World AIDS Day message on stigma, prejudice, and health care safety

[Guest guest]

Friends,

Please see our message of concern about stigma, prejudice, and health care

safety on World AIDS Day.

Best regards,

Nance Upham, Jean-Jacques Monot, Lillian Salerno,

Mariette Correa, Gisselquist

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OF HIV AND DISASTERS

Rational arguments and observed facts are of little weight to challenge a belief

based on prejudices.

General Jack M. O’No

The way in which poor people of this world are suffering from HIV/AIDS is truly

a catastrophe which will surpass WWII in direct and indirect casualties.

After years of neglect, treatment is now on the agenda. It was a moral disaster

to ignore this for so long, and we are just catching up with what must be done.

Another issue has also been ignored for far too long:

In much of the world, people live – and die – with health care that continues to

transmit HIV through unsterile procedures. Delivering and promoting medical care

that is unsafe without warning patients at risk is medically unethical. Instead

of correcting their own behavioural lapses, health experts lecture their victims

about sexual behaviour. Sexual behaviour is a risk for HIV, but it is far from

the only risk.

Lancet’s recent series on reproductive health reports: Sexual activity in young

single people is greater in industrialised countries with low rates of HIV

infection than in African countries with high rates.

Studies within Africa have shown the same: Young adults in Yaounde, Cameroon,

had more sexual partners but less HIV infection compared to young adults in

Kisumu, Kenya, with fewer sexual partners but more

HIV.

Countries with the worst AIDS epidemics – South Africa, Botswana, Lesotho,

Swaziland -- provide some of the “best” access to reproductive health care.

Moreover, random sample surveys in African countries (Demographic and Health

Surveys) show that most African women who are married and HIV-positive have

HIV-negative husbands. For example, in Ethiopia, over

75% of married, HIV-positive women have HIV-negative husbands.

This is very telling:

- Reproductive health – including STD treatment, antenatal care – appears to be

a danger for HIV in many countries with generalized epidemics.

- Faithful marriages may not reduce HIV rates, because HIV enters the marriage

through health care, and not sexual “misconduct.”

- There is not more, but less promiscuity among youth in Africa compared to

Europe and America, yet HIV continues to soar among African youth.

The over-emphasis on sexual prevention has blinded people to the OTHER ways that

HIV spreads. This over-emphasis has also strengthened stigma against people with

HIV/AIDS, by spreading the belief that HIV

infection is a reliable sign of multi-partner sexual behaviour that many people

consider to be immoral or disreputable.

The WHO 2006 report on the HIV epidemic, indicates, as in every previous year,

that intravenous drug users (IDUs) sharing needles are heavily contaminated. But

medical injections are much more common and can be as dangerous as injections

among IDUs Is there something peculiar about patients in Africa and India which

would protect them from contracting an HIV infection when they receive an

injection with a needle previously used on an AIDS patient? African magic

perhaps?

The risk of accidental transmission of HIV through blood (HIV is a bloodborne

retrovirus, isn’t it?) is extremely low in rich countries, but is important in

many countries in Africa and some countries in Asia and the Caribbean. In much

of Africa and Asia:

- Blood transfusion is still unsafe because blood is often not tested for HIV

- Medical injections are unreliably sterile. Many providers reuse needles and/or

syringes without sterilization. Multidose vials may become contaminated through

reused equipment, spreading infections to

subsequent patients.

- Blood collection may be unreliably sterile (eg, plasma collection was

responsible for a large HIV outbreak in China, and other outbreaks in Mexico and

India).

- Infection control is unreliable during tattooing, dental care, and many other

blood exposures in health care and cosmetic services.

The ongoing investigation of an outbreak of HIV among children in Kazakhstan is

an example of what needs to be done to stop HIV in all of the countries where

HIV has invaded the general population.

In Kazakhstan, after doctors noticed some HIV infections in children

with HIV-negative mothers, public health officials investigated. They tested

thousands of children who had attended hospitals to find who was infected.

To date, they have found more than 80 children who were infected through

hospital procedures earlier this year. Investigations like this are able to

trace infections to specific clinics, wards, and procedures.

In this way, infection control lapses can be found and stopped. Without these

investigations, hospitals and clinics can continue for years and years to pump

HIV infection into the community. Years later, when those who have been infected

develop AIDS, the infection may be blamed on sex.

If people in Africa and India who are aware of these risks do not demand

investigations of unexplained HIV infections – as in Kazakhstan – how many of

their relatives and neighbours will be

infected over the next decade through unsafe health care?

___________________

Gisselquist <david_gisselquist@...>