Estimation of mortality due to AIDS--a review

HIV/AIDS has emerged as a major public health problem since its recognition as an emerging disease a couple of decades ago. While detection of HIV/AIDS cases remains a problem, ascertainment of AIDS deaths has emerged as a bigger challenge and concern. Despite a plethora of literature focusing on the methods to estimate AIDS deaths, none seems to be fulfilling the requirements for universal acceptance. In this paper, we give a systematic review of various methods used by experts to have a reliable estimate of the number of deaths due to AIDS. Initial assessments were derived from morgue based estimates in Africa which showed that AIDS was a leading cause of death. Its impact on demography was noticed in some of the studies conducted wherein age and sex specific mortality rates, standardized mortality ratios, potential years of life lost and decrease in life expectancy were calculated. "Excess mortality factor" as observed in 1980s and 1990s also indicated the approximate number of AIDS deaths. Besides, orphan hood method and verbal autopsy technique too, emerged as reliable means to identify mortality due to AIDS. Some indirect methods like estimation of deaths due to opportunistic infections like tuberculosis could also be a good indicator. The paper reviews the merits and possible biases encountered with each of the methods.