2 December 2015
Under reporting of HIV-related deaths hindering the fight against AIDS
The South African Medical Research Council (SAMRC) emphasizes that continued reluctance to acknowledge AIDS as a cause of death is deterring efforts to monitor the impact of HIV control efforts in South Africa.
The SAMRC’s Burden of Disease Research Unit has developed models to produce refined estimates of mortality from HIV/AIDS in South Africa from 1997 – 2010. The refined estimates, published in the Journal of the International AIDS Society, reveal that large numbers of HIV/AIDS deaths remain unacknowledged thus impacting on reported HIV/AIDS mortality statistics.
“We found that 93% of AIDS deaths are misattributed to other causes,” says Unit Director Dr Debbie Bradshaw. “It is clear that HIV/AIDS is under-reported as a cause of death in the vital statistics in South Africa.” The study involved analyzing the existing vital statistics and looking for causes exhibiting the characteristic "AIDS signature" in the age pattern of the change in mortality to identify HIV/AIDS deaths reported as being from other causes.
The study suggests that the percentage of all deaths due to AIDS increased from 14.5% in 1997 to a peak of 42% in 2005 and dropped to 35% in 2010. However, only 6.9% of the estimated AIDS deaths were correctly reported as such. Once this is taken into account, HIV/AIDS is still the leading single cause of death.
Bradshaw says that factors contributing to under-reporting include the under-registration of deaths in general as well as misattribution of AIDS deaths to other causes by medical practitioners. She adds that the study showed that the likely AIDS deaths were attributed to ill-defined natural causes, tuberculosis, lower respiratory infections, and pseudonyms used by doctors to indicate HIV/AIDS.
"The sooner HIV/ AIDS is normalised as a chronic health condition, the sooner South Africa will be able to eliminate the epidemic," Bradshaw says. "Accurate data informs our response to major epidemics that gravely affect the socio economic health of our nation – it is the intelligence needed to guide our interventions.”
NOTES TO THE EDITOR:
Medical practitioners identify both the immediate and the underlying causes of death in patients. For example: a patient may die from pneumonia, but also be HIV positive. Pneumonia is identified as the immediate cause of death while HIV is identified as the underlying cause as it started the sequence of conditions that ultimately led to the death of the patient. Due to concerns about social stigma that may affect the family of the deceased, medical practitioners may be choosing to report the immediate cause of death only. However, from a public health point of view, it is extremely important to know the underlying causes of death so that appropriate interventions can be implemented.
Cause of death statistics reported by Statistics South Africa are based on the notification forms completed by medical practitioners. Given the high proportion of misattribution of AIDS deaths that has been shown by the research undertaken by the SAMRC, the national statistics need to be interpreted carefully.
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