Thursday, February 16, 2012

Much Needed Attention for Healthcare HIV Transmission, But Little for Patients

A married Kenyan couple decided to get tested for HIV after the woman became sick and it was found that she was positive but her husband was not. This is not particularly uncommon, but it is shocking that there is no mention in the article about the possibility that the woman was infected non-sexually. The husband considered leaving her, but it appears the counselor didn't tell them that HIV is not always transmitted sexually and that, whatever risks the woman faced, the husband and millions of other people also face.

Incidents like this can put the female partner especially in a lot of danger. Some have been thrown out of their home, either by their husband or other relatives, lost their children, possessions, job and much else. Some have been subjected to violence and even have died as a result. It is extraordinary that the counsellor's job appears to be merely to urge the couple to stay together, but not to recommend that the risks, both sexual and non-sexual, faced by the HIV positive person be evaluated and, if necessary, investigated.

The majority of Kenyans have probably never been tested for HIV and many more keep the results to themselves. But that's hardly surprising if people can face such threats just for revealing their status, even if they do so in order to avoid infecting others. It would be far preferable if more people knew their status and they were supported to reveal their status, at least to their sexual partner; in that way, their risks could be identified and many future infections could be prevented. But as long as UNAIDS and the rest of the HIV industry refuse to discuss the non-sexual risks people face, many people in a country like Kenya are at serious risk, regardless of their sexual behavior.

This situation tends to hit women harder than men; women are often expected to test for HIV, before, during or after pregnancy, sometimes on several occasions. It is more difficult for them to hide their status from others, although testing is ostensibly voluntary and confidential. Women are more likely, often a lot more likely, to be infected than men. And they do not generally have the authority in a marriage to insist that their partner is tested, or to receive a fair hearing if their partner is not infected.

The kind of irresponsible nonsense people hear about HIV and sex is epitomized in numerous articles, including one about "Tips for Making HIV Discordancy Work". There is no warning about non-sexually transmitted HIV or about the fact that the infected partner may not have been infected sexually. The article even recommends keeping antiretrovirals handy in the form of Pre-Exposure Prophylaxis (PEP), used when someone may have been exposed to HIV, through sexual or blood contact, for example. But those who keep PEP handy won't know when they need to use it if they have only heard of sexually transmitted HIV.

It seems unlikely that the HIV industry obsession with sex and their reluctance to talk about non-sexual exposure are going to disappear any time soon. But the Minister for Medical Services, Anyang' Nyong'o, who has touched on the subject before, has announced that Kenya will be opening up a Center for Training on Blood Safety. It sounds like the thrust of the training given will be to protect health care personnel from infection, but it may include training on unsafe use of medical equipment, which poses far higher risks to patients than it does to employees. Anyhow, the proposed Centre for Excellence in Phlebotomy and Specimen Collection, sponsored by medical equipment manufacturer Becton, Dickinson and Company, is a start.

Aside from the estimated 2.5% of HIV caused by medical equipment, which is likely to be on the low side, the article also cites 'rampant' misdiagnosis by health personnel, lack of training and poor practices. These phenomena are well attested in documents such as the Kenya Service Provision Assessment, but are rarely alluded to in the burgeoning HIV literature. Let's hope this facility proves to be a lot more than "a milestone towards the improvement of health-worker safety"; very few health workers have been infected with HIV through their work but many patients may have been exposed to HIV and other diseases through unsafe health care. Sexual transmission of HIV is only part of the story; we just don't know how big a part non-sexual transmission is.

[For more about non-sexually transmitted HIV, see the Don't Get Stuck With HIV website and blog.]


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