What happens when HIV tests find people with unexpected infections – children with HIV-negative mothers, virgin youth, and sexually active adults with no HIV-positive partner? Governments have responded to unexpected infections in two ways: (a) African governments have ignored them; (b) governments outside Africa have investigated to find and stop healthcare outbreaks.
(a) African governments ignore unexpected HIV infections
More and more Africans who test HIV-positive have no sexual or mother-to-child risk. But no government in sub-Saharan Africa has investigated any unexpected HIV infection to see if it might be part of a healthcare outbreak.
Over more than 30 years, newspapers and medical journals have reported some of these unexpected infections. Click on country pagers for an account of some of these reported unexpected infections (countries in alphabetical order): Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo (Brazzaville), Cote d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe.
(b) Governments outside Africa investigate to find and stop HIV outbreaks from unsafe healthcare
Governments outside sub-Saharan Africa have investigated unexplained infections: asking where people received healthcare; tracing and testing others who got healthcare from the same place; finding and fixing mistakes; and telling the public what happened. No country that has investigated unexpected infections to find an HIV outbreak from healthcare has developed a generalized epidemic. These links take you to pages with information and references for HIV healthcare outbreak investigations in 20 countries (listed in alphabetical order): Argentina, Australia, Cambodia, China, Colombia, Denmark, Egypt, India, Kazakhstan, Kyrgyzstan, Libya, Mexico, Pakistan, Romania, Russia, Spain, Tajikistan, the United States, Uzbekistan, and Vietnam. The table below lists 12 investigated and reported outbreaks with >100 HIV infections.
Table: Investigated HIV outbreaks from healthcare with >100 infections (listed by year of outbreak)
|Country, year of outbreak
||Who was infected
||Number of cases
|Mexico, circa 1986[i]
||Blood and plasma sellers
|Russia, Elista, 1988-89[ii,iii,iv,v]
|India, Mumbai, 1988[ix]
||Blood and plasma sellers
||Blood and plasma sellers
||Inpatient, outpatient children
|Kazakhstan, to 2006[xv,xvi]
|Kyrgyzstan, to 2007[xvii,xviii,xix,xx]
|Uzbekistan, to 2008[xviii]
||Patients attending a clinic
|Kot Imrana, Pakistan, to 2019[xxv]
||Patients attending clinics
|Ratodero, Pakistan, to 2019[xxvi]
||Children, adults attending clinics
 Avila C, Stetler HC, Sepúlveda J, et al. The epidemiology of HIV transmission among paid plasma donors, Mexico City, Mexico. AIDS 1989; 3: 631-3.
[ii] Bobkov A, Garaev MM, Rzhaninova A, et al. Molecular epidemiology of HIV-1 in the former Soviet Union: analysis of env V3 sequences and their correlation with epidemiologic data. AIDS 1994; 8: 619-624.
[iii] Pokrovskii VV, Eramova II, Deulina MO, et al. An intrahospital outbreak of HIV infection in Elista [in Russian]. Zh Microbiol Epidemiol Immunobiol 1990, 4: 17-23.
[iv] Pokrovsky VV. Localization of nosocomial outbreak of HIV infection in southern Russia in 1988-89. 8th Int Conf AIDS, Amsterdam 19-24 July 1992; abstract no. PoC 4138. Available at: https://quod.lib.umich.edu/c/cohenaids/5571095.0050.029?rgn=main;view=fulltext (on this page, search for PoC 4138; accessed 14 October 2018).
[v] Sauhat SR, Kotova EA, Prokopenkova SA, et al. Risk factors for HIV transmission in hospital outbreak. 8th Int Conf AIDS, Amsterdam 19-24 July 1992, abstract no. PoC 4288.
[vi] Patrascu IV, Dumitrescu O. The epidemic of human immunodeficiency virus infection in Romanian children. AIDS Res Hum Retroviruses 1993; 9: 99-104.
[vii] Apetrei C, Loussert-Ajaka I, Collin G, et al. HIV type 1 subtype F sequences in Romanian children and adults. AIDS Res Hum Retroviruses 1997; 13: 363-5.
[viii] Drucker E, Apetrei C, Heimer R, et al. The role of unsterile injections in the HIV pandemic. In Sande MA, Volberding PY, Lange J, et al. Global HIV/AIDS Medicine. Philadelphia: Saunders, 2007. pp. 755-67.
