HIV/AIDS deaths are down in South Africa, but most are still unacknowledged

But HIV/AIDS remains the leading cause of death in South Africa, according to the new research by Debbie Bradshaw, MSc, DPhil, of the South African Medical Research Council and colleagues. They emphasize that continued reluctance to acknowledge AIDS as a cause of death is hindering efforts to monitor the impact of HIV control efforts in South Africa.

Refined Estimates Suggest Nearly Three Million Deaths from AIDS by 2010

The researchers developed models to produce refined estimates of mortality from HIV/AIDS in South Africa from 1997 to 2010. Due to ongoing stigma, government denial through the late 1990s, and other factors, deaths from HIV and AIDS continue to be drastically under-reported in South Africa.

Despite clear evidence of an "extensive AIDS pandemic"--with 12 percent of the South African population being infected with HIV--"vital statistics continued to report only two to three percent of deaths being due to HIV/AIDS," Dr. Bradshaw and coauthors write.

They attempted to create more accurate estimates by accounting for factors contributing to the under-reporting of HIV/AIDS deaths--including the under-registration of deaths in general and misattribution of AIDS deaths to other causes. The study involved looking for causes exhibiting a characteristic "AIDS signature" of mortality at young adult ages increasing over time to identify HIV/AIDS deaths reported as being from other causes.

The results suggested that the percentage of all deaths due to AIDS increased from 14.5 percent in 1997, to 42 percent in 2006, then decreased to 35 percent in 2010. "Over the study period, only 6.9 percent of the estimated AIDS deaths were correctly reported as HIV/AIDS," the researchers write.

Rates of HIV/AIDS mortality began to decline for children under five in about 2004, for adult females in 2006, and for adult males in 2007. However, mortality rates for young women (aged 15 to 29) were more than double the rates for men in the same age group.

The results are consistent with the "extensive rollout" of antiretroviral therapy in South Africa beginning in 2004, and the effective prevention of mother-to-child transmission in 2003. Reflecting on the extent of the epidemic, the authors estimate that more than one million AIDS deaths have been averted. "However," Dr. Bradshaw and coauthors write, "at more than 560 deaths per day, AIDS was still the leading cause of death in South Africa."

They add that, within the limitations of the study, "It is clear HIV/AIDS is under-reported as a cause-of-death in the vital statistics in South Africa, with 93 percent of AIDS deaths misattributed to other causes." In the study, most likely AIDS deaths were attributed to "ill-defined natural causes," tuberculosis, lower respiratory infections, or "pseudonyms for HIV/AIDS."

More accurate reporting of HIV-related deaths is essential to monitor the progress of the fight against AIDS in South Africa, Dr. Bradshaw and colleagues emphasize. "The sooner HIV and AIDS are normalised as chronic health conditions, the sooner South Africa will be able to eliminate the epidemic," they conclude. "Reliably counting deaths from AIDS, an essential mechanism to monitor progress, has to become routine."