Did contaminated blood transfusions make a significant contribution to the HIV pandemic? In wealthy countries, the answer is clearly ‘yes’, blood transfusions and use of blood products was already very common when HIV was identified. Until the role of these procedures in HIV transmission was recognized, many people were infected with HIV nosocomially.
But could blood transfusions have made such a contribution to the most serious HIV epidemics in the world? Often, it is said or suggested that transfusions were not common enough in developing countries, particularly the African countries that have experienced the worst HIV epidemics. But an article published by William H. Schneider and Ernest Drucker five years ago shows that this view is mistaken.
The authors estimate that “approximately 20 million transfusions [were] done in sub-Saharan Africa during the 1980s” and that “30 to 40 million transfusions occurred in sub-Saharan Africa in the period 1950–1990.” If HIV began to spread in the 1960s in the virus’s country (or countries) of origin and had already reached several other countries by the 1970s, there would be ample opportunity for HIV to spread widely in health facilities and via health services.
Interestingly, blood transfusions started in what is now the Democratic Republic of Congo. The highest levels of genetic diversity in HIV are found in DRC, suggesting that the virus has been there for longest and probably originated there. The authors also find that blood transfusions were probably far more common among urban populations. HIV is still far more common among urban populations and is only slowly moving to more isolated areas.
Once HIV became endemic in many African countries, it would have been a short step to relatively high levels of sexual transmission. But the history of blood transfusions in African countries, along with histories of medicine in general, mass vaccination campaigns, large scale targeting of specific populations, such as miners, sex workers and truckers, and various other phenomena, show that massive HIV epidemics have never been primarily related to sexual behavior, and this is probably still the case.
Whatever the relative contributions of sexual and non-sexual behavior, Schneider and Drucker’s paper make it clear that we don’t need to posit ridiculous levels of sexual behavior to explain very high rates of transmission among Africans in high prevalence countries. People need to be aware of the non-sexual risks, not just the sexual risks.
Blood donors and recipients of blood transfusions, and recipients of all types of skin piercing medical procedures, need to be aware of the risks and of how to avoid them. The same applies to risks that people may face in cosmetic facilities, such as salons, tattoo parlors and the like.
[For more about racism in global HIV policy, see the HIV in Kenya blog.]