Bridging the Gap: Conference Record [Abstract book, International Conference on AIDS (12th: 1998: Geneva, Switzerland)]

478 Abstracts 24189-24193

12th World AIDS Conference

a efficient system of access to the information, talking about the analysis, the
software give us clearer handler of the information, but the strategies and the
recommendation must be analyzed with the traditional methods and also with a
multidisciplinary team
24189 The impact of HIV on mortality in Africa: Evidence from
national surveys and censuses
lan Timaeus. Centre for Population Studies, LSHTM, Keppel Street, London
WCIE 7HT, UK
Objective: To measure recent trends in all-cause child and adult mortality in
national populations in Africa.
Methods: The data analysed were collected in the Demographic and Health
Survey (DHS) programme of household surveys and in national censuses. The
primary index of child mortality used is the probability of dying before age 5. For
adult mortality, it is the probability of dying between ages 15 and 60. Mortality
trends are measured in 3 ways: by comparing mortality data collected in the
1990s with those from the 1980s, by using the birth and sibling survival histories
collected in DHS surveys, and by comparing the latter estimates with estimates
from data on orphanhood.
Results: Under-five mortality is stagnant or rising in several African countries.
In some countries, however, an adverse trend developed too early in the 1980s to
be attributable to HIV. The 3 approaches to monitoring increases in adult mortality
yield largely consistent results. Adult death rates doubled or tripled between
the 1980s and mid-1990s in Uganda, Zambia, and Zimbabwe. They also rose
substantially in the other Eastern African countries for which data exist but not
in those in Western Africa. By 1996, 60 per cent of those Zambians surviving to
age 15 could expect to die before age 60. The rise in mortality is concentrated
among young adults. In most countries, men have been affected worse so far. In
Uganda, however, adult women's mortality has risen most.
Conclusions: Data can be collected in household surveys and censuses to
monitor the mortality impact of HIV in African populations. The available data
begin to document the differential impact of the epidemic. In countries where
HIV became prevalent by the late-1980s and for which data exist, massive rises
in mortality occurred by the mid-1990s. Support needs to be provided for the
collection of further such data.
241901 Changes in trends of AIDS as a cause of death in
Catalonia (Spain): 1985-1995
Caries Blanch, M. Vallmayans, A. Maguire, J. Casabona. Ceescat Hospital Uni
G. Trias / Pujol, CRTA, Canyet, S/N 08916 Badalona, Spain
Aim: To compare trends in AIDS mortality in Catalonia by age groups.
Methods: Data were gathered from the Mortality Register in Catalonia and
from the integrated system for epidemiologic surveillance of HIV/AIDS (SIVES).
Age specific AIDS mortality rates were calculated and standardized to the 1991
population thus permitting the evaluation of trends in these rates the period 1985
to 1995.
Results: Catalonia is an autonomous region in northeast of Spain with 6 million inhabitants and has one of the highest cummulative incidence for AIDS in
Europe. Most affected by the epidemic have been the 20-29 and the 30-39 year
old age groups, for whom by 1991 AIDS had become the first cause of death.
The mortality rate for the 20-29 age group peaked in 1994 being 24.7% higher
than the rate observed in 1990, however the rate for 1995 dropped by 11.5% in
comparison with the previous year. No such inflection in rates was observed for
the 30-39 group which had increased by 216% between 1990 and 1995. Similarly,
an important increase was also observed among 40-49 year olds between 1990
and 1995 (177%). The trend for this group, as from 1992, was similar to that
observed for the 20-29 group three years earlier. With regards to AIDS incidence
and new diagnoses of HIV infection, there is evidence that the mean age newly
diagnosed cases of HIV and incident AIDS cases in Catalonia is increasing; in
1990, the mean age at AIDS passed the 30 year old threshold for both sexes.
Conclusions: Whilst the mortality rate for AIDS in the group of 20-29 has
begun to decrease, it is still the first cause of death in this group. Interpretations
of this decrease should be cautious. Seemingly, efforts in early HIV diagnosis,
prophylactic medication and a relative increase in median survival time of AIDS
cases, are shifting the impact of mortality to older age groups. However, the decrease of the impact of AIDS mortality in the youngest AIDS groups is foreseable
but will proabably be countered by an increase in mortality among older groups
for whom the impact has been moderate up until now. To evaluate the impact of
AIDS on mortality other, older, age groups should be considered.
S24191 Regional and gender differentials in patterns of HIV/AIDS
hospitalisation and mortality in Canada
Robert Hogg, Marianne Harris, A. Weber, R.S. Hogg, M.T. Schechter,
M.V. O'Shaugnessy. Canadian HIV - Pacific Region, Vancouver BC; B.C. Center
for Excellence in HIV/AIDS, Vancouver BC, Canada

