Tamar Kahn: Business Day

A PHARMACEUTICAL manufacturing plan for Africa will be among the issues debated at the third African Union (AU) health ministers' meeting. The ministers are expected to discuss ways of boosting local production of medicines and reducing reliance on imports, as well as the possibility of pooling regional resources to streamline the regulation of new drugs.

Health ministers from the AU’s 53 member states are expected to attend the week-long meeting and submit their agreements to the assembly of AU heads of state and government. In contrast to previous gatherings, where officials did much of the negotiation, this time the health ministers are expected to grapple with the tough issues themselves. One of their tasks will be to finalise a broad African health strategy to harmonise the plethora of regional agreements reached by groupings such as the Southern African Development Community and West African bloc Ecowas. South Africa's deputy director-general in charge of foreign relations, Nthari Matsau, said that Africa was big and diverse, but its health problems were common. For example, the entire region was grappling with the triple burden of infectious diseases such as HIV/AIDS, tuberculosis and malaria. There were non-communicable conditions such as heart disease and diabetes, while levels of child and maternal mortality were equally worrying, she said.

SA is expected to play a strong role at the gathering as its officials prepared several discussion documents, including those on traditional medicines and pharmaceutical manufacturing. The health ministers will debate a draft plan for implementing the goals declared at the Abuja summit on HIV/AIDS, tuberculosis and malaria, which included reducing HIV prevalence among young people aged 15 to 24 by at least 25% by 2010 in all African countries. They will also discuss African traditional medicines, Africa's critical shortage of doctors and nurses, and a draft plan of action on preventing violence. The gathering is also expected to launch a new strategy to combat malaria in Africa. The health ministers are expected to close their meeting with a formal declaration on strengthening the continent's health systems.

Tamar Kahn: Business Day

THE Health Department's HIV/AIDS head, Dr Nomonde Xundu, has responded cautiously to this week's United Nations (UN) endorsement of male circumcision to avert HIV infection in heterosexual men. She said that promoting circumcision would have a limited effect as at least 40% of men in SA were already circumcised.

More than 5,5-million South Africans, or one in nine citizens, are infected with HIV. With no vaccine or cure in sight, many experts hope promoting male circumcision will help prevent new infections in men.

This is after three large studies showed removing foreskins cut risk of transmission 60%.

Earlier this month, the World Health Organisation and the UN joint agency on HIV/AIDS, UNAIDS, hosted an international meeting to discuss these findings. The experts announced on Wednesday that evidence of the benefits of male circumcision was "compelling", and urged African countries with low circumcision rates and high HIV burdens to offer the procedure to uncircumcised men.

Although the exact mechanism is not properly understood, male circumcision probably reduces the risk of HIV infection as it removes foreskin tissue particularly vulnerable to the virus, and because the area under the foreskin is easily scratched or torn during sex. Uncircumcised men may also be more vulnerable to sexually transmitted diseases as the region under the foreskin is a moist, dark place where germs can thrive.

Xundu said government was considering setting up a task team to investigate implementing programmes to promote circumcision as part of its HIV-prevention effort. The team would include scientists, public health experts and traditional leaders.

While the overall public health benefits might not be as great in SA as in nations hit hard by HIV/AIDS, and with low circumcision rates, she said the procedure clearly offered individual benefits.

In addition to the practical challenges of training staff to provide safe and hygienic circumcision, she expected challenges in developing communication campaigns to promote the procedure as a way of reducing the risk of HIV transmission, as it did not provide 100% protection against the virus. She said care should be taken to ensure men did not increase risky sexual behaviour if they were circumcised

Southern African HIV Clinicians' Society president Dr Francois Venter urged government to speed up development of a policy on HIV and male circumcision. He said government might consider including circumcision in new HIV-prevention programmes aimed at men, as most initiatives focused on women.

"This is a great opportunity to access a group that is difficult to reach," he said. "Women generally have more contact with public health facilities than men because they are usually responsible for their children’s health problems too."

Lynn Carlisle, Business Day

EVEN though the effects of absenteeism from unscheduled sickness has been widely researched and discussed in business and the media it remains a major challenge for every employer, says Anton Engelbrecht, acting head of Alexander Forbes Health Management Solutions.

The employer experiences a direct cost of paying a salary or wage to the employee when he/she has been absent from work. An additional indirect cost of about 2½ times the working day's cost arises as a result of unscheduled sick leave. The indirect cost components are:

- Additional pay for casual/relief employees who are generally less productive;
- Diverted and additional management time; and,
- Reduced morale among other employees who have to work harder to carry the load.

"This challenge becomes even greater with the impact that HIV/AIDS is starting to present in the workplace."

Engelbrecht says that because employees' HIV status, or any other medical condition, cannot legally be disclosed to the employer without the employee's consent, it becomes almost impossible for an employer to manage sick leave and provide assistance to employees infected with HIV.

"It is recommended that companies use industry experts that provide integrated solutions to changing medical risks.

"The services provided should assist companies to create and implement policies to manage workplace absenteeism and incapacity. This should reduce the cost and impact of disability within the company greatly."

He says such services should be able to provide HIV/AIDS disease management. An effective programme should integrate sick leave management with confidential measurement and management processes.

"Studies have illustrated that the use of sick leave by employees who are HIV-positive and participate in an HIV/AIDS intervention programme, does not vary much from that of employees who are HIV-negative.

"For example, the sickness absence ratio of a company in the information and telecommunications sector did not differ much from the total employee population's ratio at an average of 3%. "This shows that HIV/AIDS workplace programmes allow companies to contribute not only on a socially responsible basis, but also to provide their businesses with an economic return," says Engelbrecht.