TAC Electronic Newsletter

This is an archive of the Treatment Action Campaign's public documents from December 1998 until October 2008. I created this website because the TAC's website appears unmaintained and people were concerned that it
was becoming increasingly hard to find important documents.

The menu items have been slightly edited and a new stylesheet applied to the site. But none of the documents have been edited, not even for minor errors. The text appears on this site as obtained from the Internet Archive.

The period covered by the archive encompassed the campaign for HIV medicines, the civil disobedience campaigns, the Competition Commission complaints, the 2008 xenophobic violence and the PMTCT, Khayelitsha health workers and Matthias Rath court cases.

The TAC notes the publication of Statistics South Africa's report Mortality and Causes of Death in South Africa, 1997 - 2003. This report, once more, confirms beyond reasonable doubt that South Africa is in the midst of an HIV epidemic that is maturing into an AIDS epidemic. It also provides useful information on the nature of the epidemic.

Between 1997 and 2002, the total number of deaths increased by 57%. Deaths of people aged 15 years and above increased by 62%. While some of this increase is due to population growth (10%) and improved death registration, most of the increase can be explained only by an HIV epidemic. A number of studies, mostly conducted by Medical Research Council scientists, have demonstrated the increase in mortality in South Africa due to HIV, but the Statistics South Africa report is noteworthy for having been approved by Cabinet. The tragic implication of the report - that hundreds of thousands of South Africans have died of AIDS in the last few years without access to life-saving treatment - must be used as an impetus to speed up the delivery of treatment and prevention programmes. The report has been honestly conducted despite an overly-cautious tone with regard to causes of death due to HIV.

The report is based on an analysis of 2.9 million valid death certificates collected from 1997 to 2003. The causes of death as written on these certificates were processed using a computer programme. Statistics South Africa makes it clear that approximately 90% of deaths are now certified but that the quality of ceritification remains a serious problem. For instance the report says that factors limiting accuracy of the data based on death notification forms (death certificates) include:

"The data from death notification forms is subject to content errors and omissions. Even though provision is made on the death notification form to record marital status, education, occupation, and the industrial sector in which the person worked, these variable have not been analysed in this release, due to the lack of completeness. Location could be captured at the level of province only."

"Another limitation of the data used in this study is the probable under-registration of deaths, particularly in rural areas and of children. This leads to lower estimates of the total number of deaths that have occurred in the country and may lead to an underestimation of some causes of death...."

"The causes of death may also be misreported on the form. This happens when an incorrect cause of death is given or when the cause of death is not detailed. The quality of the reported information is determined largely by the ...certifying official -- physician, professional nurse or, in some rural areas, traditional headman. For example, the certifying officials sometimes write 'natural causes' instead of stating the actual cause.

"Assessing the quality of the information reported is beyond the scope of this release, and no adjustments were made for misclassification of underlying causes of death due to miscertification." (p.2 Mortality and Causes of Death in South Africa, 1997 - 2003)

HIV is frequently not stated as the underlying cause of death. Instead, an opportunistic infection associated with HIV is usually indicated as the cause. Therefore, the number of AIDS deaths cannot be determined by simply reading the report. This is why the report states "This release covers mortality and causes of death broadly, and hence does not focus specifically on HIV and AIDS. It does, however, provide indirect evidence that HIV may be contributing to the increase in the level of mortality for prime-aged adults, given the increasing number of deaths due to associated diseases." (p. 2 Mortality and Causes of Death in South Africa, 1997 - 2003)

Causes of death due to tuberculosis and influenza and pneumonia, which are frequently opportunistic infections associated with HIV, more than doubled between 1997 and 2001. By 2001, these were the leading causes of death. Furthermore, the report states "The proportion of deaths in the age group 20-49 is increasing. While an increasing number of deaths are associated with lifestyle diseases (such as heart disease and diabetes) as the underlying cause, the dominant contributors to the growth in mortality are deaths associated with tuberculosis, and influenza and pneumonia." It therefore cannot be argued that the increase in mortality is due primarily to better death registration data and population growth, because neither of these would affect the proportion of deaths recorded in the 20-49 category. These facts, combined with all the other overwhelming evidence that South Africa is experiencing an HIV epidemic (antenatal surveys, HSRC study etc.), demonstrate beyond reasonable doubt that HIV is causing a massive increase in mortality in South Africa. More than half the number of natural deaths in men and women in South Africa occur before they reach the age of 55.

Patterns of death among children also indicate the impact of the AIDS epidemic, with substantial increases in the proportion of deaths due to tuberculosis and influenza and pneumonia. Currently very few children are being treated in the public sector. The findings of this report, as well as others, indicate the necessity of increasing access to antiretrovirals for children with AIDS and improving the mother-to-child transmission prevention programme.

Recorded Deaths in South Africa:

1997: 318, 287

1998: 367 689

1999: 381 902

2000: 413 969

2001: 451 936

2002: 499 268

The above table shows a 57% rise in recorded mortality from 1997 to 2002. The report estimates that 90% of adult deaths were recorded in 2002 and that the population grew 10% during this period. A report published by the MRC in the South African Medical Journal last year analysed death registration data over a slightly longer period, from 1996 to 2003, and found a 68% increase in adult mortality. These consistent findings cannot be explained by population growth or improved registration, but only by an HIV /AIDS epidemic leading to unncessary and premature death.

Adult deaths increased by 62% from 1997 to 2002, from 272 221 to 441 029.

Recorded deaths in the age-group 20 to 45 more than doubled between 1997 to 2002, from 106 033 to 221 260. That mortality in this age-group increased so much faster than mortality overall falsifies the argument offered by some AIDS denialists that the increase in mortality could be due solely to population growth and improved death registration, because the latter two causes of increased mortality would affect all adult age-groups in equal proportions. HIV mainly affects people in the 20 to 45 age-group and therefore the pattern of mortality is consistent with HIV. The number of recorded deaths of people aged 20 to 55 in 2002 was 250 873, more than 50% of all deaths.

In a population following normal mortality trends, a graph of the number of deaths per age-group would gradually increase for adults until the older age-groups. But in South Africa in 2002, this graph increases swiftly among young adults peaking in the 30-34 age-group. This is an abnormal situation that can only be explained by the HIV epidemic. This situation becomes steadily more pronounced in the years 1997 to 2002. The fact that this feature is already discernible in 1997 demonstrates that there were already large numbers of AIDS deaths in that year. We recommend that interested readers examine the graphs on pages 11 to 16 of the Statistics South Africa report.

Recorded tuberculosis deaths increased by 131% from 22 021 to 50 872 between 1997 and 2001. Influenza and pneumonia increased by 197% from 11 503 to 31 495 during this time. These two causes are frequently associated with AIDS-related opportunistic infections. While some people die of these diseases in the absence of HIV, the enorm