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

[E-drug <e-drug@healthnet.org>]

E-drug: Origins of AIDS (cont'd)
-------------------------------------------------------------------------

[Messages crossposted from SIGNpost. With thanks. HH]

More on Reused Needles, Sex & HIV in Africa Controversy:

- Sessions to See if Sex or Needles are Prime Cause of African AIDS
- HIV/Aids Barometer - March 2003
- U.N. Report Rejects African AIDS Data

International Journal of STD & AIDS (Royal Society of Medicine Press
Ltd) published these three articles on 20 February:

- Mounting anomalies in the epidemiology of HIV in Africa: cry the
beloved paradigm http://www.rsm.ac.uk/new/std144intro.pdf
- Let it be sexual: how health care transmission of AIDS in Africa was
ignored http://www.rsm.ac.uk/new/std148main.pdf
- Heterosexual transmission of HIV in Africa: an empiric estimate
http://www.rsm.ac.uk/new/std162stats.pdf
_______________________________________________________
____________________ 
Senator Sessions to See if Sex or Needles Prime Cause of African
AIDS

By Jeffrey Mcmurray, Associated Press Writer
24 March 2003

A study's conclusion that dirty needles might be responsible for as
many African AIDS cases as unprotected sex has piqued a key
senator's interest and opened debate on whether a $15 billion
humanitarian effort should be redirected.

Sen. Jeff Sessions, R-Ala., has called a Thursday hearing of the
Senate's health committee that could have major implications on the
focus of President Bush's five-year proposal to fight the disease in 14
African and Caribbean countries.

The study, outlined this month in a publication of the British Royal
Society of Medicine, questions the long-held belief that heterosexual
contact is to blame for as much as 90 percent of the AIDS cases in
Africa. That statistic has driven Bush's health advisers to emphasize
abstinence and safe sex education in assembling the $15 billion plan.

"The best evidence that was available just simply didn't support that,"
said David Gisselquist, an author of the study that reviewed African
AIDS research dating back to 1984. "The AIDS industry to date is
giving the signals they want the whole thing focused on sex and
treatment. We need to fight to get the message in there to look at
prevention."

Gisselquist concludes that almost a third of AIDS exposures in Africa
are due to use of contaminated needles in medical treatment, about
the same number as he blames on sex. Many other cases, he
concludes, are due to preventable medical exposures such as blood
transfusions or unsterilized equipment at a dentist's office.

The World Health Organization and Joint United Nations Programme
on HIV/AIDS disputed Gisselquist's findings earlier this month,
concluding "such suggestions are not supported by the vast majority
of evidence and unsafe sexual practices continue to be responsible
for the overwhelming majority of HIV injections."

Sessions isn't taking sides now, but he wants to hear the debate
hashed out in a public forum before Congress decides how to divvy
up the $15 billion project.

"We want to see if these findings hold up in the face of critical
analysis," said Sessions, who will preside at Thursday's hearing. "If it
is true, we need to start this very day because this very day, adults
are being infected with AIDS without their knowledge in a way that
could be easily prevented."

Gisselquist concludes needles and syringes are reused in medical
treatment as much as 50 percent of the time in sub-Sahara Africa.
Less than $1 billion a year would fund disposable needles and
education for all public health facilities, but he says a major sum
should also go toward public education efforts.

"A lot of this damage happens because people won't go to a formal
clinic because it's too far away and costs fees, so they go to their
neighbor," Gisselquist said. "You can't get at this problem by just
putting money and training through health care."

Joining Gisselquist on Thursday's panel will be Maria Wawer, a
professor of clinical public health at Columbia University who has
been researching AIDS cases in Uganda.

Wawer says her research disputes Gisselquist's findings. In Uganda,
virtually no new HIV cases are detected in people under age 13 or
over age 45, leading her to believe that sexual causes are most
responsible.

"In our population, the data suggests to me the amount of spreading
by injections is well under 10 percent," Wawer said. "If resources
were taken away to work on the injection side, that could backfire."

On the Net: Health Action AIDS Campaign:
www.phrusa.org/campaigns/aids
---

HIV/Aids Barometer - March 2003   [Edited]

http://allafrica.com/stories/200303210549.html

Mail & Guardian (Johannesburg)
March 21, 2003
Estimated Worldwide HIV Infections:
51 218 159 At 10.24am On Wednesday March 19

Unsafe sex: The World Health Organisation (WHO) and UNAids have
rejected claims that injections with reused needles are responsible for
many cases of HIV infection in Africa.