[ix] Bhimani GV, Gilada IS. HIV prevalence in people with no fixed abode – A study of blood donorship patterns and risk determinants. 8th Int Conf AIDS, Amsterdam 19-24 July 1992; abstract MoC00937.
[x] Wu Z, Liu Z, Detels R. HIV-1 infection in commercial plasma donors in China [letter]. Lancet 1995; 346: 61-2.
[xi] Wu Z, Rou K, Detels R. Prevalence of HIV infection among former commercial plasma donors in rural eastern China. Health Policy Plan 2001; 16: 41-6.
[xii] Ministry of Health, China, UNAIDS, WHO. 2005 Update on the HIV/AIDS epidemic and response in China. Geneva: WHO, 2006.
[xiii] Visco-Comandini U, Cappiello G, Liuzzi G, et al. Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya. AIDS Res Hum Retroviruses 2002; 18: 727-32.
[xiv] de Oliviera T, Pybus OG, Rambaut A, et al. HIV-1 and HCV sequences from Libyan outbreak. Nature 2006; 444: 836-7.
[xv] Kazakhstan: more HIV-infected children found in southern Kazakhstan. RadioFreeEurope/RadioLiberty, 3 October 2007. Available at: http://uqconnect.net/signfiles/Archives/SIGN-POST00405.txt (accessed 10 October 2007).
[xvi] In the courts: Health workers sentenced to prison in Kazakhstan for criminal negligence after HIV outbreak among women, children. Kaisernetwork.org, 2 January 2008. Available at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=49564 (accessed 27 March 2009).
[xvii] Shersen D. Kyrgyzstan: Officials grapple with HIV outbreak. EurasiaNet, 30 October 2007. Available at: http://uqconnect.net/signfiles/Archives/SIGN-POST00419.txt (accessed 1 November 2007).
[xviii] Thome C, Ferencic N, Malyuta R, Mimica J, Niemiec T. Central Asia: hotspot in the worldwide HIV epidemic. Lancet Infect Dis 2010; 10: 479-488.
[xix] The Telegraph. Kyrgyz officials say another 70 children are infected with HIV/AIDS virus. 6 February 2012. Available at: https://www.telegraph.co.uk/news/worldnews/asia/kyrgyzstan/9063987/Kyrgyz-officials-say-another-70-children-are-infected-with-HIVAIDS-virus.html (accessed 12 October 2018).
[xx] AP/Houston Chronicle examines HIV outbreak among 72 children, 16 mothers through tainted blood and used needles. Kaisernetwork.org, 11 April 2008. Available at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=51472 (accessed 27 March 2009).
[xxi] Rouet F, Nouhin J, Zheng D-P, et al. Massive iatrogenic outbreak of human immunodeficiency virus type 1 in rural Cambodia, 2014-2015. Clin Infect Dis 2017; epub ahead of print. Available at: https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/cix1071/4689456?redirectedFrom=PDF (accessed 12 February 2018).
[xxii] Mean Chhi Vun et al. Cluster of HIV infections attributed to unsafe injections – Cambodia December 1, 2014-February 28, 2015. Morbidity and Mortality Weekly Report 2016: 65: 142-145. Available at: http://www.cdc.gov/mmwr/volumes/65/wr/mm6506a2.htm (accessed 28 March 2016).
[xxiii] Bedford Lab. Evolutionary and epidemiological analysis of Roka HIV outbreak. Available at: https://bedford.io/projects/roka/HIV/bayesian_timetree/ (accessed 12 October 2018).
[xxiv] Millar P. How the residents of Cambodia’s “HIV village” are coping more than two years on. Southeast Asia Globe, 15 March 2017. Available at: http://sea-globe.com/how-the-residents-of-cambodias-hiv-village-are-coping-more-than-two-years-on/ (accessed 14 August 2017).
[xxv] Wahid B. An update on the severe outbreak of HIV in Kot Imrana, Pakistan. Lancet Infect Dis 2019; 19: 241. Available at: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30038-6/fulltext?rss=yes (accessed 4 March 2019).
[xxvi] No letup yet as cases jump to 445 in Ratodero. Pakistan Today 13 May 2019. Available at: https://www.pakistantoday.com.pk/2019/05/13/no-let-up-yet-as-aids-cases-jump-to-445-in-ratodero/ (accessed 15 May 2019).