AIDS-Linked Death Data Stir Political Storm in South Africa
By MICHAEL WINES
Published: February 19, 2005
JOHANNESBURG, Feb. 18 - In an implicit but devastating account of the havoc AIDS is causing here, South Africa's government reported Friday that annual deaths increased 57 percent from 1997 to 2003, with common AIDS-related diseases like tuberculosis and pneumonia fueling much of the rise.
The increase in mortality spanned all age groups, but was most pronounced among those between ages 15 and 49, where deaths more than doubled. Working-age adults are more sexually active than the rest of the population, and the opportunity for transmitting H.I.V. is greatest among members of this group.
The report, by the government agency Statistics South Africa, caused contention even before its release, which came more than a month after the originally scheduled date. Critics charged - and the agency denied - that the delay was because of political pressure from President Thabo Mbeki's government, which they say has long played down the dimensions of the AIDS crisis here.
Mr. Mbeki's office sharply rebuked the agency in 2001 after it reported that 4 in 10 deaths among working-age adults probably resulted from AIDS, saying that statisticians could not prove their conclusion.
The statistics agency has denied that its report was politically influenced. The report notes that both the total number of deaths and their causes are undoubtedly inaccurate, because death reporting is not consistent in rural areas, and medical expertise is uneven across the nation.
The report states that 499,000 of South Africa's roughly 44 million people died in 2002, up sharply from 318,000 in 1997. Much of that increase appears to result from H.I.V., the virus that causes AIDS. Experts agree that there are at least five million H.I.V.-positive citizens here, the most of any country. Diagnosing AIDS as a cause of death can require advanced medical knowledge and equipment. Moreover, an unknown number of AIDS deaths go unreported because South African life insurance policies frequently do not cover AIDS-related deaths.
Nevertheless, the agency reported that the new figures "provide indirect evidence that H.I.V. may be contributing to the increase in the level of mortality for prime-aged adults, given the increasing number of deaths due to associated diseases."
Dr. Steve Andrews, an H.I.V. clinician and consultant in Cape Town, said the sobering figures in the report suggested that it had not been politically varnished. Given the improvement in medical care and living standards in South Africa, he said, "we should not be seeing this aggressive move in death rates - not at all."
The report concluded that the average number of deaths in South Africa rose from 870 per day in 1997 to 1,370 in 2002, an increase that could not be explained by the 10 percent increase in population during the same period.
The reported causes of death point to AIDS as the factor underlying much of the increase in mortality. Deaths from tuberculosis, influenza and pneumonia - all primary causes of AIDS-related deaths - more than doubled in the five years encompassing 1997 to 2001, while deaths from other AIDS-related diseases like gastrointestinal infections rose about 25 percent.
Deaths from some ailments unrelated to AIDS, like hypertension and cerebrovascular problems, also rose, but at lower rate. General heart disease, once by far the biggest killer of South Africans, fell during the period and was well behind tuberculosis and influenza in 2001.
Two aspects of the report were especially notable.
The death-certificate figures indicate the proportion of deaths among sexually active women is rising significantly compared with deaths among men - a ratio that strongly indicates a country's AIDS-related mortality rate. In 1997, 149 men ages 25 to 29 died for every 100 deaths among women; the comparable figure in 2003 was 77 male deaths for every 100 female deaths.
The report also suggested that AIDS was increasingly exacting a toll among the very youngest South Africans. In 1999, the report stated, disorders of the immune system emerged for the first time as one of the 10 leading causes of deaths of children under 15.
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