February 20, 2003

Botched vaccinations blamed for Aids in Africa
By Nigel Hawkes, Health Editor, and Michael Dynes in Johannesburg
An international team of scientists says only 30 per cent of HIV cases were sexually transmitted

THE African Aids pandemic was caused more by careless use of needles in healthcare than by unsafe sex, a report published today by an international group of scientists says.

They estimate that more than half the cases of Aids in Africa before 1988 were caused by unsterilised needles. The claim, directly challenging the belief that 90 per cent of cases were sexually transmitted, implies that the African Aids pandemic is largely the result of unsafe medical practices and mismanaged vaccination campaigns.

The team says that the evidence was discounted because of “preconceptions about African sexuality and a desire to maintain public trust in healthcare”.

Aids experts yesterday rejected the theory, without denying that some HIV infections were caused by dirty needles. “There was an element of infection through medical interventions,” Professor Michael Adler, of University College London Medical School, said. “But I am extremely doubtful that it could have been as large as they claim.”

The team making the claims includes experts in HIV and public health and is led by David Gisselquist, an anthropologist from Pennsylvania, a private consultant, and Dr John Potterat, an infectious diseases specialist from Colorado. It also included experts from Emory University School of Medicine in Atlanta and Albert Einstein College of Medicine in New York.

In three separate articles in International Journal of STD and Aids, it says that only about 30 per cent of Aids in Africa is the result of sexual transmission, not the 90 per cent usually claimed.

The “anomalies” that it found may have alternative explanations, the team acknowledges. “Dispassionate assessment of our conclusions admittedly depends on a willing suspension of disbelief, since the current paradigm is deeply embedded,” the experts say.

Dr Gisselquist said yesterday that he had found no reliable study to back up the 1988 estimate that 90 per cent of HIV infections were sexually transmitted. The figure “did not fit the data available at the time” and suggested epidemiology and propaganda had become intertwined.

The aim of the new research was not to scare people, he said, but to show the importance of carrying out medical procedures correctly, such as using syringes only once. “People can get quality healthcare in Africa, it is just the difference between doing it right and doing it wrong,” he said.

If he is right, it is not only Africa, but also Asia and China where misuse of needles has pushed up HIV infection. Experts do concede that in many countries the re-use of needles, perhaps with only a cursorary soak in a bowl of dirty water between injections, is a serious problem.

The World Health Organisation estimates that unsafe injections are responsible for 5 per cent of HIV infections, and a new UN unit, the Safe Injection Global Network, has been established to promote safer practices. But it has focused mainly on hepatitis, much more easily transmitted in this way than HIV. Experts point out that if dirty needles were responsible, then hepatitis B would be growing faster than Aids in Africa and Asia.

“The team has not produced any new data,” Professor Adler said. “They claim that researchers had closed minds, and you could argue that this was true. But they haven’t proved the case, and most of their analysis dates back to the 1980s. Blood is now much safer, and people are much more careful about medical interventions.”

Professor Roy Anderson, of Imperial College, London, an expert in the spread of epidemics, said: “Understanding the root of infections is very difficult, unless you do cohort studies which compare groups of people who get the disease with similar groups who don’t.

“When this has been done for Aids, and the risk factors identified, two come out. One is sexual behaviour, and the other is the presence of other sexually transmitted diseases, which may facilitate infection with HIV. The number of injections anyone has had does not appear to be important.”

Dr Clive Evian, an HIV-Aids specialist at Johannesburg General Hospital, also cast doubt on the claims yesterday. “It is possible to contract HIV-Aids from a used needle which has got fresh HIV contaminated blood in it. We know that. But if HIV were spread through needles, you would expect the disease to show up in similar concentrations across all age groups. It doesn’t. It is overwhelmingly concentrated in the sexually active age groups,” he said.

But a joint study published in December by the Nelson Mandela Foundation and South Africa’s Human Sciences Research Council found that 5.6 per cent of children aged between 2 to 14 had HIV.

“This is more than can be explained by HIV transmission from mother to child or reported sexual activity,” Olive Shisana, the spokeswoman for the council said. “Further investigation will consider sexual abuse and exposure to unsterilised needles,” she said.

Dr Chris Ouma, head of health programmes for the charity ActionAid Kenya, said that the claims “fly in the face of experience on the ground”. In Kenya, he said, medical procedures have largely been made safe and still HIV infections rise. “Whilst it is important to ensure that health services remain safe, the vast majority of new transmissions in Africa are driven by heterosexual sex,” he said.

Dr Cate Hankins, of UNAIDS, disagreed with the conclusions, but said “we are holding a consultation in three weeks to review all the evidence. The worst thing would be if . . . people stop taking their kids for immunisations, or abandon the use of condoms.

“If people really began to believe they had been misled about Aids and didn’t need to do these things it would be horrible.”

There have been 28 million cases of Aids since the epidemic began in the early 1980s, most in Africa.

Signs that the experts missed

THE scientists base their claim on a series of findings from studies done by others, the implications of which, they say, were ignored:

·  The spread of HIV did not follow the same pattern as sexually transmitted disease. In Zimbabwe in the 1990s HIV infections increased by 12 per cent a year while STDs were declining by 25 per cent.

·  The spread of HIV was too fast to have been caused by sexual transmission. To explain the speed it would have to be as easy to catch HIV from sex as it is from a contaminated blood transfusion; in fact, it is much harder.

·  Behaviour surveys show that sexual activity in Africa is not very different from Europe or North America. Some places with high levels of risky sexual behaviour have low and stable rates of HIV.

·  Many young children are infected with HIV even when their mothers are not. In Kinshasa one study showed that the infected children had, on average, had 44 injections compared with 23 for uninfected children.

·  The countries where HIV has spread fastest are those, such as Zimbabwe and South Africa, where healthcare is quite developed.

·  Sexually transmitted diseases are usually commoner among the poor and uneducated, but HIV in Africa is linked to urban living, a good education and higher income.