Patron observed sterile treatment for scarification
| POST for scarification |
| 1. Avoid skin-piercing procedures |
Don’t get scarification marks. This only works for people who are willing to forego the marks. |
| 2. Use new disposable instruments |
(a) Ask the scarifier to use a new razor (or other new cutting instrument) for you. (b) If the scarifier rubs any substance into a scar, make sure there is no chance someone else’s blood has gotten into the substance. You can, for example, ask the scarifier to make a portion especially for you. If you are being treated in a group, you can ask the scarifier to set aside a portion for each person before beginning the process. (c) If you are being treated in a group, ask the scarifier to put on a new glove or gloves for each person he or she treats. |
| 3. You sterilize the instruments |
If a cutting instrument must be reused, you could ask to sterilize it by holding it in a flame or boiling it. |
| 4. Ask providers how they sterilize instruments |
If the scarifier wants to reuse a cutting instrument that he or she has used with other clients, ask if it has been boiled after the last client. |
Additional information about scarification
Scarification is common in some African communities, for example to indicate a person’s ethnic group. In some cases it is almost required.
Risk to get HIV from scarification
If the scarifier reuses a razor from an HIV-positive client with no effort to clean, your risk to get HIV may be estimated at 3% (deep cuts, but without a hollow needle; see Blood-borne Risks section). If the substance rubbed into your cut(s) has been contaminated by blood from someone who is HIV-positive, that adds to your risk.
If the razor is new, if the substance rubbed into your scar is not contaminated by anyone’s blood, and if the scarifier wears new gloves, you have no risk to get HIV from scarification.
Evidence that scarification has infected some people with HIV
In a 2006 study in rural Uganda among 2,025 adults, those with “a traditional skin-cutting” were 1.7 times more likely to be HIV-positive than other adults. Source: Guwatudde D et al. Relatively low HIV infection rates in rural Uganda, but with high potential for a rise: a cohort study in Kayunga District, Uganda. PLoS One 2009; 4: e4145. Available at: https://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0004145.
Such findings are inconsistent: sometimes people with scarification are more likely to be infected and sometimes not. This is what one would expect to see: since unsafe practices are not the same all over, scarification would not always be a risk.
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This is ridiculous. An vacuum and steam autoclave, ethyl oxide gas or gamma radiation are the ONLY ways to sterilize instruments safely. NEVER let anyone scar you if they held the blade over a flame or boiled it. Blades should NEVER be reused!
While I quite agree with you, scarification is almost by definition something that is carried out in non-sterile environments. However, it may even be possible to follow the advice given above in such circumstances. As for autoclave and other modern methods of sterilization that you mention, they are not even found in many health facilities, and don’t always work, due to lack of training, supplies, power, etc.