AFRO-NETS> HIV/AIDS and unsafe injection and needle transmission in Sub-Saharan Africa

[John Kiwanuka Ssemakula <jssemakula@medilinks.org>]

HIV/AIDS and unsafe injection and needle transmission in Sub-Saharan Africa
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In the few days since I wrote the following article, a research arti-
cle entitled "Humans in 1940; Spread During War in Guinea-Bissau, 
Study Says", claiming that not just conflict may have been a signifi-
cant factor in spreading HIV2, but it may also have spread rapidly 
among humans through non-sterile injections during Guinea-Bissau's 
war for independence, via mass vaccination campaigns that were hap-
pening around the same time. Does anyone remember "The River: A Jour-
ney Back to the Source of HIV and AIDS" by Edward Hooper?

It is a subject that needs a lot more serious research rather than 
just being swept under the rug as some people would like to do. It is 
too important for that!

--
HIV/AIDS and unsafe injection and needle transmission in Sub-Saharan 
Africa - part II

by John Kiwanuka Ssemakula (MD, MPH)
May 14, 2003

Ever since a paper was published claiming that unsafe injections and 
needle practices are a significant route for the transmission of AIDS 
there has been controversy in the scientific establishment. But the 
story will just not go away, the controversy will not end. More and 
more evidence and research keeps coming to light supporting the claim 
that unsafe injections have played a significant role in spreading 
HIV/AIDS in Africa.

On the face of it, it seems an entirely plausible scenario. And any-
where else in the world this would not be an issue. It is accepted 
that transfer by unsafe use of needles, such as by injecting drug us-
ers is a common and significant route for spreading AIDS. Anywhere 
else but in Africa, specifically Sub-Saharan Africa.

The research has been universally rejected out of hand by the scien-
tific establishment and international organizations such as UNAIDS 
and the World Health Organisation (WHO). The more evidence and re-
search people uncover and publish about the possibility, the louder 
the protestations of the scientific elite.

And this of course raises the question, why is it such an outlandish 
possibility that such a thing could take place in Africa rejected, 
despite the mounting evidence that points to the contrary?

According to the WHO modeling of the epidemic with the best available 
information also shows that the overwhelming majority of infections 
are due to unsafe sex. What if the models are wrong? The WHO has pre-
viously estimated that unsafe injection practices account for about 
2.5% HIV infections in sub-Saharan Africa saying "Although there is a 
margin of uncertainty around this estimate, the conclusion remains 
that unsafe sex is by far the predominant mode of transmission in 
sub-Saharan Africa."

The WHO/UNAIDS went on to say "The expert consultation also empha-
sized the importance of achieving safe and appropriate use of injec-
tions in both the formal and informal health care sectors of low and 
middle income countries, as in high income countries. 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."

Note the figure of 30% unsafe injection use the world over. But some-
how in Africa unsafe injection use only contributes 2.5% to HIV ac-
cording to their models - based on best available data. This is in 
Africa which of course has over burdened, under financed, under 
manned public health systems.

Furthermore their assertion in a press release saying that "For exam-
ple, children between 5-14 years, who are generally not yet sexually 
active, have very low infection rates;" (Joint UNAIDS/ WHO, Press 
statement 2003, Geneva, 14 March 2003, ("Expert Group Stresses That 
Unsafe Sex Is Primary Mode of HIV Transmission In Africa") is not 
supported by data coming out of South Africa which finds that chil-
dren between 2-14 years have rates of HIV of almost 6% (Mandela Re-
port HSS 2002) which is extremely high figure.

The current controversy comes at a time when the WHO and the Interna-
tional Community are congratulating themselves on the unprecedented 
response to SARS and their success at controlling the outbreak. Would 
that this were true for Africa!

UN, WHO and other health officials argue that if we consider such a 
scenario, it could have the possibility, and it become widely known, 
it could have the effect of undermining prevention and education cam-
paigns in Africa. This seems to be a curious kind of logic. Instead 
of protecting people from the possibility of being infected due to 
unsafe medical practices, let's keep quiet, just in case people will 
decide to go out and have sex instead!

Listening to the specious and spurious arguments being put forward by 
people who should know better, it seems that the conclusion is Afri-
cans should settle for the choice if unsafe inadequate health care or 
no health care at all, if only to protect the accepted establishment 
position that prevention and changing sexual behaviour is the only 
means to fight the HIV/AIDS epidemic.

Let's be quite clear about this it is not science fiction we are 
talking about here. It is not even scientific speculation because 
needle transmission of HIV has been proven the world over. Accepting 
the possibility that it could and has occurred in Africa, would serve 
to bring Africa's HIV epidemic in line with the rest of the world, 
and stop the endless speculation of why Africa's epidemic is so dif-
ferent. It would also sit in with all other studies that have found 
the virus is no more virulent or that apart form poverty, the condi-
tions in Africa are not so different to account for the rate of 
spread. At the very least it behoves one to at least do some research 
to either prove or disprove the theory.

But when all is said and done, the fact is what is really at stake 
here is providing safe health care to Africans. So no matter how 
small the possibility that unsafe injection may be contributing to 
HIV/AIDS, it is incumbent upon health and policy planners to deal 
with this issue. Doing nothing or denying the possibility does not 
sit well with the stated aims of proving accessible, equitable, af-
fordable health care of a high standard to all people. Indeed it is a 
human right. At the most basic level, safe quality health care is a 
right for all people. This is what the WHO and UN should be aiming to 
attain, the same standards of healthcare for all Africans as in the 
rest of the world.

--
Dr John Kiwanuka Ssemakula (MD, MPH)
CEO Medilinks
420, E54 Street, Suite 29C
New York, 10022, USA
Tel: +1-917-292-5968
Fax: +1-212-688-0223
mailto:jssemakula@medilinks.org
http://medilinks.org
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