WHO reaffirms: it's not dirty needles, it's unsafe sex.

• Author: Sarin, Radhika
• Position: Environmental Intelligence

A politically volatile finding about how HIV is transmitted in sub-Saharan Africa has been refuted by an expert group convened by the World Health Organization (WHO) and UNAIDS.

The controversy erupted in recent months with the publication of a series of articles in the International Journal of STD and AIDS, which purportedly linked the majority of infections to unsanitary medical practices, including the reuse of needles, contaminated blood transfusions, and the use of improperly cleaned surgical tools. The articles, by a group of researchers headed by David Gisselquist (an independent consultant with a Ph.D. in economics), contend that only about a third of all HIV infections in sub-Saharan Africa are due to heterosexual transmission. Those conclusions flatly contradict the findings of WHO/UNAIDS, which attribute 90 percent of African infections to unsafe sex. Gisselquist's team suggests that Western preconceptions about Africans' sexual promiscuity and the fear of generating public distrust in health care have prevented the evidence of medical exposure to HIV from being fully examined until now.

In response, WHO/UNAIDS convened an expert panel to review the evidence to date, including the work by Gisselquist. The panel found significant flaws in the Gisselquist claims, and reaffirmed that unsafe sex is the predominant mode of HIV transmission in the region, with injections accounting for approximately 2.5 percent of infections. The WHO/UNAIDS position was echoed by U.S. Deputy Secretary of Health and Human Services (HHS) Claude Allen, who stated at a Senate hearing in March, "We [HHS] would be prepared to defend the 90 percent figure [for sexual transmission]."

Making injections safer should remain a global health priority (of the estimated 16.7 billion injections given annually worldwide, about 40 percent...