Hospital-acquired HIV underestimated

The role of blood-borne HIV infections from unsanitary healthcare procedures has been underestimated in sub-Saharan Africa's HIV/AIDS epidemic, according to several researchers and epidemiologists.

Writing in the December issue of the International Journal of STD (Sexually Transmitted Diseases) and AIDS (IJSA), they argue that political expediency has motivated African governments and international donor agencies to deliberately downplay the extent of blood-borne infections because it has been easier to blame individuals and their sexual practices than to take responsibility for ensuring safer healthcare.

One study of HIV-positive Swazi children aged between 2 and 12, which relied on data from the 2006-2007 Swaziland Demographic and Health Survey, found that one in five of the children had HIV-negative mothers.

Discounting the possibility that child sexual abuse could account for such a significant share of paediatric infections, the authors suggested that contaminated needles used to administer vaccinations and injections were to blame.

This argument was supported by evidence from a Kenyan study, which found that HIV-infected children with HIV-negative mothers had experienced more potential blood exposures during malaria treatment, dental surgery and vaccinations than their uninfected siblings.

The study has caused an outcry in Swaziland. The Swaziland Nurses Association angrily denied that local nurses would ever use the same needle twice, and called the research findings "rubbish", said a local newspaper report.

Another study in the journal published by the British Association of Sexual Health and HIV, found that clients at voluntary HIV counselling and testing centres run by the University of Calabar Teaching Hospital in southeastern Nigeria, who contracted HIV, were significantly more likely to have had blood tests, vaccinations, blood transfusions or surgical procedures than those who remained negative.

Writing about unsafe medical injections in South Africa, Prof Anton van Niekerk, of the Centre for Applied Physics at the University of Stellenbosch and his co-author point out that South Africa is one of the few countries in the region not requiring non-reusable syringes for immunizations.

They cite recent reports indicating widespread lapses in infection control in public dental clinics, and maternal and paediatric wards, and note that more than a quarter of individuals detected in a 2005 national HIV prevalence survey as "recently infected with HIV" said they had not been sexually active in the past 12 months.

The authors noted that if a similar result had been found in a developed country, it would not have been dismissed as respondents lying about their sexual histories, and would have prompted further investigation.

Sexual transmission over-stated

Commenting on the studies, Moritz Hunsmann, a research scholar at the Paris Graduate School of Social Sciences, wrote that "sexual behaviour is only part of the story, and definitely an insufficient explanation for the dynamics of the epidemic spread of HIV in sub-Saharan Africa."

He conceded that sexual intercourse was probably the main mode of HIV transmission in sub-Saharan Africa, and that strategies targeting behaviour change should play an important role in prevention policies, but argued that the "fixation" on sexual transmission was obscuring the need for improved blood screening and sterilization of health equipment, while ensuring that public health authorities were not held accountable.

Hunsmann asserted that there were political incentives for keeping the extent of blood-borne HIV infections "off the public agenda". "No doubt, African leaders don't want their people to die from AIDS. But to what extent are those currently in power willing to accept fundamental changes in the allocation of political and economic resources in order to effectively address the epidemic's structural drivers?"

Prof David Gisselquist, an independent health and economics consultant, went even further in his paper on double standards - one for rich countries and another for poor - in HIV research ethics, healthcare safety and scientific studies. He alleged that "withholding evidence pointing to ... [hospital acquired] HIV transmission in Africa is both common and widely accepted among HIV/AIDS researchers."

Dr Francois Venter, president of the Southern African HIV Clinicians Society, was unimpressed. "There are lots of alternative explanations [for sub-Saharan Africa's HIV epidemic] that they haven't proved or disproved," he told IRIN/PlusNews. "It raises some interesting questions, but I don't think enough work has been done on this, and claiming conspiracy is not the way science works."

Venter pointed out that unsafe needle practices did not explain, for example, why relatively wealthy countries like Botswana and South Africa have more severe HIV epidemics than less well-resourced countries in the region.