Globe and Mail Editorial (Toronto)
Saturday, February 22, 2003 - Page A20
People who poke holes in the received wisdom may be an irritant, but their
skepticism can be valuable.
So it may be with a study released this week in the International Journal of
STD and AIDS, a peer-reviewed publication of Britain's Royal Society of
Medicine. Six American and two European researchers, two of them medical
doctors, ask an impertinent question about the rapid spread of HIV/AIDS in
sub-Saharan Africa: Why are so many AIDS experts so sure that the bulk of
the virus's transmission there is through heterosexual sex?
They found it hard to believe that the rapid speed of infection in many
African countries could be accounted for by sex. They could find no
documented explanation of the 1988 estimate by the World Health
Organization (WHO) that 80 per cent of HIV infections in Africa resulted
from heterosexual transmission -- a figure that quickly became part of the
lore and has been inflated to 90 per cent in some reports.
So they read every peer-reviewed study they could find on HIV/AIDS field
work in Africa between 1984 and 1988. They concluded that the extent of HIV
transmission through contaminated medical equipment has been drastically
understated. They even suggest that sexual transmission of HIV accounts for
only a fraction of HIV cases.
The study's authors are perplexed by the anomalies they found. How does one
explain all the HIV-positive babies whose biological mothers test negative?
Why does the spread of HIV not conform with the spread of other sexually
transmitted infections? In Zimbabwe in the 1990s, HIV increased by 12 per
cent a year while sexually transmitted diseases as a whole fell by 25 per
cent and condom use rose among those groups considered at highest risk of
infection -- prostitutes, truck drivers, miners, young people.
Why does the capital of Cameroon, Yaoundé, have a high rate of risky social
behaviour, yet "low and stable" rates of HIV infection?
The authors have, as they expected, encountered criticism, not least because
the studies they reviewed are two decades old. And certainly overreaction
would be as dangerous as no reaction.
All the authors ask, however, is that the same degree of attention focused
on heterosexual sex be given to the safety of medical treatment in African
countries where HIV has grown into a scourge of tragic proportions. One of
the authors, David Gisselquist, has been invited to a March 13-14 meeting of
WHO and the United Nations agency UNAIDS in Geneva to make his case.
Sometimes the received wisdom needs a bit of unsettling.