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Objective: To measure the impact of AIDS on adult mortality by systematically investigating all deaths during 3 months, in the city of Pointe-Noire where the HIV epidemic emerged 20 years ago and levelled-off around 5% among adults. Design: Exhaustive morgue-based study, in a city where by law all bodies should be registered at the morgue before they can be legally buried. Methods: From 30 June to 19 October 2001, a clinical examination of all bodies registered at the morgue was performed by a physician, and blood samples were systematically drawn for HIV testing. Relatives were interviewed on circumstances of death. Additional information was gathered from hospital files for cases previously hospitalized. Age- and sex-specific mortality rates were calculated using the population at risk derived from the 2001 census. Results: Overall, 1309 adult deaths were investigated and 96.5% of the bodies registered at the morgue were tested for HIV. Forty-five percent of the deaths (570) were due to AIDS. The HIV prevalence was higher in female than in male deaths (57.1 versus 44.8%; P < 0.001). The AIDS-mortality rate among adults was 6.3 per thousand for women and 4.9 per thousand for men. Among 1000 young adults aged 15 years, 442 girls and 482 boys will not reach age 60 years (45q15). Without AIDS these would have been 216 and 307, respectively. Conclusions: Our study provides a direct measure of the impact of AIDS on mortality relative to other causes. In the most productive age group, 25-44 years, mortality is tripled by AIDS.

OBJECTIVES:: The extent to which HIV affects pregnancy-related mortality in countries with high HIV/AIDS and maternal mortality is poorly understood. The objectives of this study were to investigate the mortality of women of reproductive age by both HIV and pregnancy status, and quantify the excess mortality attributable to HIV during pregnancy in Pointe Noire, Congo. DESIGN:: Prospective mortuary investigation of all deaths in women aged 15-44 years, during 112 consecutive days. METHODS:: Mortality rates by HIV and pregnancy were computed. During the study period, 378 corpses were examined, blood was tested for HIV and pregnancy, relatives were interviewed and hospital files were reviewed. Denominators were obtained from a census with women-years assigned to pregnancy and/or HIV based on levels of fertility and HIV prevalence in the city. RESULTS:: The mortality rate was 32 times higher [95% confidence interval (CI), 25-39] among HIV-positive than among HIV-negative women. The relative increase in mortality associated with HIV was much higher in non-pregnant [rate ratio (RR), 41; 95% CI, 32-52] than in pregnant women (RR, 4; 95% CI, 2-9). Among HIV-positive women, pregnancy appeared to confer a survival benefit. CONCLUSION:: These findings have important implications for the interpretation of trends in maternal mortality in the context of HIV. The apparent survival benefit of pregnant HIV-positive women is largely due to their low fertility in the latest stage of the disease. As the HIV epidemic matures and more women become severely ill, any potential adverse effects associated with HIV and pregnancy may be increasingly offset by selection effects, and maternal mortality may not increase further.

There is no evidence about an association between violent deaths and HIV in Africa. We report the results of a study performed in Pointe-Noire, Congo, where post-mortem HIV serologies were performed among all deaths referred to the morgue. The HIV prevalence among violent deaths was 37%, significantly higher than 10% among accidental deaths, with an adjusted odds ratio of 6 (P = 0.03). Prevention of domestic violence and fight against stigmatization should be parts of HIV programs in Africa.