Let it be sexual: how health care transmission of AIDS in Africa was ignored

Abstract

The consensus among influential AIDS experts that heterosexual transmission accounts for 90% of HIV infections in African adults emerged no later than 1988. We examine evidence available through 1988, including risk measures associating HIV with sexual behaviour, health care, and socioeconomic variables, HIV in children, and risks for HIV in prostitutes and STD patients. Evidence permits the interpretation that health care exposures caused more HIV than sexual transmission. In general population studies, crude risk measures associate more than half of HIV infections in adults with health care exposures. Early studies did not resolve questions about direction of causation (between injections and HIV) and confound (between injections and STD). Preconceptions about African sexuality and a desire to maintain public trust in health care may have encouraged discounting of evidence. We urge renewed, evidence-based, investigations into the proportion of African HIV from non-sexual exposures.

Cofactor infections and HIV epidemics in developing countries: implications for treatment

“…Incorporating data on medical transmission into the model in this paper would likely further improve its predictive power in analyzing the determinants of HIV spread (Drucker et al, 2001;Potterat et al, 2002;Gisselquist et al, 2003;Brewer et al 2003;Brody, 2004;Deuchert andBrody 2006, 2007).…”

Medical Waste Collectors in Eastern Ethiopia are Exposed to High Sharp Injury and Blood and Body Fluids Contamination

“…WHO studies showed that up to 5% of all HIV infections in Africa are due to unsafe injections including exposure to sharp injuries during unsafe handling of medical wastes [29,30]. On the other hand, data from two decades' studies in Africa estimated that contaminated needles and syringes used for medical treatments led to 48% of the HIV infections and sexual transmission though unprotected sex causes only 30% of the infections [31]. Study in Hawassa city of south Ethiopia showed that MCWs had experienced needle-stick injuries at least once in their life at the different HCFs ranged from 25-100% [15].…”

Transmission of HIV-1 infection in sub-Saharan Africa and effect of elimination of unsafe injections

“…This finding is important because, although an injection history was not reported, the seroconversions would not have occurred as a result of injections being given for treatment of an STI, as has been argued. 3 …”