President uses 1995 data to bolster claim that HIV/AIDS is not SA's leading killer

Business Day (SA) 10 Sept. 2001

Cape Town -- President Thabo Mbeki has ordered a re-examination of SA's social policy spending priorities in the light of 1995 "cause of death" statistics he has extracted from the internet.

It is a move intended apparently to de-emphasise the HIV/AIDS crisis in the country.

Mbeki warns, in a letter to Health Minister Manto Tshabalala-Msimang, that it will "provoke a howl of displeasure and a concerted propaganda campaign from those who have convinced themselves that HIV/AIDS is the single biggest cause of death" in SA.

However, his efforts could be undone by a Medical Research Council report, due to be published soon, which is expected to say that AIDS has indeed become the leading cause of death.

In his letter, dated August 6 which he asks the minister to share with others in the cabinet's social cluster he instructs her to examine the 1995 data, the latest available, that he extracted from the World Health Organisation (WHO) website showing "AIDS disease" to be the cause of just 2,2% of deaths in SA. These figures show the leading cause of death to be external causes, including accidents, homicide and suicide (19,8%), diseases of the circulatory system (17,5%), ill-defined conditions (13,6%), malignant neoplasms (9,9%), tuberculosis (5,3%), and respiratory diseases (4,6%). Numerous other categories are listed.

Mbeki says the cluster should consider the following factors:

* What social policies have we put in place to reduce the incidence of death, bearing in mind the causes of death by rank?

* Do our health policies and therefore the allocation of resources reflect the incidence of death as reflected by these figures? and

* Are the programmes of the state medical research institutes geared to respond to the profile of the incidence of death?

Presidential spokesman Bheki Khumalo confirmed yesterday that the president had written the letter.

He said it raised questions he had been asking all along: "It reflects ongoing discussions within government on how best to respond in a comprehensive way to the objective reality of SA's health profile."

Mbeki's methodology is likely to be criticised, firstly, because the pattern of AIDS deaths shifted significantly since the mid-1990s, the period from which his statistics come.

Secondly, the WHO figures Mbeki quotes reflect, for example, tuberculosis deaths (5,3%) as separate from AIDS, although it is known that AIDS manifests itself widely in tuberculosis in Africa.

The council's cause of death study for 1999 to mid-2001, which is understood to have found that AIDS became, in this period, the leading cause of death in SA, is likely to be subjected to vigorous scrutiny from government if its findings do not conform to Mbeki's views.

It is also understood the council has come under government pressure to delay the release of the data. Government has received some initial presentations on it. Khumalo declined to comment on this.

Council president Malegapuru Makgoba has apparently insisted that the report be released soon after his return from a visit abroad later this week, though further checking is being done to ensure the figures are beyond reproach.

A council spokeswoman said at the weekend the council was in the process of confirming results. It could not provide further detail until the report was released sometime in the next two weeks.

Mbeki's letter was sent days after he made the point in a BBC television interview with Tim Sebastian that AIDS was not the primary cause of death in SA.

The day after the despatch of the letter, Tshabalala-Msimang made a similar statement to journalists. She referred to council research for 1999 as a basis for the assertion that violence was the major cause of death and that government needed to pay more attention to this phenomenon.

However, it is understood that, unless fault is found in the research analysis, the council report will contradict this assertion.

Government is also in possession of a report by ABT Associates, commissioned by the public administration department, which confirms this trend.

The report, details of which were published in Business Day in June, forecasts that AIDS is to become the cause of the majority of deaths among public service employees from 2003, rising to more than 75% by the end of the decade. The figure stood at less than 10% in 1995.