape Town's
Unilever Institute of Strategic Marketing. The survey found
that at least one woman is raped every minute somewhere in
South Africa and about one third of South African women will be
raped in their lifetime. The survey involved 3,500 people in a
weighted sample representative of major city and rural areas.
Gender was likely to replace race as the big issue facing South
African marketers in the future. Other survey results
included: (1) 61 percent believe men and women are equal; (2)
66 percent say men and women should earn the same amount; (3)
41 percent believe it is acceptable that society favors men;
(4) 32 percent believe a woman's place is in the home; (5) 73
percent believe men should be the head of the household; and
(6) 64 percent believe men should be the primary breadwinner.
Source: Cape Times, November 15.

Anti-AIDS Seaweed Vaginal Gel Tested in SA

4. The final phase three testing of Carraguard, a seaweed-
based vaginal microbicide that could help prevent the spread of
AIDS, is currently underway in three South African locations.
The study is particularly important in societies where women
have difficulty persuading partners to use condoms. The final
phase three testing of the Carraguard gel is currently underway
at Soshanguve in Pretoria, Isipingo in KwaZulu-Natal and
Gugulethu in Cape Town. The final phase three testing involves
a larger sample of 6,200 women and began in March 2004 and is
expected to end in three years. If proven to be efficacious,
plans will be made to mass-produce and market the product.
Carrageenan - the active ingredient in Carraguard - is found in
seaweed and generally regarded as a safe product, and is
already found in ice cream and lotions. The Carraguard gel had
a negative charge, while the human immunodeficiency virus had a
positive charge. Carraguard may work by binding to the
positively charged regions of the virus and by inhibiting cell-
to-cell transmission of the virus, by acting as a barrier
between infected and non-infected cells. Carraguard would be
feasible and cost effective to mass-produce because the seaweed
was readily available, a benefit for developing countries
having high AIDS prevalence rates. Research goals look for a
33 percent difference in seroconversions between the placebo
and the Carraguard samples. However, we only expect the entire
rate of seroconversion - from HIV negative to HIV positive -
across the trial to be about 3.5 percent. Among the major
challenges for the trial was to retain all the women
participants and the possibility of prevalence rates
increasing, which would mean that less women would be eligible
and therefore requiring more screening. According to Dr Lydia
Altini, the principal investigator at the Gugulethu site,
researchers had enrolled about 800 out of a targeted 2,100
women since March. Some of the criteria needed for women to
participate included being over the age of 16, sexually active,
HIV negative, living in the area for the past two years and not
planning to fall pregnant. Women were expected to visit the
clinic about 10 times for the duration of the trial. They were
also provided with a compensation fee for traveling and
incidentals. Vice-president of the Population Council's Center
for Biomedical Research, Dr Elof Johansson, said Carraguard was
the first generation of microbicides under development. The
first generation microbicide does not kill the virus, but only
binds the virus. The South African site costs are in the
region of R40 million to R60 million ($6.7 to $10 million using
6 rand per dollar) and funded by the United States Agency for
International Development and the Bill and Melinda Gates
Foundation. Source: SAPA November 18.

Diabetes Common Among Youngest South Africans

5. More South African youth are diagnosed with Diabetes type
1, the disease that occurs when the pancreas stops production
of blood sugar-controlling insulin. One in 500 children in
South Africa have type 1 diabetes. "Twenty years ago our
youngest patients were between seven and 10 years old, now
toddlers and babies of barely five months come in," said
Professor Francois Bonnici of the diabetes education centre at
the Red Cross Children's Hospital. Bonnici states that he
knows of no clear explanation why younger patients are
diagnosed with diabetes now. There is a genetic tendency of
susceptibility of diabetes and treatment involves three to four
insulin injections per day. Short-term effects of the disease
include are extreme thirst, nausea, vomiting, dehydration,
dizziness, and coma. Source: Cape Times, November 17.

Antibiotic May Help Children with AIDS

6. The positive results of a study of children in Zambia,
carried out by the British Medical Research Council (MRC) and
funded by the Department for International Development, suggest
that deaths among children infected with HIV in Africa could be
almost halved if the antibiotic co-trimoxazole were widely
used. While co-trimoxazole will not prevent children
eventually developing AIDS, it could give extra years of
healthy life before they need the powerful and toxic anti-
retroviral drugs that suppress HIV in the blood. The results
of the trial, published in this week's Lancet medical journal,
have persuaded the World Health Organization and UNICEF to
change their policies and recommend the use of co-trimoxazole
in all children with HIV. In the study, 541 children aged
between one and 14 were given the antibiotic or a placebo. The
trial was stopped early when it became clear that substantially
fewer children on the antibiotic were dying. After 19 months,
74 (28 percent) children on co-trimoxazole had died, compared
with 112 (42 percent) of those on the placebo. All those who
took part are now taking co-trimoxazole. No severe side
effects were reported. Source: Guardian Newspapers, November

