HIV/AIDS Mortality in the Eastern Cape Province of South Africa, 2000–2023: Trends, Age–Sex Composition, and a Persistent Provincial Burden

The Eastern Cape of South Africa carries the highest crude AIDS mortality rate nationally (135.86 per 100,000 in 2023), yet a province-specific, age-sex disaggregated analysis extending beyond 2012 does not exist. This study examined AIDS mortality trends in the Eastern Cape from 2000 to 2023. A quantitative ecological design was employed using secondary analysis of modelled estimates from the Thembisa Provincial HIV Model version 4.8. Annual AIDS deaths across nine age–sex subgroups and crude AIDS mortality rate were extracted from the Eastern Cape, 2000–2023, with provincial comparisons for 2023. Total AIDS deaths declined by 72.1% from 33,301 in 2005 to 9300 in 2023. Child deaths fell 96.1% from peak. Male youth deaths (15–24) plateaued after 2015. Adults aged 50 and older constituted 24.1% of deaths in 2023, with numbers increasing since 2019. Despite substantial gains, three unresolved gaps persist: a male youth mortality plateau, an ageing epidemic burden, and the highest provincial AIDS mortality rate nationally. Targeted differentiated interventions are urgently needed.