Dirty needles bigger HIV threat than unsafe sex

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dirty syringeA study by Britain's Royal Society of Medicine found that pregnant women in sub-Saharan Africa are more likely to get HIV/AIDS from a tetanus shot with a dirty needle than from unsafe sex, reopening a debate over the best way to combat the spread of the disease.

The study, published in the November issue of the society's International Journal of STD & AIDS, found that pregnant women who received the neonatal tetanus-toxoid shot as a preventative measure were almost twice as likely to subsequently test positive for HIV as those who did not receive the injection.

Injections and other such puncture treatments -- frequently conducted with reused or improperly sterilized needles -- are the main cause of the HIV/AIDS epidemic in Africa, not heterosexual sex with multiple partners, the studies authors reported.

One of those authors, Stuart Brody, said in a telephone interview that this and earlier studies provide "mounting evidence" that health organizations are "misguided" in thinking their strategy of promoting safe sex would by itself curb the spread of HIV/AIDS.

"This is tremendously significant." said Mr. Brody, a senior researcher at the University of Paisley in Scotland.

He co-authored the study with Eva Deuchert of the University of Freiburg in Germany.

"Healthy, pregnant women are being put at risk for HIV when receiving unsafe health care, for themselves and their unborn child," he said. "Injections are given widely and regularly in sub-Saharan Africa and are a significant factor in the spread of HIV/AIDS."

Other researchers questioned the Royal Society's findings.

George Schmid, a senior researcher from the HIV/AIDS department of the World Health Organization in Geneva, said by e-mail that "the issue of unsafe injections causing HIV infection was examined in detail two years ago."

"While an exact proportion of infections transmitted by unsafe injections is difficult to determine globally, it is less than 5 percent, and very likely considerably less," said Dr. Schmid, who published his findings on the earlier studies in the Lancet, a leading British medical journal.

"Any infections that are transmitted via unsafe health care practices are unacceptable," he said. "Nevertheless, the major cause of HIV infection, globally and in Kenya, is unsafe sex, and that is where the emphasis and resources must remain."

Earlier Royal Society studies, including some reported in the same journal in March 2003, had also found that unsafe health care, particularly injections, were the primary cause of the HIV/AIDS epidemic in Africa.

Leading HIV/AIDS relief organizations met in Geneva that year to discuss those findings, which they refuted.

Other researchers said the society had identified a major problem, regardless of how many people were infected by dirty needles.

"Even if unclean injections were the cause of only a small percentage of HIV cases, it is a huge problem," said Amir Attaran, who studies population health and global development policy at the University of Ottawa in Canada.

Health organizations that distribute syringes are saving only pennies per syringe by using types that can be reused, he said.

"If they are doing that, they are killing people."

The Royal Society study analyzed data from the 2003 Kenya Demographic and Health Survey of 1,620 pregnant women who did not report being HIV-positive before the tetanus shot.

"Many women had HIV after only one shot," said Mr. Brody, who recommended that health care organizations exclusively use syringes that can be used only once.

"A study in Uganda showed clear improvement with the use of safe needles," Mr. Brody said. "It is the easiest aspect of the HIV/AIDS epidemic to fix."

But Dr. Schmid questioned the study's design and said the authors had parsed its data to reach a generalized conclusion.

"Our UNICEF colleagues tell us that [single-use syringes] became widely used in 2001. In Kenya, in 2002, there was a countrywide tetanus-toxoid campaign, conducted completely with safe syringes. Thus, during at least part of the time period covered by the Brody paper, only safe injections were being used in public programs."

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