The South African government is still in denial over the scale of the Aids crisis, it is alleged on Friday following revelations that the true death toll is three times the official figures.
Researchers backed by the South African Medical Research Council have discovered that most Aids deaths are misclassified because of the stigma attached to the disease. Death certificates omit any mention of HIV/Aids, giving the final HIV-related infection such as tuberculosis or pneumonia as the cause of death.
The true scale of the calamity is not reflected in the official statistics because of the stigma and fear that still enshrouds HIV infection and Aids, making people reluctant to acknowledge that a mother, husband or son died of the disease. The South African government, under Thabo Mbeki, has been slow to engage fully with the crisis and a drug treatment programme for those who will otherwise soon die is only in its initial stages.
Most of the under-reported deaths from Aids in adults have been ascribed to tuberculosis, and in children to lower respiratory infections, diarrhoeal disease or malnutrition.
Researchers at the Medical Research Council have now calculated the scale of this misclassification. Their work, published in the journal Aids 2005, suggests that the true death toll is nearly three times the official government statistic. That would bring the total in line with UNAids’ estimate of around 370 000 deaths last year and possibly as many as half a million.
In an editorial today the Lancet medical journal, commenting on the research, calls on the South Africa government ”to stop being defensive and show backbone and courage to acknowledge and seriously tackle the HIV/Aids crisis of its people”.
”Social stigma associated with HIV/Aids, tacitly perpetuated by the government’s reluctance to bring the crisis out in the open and face it head on, prevents many from speaking out about causes of illness and deaths of loved ones and leads doctors to record uncontroversial diagnoses on death certificates,” it says.
”Earlier this year, Nelson Mandela stepped into the limelight and was widely praised for openly attributing the death of his son Makgatho (54) to Aids just hours after he had died. To change attitudes, many more such disclosures from respected public figures are needed in a country that has more than 5-million people who are HIV positive.”
In 2001, a breakdown of a sample of 12% of deaths was released by Statistics South Africa. A new study on deaths between 1997 and 2003 is expected this month, but the official agency has warned on its website that the figures for Aids deaths will reflect only what is written on the death certificate.
Pam Groenewald and colleagues from the Medical Research Council and the University of Cape Town, however, have devised a way of calculating the numbers of deaths that should have been ascribed to the HIV infection destroying the immune system, even if tuberculosis or diarrhoea were the immediate cause.
Deaths from Aids peak among women at 30-34 and among men at 35-39. Aids has also caused a general rise in children’s deaths. The researchers studied the pattern of deaths among those said to have died from illnesses linked to HIV, such as tuberculosis, pneumonia and meningitis. They found that deaths had risen sharply among exactly the same age groups.
The researchers then calculated how many extra deaths there had been from tuberculosis and other Aids-related illnesses than would have been expected. They found that in 2000/2001, 60 295 death certificates of adults and children specifically mentioned Aids. But adding the extra deaths ascribed to other causes increased the total HIV/Aids deaths to 153 357.
In some cases, the HIV status might not be known, they say, but social stigma and the fear that funeral and life insurance policies will not pay out are also factors.
”These factors must be seen against a background of heightened politicisation of the debate about the size of, and the government’s response to, the Aids epidemic. 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 attached to the disease.” – Guardian Unlimited Â