PHA-Exchange> Unsafe healthcare "drives spread of African HIV"

[Aviva]

From: "Stephen Minkin" <niphiv at yahoo.com>

> Dear PHM Friends,
> 
> I urge you all to read the following press release
> about the current issue of the International Journal
> of  STD and AIDS. It presents groundbreaking evidence
> that while sexual transmission is a reality, medical
> infections are the major source of HIV transmission in
> many Africa countries and therefore many other parts
> of the world.   
> 
> It is time for a dialogue to re-examine many of the
> assumptions about HIV and Africa. In the United States
> and  Europe the most important successes in HIV
> prevention have been in eliminating the medical
> transmission of HIV. In this respect there have been
> many African success stories, but there is still a
> great deal more to learn and do. 
> 
> There are important questions raised by these research
> finding. As a contributor, I encourage you to read the
> articles with an open mind. I personally believe that
> the work presented will lead to a rethinking about HIV
> transmission and thereby open new doors to prevention.
> 
> Remember that there is no equality without quality. 
> Best wishes,

> Steve Minkin
> Coordinator, The Network for Infection Prevention
> (NIP)
>   
> Unsafe healthcare "drives spread of African HIV"
> 
> Since the 1980s most experts have assumed that
> heterosexual sex transmitted 90% of HIV in Africa. In
> the March International Journal of STD and AIDS, an
> international team of HIV specialists presents
> groundbreaking evidence to challenge this consensus,
> with "profound implications" for public health in
> Africa. 
> In a series of articles, Dr David Gisselquist, Mr John
> Potterat and colleagues argue that the spread of HIV
> infections in Africa is closely linked to medical
> care. In their unique study of existing data from
> across the continent they estimate that only about a
> third of HIV infections are sexually transmitted.
> Their evidence suggests that "health care exposures
> caused more HIV than sexual transmission", with
> contaminated medical injections being the biggest
> risk.
> Sexual behaviour
 HIV and STDs: According to the authors' data,
> African HIV did not follow the pattern of sexually
> transmitted disease (STD). In Zimbabwe in the 1990s
> HIV increased by 12% a year, while overall STDs
> declined by 25% and condom use actually increased
> among high-risk groups.
> 
 Infection rate: HIV spread very fast in many
> countries in Africa. For the increase to have been all
> via heterosexual sex, the study claims, it would have
> to be as easy to get HIV from sex as from a blood
> transfusion. In fact, HIV is much more difficult than
> most STDs to transmit via penile-vaginal sex.
> 
 Risky sex? Several general behaviour surveys
> suggest that sexual activity in Africa is not much
> different from that in North America and Europe. In
> fact, places with the highest level of risky sexual
> behaviour, such as Yaounde in Cameroon, have low and
> stable rates of HIV infection. "Information.from the
> general population shows most HIV in sexually less
> active adults" . 
> Did medical care spread HIV?
 Children and injections: Many studies report
> young children infected with HIV with mothers who are
> not infected. One study in Kinshasa kept track of the
> injections given to infants under two. In one study,
> nearly 40% of HIV+ infants had mothers who tested
> negative. These children averaged 44 injections in
> their lifetimes compared with only 23 for uninfected
> children.
> 
 Good access to medical care: Countries like
> Zimbabwe, with the best access to medical care, have
> the highest rates of HIV transmission. "High rates [of
> HIV] in South Africa have paralleled aggressive
> efforts to deliver health care to rural populations".
> 
 Riskier to be rich: Most STDs are associated
> with being poor and uneducated. HIV in Africa is
> associated with urban living, having a good education,
> and having a higher income. In one hospital in 1984,
> the rate of HIV in the senior administrators was 9.2%,
> compared with the average employee rate of 6.4%. 
> 
> "People often see what they wish to see" 
> The authors suggest several reasons why evidence has
> been ignored until now, including the West's
> preconceptions about African sexuality, the fear that
> people might lose trust in healthcare, and simple
> disbelief that medical practices could be so unsafe. 
> 
> They conclude: "a growing body of evidence points to
> unsafe injections and other medical exposures to
> contaminated blood" as an explanation for the majority
> of the spread of the epidemic. "This finding has major
> ramifications for current and future HIV control
> programmes in Africa".