Bloodborne HIV: Don't Get Stuck!

Guarding against transmission of HIV through blood transfusions has been found to ‘offer high returns’, which will be comforting for those who face especially high risk from such incidents. Blood transfusions are by no means the only route to HIV infection in health facilities, but the probability of transmission is very high; if someone receives a transfusion of HIV contaminated blood, they will almost certainly be infected.

However, while the probability of transmission is far lower for reused syringes, needles, intravenous drip equipment, etc, people are many times more likely to experience these procedures, often many times in their lives. In other words, these procedures may carry a low probability of transmission where the equipment is contaminated, but they happen so frequently that they could represent a significant risk to populations in countries where health facilities are in poor condition, as they are in many African countries.

The above article from the Financial Times mentions some countries, such as Angola, Niger and Tanzania, where “less than a third of donated blood is tested for HIV contamination in a quality-assured manner.” In fact, up to 90% of transfused blood given to pediatric patients may not receive adequate testing, according to research in Tanzania. The WHO even admits that “there is no reliable information on the extent of transfusion-linked infections”, which makes you wonder how commentators can claim that this risk is very small, especially in African countries such as Kenya, Uganda and Tanzania.

But the most interesting revelation is from Paul de Lay of UNAIDS, who says “if he were to have an accident near a rural hospital in some parts of Africa, he would seek a saline drip or other measures to defer the need for transfusion at least until arrival in a better resourced urban medical centre with greater chance of more effectively screened blood”.

There is some advice for Mr de Lay, which comes straight from his esteemed employer: “Use of improperly sterilized syringes and other medical equipment in health-care settings can also result in HIV transmission.” They go on to say “We in the UN system are unlikely to become infected this way since the UN-system medical services take all the necessary precautions and use only new or sterilized equipment. Extra precautions should be taken, however, when on travel away from UN-approved medical facilities, as the UN cannot ensure the safety of blood supplies or injection equipment obtained elsewhere [my emphasis]. It is always a good idea to avoid direct exposure to another person’s blood—to avoid not only HIV but also hepatitis and other bloodborne infections.”

In other words, de Lay should refuse all medical attention where other people’s blood may be involved, if possible. But what about people who are not fortunate enough to work in the UN system? Are they not entitled to a warning, at least, concerning what UNAIDS calls the “most efficient means of HIV transmission”?

It’s hard to understand UNAIDS’ policy of exaggerating the relative contribution of sexual transmission and dismissing the relative contribution of non-sexual transmission, despite there clearly being a dearth of research into this area. Catherine Hankins, also of UNAIDS, seems to suggest that warning people about health care associated risks could result in them ignoring sexual risks and, at the same time, avoiding health facilities.

But is it true that people can not mentally process the two kinds of risk? Can we really not tell people in the countries with the worst HIV epidemics in the world that they face both sexual and non-sexual risks? That appears to be UNAIDS’ stance. Are we in the West not warned about intravenous drug use, tattoo parlors and health facilities in high HIV prevalence countries as risks for infection with HIV?

Maybe UNAIDS worry about ‘complacency’ regarding sexual risks is right; after all, the obsession with sex seems to have resulted in complacency regarding non-sexual risks, such as blood transfusions, other unsafe medical practices and even cosmetic and traditional practices that involve skin piercing. But that is no reason for claiming that 80-90% of HIV transmission in African countries is a result of heterosexual sex when we have little idea of what the relative contribution of non-sexual exposures is. People need to be warned about non-sexual HIV exposure; if it poses a risk to UN employees working in African countries, it poses a risk to all Africans.