Bloodborne HIV: Don't Get Stuck!

A woman in the Indian state of Andhra Pradesh is thought to have been infected with HIV from a contaminated blood transfusion. The blood was purchased from the Red Cross blood bank. The woman had received several negative blood tests before the delivery so it is unlikely she was infected by her partner. The article doesn’t say whether her partner was tested.

While the risk of being infected through medical procedures may be low in India, where HIV prevalence is lower than it is in the US, the risk in Uganda and other African countries is a lot higher. Most Eastern and Southern African countries have HIV prevalence levels many times higher than those found in India.

Therefore, it’s surprising that health services in Uganda are being advised to continue using the injectible version of Depo Provera, despite evidence that it could be involved in higher transmission rates. Even if the hormone involved is not responsible for higher transmission rates, this does not rule out the possibility that unsafe injections are at least partly involved.

The article goes on about other worries, such as low contraceptive use, but this misses the issue of unsafe healthcare. In the long run, contraceptive use is not going to increase if the whole process of birth control becomes controversial. Rather than simply telling health services to continue using injectible Depo Provera, might it not be more reassuring to investigate safety conditions in health facilities?

The contraception agenda seems to be driven by outside interests, rather than by African countries. There may well be an ‘unmet need’ for contraception, but no one in their right mind would opt for a contraceptive method that carries risks of infection with HIV, or that increases the risk of transmitting HIV.

If those driving the contraception agenda wish to increase access to various birth control methods, they also need to be able to reassure people as to the safety of those methods. And that means the safety of the method of administration, not just the safety of the substance administered. The WHO may well wish to wait until their ‘high level meeting’ in January, but safety in health facilities should not have to wait.

In fact, we should not still be avoiding questions about HIV transmission in health facilities. Even if there were no evidence of healthcare associated infection or transmission, and that is far from the case, health facilities should be routinely inspected; they should always be able to account for their safety provisions. Right now, they are not able to do so.

If WHO and others don’t wish to address the safety or otherwise of Depo Provera, that’s bad enough. But the issue of patient safety in health facilities is far too urgent and far too long ignored to be treated in the same doctrinaire manner. HIV has been found to have been transmitted in many countries, rich and poor, in health facilities. The threat of nosocomial and iatrogenic transmission of HIV in African countries can not be dismissed any longer. As in the Indian case above, investigation is needed, not a continuation of summary dismissal of the evidence by international health institutions.