On 15 October, three managers of dontgetstuck along with five other experts sent an Open Letter to the heads of WHO, UNAIDS, and World Bank, challenging them to warn and protect Africans from HIV through health care. There is no indication that Chan, Sidibe or Kim read the letter. The only response we have received is from De Lay of UNAIDS and Nakatani of WHO (see below).
The response, which falls short of what WHO and UNAIDS could do under the circumstances, leads to several questions:
Question 1: If the evidence we presented (16%-31% of HIV-positive children with HIV-negative mothers) had come from Europe, would WHO and UNAIDS let it go by without recommending urgent actions to correct whatever happened to infect children?
Even asking this question brings the realization that governments and populations in Europe would not wait to see what WHO or UNAIDS said about the situation – they would insist on investigations to find how children had been infected and thereby to ensure that their health care is safe. We can see such investigations in Russia under Gorbachev, Romania under Ceausescu, Libya under Kaddafi, Kazakhstan, Kyrgyzstan, and Uzbekistan – all of which countries acted without waiting for WHO advice or assistance.
Question 2: Since WHO and UNAIDS have not recommended a specific response to evidence of large numbers of HIV-positive African children with HIV-negative mothers, who if anyone is going to respond to protect African children?
De Lay and Nakatani say that WHO and UNAIDS have warned African governments about unsafe health care, in effect putting the onus on Africans to respond to the evidence in the Open Letter. Whether the onus belongs there or not, it seems clear that WHO and UNAIDS are not ready to do more to protect African children from unsafe health care. Will African governments step up, or will they take the low road, like WHO and UNAIDS, letting things go on and on?
[See also Simon Collery’s comments on WHO’s and UNAIDS’ reply, with information about health care conditions in Africa.]
WHO’s and UNAIDS’ letter responding to Open Letter
23 October 2012
Dear Dr Gisselquist and colleagues,
Thank you for the open letter sent to Mr Sidibe, Dr Chan and Dr Kim on 15 October, 2012. We recognize that unsafe injections, skin piercing, blood transfusions and surgical procedures can contribute to HIV transmission, and advise countries that an effective HIV response should take into account all available data on modes of transmission in the design and implementation of their response.
As part of our commitment to reducing HIV incidence and new HIV infections, both the World Health Organization (WHO) and UNAIDS have produced guidance with unsafe skin-piercing procedures. UNAIDS Prevention Policy Paper, and the WHO Global Health Sector Strategy on HIV/AIDS, 2011-2015 make explicit reference to the importance of preventing unsafe injections, surgical practices and blood transfusions. WHO and UNAIDS advise countries to scale up proven and cost-effective strategies, policies and programmes that are tailored to their actual HIV epidemic and its social, economic and health system context (Know Your Epidemic/Know Your Response).
Recently, WHO’s Director-General, Dr Margaret Chan called for action on injection safety. Since this call, a cross-departmental working group has been created to develop a policy document and implementation plan on the safety of all therapeutic injections.
Thank you for raising these issues in the letter and for your efforts in the fight against HIV.
Paul De Lay, Deputy Executive Director, Programme, UNAIDS
Dr Hiroki Nakatani, Assistant-Director General, HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, WHO