Dirty Needles Spread HIV to South African Children

Exposure to dirty needles -- rather than sexual exposure -- may be a significant cause of HIV transmission among children in South Africa, according to new research. Dr. Stuart Brody of the Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany, and colleagues estimate that 670,000 children ages 2-14 in South Africa are HIV-infected -- almost three times more than conventional estimates for mother-to-child infection.

A previously published study carried out by the Human Sciences Research Council of South Africa revealed an HIV prevalence of 5.6 percent among this age group. An observation from the same survey noted that white children had an HIV prevalence of 11 percent, while white adults had a prevalence of 5.7 percent -- pointing to an important role for HIV transmissions other than mother-to-child.

Brody and colleagues reject the hypothesis that childhood sexual exposure is responsible for the high HIV prevalence. Sexual experience in this age group is limited, they said, despite the media reports of infected men seeking virgin girls as a "cure" for their own HIV infection. A more reasonable hypothesis, supported by other evidence, is that children are infected through non-sterile medical procedures, researchers said.

Brody's team writes: "Not only are injections popular among African patients, administered at an estimated 90 percent of medical visits, but also often unnecessary, and injection equipment is often reused without sterilization."

"The common belief that 90 percent of HIV transmission in Africa is driven by heterosexual exposure is no longer tenable," they concluded. "Doctors must educate their patients in the dangers of non-sterile injections and ensure that their own practice is beyond reproach." The full report, "Evidence of Iatrogenic HIV Transmission in Children in South Africa," is published in the May issue of the International Journal of Obstetrics and Gynecology (2003;110(5):450-452).

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