Saturday, February 12, 2011

Unsafe Health Care: the Most Efficient Means of Spreading HIV

I have often suggested on this blog that non-sexual HIV transmission could be as common as, or perhaps more common than, sexual HIV transmission. Not only do I not know the exact extent of either modes of transmission, but nor does anyone else. And I don't know of very many people who are trying to find out. Certainly none of the HIV orthodoxy.

The issue of HIV transmission in health facilities is particularly maligned by the HIV industry, who say little about it except to deny that it occurs to any great extent, even in developing countries with atrocious health facility conditions. This denial is based on anecdote, supposition and profound anti-African prejudice.

But nosocomial transmission of various diseases occurs in every country. The only difference between rich countries and poor countries is that when it occurs in a rich country, there is usually (not always, as I will argue in a future post) a thorough investigation. People who may have been exposed to diseases are recalled for testing, etc. There is no such investigation or recalling in developing countries.

Here's an example: a surgeon uses an unsterilized pair of scissors in operations, not just few times but on over 100 children. He denied operating without gloves, as well, so it may not have been just the children's health that was put at risk.

This didn't happen in a developing country, it happened in a prestigious teaching hospital in Cambridge, UK. The surgeon was sacked and the children were recalled for tests. Whether any of them were infected or received any treatment as a result of the incident (or series of incidents), is not clear. But it's good to know that someone is checking and that something happens when things go wrong.

Here's another example: a nurse thought that a machine used to check blood sugar levels automatically changed needles. It didn't, but it took two months and 55 exposed people before anyone noticed. This happened in a private radiology clinic in Australia.

A spokesperson for the facility may be right in claiming that the risk of infection is very low. In a country like Australia, there are probably not that many people visiting health facilities with undiagnosed HIV, though I'm not so sure about hepatitis B, C or other blood borne diseases. And in the UK, it's unlikely many children have HIV infections, diagnosed or undiagnosed.

But in countries where prevalence of HIV is high and prevalence of hepatitis and other diseases even higher, the risk could be tens or even hundreds of times higher. Even among children and infants in developing countries, rates can be high enough to seriously threaten the safety of those undergoing medical treatment. Undiagnosed infections could be especially common.

And just look at the numbers involved here: over 170 people at risk because of the actions of two people. Compare this with sexual HIV transmission, where most people are unlikely to infect more than one other person except under relatively ususual conditions. A handful of highly sexually active people may be able to infect a handful more and spark off a small epidemic. But only professionals can spark off the massive rates of transmission found in some sub-Saharan African countries.

A third example, and these are just ones I picked up this week: 535 attendees at a Veterans' Affairs medical facility have been recalled for testing because one dentist failed to change his gloves between patients. These failures went on for 18 years. Nor did he always sterilize all his equipment. In this instance, the person involved is still employed.

UNAIDS and the HIV industry start with the assumption (it's not a hypothesis because they refuse to modify it despite evidence that it is unwarranted) that 90% (or some such figure) of HIV in African countries is transmitted through heterosexual sex by 'promiscuous' people.

They then have to show that some people really have the amount of sex required to spread a difficult to transmit virus to the extent that it affects a large proportion of the sexually active population. And that's no small amount of sex. In fact, it's a humanly impossible amount of sex, even for commercial sex workers (and anyone else the industry finger has been pointed at, truckers, migrant workers, soldiers, teachers, etc).

For the 'reproductive number', the number of people who are subsequently infected by each infected person, to be high enough to explain the number of people infected in some countries by sexual transmission alone, people would need to be more than just promiscuous.

On the other hand, nosocomial HIV transmission is very efficient. One person can put hundreds at risk, even hundreds per year. The risk of infection for each patient who received unsafe treatment is far higher than the risk they would have faced if they had numerous unprotected penetrative sexual experiences with a HIV positive person.

Epidemiologists often talk about 'explosive' epidemics, especially in relation to HIV. But HIV as a heterosexually transmitted infection is not, by any stretch, an explosive virus. It is explosive among men who have sex with men, among injection drug users and, presumably, among women who engage in heterosexual anal sex. It is also explosive in unsafe health care contexts, highly explosive. The above figures are the tip of the iceberg because they come from rich country health facilities where something went wrong.

In poor countries, many people don't receive much health care. Those who do take their chances and many things go wrong. In African countries where health care was once available to many, HIV prevalence appears to be very high, or was once high. Zimbabwe and South Africa are two examples. In East African countries, where health care is inaccessible to most, prevalence rates are far lower, though high enough to suggest large levels of nosocomial infection.

I'm beyond calling for HIV academics to change their prejudiced attitudes, they don't see themselves as prejudiced. They don't see how ill-founded their arguments are, nor how they all stem from the 'behavioral paradigm', the belief that almost all HIV is heterosexually transmitted in African countries. They could retain these extreme racist and sexist views and still investigate levels of nosocomial HIV transmission.


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