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By Holly Burkhalter and Eric A. Friedman
Thursday, August 21, 2003; Page A23

Many AIDS-burdened countries are missing one of the most obvious ways to reduce transmission of HIV and AIDS, one that was adopted decades ago in the West. AIDS prevention leaders -- instead of demanding immediate attention to the problem -- appear to be actually playing it down. Unscreened blood transfusions and unsafe medical injections have infected millions of adults and children with HIV. It is past time to make the eradication of this means of transmitting AIDS a priority.

When the AIDS epidemic emerged in the United States in the 1980s, doctors, nurses, dentists and hospital administrators adopted extensive procedures to prevent transmission of HIV -- the blood-borne pathogen that causes AIDS -- from non-sterile equipment or infected blood supplies. Gloves, masks and disposable syringes became mandatory, and even a single transmission of HIV in a medical setting was cause for horrified publicity, investigation and correction.

But in shameful contrast to the "zero tolerance" for such medical mistakes in Western hospitals and clinics, in AIDS-burdened countries, leading authorities on the pandemic, as well as donors and health ministers, have all failed to prevent infections from unsafe health care. Doctors, nurses and health workers are unknowingly transmitting HIV through unscreened blood transfusions and un-sterile syringes to at least a half-million men, women and children every year, and are themselves at risk of occupational HIV exposure.

The United Nations warns its officials of the dangers of unsafe injections and infected blood in the developing world, and few would travel without their own supply of sterile syringes. What, then, accounts for the failure to make safe health care a priority for all? A partial answer is that UNAIDS and the World Health Organization attribute 90 percent of HIV transmissions in African adults to unsafe sex and less than 10 percent to unsafe medical injections and tainted blood supplies. Based on this math, some experts appear to consider safe health care discretionary when promoting policies and parceling out inadequate foreign aid dollars.

To be sure, safe-sex promotion and condom dissemination are vital initiatives in confronting the pandemic and deserve the billions of dollars of foreign aid they've received, and much more. But rather than demanding funds for both important prevention initiatives, some international experts on the pandemic are pitting one against another. An official from the World Health Organization's AIDS department stated recently that devoting resources to unsafe injections would be "unwise," because sexual transmission, not unsafe health care, is where the problem lies. And WHO's five-year AIDS plan, presented to the world's health ministers in May, reflects WHO's priorities: Injection safety was simply not mentioned among 19 "core components" of effective AIDS policy. Similarly, a seminal paper authored last year by experts from UNAIDS and WHO's AIDS department proposed 12 interventions that could avert 29 million HIV and AIDS infections over the next nine years. Astonishingly, neither occupational protection for health workers nor blood and injection safety was mentioned, even though WHO's data indicate that such interventions could avert millions of AIDS infections in that time period.

Another possible reason for the neglect of AIDS transmission in health care settings is the fear that attention to the issue could distract attention from sexual transmission of the disease. A senior official at UNAIDS commented that stressing the dangers of AIDS transmission from unsafe health care could cause Africans to "drop their guard" against unsafe sex and discourage condom use.

Africans and Asians have the right to information on both the risk of unsafe sex and the risk of unsafe health care. And that risk is substantial. In Africa, one-quarter of blood used for transfusions -- a common treatment for malaria -- is not screened for HIV, and as many as half of injections in Asia and Africa are unsafe because of needle re-use. Moreover, most injections are medically inappropriate or unnecessary, because oral alternatives are preferable. Unsafe injections alone appear to account for almost a quarter of the annual HIV infections in India. Among those at risk of disease transmission through contaminated blood are doctors, nurses, midwives, aides and technicians. African health workers are staggering under the burden of the AIDS pandemic. Clinics and hospitals are overflowing with patients they cannot treat, and their own numbers are falling because of illness, burnout, budget cuts and "brain drain" of their colleagues to the West.

Fortunately, the tide is beginning to turn, largely thanks to the work of African health professionals themselves. Impoverished Burkina Faso reduced needle re-use from 50 percent to 4 percent by including single-use syringes on its list of essential drugs. Senegal has established injection and blood safety policies without neglecting safe-sex promotion. Ethiopia, alone among 90 successful applicants to the Global Fund to Fight AIDS, Tuberculosis and Malaria, requested assistance to tackle the problem of needle re-use. The Safe Injection Global Network has developed standards on safe health care practices and promoted their adoption.

Despite the fact that safe health care interventions are affordable and effective, sufficient funds have not been available to correct the problem. A U.S. senator, Jeff Sessions (R-Ala.), seeks to change that. Sessions is promoting a program to fund safe blood supply and non-reusable syringes for African countries. The United States should announce its commitment to and financial support for "best practices" in AIDS prevention, including safe health care, at the international AIDS conference in Nairobi next month. It is an issue whose time should have come 20 years ago.

Holly Burkhalter and Eric A. Friedman are with Physicians for Human Rights and its Health Action AIDS Project.