Thursday, May 27, 2010

Face the Problem of Medically Transmitted HIV, Don’t Cover it Up

In December of last year, three researchers published a paper in the peer-reviewed journal, the International Journal of STD and Aids (IJSA), concerning HIV infected children with HIV negative mothers in Kenya and Swaziland (entitled 'Horizontally-acquired HIV infection in Kenyan and Swazi children'). The researchers concluded that blood exposures are the most likely routes of transmission in these cases. The researchers also called for greater surveillance and investigation of such phenomena and public education about the risks people face, along with steps they can take to reduce these risks.

The Swazi Observer, the Swazi Times and the English Telegraph all covered the research in question, with the two Swazi papers appearing to refer to the Telegraph article, rather than the original research article. [It should be noted that the Telegraph's figure of 5 million new cases of HIV being created annually by healthcare practices is an error as it's higher than the total number of new infections, which was about 2.5 million in 2007.] These newspaper articles were alarmist and tended to go way beyond anything written in the IJSA article. But they were probably no more or less irresponsible than normal newspaper coverage of medical and other issues.

A member of the public working for or studying with the London School of Hygiene and Tropical Medicine (LSHTM) then wrote to the Swazi papers complaining that this kind of sensationalist reporting is a danger to the health of Swazi people. On balance, the newspaper articles were sensationalist and distorted the findings of a careful and professional study.

But this correspondent goes on to criticize the IJSA article itself. These criticisms may need to be dealt with by the authors and by other professionals involved. However, the correspondent’s criticisms are either irrelevant or they relate to limitations that are made quite clear in the paper. It is true that the authors of the paper don’t ‘prove’ that the children were infected by medical procedures; no investigation was done in Swazi health facilities; and the data on routes of transmission were for Kenyan children, not Swazi children. These matters are all made clear in the methodology and throughout the paper.

The correspondent puts great effort into grasping at straws to defend the health services that are not necessarily being attacked by the IJSA article. And in this way, she seems to imply that there is no need to investigate the very possibility that people face risks when they attend medical facilities (and hairdressers, traditional healers, cosmetic service facilities, etc). Even the WHO and the UN would admit that there are serious risks of blood borne transmission of HIV in African medical facilities. They just don’t bother to do anything about it in African countries. They content themselves with endlessly repeating the discredited mantra that HIV is mostly spread through unprotected sex.

The correspondent goes on to clarify her worry: that people needlessly fear going to clinics for medical procedures that may save their lives, including HIV testing, and that these newspaper articles could confirm people’s fears. The IJSA authors come up with questions about the safety of health procedures in African countries, something even the WHO doubts, estimating that up to 50% of injections could be unsafe, and this correspondent thinks the public are worrying needlessly!

Perhaps this correspondent is afraid that people will think they are being lied to. And to assuage their worries, she advocates lying to them. Or, at least, she advocates keeping the truth from them. Is this the LSHTM take on medical ethics? The correspondent goes on to indulge in a bit of sensationalism herself, about newspaper articles killing people and their babies because members of the public are afraid to seek medical treatment. Her attack on the newspapers ends without further reference to a careful piece of research which shows that many questions need to be raised about medical services in Swaziland (and other countries). It is because these incidents have remained uninvestigated that the public need to be made aware. It is because they have remained unaired that people will fear medical facilities: their fears have already been realised.

The date of the newspaper articles is significant, the 2nd of December, the day after the HIV industry gets together to slap each other on the back for the great work they have done and the successes they have had in reducing HIV transmission over the past year. No doubt, it stung those in the industry to get a wake up call the day after International World Aids Day, especially those working in Swaziland, which has one of the highest prevalence figures in the world. But a sensationalist rant about sensationalist reporting should not be used to deflect attention to what may turn out to be one of the biggest drivers of HIV transmission: non-sexual transmission, either through medical procedures, cosmetic procedures or various other modes.

Anyone studying or working in public health should be concerned if there is evidence that lax procedures may be allowing people to become infected with HIV or other blood borne diseases. Anyone truly concerned with the safety of patients and members of the public would advocate that potential medical transmissions be investigated. And they would not let themselves be distracted by entirely separate issues, such as irresponsible newspaper reporting. To date, the many peer-reviewed articles highlighting possible instances of medical HIV transmission in African countries have been ignored. No investigations have been carried out. But those who are most aware of these matters (WHO, UN, CDC) continue to claim that HIV is primarily transmitted though heterosexual intercourse. If people object to what the newspapers are saying or to what the researchers in the IJSA are saying, they should carry out a thorough investigation.

If the LSHTM student or employee is so concerned about newspapers behaving irresponsibly, she could take to task the ones who always tow the official line on HIV, that it is primarily transmitted by heterosexual sex in African countries. As a result of this official view of HIV, people who find they are HIV positive are stigmatized. HIV is so closely related to illicit or unsafe sexual behaviour in people’s minds that they don’t even know that they could be at risk when they visit the dentist, the doctor or the manicurist. And if they don’t know they are at risk, they will not make any effort to protect themselves. It’s all the other newspaper articles that read like UNAIDS press releases that we should object to, not the few questioning the status quo.

If we don’t want the ‘sensationalist’ press to warn the public of the dangers they and their children may face when they visit medical facilities, we need some credible party to let people know. People need and have a right to know in order to protect themselves. But by refusing to investigate any possible instances of medically transmitted HIV, the WHO, the UN and the CDC show that they are not credible parties. It would not be a desirable outcome for people to avoid medical treatment, but nor would it be a desirable outcome for people to continue getting treatment that may be transmitting HIV. This is a dilemma that those working with HIV need to face, not cover up.


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