Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Male circumcision is not of value in preventing HIV infection
- George Hill, George C. Denniston, M.D., M.P.H. (27 January 2002)
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Thank you for identifying a major source of HIV transmission in Africa, India!
- Nance F. Monot (29 January 2002)
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The HIV-1 Urine EIA is a Safer Way to test for HIV
- Toby D. Gottfried (7 February 2002)
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Non-sexual transmission of HIV in China
- Therese Hesketh, Zhu Wei Xing (18 February 2002)
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Research findings on injecting drug users in Chennai city , Tamil Nadu State,India
- Chandra Pauline Dinakar, Roshanara, Ramachandra Sundaralingam (20 September 2007)
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George Hill, Executive Secretary Doctors Opposing Circumcision, Seattle, Washington 98107, USA, George C. Denniston, M.D., M.P.H.
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Male circumcision is not of value in preventing HIV infectionEDITOR--Gissellquist and colleagues1 make a valuable contribution to the understanding of HIV transmission risks. The role of non-sterile medical equipment in developing nations is often overlooked in identifying vectors of HIV transmission. However, Gissellquist et al. may overstate the role of circumcision in preventing HIV transmission. Gray and colleagues recently reported from Rakai that male circumcision was not of significant value in preventing HIV transmission from HIV positive male partners.2 Separately, Grulich and colleagues reported the absence of an association between circumcision status and HIV infection from receptive anal intercourse amongst men who have sex with men.3 Moreover, Van Howe carried out a statistical meta-analysis of the data from numerous studies.4 Van Howe found a slight tendency for circumcised men to have a slightly greater risk of becoming HIV positive.4 The human prepuce has numerous physiological functions.5 Amongst those functions are properties designed to protect the human body from infection via the penis.5 The advocates of male circumcision invariably overlook these valuable functions. Gissellquist and colleagues report that sterile sharps are frequently unavailable in developing nations.1 If a sterile needle cannot be guaranteed, how then can sterile circumcision operations be guaranteed? Nicoll believes that male circumcision cannot be safely delivered in developing countries.6 Bonner concurs: "…the wisest course is to recommend risk reduction strategies of proven efficacy, such as condom use."7
George Hill, Executive Secretary.
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Nance F. Monot, independant consultant The Bells, Fr-01210 Ferney-Voltaire
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Involved in HIV-AIDS since the mid eighties, as an NGO leader, I spent several years doing training in the prevention of nosocomial transmission of HIV in French speaking African countries, in collaboration with the WHO and the Pasteur Institute. As regards universal precautions and equipment, the situation is abysmal. You are absolutely right to insist on the question of transmission through unsafe injections. At the International AIDSINDIA Conference last month in Chennai (Madras), we heard presenters identified un-sterile equipment as a major source of transmission of Hepatitis B&C in the country and a source of HIV transmission! HIV, like Hepatitis B, is a bloodborn disease that can be transmitted sexually, but also by other means, and especially by unsafe injections. Laurie Garret of Newsday, has rightly pointed the finger at this issue of unsafe injections. Street dentistry is another source of HIV transmission via sharps that is hardly ever mentioned! Individual sexual behaviour cannot account for the enormous variation in HIV prevalence between North and South. Therefore, there are other factors, notably poverty - which implies two main overlooked factors for high HIV transmission: poor health care facilities lacking training, personnel and equipment, (a problem of unsafe handling of sharps which may worsen with the development of home care) and high common diseases burden. The pre-existing burden of disease leads to an over-stimulation of the immune system and thus a higher viral load for HIV+ people: HIV+ are more likely to transmit through injury, blood contact, or sexual relations, and HIV negatives run a greater chance of getting infected if in contact when they are suffering from another common disease. Further, TB and Malaria act in synergy with HIV. (NIAID worked in this preliminarily already in 1996; new work is in process on that topic). A network of researchers, from developed and developing countries, is collaborating in the search for new avenues for research to elaborate a more comprehensive anti-HIV strategy. For those of us who have worked in poor countries, letters such as yours gives us hope. |
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Toby D. Gottfried, Chief Science Officer Calypte Biomedical, 1265 Harbor Bay Parkway,Alameda, CA 94502
