This paper describes the South African cause-of-death profile in 1996, the latest year for which routine data are available. Underreporting of deaths, misclassification of causes and HIV/AIDS make face value interpretation of reported cause-of-death data difficult. Changes in subsequent years due to HIV/AIDS are considered using model projections. South Africa is undergoing a protracted bipolar transition with the coexistence of both diseases of poverty and emerging chronic diseases. In 1996 these accounted for similar proportions of the premature mortality, about 27% for males and 35% for females, with the added burden of injuries accounting for a further 35% in males and 16% in females. Tuberculosis (TB), lower respiratory tract infections, diarrhoea, HIV/AIDS, perinatal diseases, malnutrition and septicaemia contributed to the pretransitional conditions, while stroke, diabetes, ischaemic heart disease, hypertensive heart disease, asthma, chronic obstructive lung disease, cancer of the lung in men and cancer of the cervix in women contributed to the premature mortality due to non-communicable diseases. Homicide is the major cause of injury death for men while unintentional injuries are the major cause of injury death for women. Projections suggest that this triple burden (diseases of poverty, emerging chronic diseases and injuries) has now become a quadruple burden resulting from the HIV/AIDS epidemic and that without interventions to reduce mortality, by the year 2010, AIDS deaths will account for double all other causes of death combined. While efforts to improve the cause-of-death statistics are needed, the current data clearly suggest that comprehensive public health strategies to improve the health of the nation must be strengthened, and reducing the number of deaths that can be expected to result from AIDS requires urgent attention.