[This page is adapted from chapter 1 of Stopping Bloodborne HIV: Investigating Unexplained Infections, Adonis & Abbey, 2021, available for free download here.]
An unexplained HIV infection is evidence that skin-piercing procedures at some hospital or clinic may be infecting patients. When a child is HIV-positive with an HIV–negative mother, are your children at risk? When one or more pregnant women or new mothers have unexplained infections, especially new infections, are you or your family members at risk during antenatal (pregnancy) care and delivery?
How to find and fix the problem? The basics are common sense:
- Ask where people with unexplained HIV infections might have been exposed to contaminated blood.
- Test others who had skin-piercing procedures at suspected facilities.
- Find and fix dangerous procedures.
Over the years, people across sub-Saharan Africa have recognized hundreds of thousands of unexplained infections in themselves, partners, children, and friends (see “Outbreaks and unexplained infections” in the menu on the right). But no government has investigated to find other victims and to find and fix errors.
Governments outside sub-Saharan Africa have investigated unexplained HIV infections to find 12 large outbreaks – with more than 100 to an estimated 100,000 HIV infections – and many smaller outbreaks (see “Outbreaks and unexplained infections ” in the menu on the right). For example, in Roka, Cambodia, in 2014, a village leader with an unexplained HIV infection alerted others to go for tests. Within weeks, people found more infections. The subsequent government investigation found several hundred infected from a local clinic.
Because African governments have ignored unexplained infections, people who suspect infections came from health care may have to begin local investigations with friends, contacts, and local leaders. Will people talk and share information? More people are getting tested. This will not only expose more unexplained infections, but may also diminish the silence and shame around HIV.
Whenever and wherever communities work together to find unexplained infections, sooner or later, local media can be expected to hear about and to report evidence that health care has been infecting patients. Based on past experience, governments in sub-Saharan Africa may be slow to respond. But this is a struggle communities can win, forcing governments to investigate to protect public health.
Publicity is inevitable. When government investigations invite patients treated at a hospital or clinic in recent months or years to come for HIV tests, such invitations get into the news. As the investigation proceeds, and as tests find and report more HIV infections traced to medical care, these unwelcome discoveries warn both patients and healthcare staff that something is wrong, and motivate changes to eliminate risks. In this way, publicity helps to get the best possible outcome.
No fault investigations?
Keeping the focus on healthcare safety, the goal of investigations should be to find and fix errors. Investigations that look for and find many or most people who have been infected in an outbreak can work backward from who was infected to pinpoint the facilities, procedures, and specific errors that allowed HIV to go from one patient or client to another. People found to be infected can be treated.
No-fault investigations could be understood as a component of restorative justice, helping healthcare workers recognize and admit what they have done, preventing more infections, and finding and caring for victims. Free HIV care is already available to most if not all Africans with HIV from any risk.
In countries where governments found large outbreaks from unsafe medical procedures, subsequent transmission through medical care has been rare. Most infections come from injection of illegal drugs and men having sex with men. And only low percentages of the population are HIV-positive.
1. Gabagambi JJ. A comparative analysis of restorative justice practices in Africa. Hauser Global Law School Programme [internet], October 2018. Available at: https://www.nyulawglobal.org/globalex/Restorative_Justice_Africa.html (accessed 29 January 2021).