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The impact of HIV/AIDS on adult mortality in South Africa
Medical Research Council
South Africa is experiencing an HIV/AIDS epidemic of shattering dimensions. The main source of information about the epidemic is the antenatal clinic HIV seroprevalence surveys conducted by the Department of Health. Reliable statistics on HIV/AIDS deaths in South Africa are not available despite Government’s extensive, and largely successful, efforts to improve the national vital registration system. The most recent official death statistics available are those for 1996. By 1996 the proportion of deaths due to AIDS was too low to tell us much about the shape of things to come.Even if the numbers of AIDS deaths were substantial, vital registration statistics may well be an unreliable source of cause of death information because the true cause of death of someone who died of AIDS can be expected to be frequently misreported. Demographic projections of the epidemic indicate that HIV/AIDS will cause a rapid change in the age and sex pattern of deaths. A system to rapidly monitor the age pattern has been developed by the Medical Research Council. Details of registered deaths are obtained directly from the Population Register maintained by the Department Home Affairs. Standard indirect techniques have been adapted for estimating the extent of under-reporting of deaths to allow for different levels of completeness at different ages which can be expected in South Africa, in order to estimate the extent of under-registration in both the routine vital statistics reported by Stats SA as well as the data obtained from Home Affairs. The coverage of adult death registration appears to have improved from 54% of deaths occurring in 1990 being reported to 89% of adult deaths (in those older than 15 years) occurring in the 12-month period to the end of June 2000 being reported. This is a clear sign of the success of the extensive efforts on the part of Government to improve vital registration. While this system provides good information on adults, deaths among children are under-represented as a relatively high proportion of children are not recorded on the Population Register. The data show that there has been a steady increase in adult mortality during the 1990s. The mortality of young, adult women has increased rapidly in the last few years with the mortality rate in the 25-29 year age range in 1999/2000 being some 3.5 times higher than in 1985.