Tuesday, November 16, 2010

UN's IRIN Fluffs Issue of HIV Transmission in Medical Facilities

The issue of non-sexually transmitted HIV is rarely discussed in medical or official literature, or anywhere else for that matter. But there is a recent article on IRIN's PlusNews about the risk of accidental HIV transmission to health workers in Kenya. The article notes the need to provide health workers with proper safety equipment and education.

These are vital, not just to protect health workers, but to protect patients. If health workers don't have adequate equipment or if they don't adhere to strict hygiene practices, their patients face far higher risks than the health workers.

Unfortunately, the article botches the message in the second paragraph. They say that 2.5% of new HIV infections every year occur in health facilities. But this does not mean that 2.5% of the country's HIV infections occur among health workers. It means that the figure some epidemiologists have modeled, somehow, suggest that as few as 2.5% of HIV infections are caused by medical procedures, some of those being among health workers. There is no attempt to work out how many health workers are infected. And it's not as if such occurrences are properly recorded, that would be far too sensible.

In fact, the figure of 2.5% is just not credible. The WHO accepts that 70% of injections in developing countries are unnecessary and that almost 20% in some countries are unsafe. Why should Kenya, with it's deplorable health facilities, only have a 2.5% rate of medical transmission? The article even claims that "most government facilities adhere to safety guidelines" and blame "private practitioners in poor areas" for medical transmission.

Kenya's Service Provision Assessment suggests, on the other hand, that safety guidelines are not common. The assessment doesn't even question whether the guidelines are adhered to. They do assess how many facilities have the requisite equipment; not many.

The article seems to suggest that those living in rural areas are more at risk of unsafe health care. People in rural areas may face different risks that urban dwellers, possibly even high risks. But HIV rates are far higher in urban areas. People in rural areas are, however, far less likely to receive any kind of modern medical services. It's striking how the most isolated places of all have very few cases of HIV.

The article says that "patients themselves may not be knowledgeable enough to question unsafe practices", so it isn't a complete waste of space. Patients, Kenyans and other Africans, are quite unaware of the dangers they face, mainly because articles like this one seriously underestimate the level of risk.

A 'self-employed' health worker admits that they don't always have safety equipment, though they frequently give injections. Health workers are right to be concerned for their own health. But the government and those involved in improving medical safety should pay a lot more attention to patients. Health workers may receive the odd scratch or jab from a needle but patients receive much of whatever the equipment is contaminated with, under their skin, into their muscles or even into their veins.

Given the lack of training and equipment among health workers, any initiative to increase training and supplies should be commended. But this is not going to happen overnight, if it even happens at all. Everybody visiting a health facility should know about the risks they and their family members face so that they can take steps to protect themselves against nosocomial transmission of HIV, hepatitis and other blood borne diseases.

Yet again, an article touching on the issues of medical safety and the risk of HIV transmission through unsafe medical procedures completely fluffs the issue. Visiting medical facilities in African countries is extremely hazardous. An indication of how hazardous it is can be gleaned from the advice given by UNAIDS to UN employees:

"Extra precautions should be taken, however, when on travel away from UN approved medical facilities, as the UN cannot ensure the safety of blood supplies or injection equipment obtained elsewhere. It is always a good idea to avoid direct exposure to another person’s blood — to avoid not only HIV but also hepatitis and other bloodborne infections."

This is great advice for UN employees (IRIN is part of the UN), even though they have access to UN approved facilities and the option to wait till they are in a country with better medical facilities. However, UNAIDS doesn't feel it is necessary to give the same advice to Africans. They, it appears, only face a very small risk of infection.


1 comment:

Samual said...
This comment has been removed by a blog administrator.