After a recent investigation the two groups say that unsafe sexual
practices continue to be responsible for the majority of HIV infections.

The WHO estimates that unsafe injection practices account for about
2,5% of HIV infections in sub-Saharan Africa.

Research published in the International Journal of STD & Aids had
claimed that a third of HIV cases were transmitted by unsafe
heterosexual sex, but that unsafe medical practices, such as
injections and blood transfusions using unsterile needles, had proved
to be a much greater risk.

Michael Adler, a professor at University College London Medical
School, was reported in the British Medical Journal early this month
saying: "It's true there was a problem with infected needles in the
1980s, but it was nowhere near as big a factor as they suggest."
---

http://washingtontimes.com/world/20030319-202015.htm

The Washington Times http://www.washingtontimes.com

U.N. report rejects African AIDS data
Tom Carter
The Washington Times, 19 March 2003

The primary U.N. agencies responsible for combating AIDS rejected
evidence in a British medical journal that poor medical hygiene
practices are responsible for most HIV infections in Africa.

The World Health Organization and UNAIDS made the conclusion
yesterday during a meeting in Geneva called to review articles
published this month in the British Royal Society of Medicine's
International Journal of STD & AIDS.

The studies attributed two-thirds of AIDS cases in Africa to
contaminated blood and dirty needles used by hospitals, clinics and
medical practitioners.

"Following a review of evidence, which included recent articles
suggesting that a majority of HIV infections in sub-Saharan Africa are
due to unsafe medical practices, particularly injections, the experts
concluded that such suggestions are not supported by the vast
majority of evidence," said WHO and UNAIDS in a joint statement.

The statement also said that "unsafe sex is the primary mode of
transmission of HIV in Africa."

Authors of the original studies said they stood by their findings. "The
[WHO/UNAIDS] report does not reflect the sense of the meeting and
distorts facts," said David Gisselquist, a primary researcher on the
original report. "The evidence we discussed suggests hundreds of
thousands of African children with HIV through health care. The
report is grossly inaccurate to say there is no evidence. It can be
ignored or denied, but it is there, and we talked about it." HIV is the
virus that causes AIDS.

An expert in African immunization practices agreed that the report's
emphasis was a "surprise."

"The meeting was balanced. Both sides brought sound arguments. It
does not matter if the risk [of HIV infection from needles] is 5 percent
or 90 percent; ethically we cannot allow people to get HIV from
unsafe practices. This is the feeling we all had and agreed on," said
Dr. Jules Millogo, with Virginia-based BASICS, an immunization
project funded by the U.S. Agency for International Development.

Dr. Millogo, who attended the Geneva meeting, said it had been his
expectation that the WHO/UNAIDS statement would emphasize the
need for better medical practices, rather than undermine the
credibility of the Gisselquist findings.

"We agreed it would be cheap to do, about $250 million. It is clear for
us that we need to improve injection practices. This is a very high
priority for us," he said.

In a series of three articles in the International Journal of STD &
AIDS, Mr. Gisselquist and John Potterat found that "health care
exposures caused more HIV than sexual transmission."

"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 wrote.

About 30 million people in sub-Saharan Africa suffer from the
disease, and the researcher's findings suggested that as many as 20
million were infected needlessly.

The articles, based on a review of dozens of AIDS studies,
questioned the focus of AIDS-prevention programs for Africa, which
emphasize condom distribution and safe sex.

The articles caused such a stir in the international public health
community that the WHO and UNAIDS, the United Nations' leading
AIDS agency, called the meeting in Geneva.

The experts concluded in Geneva that children from ages 5 to 14,
typically sexually inactive, have low rates of HIV infections. They
estimated that "unsafe injection practices" account for about 2.5
percent of HIV infections in sub-Saharan Africa.




--
To send a message to E-Drug, write to: e-drug@usa.healthnet.org
To subscribe or unsubscribe, write to: majordomo@usa.healthnet.org
in the body of the message type: subscribe e-drug OR unsubscribe e-drug
To contact a person, send a message to: e-drug-help@usa.healthnet.org
Information and archives: http://www.essentialdrugs.org/edrug