Bloodborne HIV: Don't Get Stuck!

Michael Merson, the second head of WHO’s Global Program on AIDS and co-author Steven Inrig describe WHO’s early AIDS response in The AIDS Pandemic: Searching for a Global Response.[1] Unfortunately, their otherwise excellent and detailed history ignores a tragic and continuing failure: the decision by WHO’s experts to accept an unknown  number of HIV infections from unsafe healthcare.

This misdirection has continued. Daniel Fernando reviews the confusion that led to this misdirection in a recent article[2]: “Already by 1985, WHO staff declared ‘Heterosexual promiscuity (large number of partners) is the most important risk factor among adult AIDS patients in Africa.’[quoted from page 9 in reference 3]…If iatrogenic transmissions had been taken seriously and addressed early, HIV in Africa would have been different.” (If you want a pdf Daniel’s article, email him at: dfernando@jjay.cuny.edu.)

In a prominent 1986 paper in the prestigious journal Science, the first head of WHO’s Global Program on AIDS, 1986-91, and the subsequent first director of UNAIDS, 1996-2008, wrote [p 962 in reference 4]: “…one cannot expect public health officials to upgrade blood transfusion services to prevent HIV infection when the proposed intervention is likely to cost, per person, approximately 30 times the annual per capita public health budget. Similarly, one cannot hope to prevent reuse of disposable injection equipment when many hospital budgets are insufficient for the purchase of antibiotics.”

As if this wasn’t enough, when WHO’s experts decided to give a pass to unsafe healthcare in Africa, they didn’t know how serious it would be. There was no evidence at the time – and there still is no evidence – to say with any confidence that blood exposures account for not more than 10% or as much as 50% or 75% or more. The almost exclusive focus on sex was and is based on insufficient evidence.

Although Merson and Inrig recount many events in WHO’s early response to AIDS, they all but ignore what WHO’s experts knew and thought about HIV from unsafe healthcare. The index at the end of the book doesn’t even include these terms: “blood,” “nosocomial,” “iatrogenic,” “injections, medical,” and “scarification.”

Unsafe healthcare was and is the forgotten risk. Africans in large numbers are still getting HIV from this forgotten risk. How many? No one knows.

References

1. Merson M, Inrig S. The AIDS pandemic: searching for a global response. Switzerland: Springer International, 2018.

2. Fernando D. The AIDS pandemic: searching for a global response. J Assoc Nurses AIDS Care 2018: 29: 635-641. Article available by request from Daniel Fernando at: dfernando@jjay.cuny.edu. Abstract available at: https://www.sciencedirect.com/science/article/abs/pii/S105532901830133X?via%3Dihub(accessed 9 January 2019).

3. World Health Organization (WHO). Workshop on AIDS in Central Africa: Bangui, Central African Republic from 22 to 25 October 1985. Geneva; WHO: 1985. Retrieved from http://www.who.int/hiv/strategic/en/bangui1985report.pdf

4. Quinn T. C., Mann J. M., Curran J. W., Piot P. (1986). AIDS in Africa: An epidemiologic paradigm. Science, 234(4779), 955-963. Retrieved from https://doi.org/10.1126/science.3022379.