Durban: January 31, 2005
Dr Ruth Rabinowitz IFP Health Spokesperson
The debate around AIDS statistics preoccupying the minds of journalists, academics and commentators like Riaan Malan, amounts to a lot of hot air. We would do better to open our eyes to the reality that surrounds us daily. HIV and AIDS are steadily on the increase and more energy should be spent changing government will to end denial and change behaviour. All our stats in South Africa will be imperfect in view of the paucity of tests that are performed, the format of the Death Certificate and the inadequacy of our statistical records.
The B1 -1663 Notification of Death form, in Part G asks doctors to fill in a) IMMEDIATE CAUSE (Final condition resulting in death) and under the line states (Due to or as a consequence of), with three more lines provided to give the sequential cause of the last cause of death. The instruction is to "Sequentially list conditions, if any, leading to immediate cause. Enter underlying cause last (disease or injury that initiated events resulting in death)".
In the case of AIDS a physician might write
Pneumonia as the immediate cause, followed by "due to TB, due to
HIV". But this would necessitate a positive HIV test being in that
physician's possession or recorded on a data-base to which the doctor has
access. Given the secrecy and stigma surrounding HIV/AIDS and the limited
testing that is done routinely, few doctors would hazard a guess that the
patient died of HIV/AIDS. This is particularly true of rural areas, where
the greatest number of deaths occur and where the hospitals have
insufficient resources to treat patients, let alone perform HIV tests on
all of them.
South African studies estimate the prevalence of HIV as 11.4% of the population in 2003 while UNAIDS statistics estimate the figure to be double that at 21.5%. These large discrepancies suggest that the statistical debate is currently meaningless.
Another factor rendering the statistics virtually
useless is the time it takes for them to be published. It is now 2005 and
we are arguing about statistics from 2001. What relevance do these have to
the current situation?
The only ways statistic will start to mean something
is when the approach to HIV changes from one of academic interest to one
befitting a national emergency. Then testing will be done at all clinics,
hospitals and medical practices, tests will be provided free by government
and a data base will be kept current, listing numbers of people who test
positive and their demographic profile.
The antiretroviral roll out, although it has not reached desired levels, is increasing and will in itself encourage more people to be open. It would be informative to link statistics from testing and treatment sites of government and NGO's funded by President Bush's Emergency fund or others.
These facts (not projections) would be current and provide some insight into the progress of the pandemic and its management. The current debate is academic and superfluous.
Dr. Ruth Rabinowitz MBBCh (MP)