Why has the public been so silent about risks to contract HIV from health care?

[Guest guest]

Dear Forum,

In a previous contribution, Mariette Correa asked what people can do to promote

safe care. This contribution responds to her question.

The IPEN study of injection practices acknowledges common unsafe injections.

Many other health care procedures are often unsafe due to reuse of unsterile

instruments.

Why has the public been so silent about risks to contract HIV from health care?

Part of the problem may be widespread misinformation about HIV’s ability to

survive outside the body.

HIV can survive for hours when dry (Resnick et al, JAMA 1986; 255: 1887-1891),

and for weeks in a damp environment, such as inside a

used syringe or multidose vial (Abdala et al, J Acquir Immune Defic Syndr 1999;

20: 73-80).

Also, many people believe that the risk to transmit HIV through reused unsterile

syringes and needles is only 0.3%. This is the risk for nurses to contract HIV

from an average needlestick accident.

However, 93% of needlestick accidents are shallow scratches. For deep

needlesticks (deep enough for the needle’s hole to be within the skin as in an

injection) the average risk may be estimated at 2.3% (see: Cardo et al. N Eng J

Med 1997; 337: 1542-43; Gisselquist et al. Infect Contro Hosp Epidemiol 2006;

27: 944-952).

Health care providers – even the most committed – have competing interests,

limited budgets, etc. They will always have reasons – excuses – for not

providing safe care. So what’s the public to do?

If the public wants safe care, they need to communicate their priorities. There

may be many ways to do this. Here are some

suggestions:

(i) Individually, patients can demand safe care when they go for treatment. For

example, they can insist on new disposable equipment. If equipment is reused,

they can ask that it be sterilized or at least boiled. These options don’t work

for everyone, because some patients don’t have the courage to speak up – even to

save their lives.

(ii) Collectively – with support from newspapers, courts, and an NGO or two –

patients and the public can demand investigations of unexplained HIV infections.

Unexplained infections are all over in India: HIV-infected children with

HIV-negative mothers, HIV-positive wives with HIV-negative

husbands, etc. Yet there have been no investigations to trace these infections

to their source clinic, and to test other patients to find all related

infections. Without such investigations, clinics that are careless may continue

to pump HIV infections into the

community.

(iii) Collectively, people can arrange for organizations (district governments?

NGOs? others?) to accept and respond to complaints about unsafe practices. As

things stand now, state health officials

say they can’t do anything if patients report unsafe injections at X clinic. How

can this be changed, so that careless practices can be reported and stopped?

Gisselquist

Email: <david_gisselquist@...>