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Safer Aids Treatment

BANGKOK, Thailand
IN THE United States and other industrialized countries, HIV is transmitted most often by unprotected sex or the sharing of contaminated needles by drug users. In much of the rest of the world, though, health officials have too long minimized another source: unsafe injection practices in hospitals and clinics and the use of unscreened blood in transfusions. Donor countries and organizations and affected nations must do more to ensure that health providers are not infecting patients.

The extent of this problem is a subject of intense debate. This year's report by UNAIDS cites a World Health Organization estimate that blood transfusions may account for 5 to 10 percent of all infections worldwide, while 5 percent may stem from use of unsterilized needles in clinics or hospitals. Others blame medical infections in developing countries for 40 percent of all HIV cases.

At the recent International AIDS Conference here, delegates learned of tragic errors at a hospital in Libya, where about 400 children were accidentally infected with HIV. Six Bulgarian nurses were convicted, unfairly, of intentionally causing the infections and are appealing death sentences.

Whether medical providers are responsible for 10 or 40 percent of infections, correcting unsafe procedures should be a high priority. Efforts lagged, though, as health officials worried that a focus on the issue would divert attention from prevention and might dissuade people from seeking medical care.

These are valid concerns, and any effort to deal with medical transmission of the AIDS virus has to be handled carefully. But better transfusion and injection practices deserve more funding, not least because these preventive steps do not require changing deep-seated traditions that are a block to safer sex.

Grants in US bilateral AIDS programs this year include $27.5 million for blood safety programs and $26.9 million for safer injections out of a total of $865 million, a significant increase from the year before. As a major -- and, we hope, increasing -- contributor to the Global Fund to Fight AIDS, TB, and Malaria, the United States should also encourage grant requests from developing countries in this area. According to Physicians for Human Rights, only a few countries have sought grants from the Global Fund to reduce medical transmission of AIDS.

Jane Burgess, HIV-hepatitis C national clinical coordinator for the Department of Veterans Affairs, has worked on infection control with nurses in developing countries. "The knowledge is there," she said. "It's a question of scaling up and getting them the resources." That should be at the top of the to-do list of the world's AIDS fighters.


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