Bloodborne HIV: Don't Get Stuck!

In late July 2007, Kyrgyzstan’s Ministry of Health announced that two hospitals in the Osh region had infected 11 patients, including 9 children. “The [Ministry of Health] commission [that visited the hospitals] found that [disposable] subclavian catheters had been used many times.”[1]

Almost immediately, the UN proposed to help Kyrgyzstan deal with this situation. Notably, the draft UN Action Plan did NOT propose or support extensive testing to find the extent of the outbreak and to identify the specific clinics and procedures responsible, so transmission could be reliably shut off.[2]

Fortunately for Kyrgyzstan’s citizens, the government went ahead to investigate — testing thousands of children to find the extent of the outbreak and to find and correct the errors responsible for the outbreak. Through April 2008, the investigation identified 72 HIV-positive children infected through health care. Sixteen of these children had infected their mothers through breastfeeding.[3]

The investigation continued for more than 4 years. In early February 2012, the Kyrgyz Ministry of Health reported “it has so far tested 110,000 children in the area around the cities of Osh and Jalalabad…” and found a total of 270 persons infected through unsafe health care. The Ministry announced its intention to keep testing: “Several thousand more children need to be tested in the south of this rural, mountainous country.”[4]

During the investigation, Boris Shapiro, the founder and former head of HIV prevention in Kyrgyzstan, reflected on his and others’ failure to warn about HIV risks in health care: “I want to say that as the creator of this [HIV/AIDS prevention] service and as someone who for many years headed the service, I also feel myself to be guilty… We somehow were not able to properly instruct not only our medical personnel but also the media. The media reports the cases as they become public but [the media] needs to report regularly, to inform us. I am greatly concerned today that we are not giving enough information to the younger generation.” Shapiro’s painful insights are pertinent to ongoing failures on the part of WHO, UNAIDS, and governments throughout Africa to investigate unexpected infections and to warn people about HIV through skin-piercing procedures.[5]

As of early 2012, the government had sentenced 6 health officials to 3 years in prison, and 8 more were awaiting trial.[4] Arguably, punishing health care workers is unnecessary: once an investigation finds infections, identifies risks, and warns the public and health care workers, aren’t health care workers sufficiently motivated to stop unsafe practices without adding punishment into the balance?