Rwanda: cases and investigations
Unexpected HIV infections in children, 1984-86: During 1984-86, doctors at the Kigali Central Hospital tested the mothers of 76 HIV-positive children aged 1-48 months. Eighteen (24%) of 76 mothers were HIV-negative. The 18 children with HIV-negative mothers had received an average of 1.8 injections per month, 7 had been transfused, and 8 had previously been hospitalized. Three mothers who first tested HIV-negative later tested HIV-positive; these mothers might have been infected by their children through breastfeeding (many children infected during hospital-based HIV outbreaks in Russia, Libya, Kazakhstan and elsewhere have transmitted HIV to their mothers, presumably through breastfeeding). Source: Lepage P, Van de Perre P, Carael M, Butzler JP: Are medical infections a risk factor for HIV infection in children? Lancet 1986; ii: 1103-1104. Lepage P, Van de Perre P. Nosocomial transmission of HIV in Africa: what tribute is paid to contaminated transfusions and medical injections. Infect Control Hosp Epidemiol 1988; 9: 200-203.
Unexpected HIV infections in children, 1991-93: In 1991-93, WHO’s Global Programme on AIDS arranged for hospitals to test children aged 6-59 months (1/2 to 5 years old) admitted to pediatric care and their mothers in 4 cities in Africa: Kigali, Rwanda; Dar es Salaam, Tanzania; Kampala, Uganda; and Lusaka, Zambia. The studies tested 5,593 child-mother pairs, of which 61 (1.1% of 5,593) children were HIV-positive with HIV-negative mothers. The reports on this study do not give any breakdown by country. The authors conclude (incredibly!): “The risk of nosocomial and non-perinatally acquired HIV infection appears low among these populations.” This suggests a double-standard for Africa; if 1% of inpatient Europeans had unexpected HIV infections, such a conclusion would be unacceptable. Source: Hitimana D, Luo-Mutti C, Madraa B, et al. A multicentre matched case control study of possible nosocomial HIV-1 transmission in infants and children in developing countries. 9th Int Conf AIDS, Berlin 6-11 June 1993. Abstract no. WS-C13-2. Available at: http://ww1.aegis.org/aidsline/1993/nov/M93B3075.html (accessed 31 August 2012).
Unexpected HIV infections in wives, 1989: A study among couples in Kigali in 1988 found 25 HIV-positive women with HIV-negative husbands. Fifteen of the 25 women reported that their HIV-negative husband was their only lifetime sex partner. Source: paragraph 1, page 1609 in: Allen S, Tice J, Van de Perre P, et al: Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ 1992, 304: 1605-1609. Available at: http://www.bmj.com/highwire/filestream/331614/field_highwire_article_pdf/0.pdf (accessed 5 January 2012).