PHA-Exchange> The Safe Health Care Working Group letter to WHO and UNAIDS

[stephen minkin]

Dear Friends,

The Safe Health Care Working Group is an international coalition of organizations and individuals concerned with preventing the transmission of HIV and other diseases in health care settings. We are seeking organizations to endorse the attached letter recommending practical steps that WHO and UNAIDS can take to meet these goals.

We will be releasing the letter on World AIDS Day, December 1, 2003. Please contact Eric Friedman, at Physicians for Human Rights, if your organization wants to endorse the letter, for further information or to join us. He can be reached at efriedman at phrusa.org; or by fax: 001-202-728-3053

Sincerely,

Safe Health Care and HIV/AIDS Working Group

December 1, 2003

Dear Members of the World Health Organization Executive Board and Members of the UNAIDS Programme Coordinating Board:

We are writing as organizations and individuals deeply concerned with the problem of the transmission of HIV and other bloodborne pathogens through unsafe health care practices, as well as other disease transmission in health care settings. We urge WHO and UNAIDS to encourage and facilitate infection control and prevention efforts, including by immediately taking steps to stop the transmission of bloodborne pathogens through unsafe blood transfusions, medical injections, and other medical procedures, such as those accompanying childbirth, and to minimize the transmission of these pathogens between patients and health care providers.

We appreciate the steps that your organizations have taken to promote safe health care. Your work with numerous countries to promote blood safety and injection safety is admirable. And last year’s efforts by UNAIDS to add universal precautions and injection safety to its estimates of the cost of HIV/AIDS interventions were important. Even as we look forward to the use of injection equipment that is safe for patients, providers, and the community, we commend WHO for its leadership in the WHO-UNICEF-UNFPA joint statement on the use of auto-disable syringes in immunization services and for setting the goal of the exclusive use of single-use injection equipment for all injections by 2005, crucial because immunizations represent less than 10% of injections in developing countries.

However, much remains to be done. WHO estimates that every year, about half a million people become infected with HIV through unsafe medical injections and unsafe blood transfusions. And according to the latest WHO estimates, every year unsafe medical injections alone cause 20.6 million hepatitis B infections and 2.0 million hepatitis C infections. It has been estimated that these hepatitis infections will ultimately cause about 1.2 million deaths – deaths that should be prevented. WHO has also recognized that interventions to ensure safe medical injections and a safe blood supply are among the most cost-effective ways of preventing HIV transmission in sub-Saharan Africa.

Making health care safe strengthens health care systems. Empowering health care workers to protect themselves and their patients by following the best practices of infection control and prevention, including by adhering to universal precautions, improves the quality and value of health care services. Enabling health care workers to adhere to universal precautions will also combat stigma and discrimination against people living with HIV/AIDS by helping to alleviate health care providers’ fears for their own safety when they are required to care for HIV infected patients without appropriate protective devices. 

The Safe Injection Global Network (SIGN), whose Secretariat is housed in WHO, the Blood Transfusion Safety team at WHO, and others within the Health Technology and Pharmaceuticals cluster at WHO have taken leadership in promoting the safe and appropriate use of injections, blood safety, and other forms of infection control. Nevertheless, we are deeply concerned that there is a continuing risk of transmission of HIV and other bloodborne diseases through unsafe health care, and many countries are not on track to meet the targets established by the UN General Assembly Special Session on HIV/AIDS (UNGASS) on blood safety, injection safety, and universal precautions. 

We urge you to take the following actions to achieve these targets and otherwise advance our shared goal of safe health care:

   Establish safe and appropriate use of injections as a priority. Establish the safe and appropriate use of injections as a priority for preventing transmission of HIV and other bloodborne pathogens in all regions where WHO estimates show a substantial proportion of unsafe or unnecessary injections. As recognized by SIGN, a safe injection is one that does not harm the recipient, does not expose the provider to any avoidable risks, and does not result in waste that is dangerous for the community. With this new emphasis: include messages on the safe and appropriate use of injections in all HIV/AIDS prevention materials, as appropriate; promote targeted programs on the safe and appropriate use of injections through public and NGO initiative; establish procedures to collect and disseminate information on injection practices; and encourage relevant research. We ask you to work with the WHO Secretariat to amend the core components of WHO’s Global Health-Sector Strategy for HIV/AIDS
 2003-2007 to include the safe and appropriate use of injections.

      Develop time-bound programs of action on blood safety and infection control and prevention, including injection safety.
      Global level: Through an open and participatory process, WHO and UNAIDS should establish plans to meet the goals in the United Nations General Assembly Special Session’s (UNGASS) Declaration of Commitment on HIV/AIDS of achieving universal blood safety and injection device security by 2005. Recognizing the UNGASS goal of implementing universal precautions by 2003, WHO and UNAIDS should similarly and urgently develop a strategy to promote universal precautions.
      National level: Regional and country WHO and UNAIDS offices should encourage governments that lack effective strategies in the areas of blood safety and infection control and prevention, including the safe and appropriate use of injections, to revise their national strategies on HIV/AIDS to include programs of actions in these areas, or to separately develop such plans. WHO and UNAIDS should assist governments in revising or developing these strategies. 


   Encourage countries to include universal precautions and blood safety in proposals to the Global Fund. Encourage countries to include blood safety and universal precautions, including the safe and appropriate use of injections, in their proposals to the Global Fund to Fight AIDS, Tuberculosis and Malaria as national circumstances warrant. WHO, UNAIDS, and other donors and lenders should provide technical assistance in helping develop these proposals. 

In high-income, industrialized countries, strengthening health care systems to prevent HIV transmission was one of the central and early responses to the AIDS epidemic, including the creation of safe blood systems as well as the development and implementation of universal precautions. The fact that health care was not the major source of transmission in wealthy countries did not delay or detract from the importance of these measures. A single health care-related HIV infection in developed countries leads to investigations to find and stop the source of infection. In developed countries, HIV transmission through unsafe health care practices is deemed absolutely unacceptable. The same standard must be adhered to in developing countries.

The Committee on Economic, Social and Cultural Rights, charged with monitoring adherence to the International Covenant on Economic, Social and Cultural Rights, has determined that appropriate and quality care is one of the "essential elements" of the right to health. By taking the steps above, your organizations can help give life to this right – and to all those whose lives depend on it.

 

Sincerely,

BD Medical Systems (United States)

Global Health through Education, Training and Service (United States)

Hindustan Syringes & Medical Devices, LTD (India)

International Association of Physicians in AIDS Care (international)

Medilinks (United States)

People's Health Movement-Geneva (Switzerland)

Physicians for Human Rights (United States)

Research Center for Phytotherapy and African Traditional Pharmacopoeia (CREPPAT) (Democratic Republic of Congo)

Retractable Technologies, Inc. (United States)

Safe Health Care and HIV/AIDS Working Group (international)

TheBellsConsultants (France)

 

CC: Dr. Jong-Wook Lee, Director-General, World Health Organization

Dr. Peter Piot, Executive Director, UNAIDS

Dr. Jack C. Chow, Assistant Director-General, WHO Cluster of HIV/AIDS, TB & Malaria

Dr. Paulo Teixeira, Director, WHO Department of HIV/AIDS 

Dr. Richard Feachem, Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria

 








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