'AIDS' death certificate causes a stir

In the first case of its kind in the country, a South African pathologist has been brought before the Health Professions Council (HPCSA), a national health watchdog, for mentioning AIDS as the cause of death on a medical certificate.

Greer van Zyl, a spokesperson for the HPCSA, confirmed that the next-of-kin of a young woman who died in April 2005 had filed a complaint against former state pathologist Dr Leon Wagner, but said that so far only the formal complaint had been made and the hearing to decide the matter had been postponed.

"The family has charged Wagner with unprofessional conduct after he apparently recorded AIDS as the cause of death without proper evidence or examining the body, as well as for a breach of confidentiality.

But, due to the complexity of the case, it has been handed to our Human Rights and Ethics Committee," Van Zyl told IRIN/PlusNews.

In South Africa, medical certificates issued to the family in the event of a death attribute the cause to diseases such as tuberculosis (TB) or pneumonia, without mentioning AIDS, even if AIDS was a contributing factor, to protect the confidentiality of the deceased's status, and the family from stigma.

Van Zyl said, "Objections to the charges have been overturned by the HPCSA disciplinary committee, and the charges against Wagner will remain when the hearing resumes at a date mutually agreed upon by the complainant and the defendant."

Fatima Hassan, of the AIDS Law Project (ALP), a nongovernmental organisation providing legal assistance, agreed that the case was a sensitive one, but was confident that the HPCSA would handle it with the level of attention it deserved.

The issue has sparked debate about the extent to which families might cover up the real reason for the demise of HIV-positive relatives.

The opposition Democratic Alliance (DA) party stressed that there was still a large degree of stigma attached to AIDS and the families of HIV-positive people, even though an estimated 5.5 million of South Africa's 45 million population are living with the disease.

According to DA health spokesman Gareth Morgan, "Current policies, which protect the confidentiality of patients at all costs, could actually be hurting the national AIDS awareness campaign. Perhaps by listing AIDS as the cause of death on the certificate we could better monitor the pandemic, as well as eradicate existing stigma and continued denial among both families of patients and the government."

South Africa's approach to the pandemic has often drawn international criticism, usually as a result of Health Minister Manto Tshabalala-Msimang's promotion of natural remedies rather than antiretroviral (ARV) drugs, and the slow pace of the government's ARV rollout.

The first page of a death certificate, which went to the family, only indicated whether someone had died of natural or unnatural causes, while the second page contained more details, such as whether HIV/AIDS or any other factor had contributed to the death, and was used for statistical purposes.

Hassan did not believe statistical reporting on AIDS would improve if doctors listed the disease as a cause of death on both pages.

"As it stands, doctors are already required to submit two certificates, one to the family, and another to the government."