AFRO-NETS> Expert group stresses that unsafe sex is primary mode of HIV transmission in Africa

[Dieter Neuvians MD <neuvians@mweb.co.za>]

Expert group stresses that unsafe sex is primary mode of HIV transmission in Africa
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Source: 
http://www.unaids.org/whatsnew/press/eng/HIVinjections140303_en.html

Geneva , 14 March 2003 - An expert group has reaffirmed that unsafe sexual 
practices are responsible for the vast majority of HIV infections in sub-
Saharan Africa, and that safer sex promotion must remain the primary fea-
ture of prevention programmes in the region. 

Today the World Health Organization (WHO) and the Joint United Nations Pro-
gramme on HIV/AIDS (UNAIDS) hosted an expert consultation which addressed 
issues related to unsafe injection practices and HIV in healthcare contexts 
and evaluated the relative contribution of unsafe injections to HIV trans-
mission in sub-Saharan Africa. 

Following a review of evidence, which included recent articles suggesting 
that a majority of HIV infections in sub-Saharan Africa are due to unsafe 
medical practices, particularly injections, the experts concluded that such 
suggestions are not supported by the vast majority of evidence and that un-
safe sexual practices continue to be responsible for the overwhelming ma-
jority of HIV infections. While a combination of prevention measures are 
required to tackle all modes of HIV transmission, safer sex promotion must 
remain the primary feature of prevention programmes in the region. 

This position is strongly supported by epidemiological and biomedical data. 
For example, children between 5-14 years, who are generally not yet sexu-
ally active, have very low infection rates; age-specific infection rates 
among young women and men strongly follow patterns of sexual behaviour and 
those of other sexually transmitted infections (such as herpes simplex vi-
rus-2); in sexually active couples both partners are often infected; and, 
there is no consistent association between higher HIV rates and lower in-
jection safety standards. 

Modelling of the epidemic with the best available information also shows 
that the overwhelming majority of infections are due to unsafe sex. WHO has 
previously estimated that unsafe injection practices account for about 2.5% 
HIV infections in sub-Saharan Africa. Although there is a margin of uncer-
tainty around this estimate, the conclusion remains that unsafe sex is by 
far the predominant mode of transmission in sub-Saharan Africa. 

With approximately 3.5 million Africans becoming infected in 2002 alone, 
and a total of 29.4 million adults and children living with HIV/AIDS in the 
region, the prevention of HIV through the practice of safer sex should be 
the mainstay of the response to AIDS in the region. Discussions about the 
importance of other modes of transmission should at no time weaken this 
central part of the response. 

The expert consultation also emphasized the importance of achieving safe 
and appropriate use of injections in both the formal and informal health 
care sectors of low and middle income countries, as in high income coun-
tries. There are an estimated 16 billion injections given globally each 
year, of which an estimated 30 per cent are unsafe due to the reuse of 
equipment. The participants of the meeting fully agreed that safe medical 
injections are crucial to minimise the risk of transmission of not only 
HIV, but other pathogens such as hepatitis B and hepatitis C in healthcare 
settings, and to maintain confidence in the healthcare system. 

Injections are vital for immunization programmes and for the provision of 
life-saving treatment. Injections should be used only when medically neces-
sary, and should be given using single use equipment which is then disposed 
of safely. In the past several years, major efforts and resources have been 
devoted to enhancing injection safety in the healthcare setting through 
better planning of services including immunization, training of care pro-
viders and vaccinators, provision of single-use injection equipment and 
proper 'sharps' disposal. More needs to be done to eliminate unsafe injec-
tion practices throughout the world. To further this work, WHO has just is-
sued a framework to assist countries with all aspects of the provision of 
safe injections, entitled "Managing an Injection Safety Policy". 

In the context of the AIDS epidemic, WHO and UNAIDS continue to strive to 
understand the global and local epidemiology of HIV, consider new informa-
tion as it arises, and provide leadership to prevent HIV infection from all 
sources, including unsafe sex, mother-to-child transmission, blood and 
blood products and unsafe injections. 

_______________________________
For more information, please contact Dominique de Santis, UNAIDS, Geneva, 
(+41 22) 791 4509 or (+41 79) 254 6803 (mobile), Andrew Shih, UNAIDS, New 
York, (+ 1 212) 584 5012, or Chris Powell, WHO, Geneva, (+41 22) 791 2888 
or (+41 79) 217 3425 (mobile) or Christine McNab (+41 22) 791 4688 or (+41 
79) 254 6815 (mobile). You may also visit the UNAIDS Home Page on the 
Internet for more information about the programme (http://www.unaids.org).

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