The objective of our study was to understand the trend of AIDS deaths and the impact of AIDS-related deaths on the local mortality rate in seven villages in Shangcai County, Henan Province. A retrospective study survey among all deaths was conducted through household visits from 1 January 1995 to 31 October 2007 in seven administrative villages in Shangcai County of Henan Province. The cause of death and characteristics of the deceased were analyzed. There were a total of 2546 deaths, of which 521 (20.5%) were HIV/AIDS-related, 525 (20.6%) were suspected AIDS deaths, and 1500 (58.9%) were unrelated HIV/AIDS deaths. The proportion of deaths among people aged 20-49 years was less than 20% from 1995 to 1997, but increased to 27.4% in 1998, and reached 49.2% in 2001, followed by a decrease in succeeding years, dropping to 29.5% in 2007. HIV/AIDS-related and suspected deaths among those aged 20-49 years accounted for 63.9% and 70.9% of all deaths, respectively. The overall mortality rate was 7 per thousand from 1995 to 1999, and 14.9 per thousand in 2002. Our study shows that confirmed HIV/AIDS-related deaths and suspected AIDS deaths were the main cause of deaths at the local level after 1998, especially among those aged 20-49.