Tuesday, August 2, 2011

Role of Unsafe Injections in HIV Transmission Acknowledged

Not long ago UNAIDS launched one of those glossy publications of the sort that the UN as a whole is justly famous for. The launch was accompanied by the sort of publicity that few but the UN can afford. And the publication claimed that the 25% reduction in HIV infections among young peoplein high prevalence countries is due to sexual behavior change.

Well, they would do, because according to UNAIDS, HIV is almost always transmitted through heterosexual sex in high prevalence countries. But it would be a neat trick if non-sexually transmitted HIV were also reduced through sexual behavior change. And, given that even UNAIDS admits that some HIV is not transmitted through heterosexual sex, how do they account for reductions in non-sexually transmitted HIV?

They don't mention it much. Perhaps they hope no one will notice, or that no one will be impolite enough to mention if they do notice. But there are some who have very good reason to draw attention to the fact that a lot of HIV and other viruses are transmitted through unsafe healthcare, especially unsterile injections, disposable injection equipment that is being reused, often without any attempt made to sterilize it.

The SafePoint Trust disseminates information about unsafe healthcare, to those giving and those receiving the healthcare. They promote the use of non-reusable syringes, also called 'auto-disable' syringes, because they break after a single use. The statistics they have gathered together about syringe reuse are really shocking.

None of the information disseminated by SafePoint will be new to UNAIDS. They have access to and use the same publications as SafePoint. But UNAIDS deny that non-sexually transmitted HIV plays a significant role in serious HIV epidemics. Regardless of the weight of evidence to the contrary, they insist that 80%, even 90% of HIV is heterosexually transmitted in African countries and that much of the other 10 or 20% is transmitted from mother to child.

Among the many cited facts from SafePoint's leaflet, we are told that 20 million medical injections contaminated with blood from a patient with HIV are administered every year. From this, UNAIDS concludes that about 1-1.5% of HIV infections might come from unsterile injections. This is despite massive outbreaks of healthcare acquired HIV in non-African countries in the 1980s. And the WHO used to recommend the reuse of needles and syringes up to 200 times in vaccination programs, right up to the late 1990s.

Thankfully, many hospitals in Tanzania now use auto-disable syringes for some types of injection. But their use is by no means universal and you can still buy disposable syringes in pharmacies and shops. Also, injections are not always administered in sterile conditions, or by people who have been trained in medical safety.

The way UNAIDS and other luminaries of the HIV industry resolutely refuse to acknowledge non-sexual HIV transmission, and to persist with their highly stigmatizing ranting about African promiscuity and unsafe sex, is inexplicable. Even the mainstream MedPageToday has an article on unsafe practices in US hospitals, which are light years ahead of African countries in terms of conditions.

UNICEF has carried out a study of an initiative to improve injection safety, especially in relation to reuse of syringes for vaccination programs. Perhaps they can get in touch with UNAIDS and inform them that their intransigence is responsible for much of the continued non-sexual HIV transmission of the last 10 or more years? Perhaps also, the initiative will be extended to non-vaccine related injections, which make up the bulk of use of injecting equipment.

The Safe Injection Practices Coalition (SIPC) has launched a free online course for healthcare providers on unsafe injections, which should help inform professionals about the risks and how to eliminate them. This may take some time to get around in countries like Tanzania, where power and connectivity are not reliable. But it's a very good start. However, the course is likely to be aimed at a US or Western audience.

UNAIDS have not increased in relevance over the years and these initiatives certainly don't improve their credibility. But the institution might be entitled to a few brownie points by ensuring that some of the billions spent on HIV is now spent on non-sexually transmitted HIV. Then they might even have something to boast about. But the institution should still be abolished, for the good of those already infected and for those who will certainly be infected if global HIV policy continues to obsess about sexual behavior and ignore some of the most easily avoidable risks.


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