Alarming AIDS Statistics, But Are They Valid?

UNCLAS SECTION 01 OF 02 PRETORIA 000998 SIPDIS SENSITIVE DEPT. FOR AF/S; OES/IHB STATE PLEASE PASS OGAC:BPATEL; ALatour, MSherlock, CMarconi, PBouie STATE PLEASE PASS TO USAID/W for GH and AFR/SA HHS/PHS FOR OFFICE OF GLOBAL HEALTH AFFAIRS WSTEIGER CDC FOR GLOBAL HEALTH OFFICE SBLOUNT E.O. 12958: N/A TAGS: SOCI TBIO SENV EAID PGOV KHIV KSCA ZU SF SUBJECT: Alarming AIDS Statistics, But Are They Valid? PRETORIA 00000998 001.2 OF 002 ¶1. (U) Summary: South African media reported on Sunday May 4 that new HIV statistics attributed to the Development Bank of South Africa (DBSA) revealed that 2 million more South Africans are HIV-infected than present estimates show. The report also claimed that these statistics are more reliable than current data. The report was disputed by South Africa's National Department of Health, the Treatment Action Campaign (TAC) AIDS advocacy group, and others. DBSA stated On May 6 that it had not authorized the release of the reported statistics, which had not been validated. End Summary. -------------- Alarming Statistics -------------- ¶2. (U) The Sunday Independent newspaper reported on Sunday May 4: "Shocking new Aids statistics reveal that 2 million more South Africans are infected with HIV than the most recent government estimates show." According to the report, the 2007/2008 statistics, attributed to the Development Bank of South Africa (DBSA) show that: --7.6 million South Africans are HIV-positive -- Of these, about 6.1 million are economically active people between the ages of 20 and 64, who could contribute to the country's economy; --More than 27 percent of men and women aged between 20 and 64 are HIV positive; --More than 92,000 babies have been infected, either perinatally or through mother's milk in the past year; --The total number of Aids sick by mid-2007 was 1,287,844; --Nearly 722,000 people have died of Aids-related diseases in the past year, bringing the total number of such deaths since 2003 to more than 3.7 million; --1.2 million of the country's 1.49 million orphans have lost their parents to Aids and this number is expected to increase by more than 336,000 this year alone. The Independent's report further stated, "What makes these statistics more alarming is the fact that the data on which they are based are probably more reliable than the Department of Health's because they were collected at grassroots level and not based on estimates." -------------- Versus Current Statistics -------------- ¶3. (U) The reported statistics are in stark contrast to those currently accepted. The 2006 Department of Health statistics showed that there were 5.4 million HIV-positive people in South Africa. The Actuarial Society of South Africa (ASSA) estimated in its statistical summary for 2000 to 2015 that there would be 5.6 million HIV-positive people and 370,000 Aids deaths in 2008. UNAIDS stated in its 2006 Global Report that 18.8 percent of the adult population of South Africa was infected, and that 320,000 people died of Aids-related deaths in the country during 2005. Following the report, the opposition Democratic Alliance (DA) party on Monday accused Health Minister Manto Tshabalala-Msimang of keeping Aids statistics low. -------------- NGO and Government -------------- ¶4. (U) The Treatment Action Campaign (TAC) AIDS advocacy group issued a statement on May 5 challenging the DBSA figures, saying, "They are extremely suspicious and cannot be characterized as having been collected at grassroots level and not based on estimates. They Qbeen collected at grassroots level and not based on estimates. They are certainly not more accurate than the Department of Health's statistics." TAC has also asked why a scientific report was released to the media before it was published or without other evidence that it was subjected successfully to peer-review and why no other leading HIV demographers are aware of the grassroots work conducted by DBSA researcher Calitz. ¶5. (U) The Department of Health (DOH) spokesperson dismissed the report on May 6, noting that it seemed to be far off from the estimates of many other surveys conducted by government and independent research institutions. The department said it would study the DBSA report before responding to it in detail and encouraged other researchers involved in HIV prevalence studies to PRETORIA 00000998 002.2 OF 002 engage with the report and ensure that there was a peer review of its findings. The spokesperson noted that, "The Department of Health uses the survey of HIV prevalence among women attending antenatal clinics and follows the model suggested by United Nations AIDS Agency to estimate the level of HIV prevalence in the country." He reported that as of February 2008, DOH figures show that at least 456,000 people had been initiated on antiretroviral treatment, including 39,759 children. (Comment: This is a cumulative number of people ever started on treatment, not the actual number currently on treatment in the public health sector, which the USG PEPFAR (President's Emergency Plan for AIDS Relief) team estimates is 20% less than the government number. Nevertheless, the figure is much higher than the previously released DOH figure of approximately 329,000, indicating substantial progress in expanding antiretroviral treatment over the past six months. End Comment) -------------- Retraction - Sorry About That -------------- ¶6. (U) Finally, the Citizen newspaper published a report on May 6 stating that DBSA had released a statement clarifying that the statistics were working data that had not yet been "validated as per normal practice or put through stakeholder consultations. This is why the data had not been published or reported by the Bank, as was normally done when it released research results." The DBSA said that the information was published "without the Bank's knowledge or its explicit and formal authority." The DA has nonetheless refused to apologize to the Department of Health after calling for an explanation of why the official HIV statistics are low compared to figures released by the Development Bank of South Africa (DBSA). DA spokeswoman Sandy Kalyan said on May 7 that she based her information on the Sunday Independent article and that DBSA should apologize to South Africans. ¶7. (U) Comment: The recently released statistics attributed to DBSA have not been validated and should not be relied on at this time. Warren Parker, at CADRE, a PEPFAR supported partner working under Johns Hopkins University, confirmed to us that the statistics "were a total red herring - and not even formally in a report." He commented that it seems that the DBSA researcher sent some projections from an old ASSA model. Parker advised that the third round of the Human Sciences Research Council (HSRC) national HIV household survey that collects HIV prevalence data is currently underway and its findings are expected to be presented in December. This survey is funded primarily with PEPFAR funds through the U.S. Centers for Disease Control and Prevention (CDC). This will provide the latest population-based HIV prevalence data, and also allow for comparison of the 2008 data with prior HSRC surveys in 2002 and 2005 - which should reveal robust trends over time. The USG PEPFAR Team in South Africa generally relies on the HSRC survey and the ASSA data, both of which are considered to be reliable and are referenced in South Africa's HIV & AIDS National Strategic Plan 2007-2011. End Qin South Africa's HIV & AIDS National Strategic Plan 2007-2011. End Comment. Ball