U.N. report rejects African AIDS data

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.

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