Bloodborne HIV: Don't Get Stuck!

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Tag Archives: unsafe injection

Namibia: Lack of Healthcare or Lack of Healthcare Safety?

An online Namibian newspaper article reports that “Women who experience violence in volatile abusive relationships face four times higher risk of contracting HIV“, following a study of the links between gender based violence and HIV.

HIV prevalence is currently estimated at 13.4% in Namibia, an upper middle income country with a GDP per capita of $8,191, but also a high level of economic inequality. Population density is one of the lowest in sub-Saharan Africa.

However, when it comes to antenatal care, 81% of deliveries take place in a health facility. The only country I found in the region that was higher than that was South Africa, at 91.4%, which has the highest number of people living with HIV in the world.

81.5% of deliveries are performed by a skilled provider in Namibia. What is probably the highest figure in Africa is that for Botswana, at 99%. But Botswana has the second highest HIV prevalence in the world, at 25%, compared to swaziland’s 26%.

HIV prevalence is higher among women than men in Namibia, at 58% of all infections, and this phenomenon is common to every African country. While domestic and gender based violence need to be addressed regardless of how high or low HIV prevalence is, these are just as abhorrent in rich countries with low HIV prevalence as they are in an upper middle income country with high HIV prevalence.

According to the latest Service Provision Assessment, there are some very serious lapses in infection control in Namibian health facilities, including shortages or unavailability of syringes and needles, soap and water, latex gloves and disinfectant.

So what about addressing safety in health facilities? The number of physicians, nurses and midwives per 10,000 is higher than in other countries in Africa. Some of the biggest differences between Namibia and other much lower prevalence countries is its wealth and it’s far higher levels of access to health services. It is unlikely to be lack of healthcare that results in such high HIV prevalence, but rather lack of safe healthcare.

There is simply no evidence that HIV is ‘mainly driven by heterosexual sex’, the mantra that UNAIDS and the HIV industry have stuck to for so long. Prevalence in Namibia has increased from 1.2% in 1990 to reach a peak of at least 15.3% in 2007, but it has barely fallen since then. It’s time to abandon the sexual behavior fallacy and investigate non-sexual HIV transmission through unsafe healthcare, traditional and cosmetic practices.

[To read more about HIV transmission through unsafe healthcare, have a look at the Don’t Get Stuck With HIV site’s Healthcare Risks for HIV pages.]

HIV Transmission Via Unsafe Medical Injections in Kenya – Significant Risk

Congratulations to Kenya on being one of the first African countries with a serious HIV epidemic to investigate the role of unsafe healthcare and reuse of injecting equipment in transmitting HIV. The study finds that “Men who had received ≥1 injection in the past 12 months (adjusted odds ratio, 3.2; 95% CI: 1.2 to 8.9) and women who had received an injection in the past 12 months, not for family planning purposes (adjusted odds ratio, 2.6; 95% CI: 1.2 to 5.5), were significantly more likely to be HIV infected compared with those who had not received medical injection in the past 12 months.

But these findings make the conclusion of the article all the more striking: “Injection preference [my emphasis] may contribute to high rates of injections in Kenya.” If someone is infected with HIV as a result of receiving an injection, then it is the behavior of the health care practitioner that is at fault, not the ‘preference’ of the patient. Health facilities make more money from procedures such as injections than they do from just giving advice or handing out prescriptions, so there may be good reasons why patients ‘prefer’ injections; they may have been led to believe that injections are ‘better’. I’d also be surprised if mere patient preference made much difference to the kind of treatment a patient received in Kenya or elsewhere in East Africa.

Those providing health services need to take responsibility for healthcare associated HIV transmission, and that includes Ministries of Health, professional bodies, and also the WHO, UNAIDS, CDC and other parties who have dominated health and HIV policy in high HIV prevalence countries for decades. Reuse of syringes, needles and other skin piercing equipment carries a very high risk of transmission of HIV, hepatitis and other pathogens. It is not enough to blame patients for their ‘preferences’. Practitioners can decide what treatment a patient needs and what is the best means of administering it, if that means is available to them.

The paper recommends that “community- and facility-based injection safety strategies be integrated in disease prevention programs”. If this is UN-speak for the need to accept that HIV is frequently transmitted through unsafe healthcare and these practices need to stop, then I wholeheartedly agree. This is more than thirty years too late, but it’s good to hear the very mention of non-sexually transmitted HIV in the form of unsafe healthcare being taken seriously in a peer-reviewed journal. I look forward to hearing of other high HIV prevalence countries making the same ‘discovery’ and publicizing it, and also taking steps to reducing such transmission risks.

[To read more about HIV transmission through unsafe healthcare, have a look at the Don’t Get Stuck With HIV site’s Healthcare Risks for HIV pages.]