February 22, 2005

AIDS & Africa: South African Mortality Rate Climbs

Anyone following the issue of AIDS and South Africa will know that Mbeki, the President of South Africa, has taken the position that AIDS is not a threat to South Africa, that the issues concerning AIDS have been overblown, that basically AIDS ain't a problem for South Africa and it is just racist for us to say it is. A recent report about mortality rates in South Africa renders this position much less tenable than it could have ever been. In other words, you have to now absolutely believe in the Tooth Fairy now to buy in to Mbeki's positions while before you could just sort of suspect that the Easter Bunny and the Tooth Fairy were lovers in some alternate universe.

Here are some extracts:

South Africa's government reported Friday that annual deaths increased 57 percent from 1997 to 2003, with common AIDS-related diseases like tuberculosis and pneumonia fueling much of the rise.

The increase in mortality spanned all age groups, but was most pronounced among those between ages 15 and 49, where deaths more than doubled. Working-age adults are more sexually active than the rest of the population, and the opportunity for transmitting H.I.V. is greatest among members of this group.

The report states that 499,000 of South Africa's roughly 44 million people died in 2002, up sharply from 318,000 in 1997. Much of that increase appears to result from H.I.V., the virus that causes AIDS. Experts agree that there are at least five million H.I.V.-positive citizens here, the most of any country. Diagnosing AIDS as a cause of death can require advanced medical knowledge and equipment. Moreover, an unknown number of AIDS deaths go unreported because South African life insurance policies frequently do not cover AIDS-related deaths.

Nevertheless, the agency reported that the new figures "provide indirect evidence that H.I.V. 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."

Dr. Steve Andrews, an H.I.V. clinician and consultant in Cape Town, said the sobering figures in the report suggested that it had not been politically varnished. Given the improvement in medical care and living standards in South Africa, he said, "we should not be seeing this aggressive move in death rates - not at all."

The report concluded that the average number of deaths in South Africa rose to 1,370 per day in 2002 from 870 in 1997, an increase that could not be explained by the 10 percent increase in population during the same period.

The reported causes of death point to AIDS as the factor underlying much of the increase in mortality. Deaths from tuberculosis, influenza and pneumonia - all primary causes of AIDS-related deaths - more than doubled in the five years encompassing 1997 to 2001, while deaths from other AIDS-related diseases like gastrointestinal infections rose about 25 percent.

Deaths from some ailments unrelated to AIDS, like hypertension and cerebrovascular problems, also rose, but at lower rate. General heart disease, once by far the biggest killer of South Africans, fell during the period and was well behind tuberculosis and influenza in 2001.

Two aspects of the report were especially notable.

The death-certificate figures indicate the proportion of deaths among sexually active women is rising significantly compared with deaths among men - a ratio that strongly indicates a country's AIDS-related mortality rate. In 1997, 149 men ages 25 to 29 died for every 100 deaths among women; the comparable figure in 2003 was 77 male deaths for every 100 female deaths.

The report also suggested that AIDS was increasingly exacting a toll among the very youngest South Africans. In 1999, the report stated, disorders of the immune system emerged for the first time as one of the 10 leading causes of deaths of children under 15.

Let's do a little math together, to put some of this in perspective, ok? Just a little math, cause math is not my strong suit. But let's try. The numbers are: 499,000 of South Africa's roughly 44 million people died in 2002. 499,000 is roughly 1% of the total population of South Africa. Slightly more, but close enough for my purposes. Let's compare, then. The population of the United States, according to the Census Bureau is: 295,523,454. Let's just say 296 million. One percent of that would be just about 3 million people. Can you imagine now the scope of this disaster? If an equivalent percentage of Americans were dying of AIDS we would be loosing some three million people a year. Mind boggling, isn't it?

How can Mbeki assert AIDS is not a problem when it is killing 1% of his country a year, and rising?

And consider, briefly, those who are dying and maybe some of the implications associated with those deaths: More woman; more children under the age of 15; and more of working age.

What can we assume results from that?

More women: this would mean that more children will be born with HIV. Fewer women will be around to take care of children. Fewer women will be around to give birth to children. What does that imply about replacement rate? Beats me but I doubt it is anything good.

More children under 15: first, how are they getting this disease? Are they still being used by HIV infected men who think that sexual relations with a virgin will cure them? That belief exists and is acted upon, you know. If children are not surviving, who is going to lead their country into the future? Where will the next great innovators come from? Who will provide for parents as they age? Who will inherit family farms and property?

Working age: If these people get AIDS, who will provide the labor needed to fill government coffers with tax receipts as the economy slows because no one is alive to do the work? Does the country collapse entirely? Is this too far fetched in terms of speculation?

Go away from this post, assuming you got this far, and leave a comment if you disagree. The enormity of this problem and the implications are almost too great for me to wrap my mind around. I'd appreciate your thoughtful comments.

Posted by Random Penseur at February 22, 2005 12:45 PM

Once again I find myself full of comments but none of them are thoughtful. The sky is actually falling and Chicken Little refuses to acknowledge it.

Posted by: Jim at February 22, 2005 03:56 PM

I follow you. It sucks. I just don't know what to do about it.

Btw, I don't like the required email address AND that it won't let you put anti spam stuff in it.

Posted by: Hannah at February 24, 2005 01:11 PM

You might be interested in this post, from The
Marginal Revolution:

That graph is one of the more depressing things I've seen lately.


Posted by: tex ritter at February 28, 2005 10:15 PM
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