Monday, July 25, 2011

UN Employees Uniquely Susceptible to Non-Sexual HIV Transmission

Following a recent article about the development of a black market for donated blood that is developing in Tanzania, along comes another about similar trends in Nigeria. According to the Nigerian Independent, a considerable number of HIV transmissions are a result of unscreened blood. HIV contaminated blood carries an estimated transmission risk of 95%.

Official HIV industry publications have been claiming that 1% or fewer HIV transmissions are a result of contaminated transfusions but this article casts doubt on that claim. It suggests that 90% of blood comes from paid donors because the blood transfusion service is unable to keep up with demand.

Accepting blood from paid donors can carry high risks because the payment often attracts people who are more likely to be infected with HIV or various other blood borne diseases. It is thought that many donors are, for example, intravenous drug users. As a result, as much as 4-5% of HIV transmission may have resulted from contaminated blood transfusions.

It has been clear for a long time that HIV industry claims about 'universal precautions' against HIV transmission through contaminated blood transfusions, and even reused syringes and generally sloppy hygiene practices, are contradicted by reported conditions in high prevalence countries. (All high prevalence countries are in sub-Saharan Africa.)

But while UNAIDS argues that very few HIV transmissions result from unsafe transfusions and other medical procedures, they also publish a brochure warning UN employees that:

"We in the UN system are unlikely to become infected this way since the UN-system medical services take all the necessary precautions and use only new or sterilized equipment. 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."

The UN's advice is good but it is not clear why this advice is only given to UN employees. Non-employees, Africans, for example, are far more likely to be at risk. While those working for the UN generally don't have to avail of poor quality and downright dangerous services, most Africans have no option.

Therefore, it is heartening to hear of Tanzanian and Nigerian health experts and journalists questioning the commonly heard lie about HIV almost always being transmitted through heterosexual sex in African countries. They are to be applauded, but also encouraged to be more vocal in their questioning of the status quo. The words of UNAIDS wonks have been accepted as gospel for far too long and too many people have been infected, suffered and even died as a result.

Nigeria and other African countries may well have the right policy documents, mentioning comforting things like 'universal precautions'. But those policies are often ignored and are therefore useless. So it's interesting to look a little closer at how UNAIDS use this smug term. They say:

"When accidents do occur, the best approach is to follow what are known as universal precautions. This strategy assumes that everyone is potentially infectious—either with HIV or with another bloodborne disease, such as hepatitis. With universal precautions, no blood exposure is regarded as safe."

The document goes on: "Following universal precautions requires advance planning and preparation. UN first-aid kits, which must be available in all UN workplaces and in all UN cars, include gloves, which should be worn before you touch another person’s blood or open wound. The first-aid kits also include bleach, which can be mixed with water to clean up spills of blood or other body fluids. Because accidents can occur at home as well as at work, you should have a readily accessible first-aid kit in the home, as well."

More great advice, but quite contrary to the assurance that most HIV is transmitted through heterosexual sex in African countries and that only 1% is transmitted through blood transfusions and another 1% through other types of unsafe healthcare. If UN personnel need this advice, why don't non-UN personnel, poor and badly educated people who live in high prevalence countries with appalling health services, for example?

Report after report shows that many health facilities lack soap and water, gloves, safe disposal facilities, sterilization facilities and various other things. In fact, the vast majority of health facilities in Kenya and Tanzania do not have everything they need to ensure safety, either in the facilities or in their stores.

Are UN employees uniquely susceptible to non-sexual HIV transmission, in the way that Africans, we are told, are uniquely susceptible to heterosexual HIV transmission? Or do UNAIDS have an explanation for these double standards? If so, it's time they either warned Africans that they face very serious risks in health facilities or advise UN employees that they have exaggerated the risks that they face. Let's hope UNAIDS choose the former, rather than the latter.


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