Re: Did doctors jumpstart the HIV pandemic?

[Guest guest]

Dear All,

Re: /message/12005

The possibility of introduction of transmissible infections like HBV,HCV etc.due

to wrong injecting practices is a stark reality.

As a matter of fact we did have an epidemic of Hepatitis B recently in an Indian

state due to callous injecting practices of doctors (both qualified and quacks).

Any 'evidence' concluding about the role of such practices as the 'origin'/major

driver of the HIV pandemic(in Africa) without looking into the way it behaved in

the USA in early eighties must be examined more carefully.

We all working in the field of HIV and AIDS are committed to shatter the

greatest myth fuelling the stigma and discrimination faced by the PLHIV.

Besides the social factors responsible for stigma and discrimination related to

HIV and AIDS, there are causes specific to health care settings.

The greatest of these factors is the FEAR that many health care workers(read

doctors)have about getting infected while performing clinical duties.

There is a minimal risk of occupational exposure for the healthcare workers but

most of the fears of the healthcare workers about causal occupational exposure

are unjustified.

 

Any jumping to conclusion that docotors jumpstarted the HIV pandemic may

re-inforce that misconception for obvious reasons.

 

Most of us who are associated with quality health care provision

and are committed to establisment of right to health(beyond mere right to

healthcare)are devoted to health and community systems strregthening.

Safe infection control practices and proper bio-medical waste managment are the

topmost priorities there.

The study is very important and worth further careful examination and generation

of more evidence to support existing activities and interventions.

I hope I could express my personal views more effectively in my message.

Best wishes,

Rajesh Gopal.

e-mail: <dr_rajeshg@...>

[Guest guest]

Dear Editor:

Re: /message/12005

I have followed the debate and agree with comments of Dr. Rajesh Gopal and

others.

Let's congratulate Prof. Pepin for publishing a well-designed study on

the association of reusable injecting equipment (iatrogenic) and high

prevalence of HCV and HTLV-1 in Bangui, Congo.

Undoubtedly, it is a tough terrain for researchers.

It is biologically plausible that other blood-borne infections such as

SIV/HIV/Ebola will be transmitted through reusable injecting

equipment, more so when treatment for sleeping sickness was done on large

populations with 6 injecting sets!

As he has rightly stated in the paper, large-scale transactional sex within

cities provided the multiplier effect for sexual transmission of HIV.

I have a slightly different point of view on whether reusable injecting

equipment did jumpstart the HIV epidemic in Africa in 1950s.

To make this point, the best time (temporal) data that can be used

for this purpose is available from the CDC field station studies in Kinshasa,

Zaire.

Incidentally, Kinshasa city is located across the Congo River that divides it

from Bangui city where Dr. Pepin did his study. Hence, these are identical

settings.

In late-1986, Dr. Nahmias at CDC, Atlanta isolated primitive form of HIV from a

specimen collected from a male patient presenting with sickle-cell-like disease

in Kinshasa in 1959.

Around the same time in 1986, the CDC team led by Mann stationed in

Kinshasa pulled out 454 archival serum samples that were drawn way back in 1976

to determine the prevalence of Ebola virus in villages around tropical forests

(north-east of Kinshasa).

These frozen samples were tested for HIV-1and 4/454 (0.9%) were tested positive

with ELISA and western blot.

Subsequently, a prospective study was done by the CDC team in and

around the same villages in Kinshasa in 1986, and it showed HIV seroprevalence

of 7/757 (0.9%). No change!

The two studies cited above indicate the following:

a) HIV-1 infection remained static and low prevalence for almost 10 years

(1976-1986) in those villages in Kinshasa, Zaire despite the use of reusable

injecting equipment;

The critical threshold of 1% causes an exponential growth of HIV in a

community and this has been repeatedly validated since then across the globe.

Incidentally, this critical threshold of 1% was agreed to in December 1986 in an

expert committee meeting at WHO, Geneva (and I chaired the Delphi meeting that

released the first global estimates of HIV infections at mere 10,000);

c) the ministries of health in sub-saharan Africa moved from reusable to

disposable injecting equipment soon after 1985; yet, the HIV sero-prevalence

remained static in Kinshasa at 0.9%.

Hence, retrospectively it will be prudent to conclude that iatrogenic

transmission of SIV/HIV could have ‘seeded’ the epidemic in Africa.

The role of monkey hunting, meat cutting, and blood contact in the

transmission of SIV to man was possibly less significant.

The trigger for jump-start of a widespread epidemic was subsequently provided by

urbanization, mobility, and transactional sex.

I have attached the full text of Prof. Pepin's paper for readers to refer to.

Best,

Dr. Subhash Hira

email: subhash_hira@...

1 of 1 File(s)

Pepin-HTLV1 and HCV.pdf

[Guest guest]

Dear All,

Re: /message/12005

Recent research linking high rates of HCV infections in several Central African

countries to health care procedures during colonial times is importan not only

to show that unsafe health care likely played an important role in HIV's initial

spread before 10950, but also because of its implications for what should be

done to stop generalized HIV epidemics.

 

In many countries, especially richer countries, gay men and injection drug users

account for 70% or more of HIV infections. Because of this, HIV infects mostly

men.

 

Now, when one sees epidemics where IDUs and gay men account for small minorities

of infections, and where the ratio of infected men to women is less than 2 (as

in India) or even less than 1 (as in most of Africa) -- what is happening? 

 

Doctors, for understandable professional reasons, do not want to admit that they

have contributed to these infections. But they have. The important question to

address at this point is:

What to do about it? Deny? Assert that doctors are careful? Or do the right

thing -- investigate?

We have had 2.5 decades of denial, without any ivnestigations in sub-Saharan

Africa or India. Urge safety, yes. But also investigate, so we know what has

been and is going on.

 

On a matter such as this, we should not so easily accept assurances

from doctors, who have a professional interest that is not at all the same as

the public interest.

 

In countries where governments have responded responsibly to unexplained

infections, and have investigated to find what is happening, governments have

found outbreaks of linked HIV infections.

In some cases, these outbreaks reached hundreds and even thousands of children

and adults. In China, HIV reached 100,000 blood and plasma donors in the early

1990s. 

 

Study after study has showed that differences in heterosexual behavior cannot

explain so many infections, especially in women. It's time for doctors to accept

that they have been part of the problem, and to endorse investigations, so that

we can all find out how much unsafe health care contributes to the problem. 1%,

5%, 10%, 25%, or more? Let's look.

And then, when we know what's happening, let's stop the transmission.

 

Best regards,

Gisselquist

e-mail: <david_gisselquist@...>