Monday Morning Reflections(1)-Mar 10
Charles R Spinner
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The Washington Times
http://dynamic.washtimes.com/twt-print.cfm?ArticleID=20030304-86278376
Studies say sex not main AIDS cause
Tom Carter
THE WASHINGTON TIMES
Published 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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