The role of health care in the spread of HIV/AIDS in Africa: evidence from Kenya

Abstract

It is commonly asserted that the sub-Saharan African HIV/AIDS epidemic is predominantly due to heterosexual transmission. However, recent re-examination of the available evidence strongly suggests that unsafe health care is the more likely vector. The present report adds to the evidence for health-care transmission by showing that Kenyan women who received prophylactic tetanus toxoid injections during pregnancy are 1.89 times (95% confidence interval [CI]:1.03-3.47) more likely to be HIV-1 seropositive than women who did not receive this vaccination. In contrast, recent sexual behaviour (condom use, number of partners) was not related to HIV status. The findings are unconfounded by reverse causality (all injections were purely prophylactic rather than for treatment of any HIV-related illnesses, and none of the women reported knowing that she was HIV seropositive). Focus on a specific injection may have improved participant recall. The results are consistent with health care being a very important vector for HIV in sub-Saharan Africa. It is recommended that there be a reallocation of resources to address healthcare transmission of HIV/AIDS.

Overestimation of heterosexually attributed AIDS deaths is associated with immature psychological defence mechanisms and clitoral masturbation during penile–vaginal intercourse

“…6 However, anal sex, both homosexual and heterosexual (the latter often in a male bisexual context), in sub-Saharan Africa is rather common, 4 and blood exposures (notably from unsafe health care) alone might account for the preponderance of non-vertical HIV infections. 1,5,8,10 When unsafe health care is adequately measured in African research studies, traditional sexually transmitted disease risk factors (non-use of condoms, number of sexual partners, PVI frequency) have generally been found to be unrelated to incident HIV infection. 5,8,10 Most importantly, by avoiding the vagaries of risk-factor epidemiology and directly examining tissue susceptibility, it has been demonstrated experimentally that massive quantities of HIV applied to vaginal and cervical tissue (without leakage at the edge of the samples or using preparation methods producing excessive tissue damage) are unable to cause infection, but the same experimental conditions readily infect rectal tissue.…”

“…1,5,8,10 When unsafe health care is adequately measured in African research studies, traditional sexually transmitted disease risk factors (non-use of condoms, number of sexual partners, PVI frequency) have generally been found to be unrelated to incident HIV infection. 5,8,10 Most importantly, by avoiding the vagaries of risk-factor epidemiology and directly examining tissue susceptibility, it has been demonstrated experimentally that massive quantities of HIV applied to vaginal and cervical tissue (without leakage at the edge of the samples or using preparation methods producing excessive tissue damage) are unable to cause infection, but the same experimental conditions readily infect rectal tissue. 14 -16 The risk of a reasonably healthy adult contracting HIV infection through PVI is not only miniscule on an absolute basis, but also relative to the other willingly assumed mortal risks of everyday life.…”

Perspective on Providing Partner Notification Services for HIV in Sub-Saharan Africa

“…6 Of particular concern to the Zimbabwean researchers is the possibility that observed heterogeneity in HIV prevalence in heterosexuals could be explained by unsafe medical practices, such as the reuse of needles and other sharps, echoing similar conclusions from previous reports. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] As is well known, in poor countries, opportunities for unsanitary medical, dental, ritualistic, or cosmetic procedures abound 27,28 as do, consequently, opportunities for the effective transmission of blood-borne agents such as hepatitis viruses and HIV. Both historically and presently, most investigations into the HIV epidemics in sub-Saharan Africa have (surprisingly) focused almost exclusively on sexual intercourse variables and related risk markers.…”

AIDS epidemiology in Africa: a changing of the guard

“…15 These findings are also consistent with results from other studies showing that, when adequate measures of blood exposures are used, sexual variables play a much lesser role in HIV transmission than asserted by the received wisdom. 16,17 Just as Peters et al 8 and Okinyi et al, 9 respectively, studied correlates of HIV infection in some populations of sub-Saharan African adults and children, so do Reid and Van Niekerk 10 (adults and children) and Reid 11 (children). While these latter researchers arrive at views similar to those of the former, their methodology differs.…”