[afro-nets] AIDS In Africa Mostly Caused By Unprotected Sex... (2)

General afro-nets
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AIDS In Africa Mostly Caused By Unprotected Sex... (2)
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Dear Rana

Your synthesis is informative but I think there is an error in
your concluding remarks about South Africa. The HIV prevalence
figures that I have seen for white South Africans is adults 7%
but children 11%. If these figures are correct it is powerful
evidence that some other mechanism for HIV infection has been at
play.

I hope that health services have cleaned up their act on needles
and syringes, but I have seen in too many countries - in West
Africa, Southern Africa, and South Asia - needles being used
from one patient to the next in line with minimum or no clean-
sing between, during the 1980s and 1990s. I agree with Joint
U.N. Program on HIV/AIDS and the World Health Organization that
sexual transmission predominates but that we need to have more
risk reduction practices in health services and better systems
for monitoring transmission through health services. I do not
think that this is incompatible with there having been signifi-
cant transmission through health services, and potential for
significant transmission through health services with any lapses
into the behaviours I have seen in the past.

Yours,

Ruth Hope
mailto:rhope@s-3.com

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AIDS In Africa Mostly Caused By Unprotected Sex... (4)
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Dear Ruth Hope,

Thanks for your message. Just to clear the issue, I have just
forwarded the posting from UN service. So concluding remarks are
their and not mine. I do agree with you and others on the list
that unsafe syringes are a major problem not only in spreading
HIV in Africa but also spreading other infectious diseases in
other parts of world (e.g. hepatitis in south Asia).

Regards,

Dr Rana Jawad Asghar
Program Manager Child Survival, Mozambique
Provincial Coordinator Sofala Province, Mozambique
Health Alliance International, Seattle, WA, USA
http://depts.washington.edu/haiuw/
Coordinator South Asian Public Health Forum
http://www.saphf.org
mailto:jawad@alumni.washington.edu
http://www.DrJawad.com

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AIDS In Africa Mostly Caused By Unprotected Sex... (7)
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Safe Health Care and HIV/AIDS Working Group

RECOMMENDATIONS TO MEMBERS OF THE EXECUTIVE BOARD - WORLD HEALTH
ORGANISATION

Preventing Transmission of HIV and other Diseases through Unsafe
Health Care (January 2004)

Incorporate safe health care in "3 by 5"

As members of the Safe Health Care and HIV/AIDS Working Group,
we are encouraged to see WHO's World Health Report 2003 remind
the world that HIV is a "bloodborne retrovirus" and acknowledge
that "Poor-quality health care...contributed to the entrenchment
of" HIV/AIDS. We hope that this statement will inform planning
for the immensely important "3 by 5" initiative, so that the
initiative does not become a source of new HIV infections. We
are encouraged that WHO recommends that "The safety of health
care procedures should be ensured through the use of universal
precautions, blood safety measures, safe injections and medical
waste management." We hope that WHO and its partners will be
certain to ensure that this recommendation is implemented, and
that safe health care is incorporated into treatment scale-up
efforts at all levels.

Encourage public discussion of health care risks and safety
measures

As WHO addresses the transmission of HIV and other bloodborne
pathogens through unsafe health care practices, we are concerned
about the need for public discussion of risks for HIV and other
bloodborne pathogens in health care and associated prevention
measures. Public awareness and discussion of health care risks
for HIV are crucial to the evolution and application of effec-
tive solutions. While experts in WHO and other organizations
have much to offer, workable solutions will come from the people
who are on the frontlines as patients and healthcare workers,
who know their conditions and risks, and who will be the ones to
implement solutions.

To ensure a comprehensive approach to health care safety, in-
cluding public awareness, we urge WHO to develop and promote
policies in the following areas:

* Incorporate safe health care messaging into HIV/AIDS public
education for HIV prevention.

* Provide training for health care providers in resource-
strapped settings to help ensure adherence to safe health care
practices.