SA Government Devising Plan for Health Care Staffing Shortages
--------------------------------------------- -----------------

7. During a two-day workshop of government, health care
workers and university representatives, Percy Mahlathi, the
Health Department's Deputy Director-general, announced plans
for a comprehensive human resource strategy for the public
health sector, hoping to begin implementation by March 2005.
The proposed plan will help respond to weaknesses caused to the
system by HIV/AIDS, infrastructure challenges and the exodus of
professionals from public service. Delegates at the workshop
have been divided into several working groups to deliberate on
human resource challenges in health, and make contributions
towards the department's envisaged master plan. About 14 health
workers' organizations are represented, including the
Democratic Nursing Organization of South Africa (DENOSA).
Source: SABC, November 18.

One Million Orphans in South Africa by 2006

8. The Actuarial Society of South Africa's (ASSA) 2000
demographic model predicts that almost one million children
will be orphaned nationally due to the AIDS epidemic by the
year 2006. By 2006 the model projects that 857,000 will be
orphaned nationally - in KwaZulu-Natal more than 252,000, in
Gauteng 133,204, Eastern Cape 99,227, Free State 47,062,
Limpopo 75,487, Mpumalanga 72,995, Northern Cape 7,331, North
West Province 57,956 and Western Cape 19,648. By the year
2015, more than 1,854,462 will be orphaned because of the Aids
epidemic. The case study definition of an orphan is any child
under 15 whose mother has died of HIV and Aids. According to
child care workers poverty, depression and HIV and Aids are
some of the major factors that contribute to mothers abandoning
their babies. Source: Pretoria News, November 20.

KZN Progress in HIV/AIDS

9. In March, KwaZulu-Natal did not have a government program
for getting HIV-positive people on to anti-retroviral
treatment. In the past seven months, the province has made
good progress. As of November 5, the department had 3,247
adults and 167 children (aged from three to 15 years) on anti-
retroviral treatment, while 25,036 people had been screened for
the treatment program. The World Health Organization released
a report this year which said that 5.3 million people were
living with HIV and Aids in South Africa. The report estimated
that 370,000 people would die from Aids-related illnesses in
South Africa this year. In KwaZulu-Natal, the province
reputed to have the highest prevalence of HIV and Aids in the
country, anti-retroviral treatment involves more than just
taking medication. Patient education and building health
infrastructure are crucial elements to the comprehensive
treatment plan. Patient literacy involves education about the
disease, its implications, clinical and dietary assessments and
anti-retrovirals. Hospitals have to be equipped with all the
necessary resources before getting accreditation to administer
anti-retroviral treatment. In the province's 11 health
districts, at least two hospitals in each district have been
accredited for the anti-retroviral treatment plan. Districts
like Uthungulu (near Richards Bay) has six hospitals and
eThekwini (Durban metropolitan area) have eight. Source: IOL,
November 21.

Metropolitan Tshwane's Fight Against HIV/AIDS

10. The Tshwane (greater Pretoria) Metropolitan Council has
adopted a HIV/AIDS treatment strategy encompassing anti-
retroviral treatment, treatment of sexually transmitted
infections, behavior change, and voluntary testing and
counseling. Based on research commissioned by the Council, an
estimated 6 percent of the municipality's employees are HIV-
positive and one percent have AIDS-related diseases. The risk
profile of the metropolitan's employees is lower than that of
the general South African population. Despite the lower HIV
prevalence rates, progression to AID-related sicknesses is over
half that of the general population and there is a higher
proportion of employees who are at ages where progression to
AIDS is likely (30 - 50 years) than the case in the general
population. The research states that by beginning the broad
strategy for treatment immediately, the council could reduce
the general mortality of its employees by more than half and
the AIDS-related deaths from six out of 10 to one out of 10
within 12 months. Source: Pretoria News, November 18.

Update on Gauteng's HIV Treatment

10. On November 19, 2003, the South African government
announced its HIV/AIDS comprehensive treatment plan with the
plans to provide anti-retroviral treatment to 53,000 by March
2005. Several of the provinces only began providing treatment
until August and September 2004, however Gauteng began its
program in April 2004. Both the Western Cape and Gauteng
provinces have more developed health infrastructure and
political leadership in providing HIV/AIDS treatment and these
provinces are crucial so that South Africa can meet its stated
goal of 53,000 on treatment. Gauteng health care facilities
are experiencing the same sort of capacity problems that other
provinces endure. Large inner-city research hospitals have
been able to start programs relatively efficiently; however,
most clinics located in former township areas and opened during
the second wave of accreditation during July 2004 have similar
staffing and equipment shortages experienced by the health care
facilities located in poorer provinces. Gauteng's Department
of Health has been able to recruit 70 percent of the 214
additional staff needed to implement the comprehensive
treatment plan although it admits that filling staff
requirements for former township areas has been especially
difficult. Source: Sunday Independent, November 21.


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