E-drug: Origins of AIDS (cont'd)
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[WHO responded informally to the discussion on unsafe injections
and HIV transmission. Interesting and worrisome to see the huge
differences between the estimates of Gisselquist et al (some 60%
of HIV transmission caused by health care activities), and WHO
(only 2.5 - 5% can be attributed to it). As announced below, WHO
and UNAIDS will hold an expert consultation on 13-14 March to
address these issues. We will try to keep you informed.
Cross-posted from SIGNpost newsletter, with thanks. For
information on the Safe Injection Network and how to subscribe to
SIGNpost, see below. HH]
Articles released in the Int J STD HIV by Gisselquist et al suggest
that a far greater proportion of HIV infections in Africa may be
caused by unsafe medical practices, largely unsafe injections, than
thought. WHO, UNAIDS and the public health authorities have
always recognized the risk of HIV transmission, as well as the
transmission of other pathogens, through unsafe injections. This
risk continues to be addressed through important programmes at
WHO and other international organizations.
WHO and UNAIDS epidemiological evidence does not support the
authors' theory that as much as 60% of HIV infections in Africa are
due to contaminated needles in healthcare settings. The estimates
presented in the studies are built on data and assumptions that
need to be discussed further, as uncertainties in the series of input
values may magnify and lead to potential biases. A recent study
undertaken by WHO and CDC suggests that globally, 5% of all new
HIV infections may be due to unsafe injections in healthcare
settings. The estimate for African countries is 2.5%, with a higher
rate for some countries in Asia.
As part of continuing monitoring of the HIV epidemic globally, WHO
and UNAIDS are organizing an expert consultation on 13-14 March
which will specifically address issues related to unsafe injection
practices and HIV. The studies in question will be useful to further
inform discussions and research. The meeting will include an update
on the latest evidence and recommendations on ways forward to
better document HIV transmission through unsafe injections.
Unsafe sex continues to be the major route of HIV transmission in
Africa and efforts to prevent sexual transmission must remain the
major public health intervention there. In addition, we must of
course work to ensure the safety of injections, which should be
used only when medically necessary and in a sterile manner,
preferably using one-time use equipment.
George Schmid, M.D., M.Sc.
Department of HIV/AIDS
World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland
41-22-791-1227 (phone)
41-22-791-4834 (facsimile)
schmidg@who.int
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