Malawi: cases and investigations
Unexpected infections in young adults, 2004: Malawi’s 2004 national Demographic and Health Survey reported unexpected HIV infections among youth aged 15-24 years. Among young men who said they were virgins, 2.0% were HIV-positive vs 2.1% of all young men. Among young women who said they were virgins, 2.5% were HIV-positive vs 9.1% for all young women. Source: Table 12.9 in: National Statistical Office (NSO) [Malawi], and ORC Macro. 2005. Malawi Demographic and Health Survey, 2004. Calverton, Maryland: NSO and ORC Macro. Available at: http://www.measuredhs.com/publications/publication-FR175-DHS-Final-Reports.cfm (accessed 27 January 2012).
Unexpected infections in young adults, 2010: Six years later, Malawi’s 2010 national Demographic and Health Survey reported similar frequencies of unexpected HIV infections among youth aged 15-24 years. Among young men who said they were virgins, 1.6% were HIV-positive vs 1.9% of all young men. Among young women who said they were virgins, 2.1% were HIV-positive vs 5.2% for all young women. Source: Table 14.8 in: National Statistical Office (NSO) and ICF Macro. 2011. Malawi Demographic and Health Survey 2010. Zomba, Malawi, and Calverton, Maryland, USA: NSO and ICF Macro. Available at: http://www.measuredhs.com/pubs/pdf/FR247/FR247.pdf (accessed 27 Januaary 2012).
Some may have been infected as infants via wet nursing, which is quite common. There have been other such cases reported in the literature, e.g. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC556184/
Hi Theo. Thanks for your comment, and sorry for this later reply. We can speculate about how a child got HIV when his or her mother is HIV-negative. But speculation is not enough. If someone doesn’t trace the source of the infection to find and stop the risk — maybe a careless hospital or clinic — the risk might continue, and more children may be infected. Also a clarification: The study you cite did not identify any child infected by an HIV-positive wet nurse or by expressed breastmilk from an HIV-positive woman. The study tested children and mothers and asked if children had gotten breastmilk from any woman other than their mothers. Some HIV-positive children with HIV-negative mothers had breastfed with other women or gotten expressed breastmilk from other women at a hospital. But the study did not trace and test women who provided the milk and so cannot say if they were the source of the children’s infections. The study cannot eliminate other risks. Unfortunately, we are left with speculation — when what we need are investigations to find and stop risks.
You are right, that was indeed merely one likely explanation — I have seen other studies years earlier, that suggested re-use of sharps, improperly sterilised equipment used in health facilities children had visited. Of course, it is extremely difficult to trace the source years and years after the fact — and you have a larger problem of convincing HIV-negative parents to consent to testing of their children… when we can’t even get many HIV-exposed children tested in the first place. Operationally, how do you do it? And what of other viruses that are far more easily spread by sharps such as Hepatitis C? Why isn’t there a hepatitis C epidemic in sub-Saharan Africa? Perhaps you address these issues in your blog. I’ll have to take a closer look.
But of course, there is no question that hygiene/infection control practices need to be improved in many health facilities — which means better training and supervision, better supply chain management — and more funding for health systems strengthening. And it impacts on more than just HIV — look at the fatality rates for injuries in resource-constrained settings.