One of the world’s worst disasters is under way in Africa. AIDS is devastating sub-Saharan Africa, and South Africa has been especially hard hit. The government in Pretoria, however, has played down the scale of the crisis and, consequently, has been slow to respond to it.
New statistics should shatter the complacency that checks aggressive action against this disease in South Africa. Denial will only ensure that the AIDS epidemic picks up speed and claims yet more victims. AIDS has already claimed more than 25 million lives. Today, more than 40 million people live with the human immunodeficiency virus (HIV), the virus that causes AIDS. And almost two-thirds of those who have HIV live in sub-Saharan Africa, even though that region makes up only one-tenth of the world’s population.
In South Africa, there are an estimated 5 million HIV-positive citizens out of a total population of 45 million — the most of any nation. Some 25 percent of women between the age of 20 and 29 are infected with the virus.
In 2001, the last year for which detailed statistics are available, AIDS was the fifth leading cause of death in the country. And the families of those who live with AIDS suffer in other ways. Incomes in households with infected members fall 66 to 80 percent as a result of AIDS-related illnesses. As a result, those households spend more money on food, health and rent, and less on education and clothing, than do unaffected households. Thus an entire generation is disadvantaged.
Despite the horrific toll, the South African government has been slow to respond, denying that the scale of the disease is as bad as studies show and dismissing critics as racist or misguided. A new study makes those responses harder to defend.
According to data from Statistics South Africa, annual deaths in South Africa rose 57 percent from 1997 to 2003, from 318,000 to 499,000, with AIDS-related diseases such as tuberculosis and pneumonia responsible for much of the increase. In other words, the average number of deaths in South Africa rose from 870 per day in 1997 to 1,370 in 2002. All age groups experienced a rising mortality rate, but it was sharpest in the 15-49 age group for which deaths more than doubled. That happens to be the most sexually active age group.
The reported causes of death suggest that AIDS underlies much of the increase in mortality. Deaths from tuberculosis, influenza and pneumonia — all primary causes of AIDS-related deaths — more than doubled between 1997 and 2001, while deaths from other AIDS-related diseases such as gastrointestinal infections rose about 25 percent. Other ailments, unrelated to AIDS, also rose, but at much slower rates.
Health experts say the latest findings are a smoking gun. The head of the statistics agency is more circumspect, noting that the figures “provide indirect support” for claims that HIV is rising among South Africans. Others stick to the government line, arguing that population increases could account for the rise in mortality or that South African hospitals do not correctly report causes of death.
Previous reports by the statistics agency have caused controversy. The last one, in 2001, was criticized by some government officials for concluding that 40 percent of deaths among working-age adults were likely attributable to AIDS.
The most recent report was delayed a month, fueling charges that the government was trying to influence its conclusions. The numbers that have been released should serve as ample rebuttal to charges that the report was watered down.
The time for arguing over the size of the AIDS epidemic, the causes and its impact has long passed. Millions of people have already died and millions more have been condemned to degrading deaths. Worse, with infections continuing to rise, the fate of an entire generation is now at stake.
Fighting AIDS requires action at many levels. Those who already suffer from AIDS face a long-term debilitating illness and must be treated accordingly. Drugs and other forms of care must be provided for the millions of people who have HIV but who could enjoy nearly normal lives with proper health care.
Most significantly, education and assistance are needed for those citizens who are still not infected but may be at risk. Nothing will happen if governments continue to deny a problem exists. South Africa has 5 million reasons to act. If that is not enough of an incentive, it will soon have millions more.
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