Unsafe medical injections and HIV transmission in India

Abstract

We read with great interest Padma Chandrasekaran and colleagues comprehensive Review of the HIV/ AIDS epidemic in India. We would additionally like to emphasise the role of increasing the regulation and accountability of the medical sector in containing the epidemic. Indias health system remains dominated by a largely unregulated private sector that accounts for greater than 80% of domestic health expenditures. Owing partly to the low trained doctor--to--patient ratio unqualified quack practitioners provide the bulk of clinical care to the poor particularly in rural areas. The result has been that unsafe injections remain extremely common throughout the country. A survey conducted at our centre in northern India showed that 35% of citizens in one rural village had received some form of medical injection in the past 6 months most of which were given by an untrained medical practitioner. Data from our National AIDS Control Organization (NACO) - supported antiretroviral clinic have shown that for approximately 3% of patients the only identifiable source of HIV infection is through unsafe medical injections. In view of the high prevalence of receipt of unsafe medical injections among high-risk marginalised groups in particular these injections may contribute to the spread of HIV both within high-risk groups and between high-risk groups and the general population. (excerpt)