Needles not sex drove African AIDS pandemic
14:02 20 February 03 NewScientist.com news service
The re-use of dirty needles in healthcare - not promiscuity - was the main
cause of the AIDS pandemic now devastating Africa, according to a
controversial new analysis.
It challenges the assumption, dating from 1988, that unsafe heterosexual
sex accounted for 90 per cent of HIV transmissions in Africa.
"We've gathered all the literature we can on AIDS in Africa and the best we
can estimate, for sexual transmission, is a quarter to a third," says David
Gisselquist, an independent anthropologist from Hershey, Pennsylvania, who
led the new study.
Dirty needles accounted for almost half of all cases, the re-analysis of
research concludes. The work is published as a three-paper set in the
International Journal of STD & AIDS.
Thirty million people are estimated to be living with HIV in Africa, and
2.5 million died in 2002. Tackling the pandemic requires knowledge of how
the virus is being transmitted now, so emphasis can be placed on, say, safe
sex education programmes or provision of single-use needles.
"But no one has looked at this for a long time, or with the appropriate
data," acknowledges Yvan Hutin, a specialist on HIV transmission at the
World Health Organization in Geneva. "There isn't any solid data."
Frightened away
However, Hutin disputes the specific conclusions of the new analysis. "We
estimate that dirty needles account for five per cent of cases worldwide,
but with large variation."
Agencies managing international AIDS programmes fear that Africans could be
frightened away from visiting clinics for vital immunisations. "The other
worry is that it might encourage complacency in sex," says Catherine
Hankins, chief scientific adviser for UNAIDS in Geneva.
Other experts point out that hepatitis B, which is more easily transmitted
via unsterilised needles than HIV, has not spread as rapidly.
But Gisselquist says that with their mindsets fixed on the sexual
explanation, researchers have ignored obvious discrepancies. He says the
data contradict the idea that Africans are unusually promiscuous, or engage
more readily than anyone else in unsafe sex.
Faithful partners
For example, in a 1987-88 study of factory and bank workers in Kinshasa,
Congo, the huge majority of with HIV-positive subjects said they had
contracted the virus despite being faithful to their partners.
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Weblinks
UNAIDS
Injection safety, WHO
International Journal of STD & AIDS
"Although some may have underreported numbers of partners, the consistency
of the evidence suggests a large majority of HIV infections in
non-promiscuous adults," he says.
Gisselquist believes the role of prostitution has been overstated. In
Zimbabwe during the 1990s, he says, an increase in HIV of 12 per cent
coincided with a decrease of 25 per cent in the spread of sexually
transmitted diseases (STDs) generally.
He also cites studies suggesting a link to the use of dirty medical
needles. One showed that HIV-positive children had an average of 44
injections in their lifetimes, compared with 23 for virus-free children.
And in one clinic treating STDs, Gisselquist found that 28 per cent of
attendees treated with injections had HIV, compared with 17 per cent who
had not had injections.
Despite the disputes, Hankins says: "We all agree that [needle
transmission] is so easy to avoid, and all it requires is resources. We
definitely want to get to the bottom of it all." The WHO and UNAIDS have
now organised a meeting with Gisselquist in March to discuss his findings.
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