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.