The Safe Health Care Working Group Letter to WHO and UNAIDS
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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 rec-
ommending 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
mailto:efriedman@phrusa.org or by fax: +1-202-728-3053
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 preven-
tion efforts, including by immediately taking steps to stop the
transmission of bloodborne pathogens through unsafe blood trans-
fusions, medical injections, and other medical procedures, such
as those accompanying childbirth, and to minimize the transmis-
sion of these pathogens between patients and health care provid-
ers.
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 injec-
tion safety to its estimates of the cost of HIV/AIDS interven-
tions were important. Even as we look forward to the use of in-
jection 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 im-
munization 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 injec-
tions in developing countries.
However, much remains to be done. WHO estimates that every year,
about half a million people become infected with HIV through un-
safe medical injections and unsafe blood transfusions. And ac-
cording 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 mil-
lion deaths � deaths that should be prevented. WHO has also rec-
ognized 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. Empower-
ing health care workers to protect themselves and their patients
by following the best practices of infection control and preven-
tion, 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 oth-
ers 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 dis-
eases 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 tar-
gets 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 prior-
ity 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 in-
jections 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 infec-
tion 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 Na-
tions 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 ac-
tions 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 pro-
posals.
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 implementa-
tion of universal precautions. The fact that health care was not
the major source of transmission in wealthy countries did not de-
lay 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 de-
veloped 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 Eco-
nomic, Social and Cultural Rights, has determined that appropri-
ate 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 (interna-
tional)
Medilinks (United States)
People's Health Movement-Geneva (Switzerland)
Physicians for Human Rights (United States)
Research Center for Phytotherapy and African Traditional Pharma-
copoeia (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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