Global Policy Forum

By Jim Lobe

A group of experts convened urgently last week by the United Nations has concluded that recent articles attributing major responsibility for the spread of HIV/AIDS in Africa to unsafe medical practices are not supported by "the vast majority of evidence."

The experts reaffirmed that unsafe sexual practices are responsible for the "vast majority of HIV infections in sub-Saharan Africa," and that promoting safe sex must continue to be the focus of prevention programs in the region, according to a statement released Friday in Geneva.

The meeting was called by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) in the wake of reports about a series of scientific articles due to appear in the March issue of the International Journal of STD & AIDS that question the widely held view that heterosexual transmission accounts for 90 percent of HIV infections in African adults. STD stands for sexually transmitted diseases.

In one paper, U.S. anthropologist David Gisselquist claimed that only 25-35 percent of HIV cases in Africa were transmitted as a result of unsafe sex, while unsafe medical practices, such as the use of contaminated needles and transfusions using HIV-infected blood, could account for as much as 60 percent of cases. The studies, conducted by a team of eight researchers from the United States and Germany, were based mainly on HIV epidemiological studies done in Africa from 1984 to 1988.

Among other evidence, the researchers pointed out that South Africa, Botswana and Zimbabwe, which all have well-established health-care systems, have reported unprecedented increases in HIV/AIDS cases.

They also noted that, while HIV transmission rates in Zimbabwe rose by 12 percent each year, overall STD rates declined by 25 percent and condom usage increased. Because HIV is more difficult to transmit through heterosexual intercourse than most other STDS, according to the researchers, that result suggested the existence of other important causes besides unsafe sex for the rapid spread of HIV, which now infects more than one quarter of Zimbabwean adults.

The researchers also found that places with the highest levels of risky sexual behavior, such as Cameroon's capital Yaounde, had low and stable rates of HIV infection.

They also claimed that the depiction of AIDS in Africa as a heterosexual epidemic was used by researchers in the West to secure media coverage. "Nothing captured the attention of editors and news directors like the talk of widespread heterosexual transmission of AIDS," they wrote.

If true, the implications for the operations and priorities of international aid agencies and governments in the region that are trying to stop the epidemic, which is killing more than 5,000 people a day in Africa, would be enormous.

But in their statement the experts meeting in Geneva said the Gisselquist group's conclusions could not be sustained by the medical evidence. For example, they said, children between the ages of five and 14 and who are generally not yet sexually active have very low infection rates, while infection rates among young women and men strongly follow patterns of sexual behavior and STD rates.

In addition, they could find no consistent association between higher HIV rates and lower safety standards in medical clinics and hospitals, although they stressed that more needs to be done to ensure the safety of medical equipment, particularly in immunization programs. WHO has estimated that 2.5 percent of HIV infections in Africa are caused by medical malpractice.

"The conclusion remains that unsafe sex is by far the predominant mode of transmission in sub-Saharan Africa," the experts concluded.

A number of experts have expressed alarm at the Gisselquist team's reports and the media attention they have received. In an interview with the BBC, Catherine Hankins, chief scientific adviser for UNAIDS, cautioned that "a report like this might tend to make people drop their guard and not use condoms, when it is exactly using condoms that is required at this point."

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