In late July 2007, Kyrgyzstan’s Ministry of Health announced that two hospitals in the Osh region had infected 11 patients, including 9 children. According to the Minister, “The [Ministry of Health] commission [that visited the hospitals] found that [disposable] subclavian catheters had been used many times.”
Almost immediately, the UN proposed to help Kyrgyzstan deal with this situation. Notably, the draft UN Action Plan did NOT propose or support extensive testing to find the extent of the outbreak and to identify the specific clinics and procedures responsible, so transmission could be reliably shut off.
Fortunately for Kyrgyzstan’s citizens, the government went ahead to investigate — testing thousands of children to find the extent of the outbreak and to find and correct the errors responsible for the outbreak. Through April 2008, the investigation identified 72 HIV-positive children infected through health care. Sixteen of these children had infected their mothers through breastfeeding.
The investigation continued for more than 4 years. In early February 2012, the Kyrgyz Ministry of Health reported “it has so far tested 110,000 children in the area around the cities of Osh and Jalalabad…” and found a total of 270 persons infected through unsafe health care. The Ministry announced its intention to keep testing: “Several thousand more children need to be tested in the south of this rural, mountainous country.”
Compared to what happens in sub-Saharan Africa — where no government has tested children to find and stop HIV transmission through health care — the government of Kyrgyzstan has done the right thing, testing patients and former patients, finding cases, and thereby zeroing in on and stopping unsafe health care practices.
Donor response has been dismal. No donor has outspokenly appreciated the government of Kyrgyzstan for investigating and stopping hospitals from infecting children with HIV, and no donor has recommended Kyrgyzstan’s response as a model for what African governments should do.
Instead of appreciation, the government has received criticism. In 2011, UNICEF “warned Kyrgyz officials against conducting a witch hunt against individual health workers.” As of early 2012, the government had sentenced 6 health officials to 3 years in prison, and 8 more were awaiting trial. Arguably, punishing health care workers is unnecessary; once an investigation identifies the risks and warns the public and health care workers, aren’t people motivated to take care, without adding punishment into the balance? But UNICEF (the United Nations Children’s Fund) is wrong to ignore that the government’s investigation has protected children, and to focus instead on a minor and unnecessary aspect of the investigation (punishing health care workers).
UNICEF is also wrong to blame the outbreak on “a failure of the healthcare system as a whole to provide hospitals with the essential equipment required to prevent transmission of HIV infection.” Reliable sterilization of reused medical equipment is a matter of following some simple procedures, and has little to do with money. What is in short supply is honesty and accountability. Lies start at the top: UNICEF, WHO, and UNAIDS experts have been influential liars about what is safe and what is not safe, especially in Africa.
In 2007, when the investigation began, Boris Shapiro, the founder and former head of HIV prevention in Kyrgyzstan, reflected on his and others’ failure to warn about HIV risks in health care: “I want to say that as the creator of this [HIV/AIDS prevention] service and as someone who for many years headed the service, I also feel myself to be guilty… We somehow were not able to properly instruct not only our medical personnel but also the media. The media reports the cases as they become public but [the media] needs to report regularly, to inform us. I am greatly concerned today that we are not giving enough information to the younger generation.” Shapiro’s painful insights are pertinent to ongoing failures on the part of WHO, UNAIDS, and ministries of health throughout Africa to warn people about HIV through skin-piercing procedures.