Objective: To assess the impact of HIV/AIDS on hospitalization and mortality
patterns in Canada with reference to gender and regional differentials and to
other leading causes of premature morbidity and death.
Methods: Hospitalization and death due to HIV/AIDS were compared with
select leading causes of morbidity and mortality among men and women across
provinces, regions and select cities in Canada between 1987-94. Rates of hospi
talization and mortality were determined by calculating the standard hospitalization
rate (SHR) and standard mortality rate (SMR) respectively. Age-specific hospitalization (ASHR) and death (ASMR) rates were also calculated. Both age-specific
and standardised rates were expressed per 100,000 population.
Results: Compared with other select causes, HIV/AIDS was found to be a
leading cause of hospitalization and mortality among men and women across
Canada. Rates of hospitalization were highest for men in the provinces of Ontario
(SHR 1.09 95%CI 1.07, 1.11), Quebec (SHR 1.15 95%CI 1.13, 1.18) and BC
(SHR 1.47 95% CI 1.43, 1.50), and in the cities of Montreal (SHR 5.16 95% CI
5.05, 5.28), Toronto (SHR 6.32 95% CI 6.27, 6.47) and Vancouver (SHR 5.80 95%
CI 5.64, 5.98). The hospitalization rate was lower among women than among
men, and was higher than the Canadian average in the province of Quebec (SHR
1.90 95% CI 1.81, 1.99) and the cities of Montreal (SHR 8.05 95% Cl 7.62, 8.50),
Toronto (SHR 3.03 95% Cl 2.71, 3.37) and Vancouver (SHR 2.81 95% Cl 2.44,
3.21). HIV/AIDS mortality for men and women also increased from 1987-1994.
HIV/AIDS mortality rates for men were highest in BC (SMR 1.50 95% CI 1.43,
1.58) and Toronto (SMR 7.51 95% Cl 7.15, 7.88) For women, the rates were
highest in Quebec (SMR 2.04 95% Cl 1.81, 2.29) and Montreal (SMR 6.65 95% Cl
5.60, 7.84). Age-specific hospitalization and mortality rates for men and women
aged 25-44 years increased over the study period
Conclusions: Our analysis reveals the considerable impact of HIV/AIDS on
patterns of morbidity and mortality in Canada. Most notably, HIV/AIDS morbidity
and mortality among women in middle age are currently on par with levels associated with some leading causes of illness and death like lung cancer. Most
of the HIV infections associated with our data occurred, on average, at lease a
decade ago. Therefore, rates of HIV/AIDS hospitalisation and mortality in Canada,
especially among women, will likely continue to increase.
S24192 Mortality impact of the AIDS epidemic: Evidence from
African community based studies
Ties Boerma. Tanesa Project, PO. Box 434, Mwanza, Tanzania
Objectives: To evaluate critically the mortality findings from community based
studies in African countries, and to compare selected measures with their equivalents from studies of cohorts selected in clinics and workplaces, and measures
from developed country studies.
Methods: Mortality measures reviewed include age-specific mortality of the
HIV positive, the relative mortality of HIV+ and HIV-, and indices of impact at the
population level. Child and adult mortality effects are considered separately, and
inter-actions with TB are discussed. Most of the data come from the Lake Victoria
region.
Results: Community studies indicate a median survival time from infection of
about 7 years - higher than early indications from studies of sex workers and blood
transfusion patients, lower than estimates based on follow-up of fertility based
samples. Mortality among HIV+ adults ranges from 90 to 110 per thousand, with
a substantial proportion of HIV infected deaths occurring before the development
of clinical AIDS. In communities with prevalence levels between 8% and 20%,
the population's probability of dying between 15 and 60 is 2 or 3 times the same
probability for the HIV negative. Women lose more years of life, on average,
than men, as they are infected earlier. Excess mortality of children born to HIV+
mothers is most evident in infancy, but is also apparent at ages 1-4.
Conclusions: Clinic-based samples are not suitable for the study of HIV related
adult mortality, but may be adequate for studying child mortality impacts. Community based studies are needed urgently in southern Africa where the epidemic
is increasing very rapidly.
24193 AIDS mortality in Brazil, 1980-1995
Maria Goretti Fonseca, Euclides Castilho, M.R.O. Gomes. Brazilian AIDS
Program MOH, Espl. Ministerios BI. G. Brasilia DF 70058-900, Brazil
Objective: To describe the AIDS mortality impact in Brazil.
Methods: National mortality data on AIDS reported from 1980 to 1995 were
analyzed according to rank of causes of causes of mortality, age, sex, and three
regions (created according to the magnitude of the States AIDS incidence rates:
high, medium, and low).AIDS was codified as 279.1, in the ICD 9.
Results: In Brazil, a total of 69,503 deaths due to AIDS were reported from
1980 to 1995. Only after 1991 it appeared among the principal causes of death.
In 1995, AIDS became the 11th cause, representing, 1.71% of all causes of
death. Eighty percent of AIDS deaths were among males, and 69% were aged
20 to 39 years. The male: female ratio decreased from 24:1, in 1985, to 3:1, in
1995. The mortality rate in men increased from 0.22, in 1985, to 15.08 deaths
per year by 100,000 men, in 1995. Among women, the rate increased from 0.01
to 4.48 deaths per year by 100,000 women in the same period. The high AIDS
incidence (States of Sio Paulo, Rio de Janeiro and Distrito Federal), the mortality
rate increased 1.5 deaths per year per 100,000 population (ranging from 0.3 to
21.5 deaths per 100,000 inhabitants from 1985 to 1995); in the medium AIDS
incidence region, the mortality rate increased 0.3 deaths (ranging from 0.02 to
4.9 deaths per 100,000 inhabitants in the same period); the low AIDS incidence

region had an increase of 0.1 deaths in the period.
Conclusion: AIDS epidemic has stated to become an important cause of death
in Brazil. Women are having an important contribution in the AIDS mortality impact
in Brazil.