Dirty Needles Misjudged in AIDS in Africa
By Jeffrey Mcmurray
The Associated Press
WASHINGTON (AP) - The World Health Organization's long-held position that
dirty needles cause 2.5 percent of African HIV exposures is too conservative,
says a leading researcher at the U.N. agency, prompting questions about a
congressional bill focused mainly on unsafe sex.
Health and Human Services Secretary Tommy Thompson has launched a review of
all research linking AIDS and medical injections, possibly laying the
groundwork for changes in how the legislation's $15 billion in funding is distributed.
Sen. Jeff Sessions, R-Ala., a member of the Senate's health panel, requested
the review after he turned up a WHO report listing four separate studies that
find dirty needles responsible for 8, 15, 41 and 45 percent of exposures in
The report, dated Dec. 19, 2002, concludes that "the lowest attributable
fraction calculated on the basis of the data provided by the authors (8 percent)
exceeds our 2.5 percent modeled attributable fraction, suggesting that our
estimate is conservative."
Yvan Hutin, a WHO researcher who wrote the report, acknowledged the 2.5
percent number was probably low, although just how low remains a point of debate.
Regardless, he said, it would be wise to consider an education campaign on
unsafe needles, perceived by many as an easier and cheaper problem to correct than
"It remains a very good investment to do injection safety," said Hutin,
reached at WHO headquarters in Geneva. "It doesn't matter whether it's 2.5
percent or more or less."
Sessions, however, contends it would have mattered while Congress was
balancing the spending priorities in the AIDS bill, which President Bush signed last
month. If the widely recognized figure was even a little higher, he said,
Congress would have poured far more money into needle education - and possibly
even a clean-needle exchange program.
But some at WHO say cost isn't the only issue. Because it is widely believed
that sex is more responsible for AIDS than needles, they contend the message
would be diluted if needle and sex education were given equal weight.
"We'd all like to see there be no unsafe injections," said George Schmid of
WHO's Department of HIV/AIDS. "But to begin to place a large emphasis on the
unsafe injections, which likely would be at the expense of resources devoted
to unsafe sex, would be an unwise decision. We need to keep the resources
where the problem is."
That position outrages Sessions, who suspects it's the reason WHO continues
to tout an estimate its researchers acknowledge is low.
"This is hogwash," he said. "It's about numbers. It's about infections.
You can certainly carry two messages. This is a life-and-death issue. Whatever
bureaucratic objections are occurring here have got to be overcome because
people are dying every day."
A major part of the AIDS bill could be rerouted if new research about
injections surfaces, Sessions said. But HHS officials aren't saying how likely that
is, or even when the study is expected to be finished.
"Like Sen. Sessions, we too are interested and concerned with how AIDS is
actually transmitted," said HHS spokesman Bill Pierce.
Sessions' interest in the connection between AIDS and injections was
heightened in March after he invited Dr. David Gisselquist to testify to the Senate.
After reviewing some 19 years of research, Gisselquist concluded that at least
one-third of AIDS exposures in sub-Saharan Africa are due to contaminated
needles in medical treatment.
Gisselquist contends that because WHO's focus has been on unsafe sex for so
long, it's deliberately overlooking good research like his. But although Hutin
now doubts the 2.5 percent number, he says Gisselquist's estimate is inflated.
"If WHO says we should put more emphasis on health care risks, people will
say, 'Why didn't you do it the last 15 years?" Gisselquist said.
Similar concerns are raised by Gary Cohen, president of BD Medical Systems, a
New Jersey-based company that makes disposable syringes that permanently lock
after they're used once. The syringes cost about 6 cents each, he said.
For $75 million to $100 million a year, Cohen said, all of Africa could be
supplied with the safe syringes. He contends that a needle distribution program
is the most effective way to combat the problem because many people in Africa
don't have the option to demand clean needles.