S. Africa deaths
soar; health minister's firing urged

South Africa's death rate rose sharply over a seven-year period and the increase is partly due to the country's staggering AIDS epidemic, the government said.

The government statistical office said the death rate for women aged 20 to 39 had more than tripled between 1997 and 2004, and had more than doubled for men aged 30 to 44. It said those groups had the highest number of deaths from AIDS.

The report gave no estimate for the increase in HIV deaths, saying many AIDS-related deaths are attributed on death certificates to other causes.

''Large increases in the death rates of women in their 20s and 30s since the late 1990s are thought to result mainly from HIV,'' the government said in its report Thursday.

The government said the increase in the death rate is also due to nutritional deficiencies and infectious diseases such as tuberculosis and malaria.

However, the government said levels of HIV infection have risen rapidly and that the average time from becoming infected to death was eight to 10 years. It was likely that ''HIV deaths will continue to increase in South Africa for some years,'' according to the report.

The percentage of pregnant woman who are HIV-positive had risen from 1% in 1990 to 17% in 1997 and to 30% by 2004, the last year covered by the report.

Overall, the government has estimated more than 5.5 million South Africans are infected with HIV, a number second only to India and one that amounts to about an eighth of estimated cases worldwide.

On average, more than 900 people die of the disease in South Africa each day.

South Africa's government has come under mounting international criticism because of its handling of its AIDS epidemic. President Thabo Mbeki once questioned the link between HIV and AIDS and both he and Health Minister Manto Tshabalala-Msimang have doubted the effectiveness of antiretroviral drugs used to treat AIDS.

More than 80 international AIDS scientists, including an American Nobel laureate and one of the codiscoverers of the virus that causes AIDS, released a letter to Mbeki on Wednesday that called South Africa's AIDS policies inefficient and immoral and urged the president to fire his health minister.

Stephen Lewis, the U.N. Special Envoy for AIDS in Africa, delivered a scathing attack on South Africa at the International AIDS conference in Toronto last month, saying the government was ''still obtuse, dilatory, and negligent'' about providing treatment.

''It is the only country in Africa whose government continues to promote theories more worthy of a lunatic fringe than of a concerned, compassionate state,'' he said.

South Africa called Lewis' comments ''unacceptable'' and claimed to have the largest HIV treatment program in the world. It said it was treating 140,000 people in treatment programs, a figure less than half of the 380,000 target it set in 2003. The AIDS scientists said about 500,000 South Africans now need AIDS drugs to survive.

The increase in the death rate for almost every age and gender group in the study was particularly disturbing because the worldwide trend is for the rates to have declined.

''South Africa is a member of a select but undesirable group of countries in which life expectancy at birth declined by four years or more between 1990 and 2001,'' the government said. It said all the countries are either in Africa or part of the former Soviet Union.

The report found that deaths from murder, suicide, and accidents changed little and the number of killings had declined since the late 1990s. But the government said South Africa probably still has ''the second highest homicide rate in the world, trailing only Colombia.''

Meanwhile, a killer strain of extremely drug-resistant tuberculosis has been found in at least 28 hospitals across South Africa and almost certainly has spilled across the country's borders, a specialist said Thursday.

The virtually untreatable superbug could jeopardize efforts to deal with the AIDS epidemic, according to experts from the U.N., the U.S. Centers for Disease Control and Prevention, and 14 southern and central African nations that convened to discuss how to combat the threat.

Experts note that TB diagnostics haven't changed in 100 years and TB medication in 50 years, and they are calling for better and faster methods in dealing with the superbug. They blamed the antiquated methods on the fact that TB is largely a disease of the poor and is often spread by overcrowding when an infected person sneezes or coughs and the airborne bacteria infect someone else.

Last year the Global Alliance for TB Drug Development, a nonprofit organization, began tests on a new treatment that would halve the time of treatment to two or three months, lowering the risks of developing resistant strains and expanding the number of patients receiving treatment.

In South Africa, no one knows how many people are infected with the particularly virulent strain announced last week, Professor Willem Sturm told the conference, highlighting the dilemma facing already overburdened health workers.

Victims in South Africa were ''all over the place ... you can almost be sure there will be infection in Mozambique and even farther (abroad) because people travel--and quite some distance,'' Sturm told the Associated Press.

The new extremely drug-resistant TB strain was discovered by rural doctor Tony Moll in eastern KwaZulu-Natal province, where it killed 52 of 53 HIV-positive patients within 16 days during a study carried out from January 2005 to March 2006.

Moll became suspicious he had a superbug on his hands when HIV-positive patients responded well to antiretroviral treatment, then suddenly died.

''What's the point in investing hugely in ARV programs if patients die a few weeks later from extreme drug-resistant tuberculosis?'' Dr. Paul Nunn, head of the U.N. World Health Organization's TB resistance program, said on the sidelines of the conference.

Drug resistance grows when people do not complete a grueling six-month regimen of medication that cures the disease. That is difficult in a country where there is high illiteracy and where people might have to walk half a day to the nearest health center, which might be out of medication. Many of the affected people are poor, and if they take the medication on an empty stomach they can often become sicker.

Multiple drug-resistant TB does not respond to a ''first line'' of drugs that in South Africa cost about $200 to cure a patient, compared to R24,000 to cure multiple drug-resistant TB. Extremely drug-resistant strains do not respond to a ''second line'' of drugs.

South Africa's Health Department said this week it was exploring the feasibility of importing two even more expensive drugs that might help. But Moll noted the new strain was so virulent that patients died even before doctors received the results of their tests. (AP)