A.I.D.S. — is the West to blame?

Press, 30 May 1987, Page 16

A.I.D.S. — is the West to blame?

A new theory is that the detonator of A.I.D.S. in Africa was injections,

reports

PHILIPPA BRAIDWOOD,

of Britain’s “Observer.”

It is widely believed that the major route of transmission for A.I.D.S. is sexual intercourse, and that the rapid spread of the virus began when it reached promiscuous sections of the population in Africa.

A new explanation, published this month in the “Journal of the Royal Society of Medicine,” challenges this view. It suggests the A.I.D.S. virus could have been around for thousands of years, and its recent rapid transmission have been caused by repeated us of inadequately sterilised needles.

Dirty needles not only initiated the pandemic, claims the paper, they are driving it on. Injections have become very popular in Africa. Needles and syringes are often re-used without

proper sterilisation between patients. What’s more, “inoculators,” who peddle potency and other cures in bars, administer their wares freely with hypodermic needles bought in markets.

According to Dr John Seale, co-author with Dr Z. A. Medvedev, that Africans should suddenly become sexually promiscuous is not a plausible explanation for the onset of the A.I.D.S. pandemic. “The massive build-up in the employment of multi-use medical hypodermics for injecting antibiotics and vitamins in Central Africa since the advent of cheap penicillin over 30 years ago ... is precisely the sort of potent, novel factor which could start a pandemic.”

Three other viruses in Africa — Lassa, Ebola

and Marburg — have been transmitted this way. All started as viruses in animals which, like rabies, occasionally passed to man. It took an outside influence — dirty needles — to turn them into epidemics. These viruses died out naturally; they were not highly infectious. The controversial part of Dr Seale’s argument is that it was needles rather than sex that caused the pandemic. In other words, it was modern medicine which inadvertently caused the catastrophe. Those who dispute the

claim argue that it doesn’t explain the high prevalence of the virus only among the sexually active, and nor is it consistent with the low transmission rate, only 1 per cent, associated with needlestick accidents (self-prick-ing by medical staff). Dr Seale says the claim of low incidence among children is false. He quotes studies, by Jonathan Mann (et al), Director of the Special Programme on A.I.D.S. at the World Health Organisation, which show a 12 per cent incidence among children under two in

Kinshasa, Zaire. Half had non-infected mothers — and they had twice as many injections as the non-infected: 44 in their first two years compared with 23. Mann found a similar infection rate among two to 14-year-olds in Kinshasa. Immunisations, of which smallpox was only one, account for the minority of these injections: the bulk are for vitamins, medication, rehydration ... Studies on the elderly are lacking. Dr Seale comments: “This virus is now also transmitting by sex. The elderly are less sexually active than the young. The promiscuous are more so — hence the higher incidence among prostitutes.” Needlestick injury figures are not relevant, believes Dr Seale. They

are usually little scratches. Any virus present is not driven into the tissues. What do others think of Dr Seale’s explanation?

Dr Donald Henderson, Dean of the School of Hygiene and Public Health at John Hopkins University, Baltimore, says: “This may well account for the majority of transmissions in Africa. It sounds plausible. The data doesn’t permit us to say. We need more studies.

“A high-level Minister in Kenya told me recently it took only 10 minutes in a bar before he was approached by an inoculator.

“An awful lot of injection with Unsterilised needles goes on in Africa.”

Dr Peter Plot, Professor of Microbiology at the Institute of Tropical Medi-

cine in Antwerp, the collaborative centre on A.I.D.S. for W.H.0., says “Historically, this makes sense but it would be hard to prove. It could be that sex is now a major transmitter because people have intercourse ter more often than they have injections.” Disposable syringes, widely promoted in Africa 18 months ago, have inadvertently added to the problem: people re-use them, as they won’t survive a cycle in the steam steriliser, also now widely promoted. On April 1 U.N.I.C.E.F. banned the supply of disposable syringes to countries which couldn’t prove they threw them away after one use. We urgently need an autodestruct syringe to replace all current disposable ones.