Mail & Guardian (Johannesburg) - October 5, 2001
Howard Barrell and Jaspreet Kindra

The report, in the opinion of many the most authoritative of its kind into the effects of HIV/Aids in South Africa, predicts that Aids will have killed between five million and seven million South Africans by 2010.

The leaking of the report coincides with signs of growing disquiet in the African National Congress over the government's stance on Aids.

It glaringly contradicts President Thabo Mbeki's attempts to downplay the devastation caused by the syndrome in South Africa, unequivocally stating that it is now the biggest killer of South Africans.

Most recently, Mbeki used 1995 death figures to argue in a leaked letter to Minister of Health Manto Tshabalala-Msimang that there should be a reallocation of health resources away from treatments for HIV/Aids and towards more conventional diseases such as tuberculosis.

In his preface to the report, MRC president Malegepuru Makgoba also confronts those, like Mbeki, who question the causal link between HIV and Aids. A copy of the report, The Impact of HIV/Aids on Adult Mortality in South Africa, was leaked to the Mail & Guardian this week.

In a summary of its findings, the report says: "We estimate that about 40% of the adult deaths aged 15 to 49 that occurred in the year 2000 were due to HIV/Aids and that about 20% of all adult deaths in that year were due to Aids. "When this is combined with excess deaths in childhood, it is estimated that Aids accounted for about 25% of all deaths in the year 2000 and has become the single biggest cause of death [in South Africa].

"The projections show that, without treatment to prevent Aids, the number of Aids deaths can be expected to grow, within the next 10 years, to more than double the number of deaths due to all other causes, resulting in five to seven million cumulative Aids deaths in South Africa by 2010."

This week, in an evident attempt to defend Mbeki's views, the ANC called the report "not credible". Similarly, the government has announced it will not release the report until December.

But, amid signs of growing disquiet within the ruling party over the corner into which the ANC is being driven by Mbeki's views, the party's health committee called for the release of the report.

Committee members expressed their unhappiness at their party's hostility to the report, saying they had not been approached in formulating the ANC response to it. One senior health committee source described the researchers who drew up the report as "highly credible".

Separately, ANC health secretary Dar Saadiq Kariem called for the release of the report for the sake of transparency. "It seems much of the confusion has been created as a result of the process of the release of the report rather than its content."

The report's findings are based on a sophisticated statistical analysis of available figures on the prevalence of HIV and Aids among the population, and on available data on deaths in South Africa in recent years.

The authors are Professor Rob Dorrington of the Centre for Actuarial Research at the University of Cape Town, David Bourne of the Department of Public Health at UCT, Dr Debbie Bradshaw of the MRC's Burden of Disease Research Unit, Ria Laubscher of the council's biostatistics unit and Dr Ian Timaeus of the Centre for Population Studies at the London School of Hygiene and Tropical Medicine.

In his preface to the report, Makgoba writes: "A virus named HIV has been identified and fully characterised by its unique sequence. HIV has fulfilled all of Koch's postulates as the sole cause of Aids." Koch's postulates are the criteria by which science establishes whether a particular organism causes a disease.

The reports findings show that the death rate among women aged between 25 and 29 - the group most vulnerable to HIV/Aids - has more than trebled over the past 15 years ago. For men aged between 30 and 34 - the most vulnerable male category - the death rate has almost doubled over the same period.

"These shocking results need to galvanise efforts to minimise the devastation of the epidemic," the authors of the report say.

The report expresses concern that the number of deaths of children that go unreported and thus do not appear in state statistics is particularly high. This may mean that the actual death rate from Aids among children is considerably higher than can be extrapolated from state statistics.

They report a startling rise in the share of deaths from Aids in recent years. They estimate that in 1995 Aids caused 9% of deaths in South Africa in the age group 15 to 49, rising to 19% in 1997, to 33% in 1999 and 40% last year.
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