Unsafe injections and transmission of HIV-1 in sub-Saharan Africa

Abstract

George Schmid and colleagues’ conclusion that there is “no compelling evidence that unsafe [medical] injections are a dominant mode of HIV-1 transmission in sub- Saharan Africa” begs the question of whether unsafe health care (including injections) might account for 10% or more of HIV-1 transmission but not enough to be a “dominant mode.” To even regard injections not being a “dominant mode” as a useful endpoint in analysis is profoundly disturbing and sets Africa apart from rich countries. In 1993 WHO’s Global Programme on AIDS reported results from a study of non-vertical HIV infections in inpatient children 6–59 months old in major hospitals in Rwanda Uganda Tanzania and Zambia. In 61 (1·1%) of 5593 child-mother pairs the child was HIV-positive with an HIV-negative mother; only three of these 61 children had been transfused. In a case-control study cases had more but not significantly more skin-piercing procedures than controls. In addition four of 2005 children seroconverted within 3 months of discharge for a rate of 0·8 per 100 person-years. WHO experts concluded that “the risk of nonperinatally acquired HIV and of patient-to-patient transmission of HIV among children in health care settings is low.” A similar conclusion would be unthinkable if 1% of inpatient children in London Boston or Seoul had nonvertical HIV infections. (excerpt)