HHS To Review Studies Claiming Unsafe Medical Practices, Not Sex, Primary Mode of HIV Transmission in AfricaHHS Secretary Tommy Thompson has launched a review of several recent studies claiming that the primary mode of HIV transmission in sub-Saharan Africa is unsafe medical practices not unsafe sex, the results of which could change how money authorized under the recently signed five-year, $15 billion global AIDS bill is distributed, the AP/Fort Lauderdale Sun-Sentinel reports (McMurray, AP/Fort Lauderdale Sun-Sentinel, 6/9). A team of eight researchers from the United States and Germany led by anthropologist David Gisselquist in March published three studies in the International Journal of STD & AIDS supporting a theory that unsafe medical practices are the primary route of HIV transmission in sub-Saharan Africa. The same team published in May a similar study in the British Journal of Obstetrics and Gynaecology. While most AIDS organizations say that heterosexual contact has accounted for 90% of the HIV cases in Africa, the studies claim that only one-third of HIV cases have been transmitted in this manner, while unsafe medical practices, such as injections and blood transfusions using unsterile needles, are a much greater threat (Kaiser Daily HIV/AIDS Report, 5/7). Sen. Jeff Sessions (R-Ala.), who called a Senate hearing on the issue in March, requested the HHS review, saying that spending priorities in the global AIDS bill could be shifted if new research supporting the theory surfaces. HHS officials declined to comment on the likelihood of such a shift or when the investigation is expected to be finished.
WHO Acknowledges Low Estimate
A WHO report dated Dec. 19, 2002, cites four different studies claiming that unsafe medical practices are responsible for 8%, 15%, 41% and 45% of HIV transmission in sub-Saharan Africa, respectively, according to the Sun-Sentinel. The report concludes that "the lowest attributable fraction calculated on the basis of the data provided ... (8%) exceeds our 2.5% modeled attributable fraction, suggesting that our estimate is conservative," the Sun-Sentinel reports. Yvan Hutin, a WHO researcher who wrote the report, said that no matter what the true percentage, AIDS organizations should consider education campaigns on unsafe needle use. "It remains a very good investment to do injection safety," Hutin said, adding, "It doesn't matter whether it's 2.5% or more or less" (AP/Fort Lauderdale Sun-Sentinel, 6/9). However, a UNAIDS/WHO expert group in March concluded that unsafe sex, not unsafe medical practices, is the primary mode of HIV transmission in sub-Saharan Africa. In addition, researchers from the University of Oxford in April published a study in the journal Nature supporting the theory that unsafe sex was the primary transmission route for HIV infection in Africa (Kaiser Daily HIV/AIDS Report, 5/7).