Wednesday, January 19, 2011

When Will UNAIDS Be Abolished?

When people find used hypodermic needles in areas where children play in Western countries, they are upset. Quite rightly so. They don't like the thought that their children are being exposed to injury and diseases, possibly even serious or deadly diseases.

But even many Westerners seem to believe that HIV 'dies' within seconds, minutes or some fairly short period, outside of the body. This is not what the US Center for Disease Control (CDC) says on the subject, although it may have said that at one time. Their current answer to the question 'How well does HIV survive outside the body?' is difficult to interpret.

But no matter how you interpret the risk, no one wants a possibly contaminated needle piercing their skin or that of their children. As well as the physical injury, there is also a risk that the needle is contaminated with hepatitis and it is almost certainly contaminated with bacteria.

So the CDC's comment about 'incorrect interpretations' of risk causing 'unnecessary alarm' seems injudicious. I know the question is about HIV but the answer really needs to address risk as a whole. Potentially, HIV can survive for days and even weeks, under the right conditions. Contact with contaminated needles and other instruments should be avoided and where this is not possible, medical advice is required.

However, the idea that the HIV does not live outside the body is widely held, by professionals and lay people. And in countries like Kenya, Tanzania and Uganda, it is far more dangerous to be unaware of the risks. The chances of medical or cosmetic equipment being contaminated in countries with high prevalence of HIV, hepatitis and other diseases can be very high.

You might think that there would be a lot of awareness of these risks and how to avoid them but I have rarely spoken to anyone who has considered the risks they face from contaminated instruments in health or cosmetic facilities.

UNAIDS dismisses the importance of any form of non-sexual HIV transmission, let alone transmission in health facilities. They grudgingly accept that a few percentage points of HIV transmission in East African countries may come from such routes. But they hardly mention cosmetic instruments, razors, tattooing equipment and the like, at all.

As a result, such transmission may be occurring at high rates and people are doing nothing about it. When they take their child to the hairdresser, or go themselves, they could be picking up scabies, hepatitis, HIV or some kind of bacterial infection. To help people avoid these risks, the best thing to do would be to inform them.

Risks in health facilities are more difficult to handle. Doctors, nurses and other health personnel can be pressed for time and it is not easy for patients, or those accompanying patients, to intervene. At best, personnel will be annoyed, at worst, they will refuse to treat the patient, give them poorer quality treatment or make them wait a long time.

The WHO has published data showing that as much as 14% of injections in developing countries are contaminated with HIV and they have unpublished data showing that this figure can be a lot higher. A large proportion of hepatitis B and C is transmitted through contaminted needles. And an estimated 70% of all injections are not even necessary.

When there is even the hint that someone in a Western country may have come into contact with contaminated equipment, there is an investigation to establish how procedures could have resulted in such a risk. And anyone who may have been affected, even going back years, and through thousands of records, is contacted and screened.

Not only does this sort of investigation and screening of possible use of contaminated equipment not take place in developing countries but UNAIDS and others seem keen to deny that such things, which happen in the best resourced health systems in the world, could possibly happen in the worst resourced health systems in the world.



Joyful said...

Hi Simon, I am aware that HIV lives outside the body for a considerable period of time. Since I'm not a expert on HIV in any way, I must have picked this up in public service information in Canada; either on TV or in the papers. So I'm surprised to hear that health professionals in general are unaware of this.

I was shocked though to realize that I'd never thought of possible transmissions while I was at the hairdresser in Kenya. Can you expound on this? Should I be tested? I did get my pedicure while you have me worried.

Simon said...

Hi Joyful, I am not in a position to advise on individual risk, I am putting forward arguments that show that HIV is not all about sex and that HIV prevention should also target non-sexual transmission modes, especially in developing countries.

Outside of East Africa, I don't know how widespread the belief is, though a search on the internet suggests a lot of confusion.

Some people, including health professionals, seem to give the matter very little thought and even seem surprised when you mention non-sexual transmission of any kind to them.

What I am concerned about is that people here in East Africa seem to think that there is little or no risk.

Many people reuse equipment with little or even no attempts to sterilize. That includes hairdressers, tattoo artists and pedicurists, etc, whether they are qualified or not.

There are pedicurists here who operate on the streets and you see people waiting for buses getting their feet done. Pedicurists go from shop to shop and place to place looking for customers. They sometimes carry some kind of cleaning fluid but they are unlikely to know much about adequate sterilization.

As for hairdressers, I'm thinking of work that is close to the scalp, shaving and the like, that is likely to break the skin.

I think the risk from cosmetic practices is likely to be far lower than the risk from medical practices such as injections, because these, and many other procedures, break the skin. And people going to medical facilities are often sick, so the chances of shared equipment being contaminated is far greater.

You could always talk it over with a doctor if you think you have reason to worry and describe conditions, etc, then they would be able to advise you.

Joyful said...

I understand that you are not able to advise me but your answer reassures me that I probably have nothing to worry about. However your post does alert me to ensure that next time I do enquire about certain practises even though they appear to be a "safe place".

I did see not so long ago, a young caucasian woman who lives in Niger. She went for some kind of medical test and was told by a friend to enquire and ensure that the needle was clean. She did so and promptly the health worker, discarded the needle and got a new one. It sure illustrates for me exactly what you are talking about. I will endeavour to make a point to let my friends in Africa know to ensure about clean, new needles whenever they can.

Simon said...

Hi Joyful
I would avoid pedicurists altogether and I wouldn't let a hairdresser go near me with a razor. But many people here do each other's hair and feet and that could be risky.

It's worth considering that if all cosmetic practitioners were to take adequate precautions, it would probably be too expensive for most people to avail of their services!

Your story about the needle is interesting. Many health facilities are short of supplies and supplies are often diverted or stolen. So it may not be uncommon for such risks to be taken.

Also, people take shortcuts, for various reasons, cost being a major one. As a health professional said to me, if you don't have enough gloves, you reuse them, as you have to protect yourself. But this means you are not protecting your client.

We're lucky in the West. I am keeping my minor medical worries to myself until I'm back in Europe, whenever that may be.