Research findings on HIV/AIDS trends: briefing

Meeting report

SOCIAL DEVELOPMENT PORTFOLIO COMMITTEE
5 February 2003
RESEARCH FINDINGS ON HIV/AIDS TRENDS: BRIEFING

Chairperson: Ms W S Ramotsamai (ANC)

Documents handed out:
Presentation by Statistics South Africa
Presentation by the HSRC

SUMMARY
Statistics South Africa and Human Sciences Research Council briefed the Committee on recent research findings related to HIV/AIDS trends. The Statistics South Africa presentation reflected that the study had concentrated on how the leading underlying causes of death were changing mortality patterns. The Nelson Mandela-Human Sciences Research Council presentation showed that the study had looked into HIV prevalence, behavioural risks, mass awareness and attitudes. Members of the Committee responded with questions relating to accuracy of the data presented before them; particularly with findings related to the registrations of death and the recorded causes of death.

MINUTES
The Director of the National Population's Unit, Mr Jacques Van Zuydam, coordinated the presentations of the two major HIV/AIDS studies which were released late in 2002.

Presentation by Statistics South Africa
The first report, presented by the Chief Director of Statistics South Africa (SSA), concerned the causes of death In South Africa between 1997 and 2001. The study was based on a twelve per cent stratified random sample. The presenter highlighted that the leading underlying causes for both male and females during the said period accounted for 41 per cent of deaths in South Africa. These included unspecified unnatural causes, ill-defined causes of death, tuberculosis (TB), HIV, influenza and pneumonia. The study showed that the cause of death in males was largely unspecified deaths and TB, whereas with females it was HIV/AIDS. He noted that the quality of data was largely determined by the diligence of the certifying physician. He further explained that in terms of the Births and Deaths Act of 1992, physicians were not obliged to disclose
the underlying cause of death, which made data collection problematic.

Discussion
The Acting Chairperson, Ms C Ramotsamai, requested Members to make comments and ask questions in a series, and the presenters would then respond at the end.

Prof L Mbadi (UDM) was concerned about the accuracy of the figures being presented particularly if notification forms were used as a source when collecting data. He explained that in the deep rural areas some people did not die in hospitals. Some died in clinics whilst others died at home. In some instances the notification forms were filled in by undertakers, but then undertakers were not always used.

Ms T Tshivhase (ANC) questioned whether the study took into account the old women who got raped and kept quiet about the rape or did not go to the hospitals and were not reached by the researchers.

Ms Ramotsamai noted the finding that death from TB and pneumonia were on the increase. Since HIV/AIDS was not a notifiable disease, how were those deaths distinguished, these being opportunistic diseases? The study had lumped these deaths with solely TB and pneumonia sufferers; how did the study differentiate these cases? She was also concerned that with these opportunistic infections, doctors tended not to state on the death certificate that the cause of death was HIV/AIDS; would there perhaps be an overlap on some of these diseases?

In his response, the presenter reiterated that the quality of data depended on the diligence of the physician - and nurses in some instances - to record accurately. In terms of separating what is an AIDS-related death and what was not, for this study they had recorded what the doctor and what the death certificate showed.

He added that the issue was this: what had started the chain that led to death? In the study the first underlying cause of death in the death certificate was recorded.

The presenter said that a lesson about the quality of systems had been learnt, hence the percentage figures recorded should be read as "at least seven percent, but probably more". He pointed out that what the data did reflect was the trend. Even if they did not have accurate data, it could be refined to reflect the prevalence of HIV and AIDS; and was also the first comprehensive study done encompassing all races and gender.

Presentation by the HSRC
Dr Olive Shisana conducted the second presentation on the Nelson Mandela-HSRC study of HIV/AIDS. This study projected the impact of HIV/AIDS in demographic terms.

A comparison of HIV prevalence levels was conduct and included high transmission areas, rural, urban, formal, and informal areas. The presenter explained that for accuracy purposes children below the age of two had not been tested or included for the purposes of this study. From their findings in the age rate of two to fourteen years of age, they could not substantiate what proportion of children were infected by the different modes; namely infections from mother to child or rape (sexual abuse). They also found no differences between the girls and the boys. She highlighted that is was particularly disturbing that the female rate of infection was very high between the ages of 25-29. The notable difficulties they had with an otherwise co-operative population was that some white people would not allow them into their houses to do the study and some other people refused to do testing for religious purposes.

Discussion
Ms T J Tshivhase (ANC) said that malnutrition, lack of food, and poverty was contributing to this disease. There were also too few nurses in the rural areas. She was concerned that the statistics may not have been derived from correct data.

Dr Shisana's response was that the survey had not studied the malnutrition issue.

The Chairperson made a comparison with the previous study; the HIV prevalence was seven percent and this study said it was eleven percent. She was sceptical about the Eastern Cape results which showed that the province has the lowest HIV prevalence. The results could have been affected by fact that there were so few antenatal clinics in the Eastern Cape.

Dr Shisana assured the chairperson that the results were not made up from antenatal clinics. Retired nurses had been hired to conduct the testing in the various areas.

The Chairperson also sought clarity about the condom questionnaire; the study revealed that more females than males used condoms. Her concern about these results stemmed from the knowledge that female condoms were not distributed due to the costs involved.

Dr Shisana said that the question had related to a female using the male condom with their partners in line with having safe sex.

The Chairperson was concerned whether people coming in from other parts of the continent and the world were included in the survey.

Dr Shisana said that the survey had included everybody, but the majority of the population sample was South African.

Dr Shisana was asked what they were planning to do with the information they had in order to try and reduce the prevalence of HIV/AIDS.

Dr Shisana responded that research on its own did not help if it did not change the quality of life. The Department of Health would look at areas in which they could use the information. The Nelson Mandela Foundation would use the information to find out which groups they were not reaching. The survey revealed that certain official languages such as Shangaan, Venda, and Affrikaans were being marginalised in awareness campaigns and in methods used to disseminate information about HIV/AIDS.

A Member asked how this research would help.

Dr Shisana replied that a combination of the proposals would make an important contribution towards fighting against HIV/AIDS.

The Chairperson said that the information would help the Committee when assessing grants for orphans and and with planning legislation and policy.

She thanked the two teams and expressed the Committee's intentions to revert back to the institutions directly.

The meeting was adjourned.