Bloodborne HIV: Don't Get Stuck!

During  1986-2020 and continuing, investigations of unexplained HIV infections in 11 countries found 12 large outbreaks with hundreds to thousands of HIV infections from unsafe skin-piercing healthcare procedures. Even where careless medical practices had been widespread before investigations, HIV epidemics after investigations show little or no subsequent transmission through health care to the general population. In Romania, for example, only 0.1% of adults were HIV-positive in 2019, one of the lowest percentages in Europe. As of 2019, in nine of 11 countries with large investigated outbreaks, not more than 0.3% of adults were HIV- positive. In the other two, an estimated 0.5% were infected in Cambodia and 1.2% in Russia. In other words: Investigations not only stopped large outbreaks but also alerted everyone to avoid bloodborne risks.

In 10 of the 11 countries, HIV circulates among IDUs and men who have sex with men (MSM), with little spread into the general population. Cambodia is the only one of the 11 countries where more women than men were HIV-positive in 2019 (according to UNAIDS estimates). Cambodia’s 2014-15 investigation alerted people to risks to get HIV in health care, which has no doubt reduced those risks. If health care has gotten safer after 2014-15, this will likely change the sex ratio in coming years as fewer women and men get HIV from health care, while low numbers of men will continue to get HIV from injection drug use and sex between men.

Table: What happened after investigation discovered large HIV outbreaks from medical procedures?

Sources: For each country, see references listed here. Percentages of adults aged 15-49 years HIV-positive are from UNAIDS[1] except author’s estimates for Russia, India, China, and Mexico.

1. UNAIDS. HIV estimates with uncertainty bounds 1990-2019. Geneva: UNAIDS, 2020. Available at: https://www.unaids.org/en/resources/documents/2020/HIV_estimates_with_uncertainty_bounds_1990-present (accessed 18 February 2020).