Noseweek August 2000

All those who doubted the wisdom of Thabo Mbehi's vigorous entry into the HIV-AIDS debate should read the following story - and think again.

The questions being asked by Mbeki, we still believe, call for considered, well-researched answers. Regrettably, many participants in the AIDS arena appear to feel compelled to play to the mass audience as if they were the latest recruits to Gladiators, that popular but cheap bit of TV buffoonery.

Witness the recent presentation by Professor William "Wits Blitz" Makgoba, president of the SA Medical Research Council, to the AIDS advisory panel set up by President Mbeki.

According to the Sunday Times -- and it must be right, because he rushed to tell them himself -- Prof Makgoba "stunned the panel into silence" by presenting it with two graphs representing deaths in South Africa recorded in 1990 and 1999.

According to the graphs, the total number of deaths had increased from 63 500 in 1990 to 174 500 in 1999 (bham! bham! Wits Blitz has the Idutywa Induna looking dazed). Most horrifying of all: the number of men in the age group 25 to 30 who died was up from 3 000 in 1990 to 15 500 in 1999! (Gadoef! He's down, he's down!) Deaths among females in the same age group were up from 1 500 to 12 800 (Aaah, he's out for the count!).

Makgoba told the panel that the increase could be attributed directly to HIV/AIDS. "A major war would be the only other thing that could explain the high numbers of young men and women who are dying in our country," he said. (Wits Blitz raises his arms to receive the crowd's cheers!) It was all very horrifying and exciting.

But none of it was true. Like Gladiator contests, it was all choreographed for effect.

The MRC had only weeks before been granted access to the Department of Home Affairs's unprocessed figures for the years 1996 to 1999. The MRC hurriedly did its own breakdown, by age, of the 1999 figures -- using its own methods -- and then compared them with the official statistics for 1990 that were published by Stats SA, South Africa's official statistical service.

On Sunday 9 July, hours before President Mbeki was to open the International AIDS conference in Durban, the Sunday Times reproduced the graphs prepared by the MRC on its front page under the headline "Young, gifted and DEAD". The figures, the newspaper declared, "put an end to the debate raised by dissident scientists on whether AIDS was causing a dramatic increase in deaths in South Africa". The newspaper named the Department of Home Affairs as the source of the devastating statistics.

What the Sunday Times presumably did not know is that it had been used to publish a grotesque piece of propaganda that was calculated to mislead the public and embarrass the president.

The day after publication, the Department of Home Affairs rushed anxiously to cover its back. A senior official, Mr Eugene Kritzinger, directed an urgent request to Stats SA to provide professional comment on the graphs and analysis published in the Sunday Times. He already had a fair idea what was wrong with them.

Two days later, Stats SA gave the department a confidential critique of the comparative death statistics published in the Sunday Times and of Makgoba's claims that are quoted there.

Firstly, Stats SA pointed out what had to have been obvious to Home Affairs from the start: the figures for deaths in 1990 were for the "old" (largely white) South Africa, which excluded the entire populations of the then "Bantu homelands".

Informed sources within the department say that the process for including deaths in the former homelands only started in 1996 -- and that 1998 was the first year when the process was sufficiently advanced to produce reliable national statistics.

The 1990 graph, therefore, represents the typical pattern for a largely white, middle-class, urban -- and older -- population: a gradual increase in the number of deaths through the age groups, with the largest numbers dying in old age.

It excluded the mass of the black rural poor, whose fertility pattern is quite different from that of their wealthier urban white, Indian and "coloured" compatriots. A much, much larger proportion of of the black population -- said to be over 60% -- is under 18. And their average life expectancy has always been significantly lower than that of their better-off compatriots of other races.

Naturally, when they were reincorporated in the national statistics (as in the 1999 graph) the total number of deaths was much higher and the pattern changed. For a start, the total population being accounted for is significantly larger than that accounted for in 1990 in the official statistics for the "old" South Africa. Secondly, since black people now form the vast majority of citizens of the larger, "new" South Africa, their different pattern of deaths has a profound impact on the PATTERN of deaths for the overall population.

A dramatic increase in deaths in certain categories was to be expected in the 1999 graph, both because of the absolute increase in population being accounted for and because of its different age spread and life expectancy. But it was not only true for deaths in the younger age categories -- close readers of the Sunday Times graphs will have noticed that they also show nearly three times as many people dying over the age of 80. (Is Professor Wits Blitz suggesting that they, too, are dying of a sexually transmitted virus?)

Stats SA politely points out in its confidential memo that "a more meaningful" comparison would be of the RATE OF DEATHS PER THOUSAND people in each age and race category, rather than of the totals.

In addition, in the black community a significantly larger number of young people die of unnatural causes such as violence and accidents. A stunning 27% of South African males, Stats SA reports, die of accidents and other violent causes.

In all, Stats SA concludes, the 1999 pattern of deaths presented by Prof Makgoba and dramatically reported by the Sunday Times is, in fact, "not a new profile".

The Department of Home Affairs's response? A dry little press release (which the Sunday Times did not bother to report) that stated: "Although the department is fully aware of the serious nature of the AIDS pandemic in South Africa, panic should not be created among members of the public through selective, and sometimes incorrect, use of statistics."

Which is, apparently, what the MRC has done: create panic through the selective and incorrect use of statistics. Prof Makgoba's timing suggests he also hoped to embarrass and discredit President Mbeki.

As head of the MRC, Prof Makgoba is supposed to be our most senior medical scientist. We trust he will not continue in that post much longer.

The funny thing is that no-one at the much celebrated International AIDS conference noticed even the obvious flaws in the graphs or questioned Prof Makgoba's interpretation of them. They have simply been absorbed into the myth that passes as "AIDS science" in South Africa today.

No wonder President Mbeki feels impelled to step in and to bring some scientific rigour to the issue. If he doesn't, who will?