Death Certificates 'Inaccurate Guide' to Aids Numbers
Business Day (Johannesburg)
NEWS
February 1, 2005
Posted to the web February 1, 2005
By Tamar Kahn, Science And Health Editor
Cape Town

Just days ahead of Statistics SA's (Stats SA's) expected release of a
politically sensitive mortality report, scientists from the Medical
Research Council (MRC) and University of Cape Town (UCT) have warned
against a literal interpretation of the information recorded on death
certificates.

Stats SA's report, due on Friday, will provide details on the causes of
death between 1997 and 2003. Against the backdrop of continued controversy
over the size of the HIV/AIDS pandemic and government's response to it,
all eyes will be on the proportion of deaths the agency attributes to
AIDS.

Stats SA's report was due to be released on January 12, but was postponed
at the last minute without explanation, fuelling speculation of political
interference.

"A large proportion of deaths due to HIV infection are misclassified (on
death certificates) as the opportunistic infections that are the immediate
cause of death," said Prof Debbie Bradshaw, director of the MRC's Burden
of Disease Unit.

She is also co-author of a new study on AIDS deaths published in the
international peer review journal AIDS on Friday.

The researchers found 61% of the estimated 153000 AIDS deaths in 2000 were
misclassified, described instead as deaths due to conditions such as
tuberculosis (TB), pneumonia or meningitis.

Bradshaw said the misclassification was not necessarily deliberate, as
often the person's HIV status was unknown at the time of death.

But in many cases doctors were reluctant to certify deaths as due to HIV
because of the implications for the family they might struggle to claim on
life insurance or funeral policies, and battle with the social stigma
associated with the disease, Bradshaw said.

The researchers compared the 1996 and 2000 death rates for 22 conditions,
and found that death rates for nine of them rose in tandem with recorded
AIDS deaths, showing the same distinct age and gender pattern, said David
Bourne, study co-author and researcher at UCT's public health department.

There was a disproportionate number of deaths among young children, and
sexually active young men and women, with the peak death rate for women
(30-34) coming about five years before the peak for men (35-39).

The nine conditions were TB, pneumonia, other respiratory diseases,
diarrhoea, meningitis, gastroenteritis, other infectious and parasitic
diseases, deficiency anaemias and protein malnutrition.

Deaths from these diseases "were never (before) so marked among young
adults", said Bourne.

Respiratory conditions accounted for the majority of misclassified AIDS
deaths. Some diseases showing an increase in deaths for example melanomas
were not considered to be AIDS-related because they displayed no increase
among young adults.

The Treatment Action Campaign (TAC) lobby group welcomed the MRC-UCT
study, saying it demonstrated the need for government to speed up the
provision of free drugs to people living with AIDS.

Citing figures from the Actuarial Society, the TAC said that an estimated
300000 people died of AIDS last year.

"The number will rise unless more people are given treatment," the TAC
said in a statement, noting that only 20000 people were receiving
treatment in the public sector by the end of last October.

Commenting on the long-running South African debate over the size of SA's
HIV/AIDS epidemic, the study authors said:

"This debate has unfortunately sown confusion about the urgency of the
epidemic, delayed the implementation of interventions aimed at reducing
transmission and mortality, and contributed to the stigma associated with
the disease.

"Given the political climate and the resultant disincentives for reporting
HIV/AIDS in the South African setting, it is probably not surprising that
hte level of reporting HIV or AIDS as a cause of death is low. This is in
stark contrast to Brazil where a policy of universal access to free
treatment was implemented early in the epidemic, and the level of
reporting of HIV on death certificates is over 85%.

_________

READING BETWEEN THE LINES

Death Certificates 'Inaccurate Guide' to Aids Numbers

Translation: the number of registered AIDS cases will not be nearly what
the TAC and their consorts have been saying.
 
"A large proportion of deaths due to HIV infection are misclassified (on
death certificates) as the opportunistic infections that are the immediate
cause of death," said Prof Debbie Bradshaw, director of the MRC's Burden
of Disease Unit.
 
That sounds like correct classification to me.
 

The researchers compared the 1996 and 2000 death rates for 22 conditions,
and found that death rates for nine of them rose in tandem with recorded
AIDS deaths, showing the same distinct age and gender pattern, said David
Bourne, study co-author and researcher at UCT's public health department.

Untangling that particular piece of logic... AIDS deaths versus deaths
from infections and conditions.... without HIV tests...

Anyway. I think the interesting and undisputable factor in the upcoming
survey is going to be the population size, which I'ms sure will be
included.

But in many cases doctors were reluctant to certify deaths as due to HIV
because of the implications for the family they might struggle to claim on
life insurance or funeral policies, and battle with the social stigma
associated with the disease, Bradshaw said. The researchers compared the
1996 and 2000 death rates for 22 conditions, and found that death rates
for nine of them rose in tandem with recorded AIDS deaths, showing the
same distinct age and gender pattern, said David Bourne, study co-author
and researcher at UCT's public health department.
 
It doesn't show they showed that these folk even had positive "HIV
tests".
 
There was a disproportionate number of deaths among young children,
 
Deaths among young children? How are they going to be AIDS related??
 
and sexually active young men and women, with the peak death rate for
women (30-34) coming about five years before the peak for men (35-39). The
nine conditions were TB, pneumonia, other respiratory diseases, diarrhoea,
meningitis, gastroenteritis, other infectious and parasitic diseases,
deficiency anaemias and protein malnutrition. Deaths from these diseases
"were never (before) so marked among young adults", said Bourne.
 
THESE ARE DISEASES OF POVERTY...
 
They hail from bad water, no food and close confines. What a way to cover
up the increased poverty caused by Structural Adjustment Programs.
 
 
Respiratory conditions accounted for the majority of misclassified AIDS
deaths. Some diseases showing an increase in deaths for example melanomas
were not considered to be AIDS-related because they displayed no increase
among young adults.
 
But even thinking within the Orthodox mindset - how could they ever prove
they were misclassified? And I'm sure there are other reasons why melanoma
isn't classified as an opportunistic infection/AIDS related illness, other
than that there was no increase among young adults.

This article is so full of circular arguments, it makes your head spin.