San Francisco Chronicle - July 13, 2004
Gavin du Venage, Chronicle Foreign Service

As the Luthuli clan gathered around the freshly dug grave over the weekend to bury Sfiso, they learned he had assumed he was infected because his girlfriend, 18-year-old Mabongi Gaza, had told him a few days earlier that she had AIDS. This turned out to be a lie with tragic consequences. Gaza told a South African newspaper that she wanted to break up with Luthuli, and, when he insisted they stay together, she pretended to be HIV positive to ward him off.

Luthuli's death is only one example of a steady toll of suicides that experts say is linked to the AIDS crisis in the country. Now, a new academic study shows that one South African takes his or her life every hour -- about 8,000 per year -- and it's estimated as many as 20 make a failed attempt to do so, largely to escape the torment of AIDS.

A 25-year study into suicide compiled by Professor Lourens Schlebusch and a team of researchers at the department of behavioral medicine at the Nelson R. Mandela School of Medicine, University of Natal, shows suicide is now the third most common nonnatural way to die, after homicide and car accidents. Especially alarming is that most victims are young, with children as young as 10 years old taking their own lives.

"Life is very stressful here, and more so if you are HIV positive", says Schlebusch. The rapidly changing society -- moving from an iron-clad racial dictatorship where people had their roles defined for them to an open and free democracy -- has led to increased suicides, much as it did in Russia after the collapse of the Soviet Union.

It is HIV, however, that is the biggest single factor involved in people taking their own lives. A sense of hopelessness about having an incurable disease, compounded by the difficulty in getting treatment, means that South Africans with HIV are 36 times more likely to kill themselves than those without the virus, says Schlebusch.

Most South Africans cannot afford the treatments commonly available in the West, and the government has yet to begin its long-promised program to provide anti-retroviral drugs to state hospitals throughout the country.

"It is not just a matter of jumping off a building or blowing your brains out," says Schlebusch. "Suicide has many faces and can take different forms, such as a 'crime of passion' where a man will first kill his family because he does not want them left to cope after he is gone."

The highest risk is in the 20- to 29-year-old age group, followed by those in the 10- to 19-year-old bracket. "We have had cases of children as young as 10 killing themselves, and incidents of 6-year-olds who tried to take their lives," says Schlebusch.

Internationally, suicide rates are also on the rise. According to the United Nations, about 1 million people kill themselves each year worldwide, and this figure is expected to increase to 1.5 million by 2010.

The link to AIDS, experts say, is what makes South Africa's climbing suicide rate especially alarming. In a separate study carried out by the head of Forensic Medicine at the University of Transkei last year, figures show deaths from self-poisoning have increased from 4 percent to 28 percent since 1996; hangings have increased from 16 percent to 24 percent, and self- inflicted gunshot related deaths have also increased from 14 percent to 25 percent in the same period. These increases correspond to the increase in the estimated prevalence of HIV infection in South Africa from 14 percent in 1996 to 25 percent today, says author of the study, Professor Banwari Lal Meel.

"The figures show there is definitely something going on here," says Meel. "As the level of HIV increases, so does the level of unnatural death."

Meel notes that not all suicides are obvious. Many people try to kill themselves in a way that appears natural. For instance, deaths from auto accidents also have risen in tandem with AIDS.

"A person who kills himself by crashing his car knows his family will at least get compensation through insurance," Meel says. "He can at least leave something for them after he goes."

Schlebusch concurs. "I am treating a patient right now who tried to kill himself driving his SUV down the wrong side of the street here in Durban," he says.

Meel points out that studies show that in the United States, suicide among HIV-positive victims also increased initially but declined as drug treatments improved and became widely available.

"In Africa there's little access to treatment, so we can expect suicide levels among people with the disease to keep climbing."

According to UNAIDS, at least 5.2 million people are HIV positive in South Africa. This will translate to 500,000 AIDS-related deaths by 2010. To illustrate the problem, Meel cites the dilemma that confronts South Africa's largest city, Johannesburg, which is running out of space to bury the dead. The city inters 20,000 people a year but expects this to increase to 70,000 in the next six years. City authorities are now considering using abandoned gold mines to warehouse the dead.

Zane Wilson, chief executive of the Depression and Anxiety Support Group, one of the few national counseling services in the country, says suicide has become the No. 1 health risk to people with HIV.

"We are in a very scary situation," Wilson says. "People who find out they are infected have no hope. We need to give them hope."

Especially traumatic for counselors is trying to talk would-be suicides who contact the organization's offices or help line out of the idea that their families would better off without them.

"Many people think if they die sooner it will spare their families the pain and cost of caring for them," Wilson says. "So they would rather kill themselves before they become a financial burden. Our job is to get them to see it the other way around, that time spent now with their children is the most valuable gift they can leave."

040713
SC040719

Always watch for outdated information. This article first appeared in 2004. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 2004. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .