Global Health Watch: HIV/AIDS deaths in South Africa often attributed to other causes

Deaths in South Africa, one of the world’s hot spots for HIV and AIDS, appear to have peaked in 2006, according to figures released by the government statistician Thursday. But in many cases, death certificates still don’t record AIDS as an underlying cause of death, instead reporting TB or pneumonia as the cause.

According to the figures, TB is the biggest killer in South Africa, with just under 75,000 deaths in 2008. Next was pneumonia and influenza, which killed about 45,600. TB is the main cause of death for people with AIDS, according to advocacy group the Treatment Action Campaign. It says the sharp rise in TB deaths since the 1990s indicates the vast majority of cases are HIV-related, even though AIDS is not listed as a cause of death.

This group and others argue that the number of AIDS deaths in South Africa has been masked because AIDS or HIV are not recorded on death certificates. In 2005, the Medical Research Council said the number of AIDS deaths was triple the number that government figures suggested.

Critics also say the reason TB -- a curable, preventable disease -- became South Africa’s biggest health emergency is because it was mismanaged for years, leading to the emergence of XDR TB, or extensively drug resistant TB, which is difficult to treat and responds to few drugs.

The number of all recorded deaths in South Africa rose sharply from 317,000 in 1997 to almost 613,000 in 2006. In 2007 and 2008, the number of deaths eased slightly to 603,000 and 592,000 respectively. HIV and AIDS remain deeply stigmatized in South Africa, one reason why death certificates often fail to record these, according to analysts.