On July 31, the Senate Health, Education, Labor and Pensions Committee held a hearing on the medical transmission of HIV/AIDS in Africa.
Although some progress has been made towards preventing the sexual transmission of HIV/AIDS in developing countries, little has been done to address the medical transmission of the virus, which includes unsafe injections and blood transfusions.
Dr. Anne Peterson of the U.S. Agency for International Development (USAID) cited health care safety as a major concern in the developing world’s HIV/AIDS epidemic. With regard to unsafe injections, she noted that the World Health Organization (WHO) “estimates that in sub-Saharan Africa approximately 18% of injections are given with reused syringes or needles that have not been sterilized.” She added, “Over 16 billion injections are given every year in developing countries for immunizations, therapeutic purposes, transfusion of blood and blood products, vitamin treatments, and injectable contraceptives.” She added
The issue of blood safety in Africa, and in particular, HIV/AIDS prevention during obstetrical care is a focus of USAID’s global activities. Dr. Peterson noted that the program “focuses on the prevention of mother-to-child transmission of HIV and safe motherhood service delivery. In addition, we emphasize several key infection prevention behaviors: injection safety, universal precautions, hand-washing, clean, safe delivery, avoiding unnecessary medical procedures, proper sterilization of instruments, proper disposal of hazardous waste, and newborn umbilical cord care.”
A physician in the Department of Blood Safety at WHO, Dr. Yvan Hutin has been a leader in studying the transmission of HIV/AIDS in medical settings. He estimated that, in Africa, unsafe injections were responsible for 2.5% of new HIV/AIDS cases and blood transfusions were responsible for 5-10% of new cases. Blood transfusions are a major concern in many African nations because a third of the blood supply is provided by paid donors and WHO estimates that 50% of that supply is not tested for HIV/AIDS or other diseases.
Dr. John Ssemakula of Medilinks has treated patients in a number of African countries. He testified that funding should be provided for clinics to purchase single-use injection devices. When hospitals and clinics run low on these supplies, patients are forced to purchase their own syringes. He said that, to save costs, a patient will purchase only one syringe and then share it with his family and neighbors, spreading the virus throughout the entire community.
Speaking on behalf of Physicians for Human Rights, Holly Burkhalter stated that, every year, “at least half a million people will become infected with HIV/AIDS through unsafe medical injections and blood transfusions.” She highlighted a number of recommendations on how the United States can assist the developing world in eliminating the medical transmission of disease and pointed out that the June 2001 United Nations Declaration of Commitment on HIV/AIDS “called upon all countries to implement universal precautions in health-care settings to prevent transmission of HIV infection by 2003 and to implement a wide range of prevention programs by 2005, including sterile injecting equipment and safe blood supply.” Of particular interest to Congress, Ms. Burkhalter cited an April 2003 WHO study estimate that the global cost of an injection safety program would be approximately $905 million.
John Stover of The Futures Group International concluded, “It is clear that no single intervention will be enough, but a comprehensive approach that reaches people with different risks with a variety of information and services…by 2005 would reduce the total number of new infections by 29 million, averting about two-thirds of the infections that would otherwise occur.”
