Unsafe medical injections and HIV transmission in India

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Unsafe medical injections and HIV transmission in India

Mohammad Tahir a, SK Sharma a and Duncan -Rohrberg b

The Lancet Infectious Diseases 2007; 7:178-179.

DOI:10.1016/S1473-3099(07)70034-8

We read with great interest Padma Chandrasekaran and colleagues'

comprehensive Review of the HIV/AIDS epidemic in India.1 We would

additionally like to emphasise the role of increasing the regulation

and accountability of the medical sector in containing the epidemic.

India's health system remains dominated by a largely unregulated

private sector that accounts for greater than 80% of domestic health

expenditures. Owing partly to the low trained doctor-to-patient

ratio, unqualified " quack " practitioners provide the bulk of

clinical care to the poor, particularly in rural areas.

The result has been that unsafe injections remain extremely common throughout

the country.2–5 A survey conducted at our centre in northern India showed that

35% of citizens in one rural village had received some form of medical injection

in the past 6 months, most of which were given by an untrained medical

practitioner.4 Data from our National AIDS Control Organization (NACO)-supported

antiretroviral clinic have shown that for approximately 3% of patients the only

identifiable source of HIV infection is through unsafe medical injections.

In view of the high prevalence of receipt of unsafe medical injections among

high-risk marginalised groups in particular,3 these injections may contribute to

the spread of HIV both within high-risk groups and between high-risk groups and

the general population.

To combat the small but significant ongoing transmission of HIV via

unsafe medical injections, it would be wise for NACO to incorporate

the following strategies into its comprehensive control programme.

First and foremost is strengthening and expanding public sector

primary medical care. Comprehensive AIDS control cannot occur in the

absence of a strong public sector capable of meeting the basic

medical needs of the poor. The private sector has proven woefully

inadequate and dangerous in this regard. By meeting these needs, the

use of quack practitioners will decrease. Second, expanding the use

of auto-disable syringes would help to decrease the secondary use of

contaminated needles by medical providers.5 Finally, concrete steps

need to be taken to increase governmental and self-regulation of

medical practice, in both the private and public sectors.

The rapid expansion of HIV/AIDS in India is a symptom of a larger

disease: the failure of the public provision of health care to vast

swaths of the nation's poor. The persistent transmission of HIV by

unsafe medical injections is but one manifestation of this failure.

While the prescriptions laid out by Chandrasekaran and colleagues

are crucial and immediate steps to take, we must also remain

cognisant of the broader health systems perspective if we are to

truly stop HIV.

We declare that we have no conflicts of interest.

References.

1. Chandrasekaran P, Dallabetta G, Loo V, Rao S, Gayle H,

A. Containing HIV/AIDS in India: the unfinished agenda. Lancet

Infect Dis 2006; 6: 508-521.

2. Kermode M, Holmes W, Langkham B, MS, Gifford S. Safer

injections, fewer infections: injection safety in rural north India.

Trop Med Int Health 2005; 10: 423-432.

3. Kermode M, Singh LB, Raju RK, Alam S, H, Crofts N. Injections

for health-related reasons amongst injecting drug users in New Delhi

and Imphal, India. Public Health 2006; 120: 634-640.

4. Anand K, Pandav CS, Kapoor SK. Injection use in a village in

north India. Natl Med J India 2001; 14: 143-144.

5. Sharma DC. India to use AD syringes to stem infection from reused

needles. Lancet Infect Dis 2004; 4: 601.

Affiliations

a. All India Institute of Medical Sciences, New Delhi, India

b. AIDS Program, Yale School of Medicine, New Haven, CT, USA