Sunday Times, 24 November 2002, Aids Needn't Wipe Out Millions

THE mortality figures released this week by Statistics South Africa are a timely warning about our lifestyle as a nation.

Based on a 12% sample of 279 581 recorded deaths out of a total of two million between 1997 and 2001, the study's methodology is not in doubt, nor is its representivity.

The study found that the major cause of death, at 11%, were unnatural incidents such as road accidents, injuries, suicide and drowning. This was followed by ill-defined causes and tuberculosis at 8% each, HIV at 7% and influenza and pneumonia at 6%.

What this means is that violent deaths are the biggest killer in South Africa. It is a sobering reality of our time that more people die violently than from old age and disease.

The second point is that everyone knows that the attitudes of insurance companies towards Aids have a lot to do with the low disclosure levels of the true causes of death.

We therefore need to enter into a debate as a nation about how we deal with external factors that make correct data capturing so difficult.

Should we make Aids a notifiable disease? If so, what do we do with the existing stigma of the disease, fed by ignorance? What will that do to insurance policies and premiums? These are important questions that will need answers.

When the Medical Research Council issued results of a similar study last year and declared that 20% of adult deaths were caused by Aids, the government ordered a new investigation.

Given the stance it has taken at various times about the causes and impact of Aids, it was clear its hope was that Stats SA would produce "better" results.

It has not. Instead the results are essentially the same, for if the figures for "pure" HIV/Aids were added to about 50% of both TB and pneumonia deaths, HIV becomes the biggest killer, at about 14%.

The results also indicate that African women are the biggest group dying from identified Aids.

What can be done?

The debate about cause and effect must die a natural death - now. In its place must come a vigorous programme that must involve government, civil society organisations and individuals.

Aids is a lifestyle infection. No legislation can change people's sexual behaviour. A change in behaviour, preceded by an acceptance that Aids is real, is a good starting point.

Another study measuring the effectiveness of the government's Aids awareness campaign shows that 67% of South Africans now worry about getting Aids, compared with 47% two years ago. And 49% of those surveyed say they always use condoms during sex.

There is also progress in the destigmatising of the disease.

While the indicators are encouraging, mass information campaigns, empowerment lessons for women, and the promotion of the use of condoms and of drugs to curb the spread of infections need to be intensified.