If you have sex with a stranger, wearing a condom protects you from HIV. But condoms aren’t the answer if you need an injection, or if you wake up with a toothache. In such situations, you may be at risk to acquire HIV if your health care provider reuses instruments without sterilization.
Some governments regulate providers of health care and cosmetic services so that they do not reuse unsterilized instruments. But governments in India and in some other countries in Asia do not have or do not enforce such regulations. When governments do not protect the public, it is up to people to protect themselves. To do so, people need to know how to recognize safe and unsafe procedures.
Blood exposures are common. For example, a survey by the IndiaCLEN Program Evaluation Network (IPEN) in 2002-03 found that 23.5% of all medical injections in India were given with reused unsterile or unreliably sterile syringes and/or needles. In 2005, women in sex work in Karnataka, India, reported standing in line for tattoos, administered with needles and ink-pots reused without any effort to clean from one client to the next. They thought that was safe, because they mistakenly believed that HIV survives only seconds outside the body.
Blood-borne HIV: risks and prevention (by Correa, Gisselquist, and Gore; published by Orient Longman, 2008) addresses common misinformation that understates HIV risks in blood exposures. Contrary to popular belief, HIV can survive outside the body for hours to days in dry conditions (such as on a razor), and for weeks in wet conditions (such as in a syringe or needle). HIV can be reliably killed by boiling, but not by wiping with alcohol or bleach.
In Russia, Romania, Libya, and Kazakhstan, investigations found that medical injections, infusions, and other health care procedures infected hundreds or thousands of children. In India, unexplained HIV infections – in children with HIV-negative mothers and in men and women with no sexual exposures to HIV – are common, but there have been no thorough investigations to trace these infections to their sources and to identify other victims.
When you are facing a skin-piercing procedure, such as an injection, you can go to specific pages in
Blood-borne HIV: risks and prevention to find detailed information about that procedure. The core of the book is organized around 15 common skin-piercing procedures in health care (injections, dental care, OBGYN care, others), in cosmetic services (shaving, tattooing, others), and in other situations. For each of these events, the book discusses the risks, and advises how to ensure that you are safe. For example, when you go for an injection, you can ask the provider to take a new syringe and needle from a sealed package and to take what is injected from a single-dose vial. The 4-point common strategy is: (a) avoid skin-piercing procedures; (b) ask the provider to use new disposable
instruments; (c) ask the provider to boil or sterilize reused instruments; and (d) talk with your provider about your concerns.
The suggestions in the book may not work for everyone. Some people may not feel they are in a position to ask doctors to change their practices. But when people are aware, they may find other ways to protect themselves. For example, people may be able to work together with neighbors and through community groups to bring their concerns to the attention of service providers.
The book may also be used as a resource by organizations involved in health care and HIV prevention, providing information and ideas that they could incorporate into their programs. Hopefully, readers will accept this book as a beginning, try out what seems promising, and develop and share better solutions.
The price is Rs 95 (US$ 2.45). All profits from the sales of this book go to a drop-in centre for people living with HIV/AIDS in Ratnagiri, India.
The book’s three authors are: Mariette Correa (
mariettec@gmail.com), David Gisselquist (
david_gisselquist@yahoo.com), and Deodatta Hari Gore (
deo64@rediffmail.com).
- India Clinical Epidemiology Network (IndiaCLEN) Program Evaluation Network (IPEN). Assessment of Injection Practices in India (2002-03). New Delhi: IPEN, 2005. Available at: http://www.ipen.org.in/index.php?option=content&task=view&id=225&Itemid=275 (accessed 5 January 2007).
- Correa M, Gisselquist D. HIV from blood exposures in India – an exploratory study. Colombo: Norwegian Church Aid, 2005. Available at:
http://www.ncasaga.org/Resources.html (accessed 4 April 2008).
