PHA-Exchange> Non-sexually transmitted AIDS?

[claudio at hcmc.netnam.vn]

 from Garance Upham <garance at gawab.com> -----


The way in which poor people of this world are
suffering from HIV/AIDS is truly a catastrophe which
will surpass WWII in direct and indirect casualties.
After years of neglect, treatment is now on the
agenda. It was a moral disaster to ignore this for so
long, and we are just catching up with what must be
done.

Another issue has also been ignored for far too long:
In much of the world, people live – and die – with
health care that continues to transmit HIV through
unsterile procedures. Delivering and promoting medical
care that is unsafe without warning patients at risk
is medically unethical. Instead of correcting their
own behavioural lapses, health experts lecture their
victims about sexual behaviour. Sexual behaviour is a
risk for HIV, but it is far from the only risk.

Lancet’s recent series on reproductive health reports:
Sexual activity in young single people is greater in
industrialised countries with low rates of HIV
infection than in African countries with high rates.
Studies within Africa have shown the same: Young
adults in Yaounde, Cameroon, had more sexual partners
but less HIV infection compared to young adults in
Kisumu, Kenya, with fewer sexual partners but more
HIV. Countries with the worst AIDS epidemics – South
Africa, Botswana, Lesotho, Swaziland -- provide some
of the “best” access to reproductive health care.

Moreover, random sample surveys in African countries
(Demographic and Health Surveys) show that most
African women who are married and HIV-positive have
HIV-negative husbands. For example, in Ethiopia, over
75% of married, HIV-positive women have HIV-negative
husbands.

This is very telling:
- Reproductive health – including STD treatment,
antenatal care – appears to be a danger for HIV in
many countries with generalized epidemics.
- Faithful marriages may not reduce HIV rates, because
HIV enters the marriage through health care, and not
sexual “misconduct.”
- There is not more, but less promiscuity among youth
in Africa compared to Europe and America, yet HIV
continues to soar among African youth.

The over-emphasis on sexual prevention has blinded
people to the OTHER ways that HIV spreads. This
over-emphasis has also strengthened stigma against
people with HIV/AIDS, by spreading the belief that HIV
infection is a reliable sign of multi-partner sexual
behaviour that many people consider to be immoral or
disreputable.

The WHO 2006 report on the HIV epidemic, indicates, as
in every previous year, that intravenous drug users
(IDUs) sharing needles are heavily contaminated. But
medical injections are much more common and can be as
dangerous as injections among IDUs Is there something
peculiar about patients in Africa and India which
would protect them from contracting an HIV infection
when they receive an injection with a needle
previously used on an AIDS patient? African magic
perhaps?

The risk of accidental transmission of HIV through
blood (HIV is a bloodborne retrovirus, isn’t it?) is
extremely low in rich countries, but is important in
many countries in Africa and some countries in Asia
and the Caribbean. In much of Africa and Asia:
- Blood transfusion is still unsafe because blood is
often not tested for HIV
- Medical injections are unreliably sterile. Many
providers reuse needles and/or syringes without
sterilization. Multidose vials may become contaminated
through reused equipment, spreading infections to
subsequent patients.
- Blood collection may be unreliably sterile (eg,
plasma collection was responsible for a large HIV
outbreak in China, and other outbreaks in Mexico and
India).
- Infection control is unreliable during tattooing,
dental care, and many other blood exposures in health
care and cosmetic services.

The ongoing investigation of an outbreak of HIV among
children in Kazakhstan is an example of what needs to
be done to stop HIV in all of the countries where HIV
has invaded the general population. In Kazakhstan,
after doctors noticed some HIV infections in children
with HIV-negative mothers, public health officials
investigated. They tested thousands of children who
had attended hospitals to find who was infected. To
date, they have found more than 80 children who were
infected through hospital procedures earlier this
year. Investigations like this are able to trace
infections to specific clinics, wards, and procedures.
In this way, infection control lapses can be found and
stopped. Without these investigations, hospitals and
clinics can continue for years and years to pump HIV
infection into the community. Years later, when those
who have been infected develop AIDS, the infection may
be blamed on sex. If people in Africa and India who
are aware of these risks do not demand investigations
of unexplained HIV infections – as in Kazakhstan – how
many of their relatives and neighbours will be
infected over the next decade through unsafe health
care?

Mariette Correa, Lillian Salerno, David Gisselquist, Jean-Jacques Monot, 
Nance Upham,



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