AIDS and mortality in South Africa

On 2 November 2009, Statistics South Africa released the latest mortality data, which goes up to 2007 (Stats SA, 2009).

This table gives the number of recorded deaths per year:

You do not need to be a statistician to be astounded by this. Recorded deaths have increased over 90% in a decade. Improved death registration and population growth can account for only a small portion of this increase. The vast majority of additional deaths are due to the HIV epidemic. A huge body of evidence shows this. For example, there has been a three-fold increase in TB deaths over the same period and TB is the leading cause of death in people with HIV. Also the age pattern of the deaths --younger instead of older adults comprise the bulk of them-- and the drop in the median age of death from 51 in 1997 to 44 in 2007 are consistent with the way AIDS works. (For more detailed evidence see Dorrington et al. 2006, Dorrington et al. 2001 and Stats SA, 2002).

Also noticeable is that the number of deaths appears to have stabilised from 2005 to 2007 and perhaps has even begun to decrease slightly. This is most likely due to the state's antiretroviral (ARV) treatment programme.

Unfortunately because the public sector programme has not been well monitored and there are numerous treatment providers in the private sector, there is not accurate data on the number of people on treatment. But by using several sources of data, including figures published by the Department of Health, medical aid data and public sector ARV procurement data it is possible to make reasonable estimates. Muhammad Aarif Adam of Sanlam and Leigh Johnson of the Centre for Actuarial Research have made plausible calculations of the number of people on treatment in the middle of each year up until mid-2008, shown in the next table (Adam and Johnson, 2009).

The programme began in earnest in 2004 and the stabilisation of the death rate has coincided with it. If you consider that many, perhaps most, of the people on the programme would be dead by now that would easily account for stemming rising deaths. Make no mistake; there has been a massive surge in deaths in South Africa for more than a decade and AIDS deaths continue to be very high; deaths might have stabilised but at a very high number. Life-expectancy declined to the low-50s. At least though, we are implementing the most effective known scientific medical intervention to mitigate the effects of the disease and it now appears that life-expectancy is increasing again.

But many unnecessary deaths occurred because of the delayed rollout of the ARV treatment programme. Two studies have conservatively estimated that former President Thabo Mbeki's AIDS denialist policies cost well over 300,000 lives (Nattrass, 2008; Chigwedere, 2008). Mbeki did not pursue this deadly policy without help though. Officials in government, civil servants and even  some journalists supported his policy, tried to give it legitimacy and for a time succeeded in quashing the demand for a treatment rollout from health workers and AIDS activist organisations, like the Treatment Action Campaign (TAC). Thankfully, we have moved beyond this awful era of South African history.

PS: The last two weeks have seen what I believe is the final death-knell of state-supported AIDS denialism. Both President Zuma and Minister of Health Motsoaledi have delivered important speeches showing their intention to fight the epidemic. On page 35 of his presentation Motsoaledi quoted mortality data for 2008 from Home Affairs which appears to be far too large. I am unaware of how this number was derived and it appears to be an error. In other respects Motsoaledi's speech was excellent and his mistake is of no great importance.

References

Adam M and Johnson L. 2009. Estimation of adult antiretroviral treatment coverage in South Africa. September 2009, Vol. 99, No. 9 SAMJ

Chigwedere P. 2008. Estimating the Lost Benefits of Antiretroviral Drug Use in South Africa. JAIDS Journal of Acquired Immune Deficiency Syndromes. 49(4):410-415, December 1, 2008.

Dorrington R et al. 2001.  The impact of HIV/AIDS on adult mortality in South Africa .

Dorrington R et al. 2006. The Demographic Impact of HIV/AIDS in South Africa .

Nattrass N. 2008. AIDS and the Scientific Governance of Medicine in Post-Apartheid South Africa. African Affairs 2008 107(427):157-176.

Statistics South Africa. 2002. Causes of death in South Africa 1997-2001 :  Advance release of recorded causes of death .

Statistics South Africa. 2009. Mortality and causes of death in South Africa, 2007: Findings from death notification.

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responses to this article

NO, THE DEATH RATE HAS NOT STABILISED The data cited appear to indicate a stabilisation of the death rate, everything else being equal. But "everything else" is not cooperating. The collapse of the globalised economy means a continuing haemorrhaging of jobs and incomes, intensifying poverty. . .more But poverty is a very powerful co-factor of HIV/AIDS and other nasty infections. While treatment improves, the single most important factor in preventing new infections - good health - is eroding or is going to erode for the mass of the population. And treatment is simply no substitute for it. This would not be so serious if we were merely facing a recession. Instead, it is a downward spiral. The Obama Administration, with tacit British encouragement, has rewarded the banks that speculated wildly by giving them bailout money. They have gotten the message and are continuing to speculate, and continue to refuse to invest in the real economy. They are not providing new loans. Do you think the golem can be caged with a new wave of regulation? It won't work. And South Africa cannot build a fence and shut out this larger reality. This is not a counsel of despair, just a statement of where we stand. Treatment of HIV/AIDS must continue full bore, but it must be seen in the larger picture. . .less by David Cherry on November 17 2009, 05:10 Find this comment inappropriate? Report it

Come one mineemee That is so barbaric it's almost unbelievable. Shame on you! by Alto on November 17 2009, 13:11 Find this comment inappropriate? Report it

rabid Screw off, marc. You are a disgrace to the honkey persuasion and stupid to boot. Screw your rights too. You should be tracked down and given a sound thrashing, as in the old days, administered by police in accordance with law. by rian malan on November 17 2009, 13:24 Find this comment inappropriate? Report it

Prevention is better than cure. If the information were available I think the more important number to look at would be the increase or decrease in new infections; spreading of the virus is the biggest problem. AIDS sufferers are able to live healthier more active lives while on ARV . .more medication, but the question is have they altered there social lifestyles, is the virus still being spread unnoticed by seemingly healthy carriers? . .less by Max on November 17 2009, 17:35 Find this comment inappropriate? Report it

@marc Marc, I abhor corporal punishment but in your case I'd make an exception. and you'd STILL be the savage between us. by murray hunter on November 19 2009, 13:42 Find this comment inappropriate? Report it

HIV accountability Zuma and his lot admits to anything they can blame on someone else, in this case Mbeki, truth is the ANC has to take collective responsibility. They have proven they can move their "cadres" around at will. Why not then? see more onthe point . .more at: http://letterdash.com/g.annandale/denialism-and-apartheid-birds-of-a-feather and http://letterdash.com/g.annandale/health-department-and-life-on-the-edge . .less by Geanann on November 24 2009, 09:19 Find this comment inappropriate? Report it

AIDS class action Children born HIV positive from HIV positive mothers who were denied the drugs to prevent mother to child transmission of HIV during the Mbeki denialist years should initiate a class action suing Mbeki and his cohort of denialists for . .more damages. Mbeki and his horde of AIDS murderers should be brought to book; or is black African life deemed to be cheap? . .less by Oompah on December 12 2009, 15:26 Find this comment inappropriate? Report it

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