- The Washington Times - Tuesday, March 4, 2003

Dirty needles and tainted blood not unprotected sex or the lack of condoms are the primary cause of Africa's AIDS epidemic, according to three articles published this month in a leading medical journal.
"Health care exposures caused more HIV than sexual transmission," write David Gisselquist and John Potterat in the March edition of the International Journal of STD & AIDS, a publication of the British Royal Society of Medicine.
Mr. Gisselquist and Mr. Potterat are the primary authors of the three articles that challenge the almost universal belief that heterosexual contact is primarily responsible for AIDS in Africa.
The articles have caused such a stir in the international public health community that the U.N. World Health Organization and UNAIDS, the United Nations' leading AIDS agency, have called a meeting in Geneva later this month to discuss the findings.
In the articles, which include a review of dozens of health studies throughout Africa, the authors question the "safe sex" premise behind Western-funded AIDS prevention programs.
"Roughly one-third of the spread of HIV in Africa can be associated with heterosexual transmission. … A growing body of evidence points to unsafe injections and other medical exposures to contaminated blood as pathways" to HIV transmission, they write.
If the findings prove accurate, it would mean that as many as 20 million Africans may have been infected needlessly, for want of a clean syringe in procedures as simple as childhood vaccinations.
"We need to ground our prevention programs in fact," Mr. Gisselquist, an economic anthropologist, said in an interview yesterday. "The figure that 90 percent of HIV transmission is sexual has never been grounded in fact."
HIV, or human immunodeficiency virus, causes AIDS.
Mr. Gisselquist said that a "comprehensive safe injection" program could be in place worldwide for between $300 million and $900 million a year.
"Only about 10 percent of injections in Africa are vaccinations. Injections are popular and fairly cheap. Most are curative, and most are unnecessary," he said.
The articles note the following:
Many studies report HIV-infected children who have mothers who are not infected. According to one study, 40 percent of children with HIV had mothers who tested negative for the virus.
African countries with the best health care Zimbabwe and South Africa have some of the highest rates of infection and show a direct rise in HIV in concert with "aggressive efforts to deliver health care to rural populations."
While most sexually transmitted diseases (STD) are associated with being poor and uneducated, AIDS is an urban disease, occurring among the educated and those with higher incomes, and therefore, better access to health care.
"The important thing is that people need to rethink the postulate of heterosexual HIV transmission," said Richard Rothenberg, a physician at Emory University School of Medicine in Atlanta, who co-authored one of the articles.
"No one is saying let's stop using condoms … but we have to change the way we think about health care in Africa. The likelihood of propagating disease [with unclean medical practices] is real."
"This finding has major ramifications for current and future HIV control programs in Africa," the authors write.
The U.S. Agency for International Development, the largest purchaser and distributor of condoms in Africa, declined to comment yesterday on the articles.
Several international family-planning organizations, which promote condom use to prevent HIV transmission, also declined to comment, saying they were unfamiliar with the studies.
According to the studies, children with HIV averaged 44 injections from vaccines, antibiotics and other medicines, while uninfected children averaged 23 injections. Researchers in the studies conclude that the more the injections, the greater the chances of contracting the virus.
The studies also question conventional wisdom about African sexual practices. While it is widely assumed that Africans have a higher incidence of HIV because they are more promiscuous and engage in more risky sex than their Western counterparts, the studies found no evidence to support the belief.
"Several general behavior surveys suggest that sexual activity in Africa is not much different from that in North America and Europe," according to a British Royal Society of Medicine statement on the study.
Although HIV in the West is believed to be transmitted mostly through anal sex between men, or with needles shared among drug users, in Africa, HIV has infected the general population.
In one of the articles, on how and why safe health practices have been ignored as effective AIDS prevention measures in Africa, the authors were particularly critical of efforts to fight the disease.
"It was in the interests of AIDS researchers in developed countries where HIV seemed stubbornly confined to [homosexual men, drug users and their partners] to present AIDS in Africa as a heterosexual epidemic," they write.
They suggest that the researchers were afraid of blaming injections for fear it would scare people from getting immunizations.

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