A new study says that the re-use of dirty needles in healthcare is the main cause of the AIDS epidemic that is depopulating Africa. For years, researchers puzzled over the fact that they could find no common sexual practices that explained the rise in AIDS among heterosexuals there. “We’ve gathered all the literature we can on AIDS in Africa and the best we can estimate, for sexual transmission, is a quarter to a third,” says anthropologist David Gisselquist. This means that AIDS prevention should concentrate on providing single-use needles rather than on sexual education or condoms.

Yvan Hutin, an HIV specialist with the World Health Organization, disagrees. He says, “We estimate that dirty needles account for 5% of cases worldwide, but with large variation,” and notes that Hepatitis B, which is even more easily transmitted by unsterilized needles than HIV, has not spread as rapidly as AIDS.

Health organizations are afraid this news may make Africans stay away from clinics where they receive immunizations. “The other worry is that it might encourage complacency in sex,” says Catherine Hankins of UNAIDS.

Gisselquist says his data contradicts the idea that Africans must be unusually promiscuous, or engage in a lot of unsafe sex. In a 1987-88 study of factory and bank workers in the Congo, most of the HIV-positive subjects said they had been faithful to their partners. No one has ever identified a large amount of unsafe sexual activity in Africa and some researchers assumed that African men were embarrassed to admit engaging in homosexual activity.

Gisselquist also thinks the part prostitution plays has been overstated. In Zimbabwe during the 1990s, an increase in HIV of 12% occurred at the same time as a decrease of 25% in the spread of other sexually transmitted diseases, so an increased amount of prostitution is unlikely.

There’s also a link between other ailments and HIV that suggests that people who seek medical help as children later come down with AIDS, because they’ve been given injections with dirty needles. One study showed that HIV-positive children had an average of 44 injections in their lifetimes, compared with 23 for virus-free children. In one clinic, Gisselquist found that 28% of the patients who received injections had HIV, compared with 17% who did not get injections.

In the 18th century, doctors were considered to be killers, with their blistering and use of leeches?but who would have thought it could still happen 200 years later?

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