AFRO-NETS> HIV/AIDS through Unsafe Medical Care (10)

[Malcolm Bryant <mbryant@usa.healthnet.org>]

HIV/AIDS through Unsafe Medical Care (10)
-----------------------------------------

I am disturbed by the recent correspondence around the article by 
Gisselquist, Rothenberg, et al.

The authors are to be commended for challenging conventional wisdom 
and raising valid questions about the mode of transmission of HIV in-
fection. Based on my own experience I would agree that re-use of nee-
dles may play a significant role in transmission of HIV and other 
blood-borne diseases in Africa. However, I fear that branding every 
health care worker on the continent as being guilty of fuelling the 
epidemic through iatrogenic transmission shows a considerable lack of 
understanding of the reality of Africa, and immediately demonizes 
many hundreds of thousands of dedicated health care workers.

As someone who has been in the position of having to re-use dispos-
able needles and syringes because to not do so would mean the death 
of my patients, I could not agree more with the sentiment that the 
global community has not given sufficient attention to such issues 
and thus putting front-line health workers in a very difficult posi-
tion. While it is perhaps logical for the discussants to blame the 
obvious potential culprits, my own experience suggests that trained 
health care workers are not the problem.  

Unlicensed and illegal practitioners abound in Africa. Most intend 
well, but have not benefited from the knowledge of how to prevent 
blood-borne disease. A minority are simply profit motivated and do 
not care about potential risks when re-use can significantly increase 
their profits. Without detailed research data I can only make an an-
ecdotal statement, but during my time as a practitioner in Southern 
Africa, I would estimate that unlicensed and illegal injections 
greatly exceeded the number of injections given by all the health 
care staff in my district.

Let us investigate this issue promptly, let us correct any problems 
we find, let us advocate at the highest levels for adequate resources 
in our health care systems, but please let us not start with the as-
sumption that our greatest resource (the people who deliver health 
care services in exceptionally difficult situations) is negligent or 
delinquent.

Malcolm Bryant MD., MPH.
Medical Director
SATELLIFE
30 California Street
Watertown MA 02472, USA
Tel: +1-617-926-9400
mailto:mbryant@usa.healthnet.org

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