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.

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Alarming Statistics
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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."

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Versus Current Statistics
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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.

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NGO and Government
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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)

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Retraction - Sorry About That
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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.

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