* Monitor and identify gaps in collecting information about
health care transmissions of HIV, including in HIV-positive
children with HIV-negative mothers.

* Conduct outbreak investigations of iatrogenic infections (as
in Libya, Russia, and Romania).

* Ensure single-use equipment for drawing blood (for HIV testing
and other aspects of "3 by 5").

* Ensure the appropriate use of injections.

* Assist countries in choosing and supplying equipment for
health care safety (including syringes with re-use prevention
features and safety features).

* Institute infection prevention and control policies and guide-
lines in all health care facilities (public and private), in-
cluding home-based care.

* Ensure adequate supplies of syringes, gloves, and other infec-
tion prevention and control items (including possibility of de-
veloping an essential supplies list to parallel WHO's essential
medicines list).

* Incorporate health care safety into maternal health programs.

* Ensure safe health care aid in post-conflict settings (such as
in Sierra Leone).

For more information, please contact
Eric Friedman
Physicians for Human Rights, USA
Tel: +1-202-728-5335
Fax: +1-202-728-5335
mailto:efriedman@phrusa.org
http://www.htm-journal.info

--
The Safe Health Care and HIV/AIDS Working Group is an interna-
tional coalition that includes members from NGOs, health minis-
tries, academic institutions, labor unions, and industry, all
committed to ending the transmission of HIV, hepatitis B and C,
and other bloodborne pathogens through unsafe health care. We
believe that all forms of HIV transmission must be stopped, and
do not seek to minimize the importance of stopping sexual trans-
mission. We maintain that respect for human rights must underpin
all responses to HIV/AIDS, and that the right to safe health
care is held by all people, everywhere.

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AIDS In Africa Mostly Caused By Unprotected Sex... (6)
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Dear All

The issue is important, because the question is: Should billions
of dollars continue to go on sex education by itself? A, B or
C??? or should the money start flowing to rebuilding collapsed
health infrastructure? Could it be the case that structural ad-
justment etc. have collapsed the health systems such that there
is not even the slightest disinfection procedures in most health
centers in many places of Africa? If needles are said to play no
part "because" SA has better health system than neighbours, is
it saying that the RSA has the highest rates because it has the
highest sexual activity and the lowest rate of "safe" sex? Are
South Africans able to have ten times more partners than Sene-
galese?

There is NO correlation between sexual behavior and HIV rates in
countries of Africa, several studies have shown that. I would
venture that malaria and TB are also causes for HIV transmission
(recent studies over several hundred women in Uganda over five
years have shown an increased risk of MTCT when the pregnant
mother has malaria), this means that all forms of transmission
will be enhanced in an environment where there are lots of com-
mon diseases of poverty (there are also studies in SA showing
that children with Helminths have a greater risk for TB, and we
know that TB increases the chances of HIV transmission).

Why deny the risk from injections? There are studies on paraly-
sis induced by intramuscular injections (for example Barenne,
Pasteur Institute) 1998 which reports on 80% non-sterile injec-
tion in Africa!!! Even the WHO's own figures put it at about 35%
internationally (Hutin) for all developing countries (figure
goes up to 70% for parts of Eastern Europe and Asia. - Why the
hysteria about HIV/AIDS being a disease of poverty like any
other?

I was involved for about ten years in seminars to prevent the
transmission of HIV in health care settings in French speaking
Africa. There is not ONE Minister of Health who will not tell
you that it is not a problem. Why can't we let Africans decide
what is their priorities! A Safe health care and HIV working
group has been set up with NGOs, Unions, and others (see other
e-mail on our letter to the WHO), coordinated by Physicians for
Human Rights. We are not denying sexual transmission, we just
say that unsafe health care is a VERY big problem that needs to
be addressed! The WHO World Health report 2003 itself says that
HIV is a "bloodborne pathogen" and that run down health system
and high indebtedness are factors to HIV spread in Africa!

Nance
mailto:nance@documentaliste.com