South Africa's death rate rose sharply over a seven-year period and the increase is partly due to the country's staggering AIDS epidemic, the government said.

The government statistical office said the death rate for women aged 20 to 39 had more than tripled between 1997 and 2004, and had more than doubled for men aged 30 to 44. It said those groups had the highest number of deaths from AIDS.

The report gave no estimate for the increase in HIV deaths, saying many AIDS-related deaths are attributed on death certificates to other causes.

"Large increases in the death rates of women in their 20s and 30s since the late 1990s are thought to result mainly from HIV," the government said in its report Thursday.

The government said the increase in the death rate is also due to nutritional deficiencies and infectious diseases such as tuberculosis and malaria.

However, the government said levels of HIV infection have risen rapidly and that the average time from becoming infected to death was eight to 10 years. It was likely that "HIV deaths will continue to increase in South Africa for some years," according to the report.

The percentage of pregnant woman who are HIV-positive had risen from 1 percent in 1990 to 17 percent in 1997 and to 30 percent by 2004, the last year covered by the report.

Overall, the government has estimated more than 5.5 million South Africans are infected with HIV, a number second only to India and one that amounts to about an eighth of estimated cases worldwide.

On average, more than 900 people die of the disease in South Africa each day.

South Africa's government has come under mounting international criticism because of its handling of its AIDS epidemic. President Thabo Mbeki once questioned the link between HIV and AIDS and both he and Health Minister Manto Tshabalala-Msimang have doubted the effectiveness of anti-retroviral drugs used to treat AIDS.

More than 80 international AIDS scientists, including an American Nobel laureate and one of the co-discoverers of the virus that causes AIDS, released a letter to Mbeki on Wednesday that called South Africa's AIDS policies inefficient and immoral and urged the president to fire his health minister.

Stephen Lewis, the U.N. Special Envoy for AIDS in Africa, delivered a scathing attack on South Africa at the International AIDS conference in Toronto last month, saying the government was "still obtuse, dilatory and negligent" about providing treatment.

"It is the only country in Africa whose government continues to promote theories more worthy of a lunatic fringe than of a concerned, compassionate state," he said.

South Africa called Lewis' comments "unacceptable" and claimed to have the largest HIV treatment program in the world. It said it was treating 140,000 people in treatment programs, a figure less than half of the 380,000 target it set in 2003. The AIDS scientists said about 500,000 South Africans now need AIDS drugs to survive.

The increase in the death rate for almost every age and gender group in the study was particularly disturbing because the worldwide trend is for the rates to decline over the period.

"South Africa is a member of a select but undesirable group of countries in which life expectancy at birth declined by four years or more between 1990 and 2001," the government said. It said all the countries are either in Africa or part of the former Soviet Union.

The report found that deaths from murder, suicide and accidents changed little and the number of killings had declined since the late 1990s. But the government said South Africa probably still has "the second highest homicide rate in the world, trailing only Colombia."

A controversial policy promoting abstinence education to fight AIDS may be the best way to get men to treat women better, which experts agree is key to battling the AIDS epidemic, U.S. government AIDS officials said on Wednesday.

But a congressional investigator said a study found that the policy often confused AIDS workers and may have interfered with prevention efforts.

"We are teaching young men a lot of important lessons about respecting women," U.S. Global AIDS Coordinator Mark Dybul told the hearing of the U.S. House of Representatives Subcommittee on National Security, Emerging Threats and International Relations.

The legislation that funds the President's Emergency Plan For AIDS Relief, or PEPFAR, requires that 33 percent of all money spent on prevention in 2006 must be used to promote abstinence. This has been controversial, with some groups that are funded by PEPFAR complaining they cannot provide services because of the restriction.

Dybul defended the ABC policy -- which stands for Abstain from sex before marriage, Be faithful, and use Condoms -- as the best way to achieve this. "The data for ABC are overwhelming," Dybul said.

The AIDS virus infects close to 40 million people globally and has killed nearly 25 million.

CARE says that worldwide, 80 percent of women newly infected with HIV are monogamous, but their husbands or partners are not. In sub-Saharan Africa, women make up 60 percent of those infected with HIV.

Experts agree a big part of the problem is that women globally are unable to refuse sex and are unable to force men to be faithful or to use condoms.

Dybul said PEPFAR was addressing this.

"If men learn ABC, if men practice ABC, gender issues become easier to deal with," Dybul said. "Men will negotiate."

He described a program in Namibia that aims to stigmatize older men, called "sugar daddies," who prey sexually on young girls. "Sometimes stigmatization is a good thing," he said.

He also defended the use of religious pressure.

"If these folks are from a Muslim culture or orthodox culture and if there is something there that stresses monogamy or faith or not lying, for goodness sakes use those arguments," Dybul said. "We have got to stop the spread of HIV."

Connecticut Republican Rep. Christopher Shays (news, bio, voting record), who held the hearing, said perhaps the problem simply lies in the way the funding legislation is written -- it requires that 33 percent of prevention funds spent in 2006 be spent promoting abstinence.

"The program you just described, teaching a different behavior, I think there is a logic to that," Shays said. "But there is no logic to me that says one-third (of funding) should go that way."

President George W. Bush has asked Congress for $4 billion to fight AIDS in 2007, a big increase from the $3.2 billion budgeted this year and by far the biggest amount spent by any government.

David Gootnick, director of international affairs and trade at the General Accountability Office, said a GAO study showed that abstinence-until-marriage spending requirement "presents challenges to most" of the groups trying to spend that money.

"About half of the country teams indicated that adherence to the spending requirement can undermine the integrated nature of HIV/AIDS prevention programs," Gootnick told the hearing.