For decades, researchers have not been able to explain how so many people in Africa could be getting HIV from sex. At the same time, researchers and public health managers have been trying to avoid and ignore evidence that injections, antenatal care, tattooing, and other skin-piercing blood contacts are responsible for a lot of HIV infections.
Sometimes some evidence slips through. For example, a survey of students in five public high schools in Vulindlela subdistrict in KwaZulu-Natal, South Africa, reported 56 (54% of) 104 HIV-positive girls said they were virgins; and so were 21 (55%) of 38 HIV-positive boys. The study ignored the possibility students got HIV from healthcare; instead the authors suggested women lied about being virgins. Students were doubly harmed: Injury (HIV from healthcare) followed by insult (accusation of sexual misbehavior).
Some new evidence may be harder to sweep under the rug. First some explanation of what this evidence shows. Each HIV is a large molecule made of thousands of parts (smaller molecules). Over time, these parts change little by little. Researchers can take HIV from anyone and “sequence” it to determine its parts. After taking HIV from a lot of people, they can do a “phylogenetic analysis,” looking for similarities among HIV from different people. Very similar HIV can show one person very likely infected the other. If two HIV are less similar, transmission may have happened a long time ago, or may not have been direct, but rather through others. With phylogenetic analysis, researchers can draw trees (phylogenetic trees) showing the likely connections among a lot of HIV.
Now the new evidence: In March 2018, a team of researchers from South Africa and the UK reported a study that sequenced more than 1,300 HIV collected from adults in mKhanyakude District, KwaZulu-Natal Province, South Africa. They were surprised to find a cluster of 75 very similar HIV. Even more telling, most of the links (transmissions) in this cluster occurred during a matter of months in 2014.
Slide 10 in the presentation by Coltart (click here and scroll down to slide 10) shows the portion of their tree that includes this cluster. Each horizontal line represents HIV from a different person. The short vertical lines that connect the horizontal lines show who seems to have infected whom (either directly or indirectly). The timeline on the bottom shows when transmissions likely occurred.
Most people in this cluster got infected in 2014. Such rapid transmission to so many people is what one would expect from a bloodborne outbreak – maybe from a hospital or clinic reusing bloody instruments. Distressingly, neither the presenter at the March 2018 conference nor anyone who asked questions mentioned nosocomial (healthcare) risks. As far as researchers are concerned, it’s all about sex…blaming the victim.
More than a dozen large HIV outbreaks with 100s or more infected by healthcare have been investigated in Asia, North Africa, Latin America, and Central and East Europe (click on “outbreaks and unexplained cases” in the menu on the right). But nobody has investigated any bloodborne HIV outbreak in Africa. Will someone finally wake up and look at what’s happening in KwaZulu-Natal?
In any case, people living in communities with a lot of HIV in Africa should be careful about blood exposures. Make sure skin-piercing instruments are at least boiled. Be aware: you can’t trust the researchers and public health managers to protect you from HIV during healthcare. They have been denying and ignoring the risk…and blaming HIV-positive people for sexual misbehavior.
1. Kharsany ABM, Buthelezi TJ, Frohlich JA, et al. HIV infection in high school students in rural South Africa: role of transmission among students. AIDS Res Hum Retroviruses 2014; 30: 956-965, Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179919/ (accessed 4 April 2018).
2. Coltart C, Shahmanesh M, Hue S, et al. Ongoing HIV micro-epidemics in rural South Africa: the need for flexible interventions. Conference on Retroviruses and Opportunistic Infections, 4-7 March 2018. Available at: http://www.croiwebcasts.org/console/player/37090?mediaType=slideVideo&&crd_fl=0&ssmsrq=1522772955419&ctms=5000&csmsrq=5001 (accessed 4 April 2018).