E-drug: HIV/AIDS and needle transmission in Sub-Saharan Africa
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[Crossposted from Afro-nets. With thanks. BS]
HIV/AIDS and unsafe injection and needle transmission in
Sub-Saharan Africa
In the few days since I wrote the following article, a research article
entitled "Humans in 1940; Spread During War in Guinea-Bissau,
Study Says", claiming that not just conflict may have been a significant
factor in spreading HIV2, but it may also have spread rapidly among
humans through non-sterile injections during Guinea-Bissau's war for
independence, via mass vaccination campaigns that were happening
around the same time. Does anyone remember "The River: A Journey
Back to the Source of HIV and AIDS" by Edward Hooper?
It is a subject that needs a lot more serious research rather than just
being swept under the rug as some people would like to do. It is too
important for that!
HIV/AIDS and unsafe injection and needle transmission in
Sub-Saharan Africa - part II
by John Kiwanuka Ssemakula (MD, MPH)
May 14, 2003
Ever since a paper was published claiming that unsafe injections and
needle practices are a significant route for the transmission of AIDS
there has been controversy in the scientific establishment. But the
story will just not go away, the controversy will not end. More and
more evidence and research keeps coming to light supporting the
claim that unsafe injections have played a significant role in spreading
HIV/AIDS in Africa.
On the face of it, it seems an entirely plausible scenario. And
anywhere else in the world this would not be an issue. It is accepted
that transfer by unsafe use of needles, such as by injecting drug users
is a common and significant route for spreading AIDS. Anywhere else
but in Africa, specifically Sub-Saharan Africa.
The research has been universally rejected out of hand by the
scientific establishment and international organizations such as
UNAIDS and the World Health Organisation (WHO). The more
evidence and research people uncover and publish about the
possibility, the louder the protestations of the scientific elite.
And this of course raises the question, why is it such an outlandish
possibility that such a thing could take place in Africa rejected, despite
the mounting evidence that points to the contrary?
According to the WHO modeling of the epidemic with the best
available information also shows that the overwhelming majority of
infections are due to unsafe sex. What if the models are wrong? The
WHO has previously estimated that unsafe injection practices account
for about 2.5% HIV infections in sub-Saharan Africa saying "Although
there is a margin of uncertainty around this estimate, the conclusion
remains that unsafe sex is by far the predominant mode of
transmission in sub-Saharan Africa."
The WHO/UNAIDS went on to say "The expert consultation also
emphasized the importance of achieving safe and appropriate use of
injections in both the formal and informal health care sectors of low
and middle income countries, as in high income countries. There are
an estimated 16 billion injections given globally each year, of which an
estimated 30 per cent are unsafe due to the reuse of equipment... The
participants of the meeting fully agreed that safe medical injections are
crucial to minimise the risk of transmission of not only HIV, but other
pathogens such as hepatitis B and hepatitis C in healthcare settings,
and to maintain confidence in the healthcare system."
Note the figure of 30% unsafe injection use the world over. But
somehow in Africa unsafe injection use only contributes 2.5% to HIV
according to their models - based on best available data. This is in
Africa which of course has over burdened, under financed, under
manned public health systems.
Furthermore their assertion in a press release saying that "For
example, children between 5-14 years, who are generally not yet
sexually active, have very low infection rates;" (Joint UNAIDS/ WHO,
Press statement 2003, Geneva, 14 March 2003, ("Expert Group
Stresses That Unsafe Sex Is Primary Mode of HIV Transmission In
Africa") is not supported by data coming out of South Africa which
finds that children between 2-14 years have rates of HIV of almost 6%
(Mandela Report HSS 2002) which is extremely high figure.
The current controversy comes at a time when the WHO and the
International Community are congratulating themselves on the
unprecedented response to SARS and their success at controlling the
outbreak. Would that this were true for Africa!
UN, WHO and other health officials argue that if we consider such a
scenario, it could have the possibility, and it become widely known, it
could have the effect of undermining prevention and education
campaigns in Africa. This seems to be a curious kind of logic. Instead
of protecting people from the possibility of being infected due to
unsafe medical practices, let's keep quiet, just in case people will
decide to go out and have sex instead!
Listening to the specious and spurious arguments being put forward
by people who should know better, it seems that the conclusion is
Africans should settle for the choice if unsafe inadequate health care
or no health care at all, if only to protect the accepted establishment
position that prevention and changing sexual behaviour is the only
means to fight the HIV/AIDS epidemic.
Let's be quite clear about this it is not science fiction we are talking
about here. It is not even scientific speculation because needle
transmission of HIV has been proven the world over. Accepting the
possibility that it could and has occurred in Africa, would serve to bring
Africa's HIV epidemic in line with the rest of the world, and stop the
endless speculation of why Africa's epidemic is so different. It would
also sit in with all other studies that have found the virus is no more
virulent or that apart form poverty, the conditions in Africa are not so
different to account for the rate of spread. At the very least it behoves
one to at least do some research to either prove or disprove the
theory.
But when all is said and done, the fact is what is really at stake here is
providing safe health care to Africans. So no matter how small the
possibility that unsafe injection may be contributing to HIV/AIDS, it is
incumbent upon health and policy planners to deal with this issue.
Doing nothing or denying the possibility does not sit well with the
stated aims of proving accessible, equitable, affordable health care of
a high standard to all people. Indeed it is a human right. At the most
basic level, safe quality health care is a right for all people. This is
what the WHO and UN should be aiming to attain, the same
standards of healthcare for all Africans as in the rest of the world.
Dr John Kiwanuka Ssemakula (MD, MPH)
CEO Medilinks
420, E54 Street, Suite 29C
New York, 10022, USA
Tel: +1-917-292-5968
Fax: +1-212-688-0223
mailto:jssemakula@medilinks.org
http://medilinks.org
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