This editorial discusses the contribution of unsafe injection practices to the transmission of HIV referring to an article by French et al in the same issue and to papers by Gisselquist and colleagues, which postulate that unsafe medical injections may be responsible for the majority of HIV infections in sub-Saharan Africa. The author points out that control programs have been based on the assumption that heterosexual intercourse is the predominant mode of HIV transmission among adults, whereas mother-to-child transmission predominates in children. So the alternative possibility for primary disease transmission has caused considerable discussion. The paper by French and colleagues use deterministic models to project the HIV epidemics that would arise from unsafe injections or heterosexual transmission given a range of assumptions concerning contact rates, mixing patterns, and transmission probabilities. Their key conclusion is that unsafe injections could not produce sustained HIV epidemics in adults without making implausible assumptions, for example, that the transmission probability from an unsafe injection is in the range 30% to 50% rather than below 3% as estimated from empiric studies of accidental needlestick exposures. In contrast, heterosexual transmission is able to explain epidemics compatible with those seen in Africa for a range of assumptions lying well within plausible bounds. The editorial supports this view.
Hayes, R.J.; White, R.G. How Important Are Unsafe Medical Injections in the Spread of HIV in Africa? Sexually Transmitted Diseases (2006) 33 (3) 135-136. [DOI: 10.1097/01.olq.0000204772.27981.d4]