Tuesday, May 22, 2012
A document available on Wikileaks begins: "Recent outbreaks of HIV and AIDS among children in three countries of Central Asia point to dangerous and unnecessary medical procedures being performed throughout the region." The countries are Kyrgyzstan, Kazakhstan and Uzbekistan. Among the medical procedures named are blood transfusion and injections. But I wonder if, under the conditions mentioned in the document, male circumcision would be considered dangerous and unnecessary. Circumcision rates are very high in Kyrgyzstan and Uzbekistan and over 50% in Kazakhstan.
According to the leaked cable, a PEPFAR (US President's Emergency Plan for Aids Relief) assessment concludes that "health providers and managers lack the knowledge, supplies, and equipment to protect their patients from acquiring infections such as HIV in the clinical setting", also citing reuse of medical instruments and lack of blood safety. Unsafe medical interventions are said to have resulted in several outbreaks of HIV. 155 children were found to have been infected in Kazakhstan, 110 in Kyrgysztan and over 40 in Uzbekistan.
As a result of all this attention to infection prevention and control there is now said to be a high level of awareness of health facility risks for HIV transmission, although there is little scope for doing anything about it. In stark contrast, several reports into health facility conditions in East African countries have found conditions far worse than those found in Central Asia without this resulting in any investigations into health facility HIV transmission, by CDC, PEPFAR or any other institution. The situations in Central Asia and other areas are well described on the Don't Get Stuck With HIV site, but in East Africa the official line is that 80% of transmission is a result of heterosexual contact and almost 20% is a result of mother to child transmission.
Given the ridiculous plans to circumcise tens of millions of adults (also, tens of millions of infants) in Africa in the name of HIV transmission reduction, it would seem a good idea to refer to various service provision assessments and other data which show that African health facilities are barely equipped to deal with in-grown toenails safely, let alone circumcisions. The Wikileaks cable cites USAID's health program which "seeks to improve care and decrease infections by introducing and reinforcing the concept of evidence-based medicine, or utilizing medical techniques that have been scientifically proven to be effective, only when they are proven necessary". If only the same precautions were applied to mass male circumcision programs in Africa!
If only USAID or some other body were planning "a situational analysis of primary health care facilities and tuberculosis hospitals in the region, to further identify institutional and systemic barriers to infection prevention" in Eastern and Southern African countries, as they are in Central Asia. After all, HIV rates are higher in sub-Saharan Africa than anywhere else in the world. There's so much to gain from carrying out such an analysis and so much to lose from continuing to ignore health facility transmission of HIV, also called nosocomial transmission.
Central Asian countries are poor, but most African countries are a lot poorer, with fewer medical personnel, lower levels of education, appalling health indicators and crumbling infrastructure. Perhaps nosocomial HIV transmission in African countries is very rare, as UNAIDS, WHO, CDC and others claim. But wouldn't it be a good idea to investigate conditions in African health facilities, as has been done in some countries, especially in areas where HIV transmission rates are far too high to be explained by reference to sexual behavior alone? After all, it's an empirical matter, not something to be decided on the whim of a bunch of bureaucrats, however well resourced they may be.
[For more about non-sexual HIV transmission and injectable Depo Provera, see the Don't Get Stuck With HIV site.]