Saturday, July 2, 2011

Buying Blood on the Black Market in Tanzania: Tempted?

UNAIDS continue to insist that HIV is almost always transmitted sexually in African countries and they still discount the contribution made by non-sexual transmission routes, such as blood transfusion, unsterile injecting and other skin piercing equipment and lack of sterile procedures.

But those working in, visiting and being treated in health facilities here in East Africa have other stories. Anecdotal though they may be, you hear of women about to give birth being ignored until the last minute and then being assisted by someone who has made no preparations or has come straight from another delivery.

Others say they are not allowed to ask about or criticize procedures in health facilities without fear of being sent to the back of the queue, refused treatment or being loudly humiliated in front of others. So even those who know they may face risks in health facilities are in no position to do anything to protect themselves or their families.

When it comes to blood transfusions, blood that has already been tested when it was received by the blood bank turns out to be contaminated with HIV, hepatitis, bacteria, etc. Shortages mean that a lot of blood comes directly from donors, rather than from the blood bank. And this is especially the case for infants, pregnant women and road traffic accidents.

So I was not surprised to read an article in The Citizen (Tanzania) about 'informal payments' being demanded for blood. There is an extreme shortage of blood but no shortage of people only too willing to donate theirs in return for what could be the equivalent of a couple of week's pay.

How UNAIDS has the arrogance to insist that Tanzanians do not face any danger in health facilities, they insist that only 1 or 2% of HIV is transmitted through unsafe practices, including transfusions, is something I have never understood. Especially when they go to so much trouble to ensure that UN employees know that their safety can not be assured in facilities that are not approved by UNAIDS!

It's hardly surprising that crumbling health services and a highly impoverished population results in people taking risks. The risks involved in collecting blood in return for payment was recognised in the 1980s, shortly after HIV was identified. Once it was clear that intravenous drug users, sex workers and others who may need a bit of easy cash would be tempted to donate, regularly, the practice of soliciting blood donations in return for cash was stopped in many countries, including Tanzania.

But where there is such an urgent need for blood for patients and an urgent need for money for donors, how likely is it that a mere policy change will succeed in preventing such practices? The article describes people who identify customers and donors and attempt to fill in one of the many huge gaps that exists in the country's health services.

UNAIDS seem interested enough in women who sell sex for money because it's their only way of making enough to survive. It remains to be seen whether they will now provide training courses, counselling, various products, services and even ready cash available to prevent HIV transmission through contaminated blood. The practice is even said to occur in Iringa, which has the highest HIV prevalence in the country.

Similar practices have been reported in Nigeria. HIV prevalence there is a lot lower than in Tanzania but the population is more than three times higher. The number of HIV positive people in Nigeria, therefore, is probably the second highest in the world, after South Africa.

I make no apology for repeating myself: if UNAIDS can not guarantee the safety of UN employees in health facilities in countries like Tanzania, then they can not guarantee the safety of Tanzanians either. Therefore, health facility transmission of HIV needs to be investigated so that the risks can be reduced and people can be informed about how to protect themselves and their families. Tanzanians are as entitled to health, safety and life as UN employees.


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