The burden of disease attributable to sexually transmitted infections in South Africa in 2000

Objectives. To estimate the burden of disease attributable to sexually transmitted infections (STIs) in South Africa, to identify the factors contributing to this burden, and to review successes and failures in reducing this burden. Design. Years of life lost (YLL) and years lived with disability (YLD) were estimated using different approaches for HIV/ AIDS, other STIs and cervical cancer. Burden in respect of HIV/ AIDS was estimated using the ASSA2002 model, and for the other diseases the revised national burden of disease estimates for 2000 based on 1996 cause-of-death data were used. The ASSA2002 model was used to estimate numbers of AIDS deaths under different prevention and treatment scenarios. Setting. South Africa. Outcome measures. Deaths, YLL and disability-adjusted life years (DALYs) associated with HIV/AIDS, other STIs and cervical cancer. Results. STIs accounted for more than 26% of all deaths and over 5 million DALYs in 2000 and over 98% of this burden was due to HIV/AIDS. A combination of social, behavioural and biological conditions contribute to this burden. HIV/AIDS mortality and morbidity are estimated to have increased significantly since 2000, and the future change in this burden is largely dependent on the extent to which antiretroviral treatment and HIV prevention programmes are introduced. 2.5 million AIDS deaths could be prevented by 2015 if high levels of access to antiretroviral treatment are achieved. Conclusion. South Africa faces one of the largest STI epidemics in the world. A multifaceted strategy to prevent and treat STIs is needed, and burden of disease assessments should look beyond the role of 'unsafe sex' when attributing this disease burden to risk factors.