Possible modes of HIV transmission to the Middle East Region [Archives:2005/846/Health]
By Dr K Abdel-Aziz
For the Yemen Times
Human Immunodeficiency Virus (HIV) is continuing to spread across the globe. Spread of HIV to the Arab World is real, and if this is allowed to happen, it would result in devastating effects on the regions health, economy, education and bring the already slow process of development to a halt. Countries that have taken measures to prevent, or slow down, the spread of HIV have avoided the catastrophic effects, while countries that failed to do so have suffered terrible consequences including loss of half of their populations and complete collapse of their economies.
In this short communication, we have discussed the potential modes by which HIV could spread to the region, and suggested a number of measures that could be taken to prevent such spread.
Potential routes by which HIV could spread to the region.
1- Through returning HIV-infected students. A small number of the regional students and tourists, while abroad, indulge in sex with prostitutes, the majority of whom are HIV-infected. A number of research papers have shown that 20-50% of the prostitutes in Uganda, India and South East Asia are HIV infected. Similarly, the number of HIV-infected prostitutes in the West is also relatively high. Therefore, the chance of those students/tourists becoming infected with the virus is quite high. On returning, these same people would undoubtedly indulge in sex with the regional hidden prostitutes, who would in turn pass it on to all their clients. In turn, the latter would then spread the virus to their families and children. Moreover, since screening for HIV during blood donation may not be perfect in all parts of the region, the virus would spread to a large part of the population through blood transfusion. In addition, repeated use of HIV-contaminated medical appliances (e.g. syringes) in some parts of the region would lead to further spread of the virus.
2- Through imported HIV-contaminated blood products. The second potential route of spreading of HIV to the region could occur through the use of imported HIV-contaminated blood products. In the early nineties, drug companies in France, Canada and Japan sold, knowingly, HIV-contaminated blood-products to their local populations, resulting in the infection of hundreds of haemophilic patients with HIV. These companies had a large stock of blood-products that had not been heat-sterilised. When research showed that heat-sterilisation inactivated the virus, all companies were required to heat-sterilise their blood-products, including that already in stock. However, since the process of sterilisation of the stock would have cost millions of dollars, many companies risked selling their stock products with out sterilisation. Subsequent investigation into the spread of HIV in the haemophiliac populations in each country led to the exposure of these companies (Nature~90s). These companies sold un-sterilised blood-products to their own populations, knowing the strict screening and law enforcement systems of their respective countries. One is forced to ask what would they do when dealing with Third World countries?
3- Through sex trade which is flourishing in some parts of the region. Prostitutes who are brought to the region in increasing numbers from abroad would serve as a good nucleus for the spread of the HIV to the regional population.
4- Finally, through illegal emigrants. Thousands of illegal emigrant enter the region annually. Most of these emigrants originate from HIV endemic countries. Relaxation of the morale codes in the region, combined with poverty, particularly amongst those emigrants, would encourage prostitutions thereby accelerating the spread of the HIV across the region.
Potential preventive measures
We believe that the risk of HIV spreading to the region is real and consequences of this happening are grave. Academics, health professionals and health-planners would need to take this topic very seriously and appropriate actions are taken.
The most effective way of combating the spread of the virus has been through educating the population on the ways the virus is transmitted, and the consequence of becoming infected with HIV. Through education, the West has managed to halt the spread of the virus. Today in the UK, the rate of HIV infection has been reduced to 2000-3000 per a year. In countries where educational programs were not implemented, the virus has spread rapidly infecting half the populations in some African countries. Similarly, the spread of HIV in India and Russia is growing at an alarming rate. Therefore, appropriate educational programs would need to be devised and implemented. Below we have made a number of suggestions:
1- Produce educational booklets on HIV/AIDS and distribute them to all students/tourists/businessmen travelling to HIV-endemic countries.
2- Produce educational programs for the general populations and air them at peak viewing times.
3- Initiate basic research work into the general population awareness about the mode of HIV-transmission, consequence of infection and its avoidance.
4- Establish local/regional call centers for the dissemination of HIV/AIDS education.
5- Direct special HIV/AIDS educational programmes to poverty stricken areas where prostitutions would likely to occur (although tackling poverty itself would be the best solution).
6- Strengthening of the morale codes and fighting prostitution. One way of achieving this is to tackle poverty and thus provide prostitutes with an alterative incomes as well as providing them with appropriate counselling.
7- Appropriate solutions to the commercial sex industry in the region.
8- Controlling the spread of pornographic materials to the region.
9- Encourage tourists to travel to Regional countries (e.g. increase the production of holiday programmes and advertisements of regional holiday resorts).
10- Import blood products from well known companies that use donated blood only (companies which use bought blood risk HIV and other viral contamination, since the majority of people selling their blood are either drug addicts or prostitutes; both are HIV high risk groups). In addition, regardless where the blood products are imported from, all batches would need to be tested locally for HIV, HBV and HCV, using up to date screening methods.
11- Ideally, produce blood-products locally/regionally.
12- Educate all health professionals on the danger of re-using medical appliances (e.g. syringes).
13- Audit the existing sterilisation procedures for medical and dental appliances.
14- Use of up to date HIV-screening methods in blood donation centres.
15- Put in place strong legislations to deter medical/dental negligence.
16- Improve the health and safety systems in both the academic and the medical sectors (e.g. education of save disposal of clinical and laboratory materials, compulsory vaccination against HBV for medical, dental and other health workers).