“One of the best ways to help the living is by counting the dead,” Statistics South Africa said in its report on mortality in South Africa, released this week. It says that HIV-related disease as a cause of death has moved up from sixth to third place. But public health experts say this is actually good news: doctors who used to give tuberculosis or meningitis as the causes of deaths from HIV are now more comfortable with saying HIV itself was the cause.
The country’s overall mortality rate decreased by 6.5% between 2012 and 2013. In other words, fewer people in South Africa are dying. A 2012 Lancet study directly linked this increased life expectancy – from 54 years in 2009 to 60 years in 2012 – to the public sector’s HIV treatment programme, which now provides free antiretrovirals to 2.7?million HIV-positive South Africans.
HIV expert Salim Abdool-Karim estimates that, in the past, HIV-related deaths made up a third to 40% of the annual total. Stats SA’s numbers do not reflect this: over the past two years, reported HIV deaths have increased from 3.1% to 5.1%.
A 2011 World Health Organisation bulletin, however, said that up to 94% of deaths from Aids between 1996 and 2006 were misclassified. The increase reported by Stats SA could be a result of the improved filling-in of death notifications.
An alarming shift is the increase in diabetes as a cause of death: 4.8% of all deaths recorded last year. South Africa has one of the fastest-growing diabetes epidemics in the world, with obesity at its root. The Lancet said we are the fattest nation in Africa: 70% of women and 40% of men have much more body fat than is healthy.
Ironically, the fact that HIV-positive South Africans are now living longer is also contributing to higher diabetes figures, because the condition generally emerges later in life.
But the gain of South Africans living longer should not be underestimated: we now have significantly more people to contribute to the country’s economy because, unlike most diseases, which prey on the oldest and youngest among us, HIV tends to kill people in the most productive years of their lives.