A re-look at recent statistics on mortality in the context of HIV/AIDS with particular reference to South Africa

Abstract

Since the outbreak of the HIV epidemic in the 1980s, various organisations and researchers have produced statistics on HIV/AIDS including HIV prevalence, incidence, number of AIDS cases, AIDS-related mortality as well as life expectancy at birth in the context of HIV/AIDS. Until recently HIV-prevalence statistics as well as models projecting the impact of HIV/AIDS utilised HIV-prevalence statistics based on women attending antenatal clinics as population-based prevalence statistics were non-existent. Among others, the extrapolation of HIV-prevalence statistics from surveillance sites to the general population has been questioned. Recent statistics on HIV-prevalence from population-based surveys strongly suggest that HIV-prevalence in many countries may not be as high as earlier estimated and projected. In addition, model estimates of HIV/AIDS-prevalence and impact on mortality often use conventional model life tables such as the Coale-Demeny Regional, UN, and Brass standard life tables, which in the case of South Africa give female life expectancy at birth plummeting from about 65 years in the mid-1990s to around 49-50 years in 2005. The standard life tables often employed in these estimates do not take account of the 'hump' in the mortality curve due to AIDS-related deaths as these standard mortality schedules were developed prior to the HIV/AIDS epidemic. Given this background, this paper provides a critical look at recent statistics on infant mortality rates and life expectancies at birth in the context of HIV/AIDS in parts of Southern and Eastern Africa with particular reference to South Africa.