Latrogenic HIV transmission in South Africa: Evidence, estimates and moral perspectives
The risks of HIV transmission to patients exceed many health professionals’ expectations in South Africa. Non-vertical HIV transmission to children is more common in cases where adherence to infection control guidelines is generally poor. Given the extent and seriousness of the HIV/ AIDS pandemic, the moral abhorrence of offering resource scarcity as justification for tolerating unsafe health care where appropriate oversight is clearly lacking must be brought to light. The management of HIV, so often hampered by factors that are extremely difficult, if not impossible, to control, is more straightforward where patient safety is concerned. At the very least, injection safety can be fully controlled. Every possible measure ought therefore to be taken to prevent HIV infections through syringe reuse, needle reuse, multi-dose vial reuse after reconstitution with a used syringe or unsafe procedures other than injections. The recognition of clusters of cases could prompt a search for other iatrogenic infections in patients served in the same medical settings. Patient-observed sterile treatment (POST) has been described as a practical goal for preventing unsafe procedures, and would protect patients both in and outside the clinical setting. At present, public awareness that small blood exposures carry an HIV-transmission risk is inadequate, at least in relevant professions (e.g. dentistry and barbering). Programmes to raise public awareness of parenteral transmission risks would complement provider-oriented injection-safety interventions. This review examines the epidemiological evidence that patient safety interventions are needed to combat the spread of HIV/AIDS in South Africa, and sets forward an ethical imperative to prevent iatrogenic HIV transmission entirely.