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Because of your convincing report on the dangers of needle use in developing countries may I call to the authors attention an FDA approved Urine Antibody Test for HIV-1 (Calypte Biomedical-HIV-1 Urine EIA) as an alternative fluid and an additional safeguard against blood collection by phlebotomy. The Johns Hopkins School of Public Health and collaborators have published (Sexually Transmitted Diseases,Vo.26 No.10, Nov.1999) the results of their studies in Uganda where offering urine HIV testing increased voluntary compliance with a test of 100% sensitivity and 98% specificity compared to paired serum specimens. This strategy of urine HIV testing was also used by community based organizations in Baltimore City in conjunction with Johns Hopkins School of Public Health and the School of Medicine to help increase the identification of HIV infected people. Of the 122 people tested positive, 47 had never been tested and 50 had never previously tested positive. |
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Therese Hesketh, Senior Research Fellow Institute of Child Health, London WC1N1EH, Zhu Wei Xing
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Editor- Gisselquist et al have drawn attention to the very important issue of iatrogenic acquisition of HIV infection. In China we believe that iatrogenic infection, acquired through paid blood donation and receiving blood products, is a major contributor to the HIV epidemic. Official HIV figures show that the total number of HIV infections in China has just passed 28,000, with a current increase of 30% annually.[1] Modes of transmission are shown in the table. Of the 5201 new cases reported in 2000 67% were from intravenaous drug use (IDUS) 8% were from sexual transmission and 2.3% from transfusion or blood products. [2] But these figures are based mainly on data from sentinel surveillance sites which target high risk groups: IDUs, commercial sex workers and attendees at STI clinic and present a very partial picture. Based on these figures the actual number of HIV infections is estimated to be between 600,000 and 1 million or 0.04% to 0.07% of the total population.[3] The proportion of this figure which is the result of iatrogenicity is unknown. What is known is that from the early 1980s donating blood (and particularly the more lucrative plasma) became an acceptable way for poor peasants in provinces such as Hebei, Hubei, Shaanxi, Shannxi and Gansu to make a living.[4] The Vice Minister of Health himself admitted at a Press Conference in late 2001 that 30,000-50,000 paid blood donors have become infected, and this is widely believed to be an underestimate. But a rough estimate of the impact can be made: many of those who are known to be infected were plasma donors who gave blood over 100 times. But even if they gave blood just 10 times following seroconversion this would mean that 500,000 people could have acquired HIV from these blood products alone. The Government has acted: in October 1998 a law was passed banning paid blood donation, and donors must now be tested for HIV. This has reduced the scale of the problem, but has also resulted in driving it underground. The traditional Chinese reluctance to donate blood voluntarily means there are chronic blood shortages, so demand in the paid sector remains high. This does not even consider the potential for transmission through unsafe injection. In a country where injections and infusions are used very widely, this is an area of grave concern.
Mode of transmission of HIV in China: official figures. Source: ref
[2]
2000 1985-1999
n % n %
Heterosexual 407 7.8 1135 6.5
Homosexual 12 0.2 27 0.2
IDU 3460 67 12531 72
Blood transfusion 107 2.1 50 0.3
Blood products 8 0.2 19 0.1
Vertical 10 0.2 13 0.1
No detail 1196 23 3541 20
Total 5201 100 17316 100
1. www.ns.unchina.org/unaids. Present AIDS epidemic situation in China. Accessed Feb 1, 2002 2. The National HIV Sentinel Surveillance Group. National Sentinel Surveillance data for HIV infection in China for 2000. Ministry of Public Health, Beijing 2001 3. www.unaids.org/wac/2000 UNAIDS AIDS Epidemic Data for China to December 2000. 4. Wu Z, Rou K, Detels R. Prevalence of HIV infection among former commercial plasma donors in rural Eastern China. Health Policy and Planning 2001;16(1):41-6 |
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Chandra Pauline Dinakar, Ph.D Research Scholar Justice Basheer Ahmed Sayeed college for Women,600018, Roshanara, Ramachandra Sundaralingam
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Very true the non-sexual transmission of HIV has been overlooked and has been the reason for the HIV infection skyrocketting among the injecting drug users (IDU)in India. The latest finding of this research on IDU reveals that 80% of the HIV infected injecting drug users reported having shared needles with three or more partners. An alarming 60% of injecting drug users who were reached by community based organizations were tested positive for HIV; of which 20% were identified with symptoms of AIDS(the hidden population of injecting drug users are yet to be reached ). The use of Anti retroviral treatment is very poor among injecting drug users and hence a rapid progresion of HIV infection to AIDS was observed among the IDU. Thus it is highly essential to focus on the non sexual transmission of HIV and highlight safe injection practices in developing countries like India as per your article and thr rapid response from Nance F.Monot. Competing interests: None declared |
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