After 10 years of democracy we have many things to be grateful for, not least of them the fact that South Africa is preparing to launch the world’s biggest public sector anti-retroviral treatment programme.
But our president does not want to celebrate that his government, by deciding to provide the free drugs, may well have extended the lives of over 4,5-million people living with HIV by more than 10 years.
Inconceivably — especially in an election year — President Thabo Mbeki refused to highlight this either when he opened Parliament a week ago or when he was interviewed by the national broadcaster last weekend.
Instead, he says that his deputy, Jacob Zuma, is in charge of HIV/Aids policy, that government’s campaign against “this thing” is well established, and that ongoing diabetes and tuberculosis (TB) are serious health problems that are being overshadowed by HIV/Aids.
It is true diabetes is a growing problem. But it is a non-contagious lifestyle disease linked to diet, lack of exercise and genetics, and so is much more manageable than HIV/Aids.
It is also true that we have a serious TB epidemic. TB is highly contagious and spread in the air, usually when an infected person sneezes or coughs. But the rapid increase in TB is directly related to the HIV/Aids epidemic.
Millions of South Africans carry latent TB bacteria, but if their immune systems become weak they are at greater risk of getting TB disease.
The number of TB cases almost doubled between 1996 and 2002, according to the Department of Health, which correlates directly with the maturing of the HIV epidemic.
South Africa’s cure rate for TB in 2001 was a mere 54%, a rate worse than that in poverty-stricken Mozambique.
But again, HIV pays a role. Combined TB and HIV infections are causing complications, with hospitals in KwaZulu-Natal seeing increasingly unusual presentations of TB.
In the context of Aids, Mbeki also said that we lack proper mortality figures to tell us “what are the things that kill South Africans”. This is being rectified, he said, by a study of all notices of death from 1996 to June 2003.
Statistics South Africa spoksperson Trevor Oosterwyk confirmed that his organisation, in collaboration with the Medical Research Council (MRC), is in the process of compiling the study.
A few years ago, the MRC’s research into mortality estimated that, in 2000, 39% of premature deaths of South Africans aged 15 to 49 were the result of Aids.
However, the research caused a storm and the health minister ordered a forensic audit in the MRC to establish who had “leaked” the results.
Stats SA and the departments of health and home affairs also issued a statement in which they noted that “there are inherent problems in measuring Aids-related deaths, precisely because such deaths are often recorded under other causal categories.”
Such caution should be applied to the current study too. There is an under-registration of deaths in South Africa, and a serious under-reporting of Aids-related deaths, both because of the nature of the disease and the stigma associated with it. People die of the opportunistic infections that take advantage of the fact that the virus has weakened the person’s immune system so such infections are recorded as the cause of death.
In the past, many doctors admitted that they did not record Aids as the cause of death because they did not want to jeopardise people’s death benefits. In response, the Department of Home Affairs introduced a confidential section in death registration reports, but this also has limitations.
When a politician fails to claim credit for a policy that could reverse such perverse death patterns, alarm bells ring. We can only hope that such modesty is not caused by the Aids denialism that has underpinned much of Mbeki’s view on Aids since late 1999. — Health-e News Service