*EPF512 08/01/2003
Experts Cite Health Clinics as Source of HIV/AIDS in Africa
(Potentially high infection rate is "preventable") (820)

By Jamie Martin
Washington File Staff Writer

Washington -- Those living in sub-Saharan Africa not only fear contracting HIV/AIDS through sexual intercourse, but are often at equal risk when they visit their local health care clinics, where they are exposed to dirty injection needles and transfusions administered with contaminated blood.

A panel of medical experts including Yvan Hutin, a blood safety officer for the World Health Organization (WHO), Dr. E. Anne Peterson, assistant administrator for the Bureau of Global Health at the U.S. Agency for International Development (USAID) and Dr. John Ssemakula, a Ugandan medical consultant, made this point to a Senate hearing July 31 but also said that transmission of the disease through healthcare institutions in Africa is "completely preventable."

Hutin told the lawmakers that WHO estimates that approximately 2.5% of all HIV infections in sub-Saharan Africa are transmitted through unsafe healthcare injections but warned that his research of several "relatively reliable" HIV studies has revealed that medical transmission could actually be three to fifteen times higher than the conservative WHO figure.

It doesn't matter which figure is correct, Hutin said, because evidence indicates that all the deaths could be "highly preventable" by implementing specific interventions and providing more medical supplies to clinics. Additionally, he said, "Injection safety is not a costly intervention."

Re-use of medical needles is a major problem in Africa, Hutin warned, noting that even though the cost of a syringe is relatively low, patients have to purchase the needles themselves and poverty means they will buy only one. Individuals use the single needle over and over and then share it with family members and neighbors, so "infected needles could potentially have far-reaching effects with these practices," Hutin noted.

"To prevent re-use of syringes," Hutin said, "single-use syringes must be made readily available in each health care facility [in sub-Saharan Africa]," adding, "Some of the poorest countries in the world have actually achieved substantial success through ensuring that all injectable medications are made available with sufficient quantities of single-use syringes and needles."

Peterson told the senators how U.S. Government programs are making injection safety a reality for Africa. "USAID, through the Program for Appropriate Technologies for Health (PATH), has developed and introduced single-use injection devices, and is currently developing and introducing systems for safely disposing of contaminated needles [in Africa]," she explained.

Peterson, who currently supervises a major portion of the U.S. effort against AIDS in Africa, added, "Uniject, a new smaller single-use device, will reduce costs, medical waste, and the risk of unintentional needle sticks. USAID is supporting research to expand the number of injections that can be given with Uniject."

USAID, she said, realizes that the problem of unsafe healthcare facilities in Africa is bigger that any single solution but all solutions must address safety in every area of healthcare. "USAID has provided leadership to change country policies and procedures: to improve medical practices; to promote behavior change by recognizing the role of unsafe medical practices; to create a research agenda to identify risk factors in poorly covered areas; and to reduce unnecessary injections," she said.

USAID is implementing programs to prevent contaminated blood supplies in Africa as well. For example, Peterson said, "through the new Safe Blood for Africa project, USAID will help develop a blood collection and distribution center in Abuja, Nigeria to help combat the crisis of HIV transmission through blood transfusions in Nigeria." She warned, however, "in Abuja, blood services are severely understaffed, underfunded and far from meeting standards for blood collection and distribution set by the WHO."

Ssemakula, a Ugandan doctor now working as a public health consultant in Washington, described his first-hand experience of the "devastating" health care situation. Ssemakula told the lawmakers he interviewed several doctors in Africa, one of whom told him, "It is time we started looking at AIDS in a bigger way. The issue [of basic healthcare] is a real problem, especially in country clinics where equipment is hard to come by."

Given the personal and governmental poverty faced by African health care clinics, Ssemakula sees the issue as "simple black and white, that of providing safe healthcare to the people who seek it most. Can I honestly go into my home village in Uganda," he asked, "and tell my relatives there they should not have access to safe health care?"

The key point of agreement among the panel was that the U.S. government should raise the issue of safe health care within international agencies and insist on "best practices" to eliminate disease transmission to and from health care workers in the workplace, to assure injection safety and a clean blood supply, and to promote public education to discourage unnecessary injections be included in prevention strategies and programs.

(The Washington File is a product of the Bureau of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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