[e-drug] Origins of AIDS (cont'd)

[Beverley Snell <bev@burnet.edu.au>]

E-drug: Origins of AIDS (cont'd)
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A recent posting on e-drug suggested that we need focus more on
injection safety than we have done so far. I agree. However, I think
there are many issues that need to be addressed. There is a large
variation in the mode of transmission in different places.
Interventions need to be based on situation analyses and strategic
planning for each situation.

When you look at the Gisselquist et al articles there seem to be
indications that HIV may be less sexually transmitted in Africa than
estimated previously.

I don't think we can accept that analysis at face value. The
accurate reporting of sexual activity eg through questionnaires may
be questioned for a start. There are settings in Africa where
transmission has been shown to be almost entirely through
heterosexual contact. For example:

Hope KR. Population mobility and multi-partner sex in Botswana:
implications for the spread of HIV/AIDS. Afr J Reprod Health 2001
Dec;5(3):73-83.

  For cultural and economic reasons, Botswana has one of the
  most mobile populations in the world. People move around the
  country frequently for employment opportunities and because of
  the nature of the settlement patterns. Also, there is extensive
  multi-partner sexual activity in the country. This study analyses
  the relationship between population mobility and multi-partner
  sex and their implications for the spread of HIV and AIDS in
  Botswana. The unit of analysis is a sample of 292 mobile
  working in rural and urban settings in four selected districts of
  the country

MacDonald DS. Notes on the socio-economic and cultural factors
influencing the transmission of HIV in Botswana. Soc Sci Med
1996, May;42(9):1325-33.

  Botswana currently has one of the highest recorded incidences of
  HIV infection in Africa although AIDS was only first publicly
  recognized in 1985. By this time other countries in the region
  such as Malawi, Zambia and Uganda were already showing signs
  of epidemic levels of HIV. The rapid transmission of HIV in
  Botswana has been due to three main factors; the position of
  women in society, particularly their lack of power in negotiating
  sexual relationships: cultural attitudes to fertility; and social
  migration patterns. These three factors along with other,
  arguably more minor, ones have been shaped and mediated
  within the specific context of Botswana's rapid socio-economic
  development and cultural milieu. This has resulted in a
  constellation of factors unique to Botswana which accounts for
  the current high seroprevalence rate in the country.

A series of postings on e-drug last year (search archives on 'Bad
blood') highlighted the transmission through transfusion blood. A
long front page article appeared in the Washington Post of 11 Jan
01 and was called "The High Cost of Selling Blood: As AIDS Crisis
Looms in China, Official response is Lax." It was shown that whole
communities have been infected through transfusion practices.

Here are two pars from the Washington Post article:

  While AIDS is generally contracted through sex or drugs in the
  rest of the world, it came into Chenglao and the rest of Shangcai
  County by blood. For decades people from Shangcai and other
  counties in Henan, Hebei, Anhui, Shanxi and Hubei provinces
  relied on selling blood to pad out a lean year or to live a little
  better in a fat one. China's government used to force its citizens
  to give blood, but after economic reforms in 1978 donations fell
  off and a market in blood emerged. Farmers in Chenglao, for
  example, said they have been selling blood since the early
  1980s.

  No testing was done for HIV in the beginning. Shangcai County
  is now believed to have as many as 10,000 HIV carriers, a local
  health official said. The senior scientist said his figures indicate
  hundreds of thousands of blood donors all over China were
  infected in this way. He and other researchers say the blood
  market was a major catalyst for the AIDS explosion in China.

Injecting drug use

In some communities the main mode of transmission is through
injecting drug use. In January 2002 Gary Reid, from The Burnet
Institute Centre for Harm Reduction, published Revisiting 'The
Hidden Epidemic' A Situation Assessment of Drug Use in Asia in
the context of HIV/AIDS
http://www.chr.asn.au/Rapidassessment.pdf
Gary can be contacted at <reid@burnet.edu.au>

Safe injection practices

As Hilbrand pointed out, it is extremely important to focus
education on safe injecting practices. Unnecessary injections and
multiple use of needle and syringes remain far too common.

Single use of injecting equipment and waste disposal

Problems associated with building, maintaining and using
incinerators have been documented on SIGNpost.

What is needed is the inclusion on training for waste disposal
together with training for curative care and rational use of drugs
(including injections only according to treatment guidelines).
Appropriate collection of infectious and sharp waste for transport to
a regional waste disposal mechanism may be a solution.

Populations need to be sensitised so that they demand safe
injections: this would shift the balance of power.

I look forward to hearing more from e-druggers

Best wishes

Beverley

Beverley Snell
Essential Drugs and Community Health Specialist
Centre for International Health
Macfarlane Burnet Institute for Medical Research & Public Health
Telephone 613 9282 2115 / 9282 2275
Fax 61 3 9282 2144  or 9282 2100
email <bev@burnet.edu.au>

GPO Box 2284, Melbourne 3001 Australia
Site: Alfred Medical Research & Education Precinct (AMREP),
corner Punt & Commercial Roads, Prahran 3181

Time zone: 11 hours ahead of GMT.

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