Number of AIDS-Related Deaths in South Africa Three Times Official Figures, Report Says

The number of people dying of AIDS-related causes in South Africa is at least three times as much as official figures suggest, the country's Medical Research Council said in a report published in the Jan. 28 issue of the journal AIDS, London's Independent reports. MRC estimates that about 112,000 people died of AIDS-related causes from 2000 to 2001, which is almost three times as many as the country's Department of Home Affairs estimated died during the same period. In addition, the report says that during that year about 74% of deaths among children under age five were from AIDS-related illnesses, compared with data cited by the government claiming 25% of deaths among young children are AIDS-related (Selva, Independent, 2/2). Many deaths were recorded as pneumonia or tuberculosis, partly so the family could claim life insurance or funeral policies and also to protect families from the social stigma surrounding HIV/AIDS, according to South Africa's Star. "A large proportion of deaths due to HIV infection are misclassified (on death certificates) as the opportunistic infections that are the immediate cause of death," Debbie Bradshaw, director of MRC's burden of disease unit and co-author of the report, said (Selva, Star, 2/2). A "politically sensitive mortality report" by Statistics South Africa is expected to be released on Friday that will provide details on the causes of death in the country between 1997 and 2003, South Africa's Business Day reports (Business Day, 2/1). However, MRC "warned" that the agency's survey "will again underestimate" the number of AIDS-related deaths in South Africa, according to the Independent (Independent, 2/2).

Reaction
The study's authors commented on the "long-running" debate over the size of South Africa's HIV/AIDS population, saying, "This debate has unfortunately sown confusion about the urgency of the epidemic, delayed the implementation of interventions aimed at reducing transmission and mortality and contributed to the stigma associated with the disease." They added, "Given the political climate and the resultant disincentives for reporting HIV/AIDS in the South African setting, it is probably not surprising that the level of reporting HIV or AIDS as a cause of death is low." The South African HIV/AIDS treatment advocacy group Treatment Action Campaign said the study demonstrates the need for government officials "to speed up" the distribution of antiretroviral drugs at no cost to HIV-positive people, according to Business Day. "The number [of deaths] will rise unless more people are given treatment," the group said in a statement (Business Day, 2/1). Ruth Rabinowitz, a health spokesperson for the Inkatha Freedom Party, on Tuesday said that all of the figures on HIV/AIDS are "virtually useless," South Africa's Cape Times reports. "All our statistics in South Africa will be imperfect in view of the paucity of tests that are performed, the format of the death certificate and the inadequacy of our statistical records," Rabinowitz said, adding that the delay in publishing data makes them outdated. According to Rabinowitz, the government will gather accurate statistics only when the country's approach to HIV/AIDS changes from one of "academic interest" to one addressing a "national emergency," according to the Cape Times. "Then testing will be done at all clinics, hospitals and medical practices; tests will be provided free by government; and a database will be kept current, listing numbers of people who test positive and their demographic profile," she said (Cape Times, 2/1).

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