- The Washington Times - Wednesday, March 5, 2003

The U.S. Agency for International Development said yesterday that its HIV/AIDS experts plan this week to begin examining research suggesting that AIDS in Africa is more commonly transmitted through dirty needles than through heterosexual contact.
"I have asked to see the original scientific studies. … The epidemiology of the disease fits that it is mainly a sexually transmitted disease. I need to see the data," said Dr. Anne Peterson, a physician and head of the USAID bureau of global health.
Three articles published in the March edition of the International Journal of STD & AIDS, a publication of the British Royal Medical Society, upend the almost universal belief that 90 percent of HIV in Africa is transmitted by heterosexual sex.
According to the authors, as little as 30 percent of HIV transmission in Africa can be attributed to sex, while a much greater amount can be attributed to unclean health care practices, such as dirty needles used to vaccinate people and contaminated blood.
The study has roiled the public health community. The United Nations' World Health Organization and UNAIDS, have called a meeting for March 17 in Geneva to discuss the same research, which threatens to discredit years of conventional condom-based programs to fight AIDS in Africa.
Dr. Peterson said someone from USAID would attend the Geneva meeting as well.
"Roughly one-third of the spread of HIV 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, authors David Gisselquist and John Potterat write in the March issue of the prestigious journal. "This finding has major ramifications for current and future HIV control programs in Africa."
If the findings are correct, it could force a major reallocation of funds that go into HIV-prevention programs.
There are currently 30 million people in Africa with HIV, the virus that causes AIDS. According to its Web site, USAID has spent $2.3 billion in AIDS prevention and treatment since 1986.
Dr. Peterson said she did not know how much of that had gone for condom distribution in Africa. She said USAID spent $25 million on condoms worldwide last year.
President Bush, in his State of the Union address, asked Congress for $15 billion over the next five years for AIDS prevention and treatment in Africa and the Caribbean.
USAID will be responsible for disbursing most of the AIDS money Congress allocates.
Dr. Peterson said that she knows several of the report's authors, and that they are "pretty reputable," but she is withholding judgment on their findings until she can see their research for herself.
"We have always been concerned about needles as a route of transmission," she said, noting that USAID has pioneered research in disposable and "auto-destruct" needles to prevent HIV transmission.
She said it was her goal to designate AIDS-prevention funds to the areas that scientific data indicates would be the most effective.
"It is possible that we have underestimated" the number of people infected through unclean medical practices, she said. "We plan to take a pretty hard look at this."

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