Estimating the size of the HIV epidemic by using mortality data

Evidence that more people are dying as a result of HIV infection than is reflected by the number of deaths among reported cases meeting the WHO definition of AIDS is derived from mortality data. Ninety-five causes of death likely to be associated with HIV infection were selected. Standardized mortality ratios due to these causes increased for single men aged 15-54 years from 100 in 1984 to 118 in 1987. The age, sex, marital status, temporal and geographic distribution of these excess deaths suggest that they are HIV-associated. It is estimated that 58% of excess deaths due to HIV-related causes were among cases reported to the CDSC AIDS Surveillance Programme in 1987. Some of these deaths may have been among HIV-positive people who did not meet the WHO definition at the time of death. There is a need for surveillance to be extended to include HIV-positive people who die before meeting the WHO definition if the full extent of the HIV epidemic is to be identified.