E-drug: Origins of AIDS (cont'd)
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Hi all
The report of the World Health Organization (WHO) and the Joint
United Nations Programme on HIV/AIDS (UNAIDS) expert
consultation on issues related to unsafe injection practices and HIV
in healthcare contexts has gone some way to providing clarity in
this regard - in the words of the press release: "While a combination
of prevention measures are required to tackle all modes of HIV
transmission, safer sex promotion must remain the primary feature
of prevention programmes in the region".
The import for those active in the field of essential medicines is
clear - efforts to improve access to treatment must go hand-in-hand
with primary prevention (aiming mostly at sexual spread), but there
must be continued efforts to ensure the "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".
Equally, there must be continued research to answer the questions
posed, not only by the paper that evoked this response, but by
other work. One such finding was that in the Nelson Mandela/HSRC
Study of HIV/AIDS Household Survey 2002 (see
http://www.hsrcpublishers.co.za/hiv.html for access to the full
report) regarding prevalence in an age group generally considered
sexually inactive. This study estimated the overall HIV prevalence in
the South African population (over the age of two) to be 11.4%.
HIV prevalence among those aged 15-49 was 15.6%. However,
one surprise finding was that the prevalence rate for children 2-14
"was unexpectedly high at 5.6% and it remains unclear how these
children were infected". The executive summary quotes one of the
co-authors, Dr Olive Shisana as saying "The study draws no
conclusion on how these children were infected, but states that
possible factors to be investigated are sexual abuse and exposure
to unsterile needles". More details are provided in the full report
(section 3.2.2; pg 47): "The results indicate that the epidemic
seriously affects South African children aged 2-14 years. The
prevalence among girls and boys was estimated to be 5.2% (95%
CI=3.2-7.3%) and 5.9% (95% CI-2.8-8.9%) respectively. Due to
relatively small sample numbers, the prevalence for girls should be
interpreted with caution. Among African children the HIV
prevalence is 5.4% (95% CI=3.3-7.6%). Based on the observed
coefficient of relative covariation, it is not possible to reliably
estimate child HIV prevalence for other race groups, locality type or
province".
In the final chapter, the study's authors recommended the
following, noting the Gisselquist paper in particular: "HIV
prevalence among persons aged 2-14 years was much higher than
expected. It could not adequately be explained by heterosexual nor
by vertical transmission. This finding requires further investigation.
Thus, it is recommended that a detailed study be undertaken to
explore the finding, examining the role of sexual abuse and
nosocomial infection (health service acquired infections). This factor
was alluded to recently by the World Health Organisation's model
which estimates that at least five percent of all HIV infections are
due to unsterile needles and that it is difficult to estimate this
figure. Gisselquist et al. (2002) estimate that 20-40 per cent of HIV
infections cannot be explained by mother-to-child transmission or
heterosexual transmission, but may be due to inadequate medical
care".
So, insufficient evidence to alter policy and practice today, but
sufficient to spur further research, and a timely reminder that we
still face many unanswered questions in this field (as in all).
regards
Andy
Andy Gray MSc(Pharm) FPS
Senior Lecturer
Dept of Experimental and Clinical Pharmacology
Nelson R Mandela School of Medicine
University of Natal
PBag 7 Congella 4013
South Africa
Tel: +27-31-2604334/4298 Fax: +27-31-2604338
email: graya1@nu.ac.za or andy@gray.za.net
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