After 10 years of democracy we have many things to be grateful for, not
least of all 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 government, by deciding to
provide the free drugs, may well have extended the lives of over 4.5 million
people living with HIV by over 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 and that government’s campaign against “this thing” is well
established and ongoing.

Instead of highlighting government’s efforts, he said that diabetes and
tuberculosis 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. It is thus
much more manageable than HIV/AIDS and accounted for around 1% of deaths in
2000, according to the Medical Research Council (MRC).

It is also true that we have a serious TB epidemic. TB is highly contagious,
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 great 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 maturing of the HIV
epidemic.

Doctors at many KwaZulu-Natal hospitals say that around 70% of their TB
patients are also HIV positive.

South Africa’s cure rate for TB in 2001 was a mere 54%, a rate worse even
than 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, including TB-meningitis, mental retardation from TB and
fits, according to KwaZulu-Natal Health MEC, Dr Zweli Mkhize. These cases
are far harder to cure.

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 SA spoksperson Trevor Oosterwyk, confirmed that his organisation,
in collaboration with the Medical Research Council (MRC), was in the process
of compiling the study.

A few years back, the MRC’s research into mortality estimated that, in 2000,
about 40% 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.

Statistics 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. Accordingly, scientists are forced to use indirect
measurements rather than simply count the numbers.”

Such caution should be applied to the current study too. While the results
will enable policy-makers to allocate resources better, it would be wrong to
assume that the study will supply definitive figures about AIDS deaths.

According to Professor Carel van Aardt from Unisa’s Bureau of Market
Research, there is an under-registration of deaths in South Africa.

There is also 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 to death registration report but this also has
limitations.

“The doctor is supposed to give the family of the deceased the report in a
sealed envelope. We only show them page one. The confidential part on page
two is only for us and the doctor,” said a home affairs official dealing
with death registrations.

But the official, who asked not to be named, conceded that family members
could read the confidential portion as they were responsible for taking the
report to Home Affairs to get a death certificate. Thus a doctor not wishing
to offend a family may well obscure AIDS as the cause of death.

Patterns of death are harder to obscure than causes, however. Before 1996,
the mortality pattern was as expected for a country such as ours. But in
2000, three times the number of women aged 25 to 29 and two and a half times
the number of men aged 35 to 39 died, than expected, according to Professor
Van Aardt.

While South Africa has high levels of non-natural deaths, these accounted
for about 12% to 15% of all deaths in 2002, according to the MRC. This does
not fully explain the excessive deaths among men and women in their prime.

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
President Mbeki’s view on AIDS since late 1999.

E-mail Kerry Cullinan