HIV risks with medical injections -- and other blood exposures

[Guest guest]

Dear Forum,

In a recent contribution to AIDS-India, Bernard asks for more information

on injection practices from IPEN’s recent Assessment of Injection Practices in

India (executive summary available at:

http://www.ipen.org.in/).

The study looked at all injection providers, including formal and informal,

rural and urban. Injections from all classes of providers were unreliably safe,

with some differences (page ix): “risk of unsafe injection when administered at

non-allopathic health facilities (ISM [indian System of Medicine] and informally

trained prescribers) was almost one and a half times…more as compared to that

with allopathic prescribers….”

The Bottom line: If you’re going for an injection, you cannot assure that you

will be safe by avoiding informal providers. More than 30% of all injections

were a risk to transmit bloodborne viruses.

However, unsafe injections are only the tip of the iceberg. To ensure safe

health care, it is important to consider blood exposures other than injections.

The common and continuing focus on injection safety comes from donors pushing

vaccinations. For years, donors observed that vacccinators often reused syringes

and/or needles without sterilization – despite training, supervision, and

equipment supply.

Finally, from 1999, donors got together through Safe Injection Global Network

(SIGN) to promote auto-disable syringes – which break after one use.

Auto-disable syringes are a useful innovation. They

make vaccinations safer (but not safe; multidose vials can be contaminated from

a previous injection, and are not as safe as single-dose vials).

But, take another look at this: What does the shift to auto-disable syringes

mean? Health program managers focusing on vaccinations have in effect given up

on sterilization! Failure to sterilize instruments

continues. When sex workers or clients go for injections to treat STDs – are

they safe? When you go for a blood test, are you safe? When women go for tubal

ligations, are instruments reused without

sterilization? Are dental drills sterilized between patients? Too often, the

answer is “No.”

Furthermore, there are dangerous blood exposures outside health care. Cosmetic

procedures such as tattooing, manicures, pedicures, etc, expose clients to HIV

and other bloodborne viruses if instruments are reused without sterilization

(note: Dettol and other

disinfectants are not effective against viruses).

Last year, I sat in a meeting where sex workers from Karnataka reported standing

in line for tattoos during festivals to honor the Goddess Yellama. (Sex workers

are besieged with information about HIV from sex – why did no one tell them

about HIV from blood exposures, such as tattooing? Considering this oversight,

and

considering the findings of the IPEN study noted above, are all those NGO and

government programs that treat sex workers’ STDs providing safe care?)

Gisselquist

Email: <david_gisselquist@...>