HIV/AIDS through Unsafe Medical Care (8)
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Dear Colleagues,
I must commend David Gisselquist, and his co-authors for their paper
on "Africa: HIV/AIDS through Unsafe Medical Care". Could this be the
missing link that could explain the rapid spread of HIV/AIDS in Af-
rica when compared to other parts of the world?
In making their case, the authors made the very important observation
that �Studies of sexual behavior do not show as much partner change
in Africa as modellers have assumed, nor do they show differences in
heterosexual behavior between Africa and Europe that could explain
major differences in epidemic growth.� In fact studies had found
rates of partner change in Europe were up to 10 times higher than in
equivalent African populations.
One of the more controversial and acrimonious areas of debate, from
the beginning of the HIV/AIDS epidemic has been around sexual behav-
iour in Africa. Many Africans were resented the implication of being
sexually rampant without care. But despite there being much scien-
tific evidence to support this view it is now commonly accepted that
the high rates of sexual partner change in Africa were one of the
main reasons for the rapid spread of HIV/AIDS. Many Africans would
beg to differ.
But if Africans are not having anymore sex that anyone else in the
world, why is HIV/AIDS spreading so fast. And what would this mean
for all the prevention programmes that are based on behaviour change
in sexual patterns has, one of the main weapons in preventing HIV/
AIDS. How will one know if their efforts are working? There have been
few if any baseline studies on behaviour in Africa (a significant
oversight in my opinion) which means that we will have no way of
knowing the impact of prevention programmes.
The implications of this finding if true are enormous. It will have a
considerable impact on the way the HIV/AIDS epidemic is being tackled
in the future and I commend the authors for highlighting this very
important point.
I like many other scientists have long wondered what could explain
the rapid and aggressive spread of HIV/AIDS in Africa other than sex-
ual transmission. I have always had a nagging suspicion that there
was something not being considered, but did not have the ability to
put any hypotheses to the test.
However recently I have come to the conclusion that two other factors
need to be considered in the spread oh HIV/AIDS:
1. Health systems (or lack of) are a possible significant factor in
the transmission of HIV.
2. The other factor is of course conflict:
<http://www.medilinks.org/Features/Articles/Warandepidemics.htm>
which was a significant factor in spreading AIDS in Uganda and Ethio-
pia.
The two are deadly combination. Conflict leads to the disruption and
breakdown of health systems, and of course injuries, disease, refu-
gees, immunization campaigns etc. One can of course see how such con-
ditions where with lack of health services, with few health personnel
and the pressure to ensure disease outbreaks do not occur, the need
to treat wounded or sick people less than perfect sterilization tech-
niques may be used. And the re-use of needles and syringes is a very
common affair throughout Africa.
For a doctor it is uncomfortable feeling to consider that in attempt-
ing to help save lives and alleviate suffering you could be contrib-
uting to the problem. But this is a possibility that must be faced.
There is need for more large well funded comprehensive studies in
looking at risks for HIV transmission through health care in Africa.
This comment and other articles are available on:
http://medilinks.org
Sincerely,
John Kiwaanuka Ssemakula (MD, MPH)
CEO Medilinks
New York, USA
Tel: +1-212-739-7893
Fax: +1-212-739-7923
mailto:jssemakula@medilinks.org
http://medilinks.org
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