USAID on Wednesday as part of the President's Emergency Plan for AIDS Relief awarded $6 million to organizations working in six African countries to improve medical injection safety programs, which could help reduce the risk of HIV transmission in medical settings in those countries, according to a release (USAID release, 5/26). Although most AIDS organizations say that heterosexual contact is responsible for the majority of HIV cases in Africa, some studies have said that unsafe medical practices -- such as injections and blood transfusions using unsterile needles -- are a much greater threat. The World Health Organization estimates that 90% of HIV-positive people in sub-Saharan Africa have been infected through sexual contact and 2.5% of HIV-positive people have contracted the virus through unsafe injections. However, three studies published in March 2003 in the International Journal of STD & AIDS by a team of eight researchers led by anthropologist David Gisselquist support a theory that unsafe medical practices are the primary route of HIV transmission in sub-Saharan Africa (Kaiser Daily HIV/AIDS Report, 10/29/03). However, a study published in the Feb. 7 issue of the Lancet said that sex, not unsafe medical practices, is the primary mode of HIV transmission in sub-Saharan Africa. Researchers said that about 39% of the average 3.4 injections given per person, per year in low-income and middle-income countries are administered with unsterile equipment, which is "considerably less" than the 50% of injections cited by Gisselquist and colleagues (Kaiser Daily HIV/AIDS Report, 2/6).

Organizations
USAID awarded $1.3 million to Chemonics International for an injection safety project in Zambia; $3.9 million to John Snow, Inc. for work in Ethiopia, Mozambique, Nigeria and Uganda; and $800,000 to University Research for an injection safety project in Namibia. The projects plan to offer health care provider training, logistics management, improvement in health care waste disposal and a reduction in the number of unnecessary injections. The organizations will assess injection and supply management, support the creation of national policies and develop monitoring and evaluation programs to "accurately determine progress," according to the release. USAID Administrator Andrew Natsios said that PEPFAR "is focused on achieving the goals of treating at least two million HIV-infected persons with antiretroviral therapy, preventing seven million new infections and caring for 10 million persons infected with or affected by HIV. Through all of our efforts, treating and caring for individuals in a safe, effective manner is a top priority" (USAID release, 5/26).

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