E-drug: Origins of AIDS (cont'd)
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Dear E-druggers,
I received quite some requests for the url's of the articles on the
origins of AIDS. Here they are:
http://www.rsm.ac.uk/new/std144intro.pdf
http://www.rsm.ac.uk/new/std148main.pdf
http://www.rsm.ac.uk/new/std162stats.pdf
Many of the responders agree with my worries and believe we
should step up injection safety and get the medical waste
incinerators out there as soon as possible. The WHO Injection
Safety Initiative is working on this and discussions in their
newsletter 'SIGNpost' tend to focus on technical solutions to use
injections more safely.
I understand that safe needle disposal is of crucial importance in
vaccination activities, but I am not very convinced that this is
getting us very far in improving injection use in regular health care
delivery. We know that in developing countries typically between
20-50% of prescriptions contain one or more injections. These
studies are mostly from public sector facilities only. I don't dare to
think about which proportions of drugs are provided in injectable
form in private sectors of these countries. What I hear in countries
is that some private doctors prefer to give almost all drugs in
injectable form, as they do not trust patients to take oral
medications appropriately. WHO estimates that 15 billion injections
are given annually and that half of them are unsterile. In some
areas, children have had more than 20 injections by the age of 2.
Keeping such figures in mind, it is not difficult to put into context
Gisselquist's comments on HIV+ babies from uninfected mothers.
In my view the issue is about much more than getting the
incinerators in place. I cannot see that people in resource strapped
societies are going to routinely burn 'good-looking' needles and
syringes after one-time use only. It hasn't happened until now,
despite the low-cost technology that is available, and it isn't going
to happen any time soon. It is simply against the logic of
populations who have to get by with very few resources. We will
have to accept that and focus on decreasing injection use in the
first place. Just as we have believed that it would mainly require
change of sexual behaviour to control the epidemic.
A problem may be that behavioural change cannot easily be
'bought', as opposed to incinerators. Behavioural change will take
time, something donors, international agencies and Ministries of
Health often do not have. Another problem is that controlling sexual
behaviour offered some business opportunities (e.g. condoms),
whereas controlling injection use will probably limit major business
activities (injectable drugs, needles and syringes). We will need to
find creative solutions to deal with these challenges. However,
good models of behavioural change exist and they can be applied,
provided public health experts are willing to take them serious and
see the need for implementing them. Gisselquist et al have started
the discussion, and I would hope E-druggers enter that debate, as it
may concern the work of many of them.
Regards,
Hilbrand Haak
Consultants for Health and Development
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Sleedoorntuin 7 tel: +31-71-523.2052
2317 MV Leiden fax: +31-71-523.3592
The Netherlands haakh@chd-consultants.nl
Visit CHD's website at www.chd-consultants.nl
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