Deuchert Eva, Brody Stuart
Department of International Economic Policy, University of Freiburg, Germany.
Int J STD AIDS. 2006 Nov;17(11):749-52. doi: 10.1258/095646206778691167.
It is commonly asserted that the sub-Saharan African HIV/AIDS epidemic is predominantly due to heterosexual transmission. However, recent re-examination of the available evidence strongly suggests that unsafe health care is the more likely vector. The present report adds to the evidence for health-care transmission by showing that Kenyan women who received prophylactic tetanus toxoid injections during pregnancy are 1.89 times (95% confidence interval [CI]:1.03-3.47) more likely to be HIV-1 seropositive than women who did not receive this vaccination. In contrast, recent sexual behaviour (condom use, number of partners) was not related to HIV status. The findings are unconfounded by reverse causality (all injections were purely prophylactic rather than for treatment of any HIV-related illnesses, and none of the women reported knowing that she was HIV seropositive). Focus on a specific injection may have improved participant recall. The results are consistent with health care being a very important vector for HIV in sub-Saharan Africa. It is recommended that there be a reallocation of resources to address healthcare transmission of HIV/AIDS.
人们普遍认为，撒哈拉以南非洲地区的艾滋病毒/艾滋病疫情主要是由异性传播所致。然而，最近对现有证据的重新审视有力地表明，不安全的医疗保健更有可能是传播媒介。本报告通过表明在孕期接受破伤风类毒素预防注射的肯尼亚妇女感染HIV-1呈血清阳性的可能性比未接受该疫苗接种的妇女高1.89倍（95%置信区间[CI]：1.03 - 3.47），进一步证明了医疗保健传播这一情况。相比之下，近期的性行为（使用避孕套情况、性伴侣数量）与艾滋病毒感染状况无关。这些发现不存在反向因果关系的干扰（所有注射均纯粹是预防性的，而非用于治疗任何与艾滋病毒相关的疾病，且没有女性报告知道自己艾滋病毒血清呈阳性）。关注特定的注射可能提高了参与者的回忆率。这些结果与医疗保健是撒哈拉以南非洲地区艾滋病毒的一个非常重要的传播媒介这一观点相符。建议重新分配资源以应对艾滋病毒/艾滋病的医疗保健传播问题。
