Unexplained HIV infections: ignored or investigated

Have you heard of people in your community with unexplained HIV infections – children with HIV-negative mothers, virgin youth, spouses with one lifetime HIV-negative partner? In countries outside sub-Sahara Africa, communities have recognized such infection as warnings that hospitals or clinics may be infecting patients, and have investigated for self-protection — testing to find more victims and thereby to identify the responsible skin-piercing facilities and procedures. Investigations protect patients. This has not happened in Africa.

(a) African governments ignore unexplained HIV infections

Over more than 30 years, people in Africa have recognized hundreds of thousands — maybe millions — of unexplained infections in their families and communities. No community or government has investigated by testing widely to find all victims and to zero in on and fix dangerous skin-piercing procedures. Click on country pagers for an account of some reported unexplained infections (countries in alphabetical order): Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo (Brazzaville), Cote d’Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mozambique, Namibia, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Somalia, South Africa, South Sudan, Swaziland, Tanzania, Togo, Uganda, Zambia, Zimbabwe.

(b) Governments outside Africa investigate to find and stop HIV outbreaks from unsafe healthcare

Communities and governments outside sub-Saharan Africa have investigated unexplained infections: asking where people received healthcare; tracing and testing others who got healthcare from the same place; finding and fixing mistakes; and telling the public what happened. No country that has investigated to find an HIV outbreak from healthcare has developed a generalized epidemic. These links take you to pages with information and references for investigations in 20 countries (listed in alphabetical order): Argentina, Australia, Cambodia, China, Colombia, Denmark, Egypt, India, Kazakhstan, Kyrgyzstan, Libya, Mexico, Pakistan, Romania, Russia, Spain, Tajikistan, the United States, Uzbekistan, and Vietnam. The table below lists 12 investigated and reported outbreaks with >100 HIV infections. 

Table: Investigated HIV outbreaks from healthcare with >100 infections (listed by year of outbreak)

Country, year of outbreak	Who was infected	Number of cases
Mexico, circa 1986[i]	Blood and plasma sellers	281
Russia, Elista, 1988-89[ii,iii,iv,v]	Inpatient children	>260
Romania, 1987-1992[vi,vii,viii]	Children	~10,000
India, Mumbai, 1988[ix]	Blood and plasma sellers	~172
China, 1990-95[x,xi,xii]	Blood and plasma sellers	~100,000
Libya, 1996-99[xiii,xiv]	Inpatient, outpatient children	>400
Kazakhstan, to 2006[xv,xvi,xvii]	Inpatient children	~150
Kyrgyzstan, to 2007[xviii,xix,xx, xxi]	Inpatient children	~270
Uzbekistan, to 2008[xxii]	Inpatient children	>140
Cambodia, 2012-14[xxiii,xxiv,xxv,xxvi]	Patients attending a clinic	~292
Kot Imrana, Pakistan [xxvii]	Patients attending clinics	~669
Ratodero, Pakistan 2020[xxviii]	Children, adults attending clinics	as of end-Nov 2020: >1,540

References

[1] Avila C, Stetler HC, Sepúlveda J, et al. The epidemiology of HIV transmission among paid plasma donors, Mexico City, Mexico. AIDS 1989; 3: 631-3.

[ii] Bobkov A, Garaev MM, Rzhaninova A, et al. Molecular epidemiology of HIV-1 in the former Soviet Union: analysis of env V3 sequences and their correlation with epidemiologic data. AIDS 1994; 8: 619-624.

[iii] Pokrovskii VV, Eramova II, Deulina MO, et al. An intrahospital outbreak of HIV infection in Elista [in Russian]. Zh Microbiol Epidemiol Immunobiol 1990, 4: 17-23.

[iv] Pokrovsky VV. Localization of nosocomial outbreak of HIV infection in southern Russia in 1988-89. 8th Int Conf AIDS, Amsterdam 19-24 July 1992; abstract no. PoC 4138. Available at: https://quod.lib.umich.edu/c/cohenaids/5571095.0050.029?rgn=main;view=fulltext (on this page, search for PoC 4138; accessed 14 October 2018).

[v] Sauhat SR, Kotova EA, Prokopenkova SA, et al. Risk factors for HIV transmission in hospital outbreak. 8th Int Conf AIDS, Amsterdam 19-24 July 1992, abstract no. PoC 4288.

[vi] Patrascu IV, Dumitrescu O. The epidemic of human immunodeficiency virus infection in Romanian children. AIDS Res Hum Retroviruses 1993; 9: 99-104.

[vii] Apetrei C, Loussert-Ajaka I, Collin G, et al. HIV type 1 subtype F sequences in Romanian children and adults. AIDS Res Hum Retroviruses 1997; 13: 363-5.

[viii] Drucker E, Apetrei C, Heimer R, et al. The role of unsterile injections in the HIV pandemic. In Sande MA, Volberding PY, Lange J, et al. Global HIV/AIDS Medicine. Philadelphia: Saunders, 2007. pp. 755-67.

[ix] Bhimani GV, Gilada IS. HIV prevalence in people with no fixed abode – A study of blood donorship patterns and risk determinants. 8th Int Conf AIDS, Amsterdam 19-24 July 1992; abstract MoC00937.

[x] Wu Z, Liu Z, Detels R. HIV-1 infection in commercial plasma donors in China [letter]. Lancet 1995; 346: 61-2.

[xi] Wu Z, Rou K, Detels R. Prevalence of HIV infection among former commercial plasma donors in rural eastern China. Health Policy Plan 2001; 16: 41-6.

[xii] Ministry of Health, China, UNAIDS, WHO. 2005 Update on the HIV/AIDS epidemic and response in China. Geneva: WHO, 2006.

[xiii] Visco-Comandini U, Cappiello G, Liuzzi G, et al. Monophyletic HIV type 1 CRF02-AG in a nosocomial outbreak in Benghazi, Libya. AIDS Res Hum Retroviruses 2002; 18: 727-32.

[xiv] de Oliviera T, Pybus OG, Rambaut A, et al. HIV-1 and HCV sequences from Libyan outbreak. Nature 2006; 444: 836-7.

[xv] Kazakhstan: more HIV-infected children found in southern Kazakhstan. RadioFreeEurope/RadioLiberty, 3 October 2007. Available at: http://uqconnect.net/signfiles/Archives/SIGN-POST00405.txt (accessed 10 October 2007).

[xvi] Magauin E. Kazakh health workers jailed over HIV-infected children. Radio Free Europe Radio Liberty 27 June 2007. Available at: https://www.rferl.org/a/1077350.html#:~:text=(InterPressNews)%20June%2027%2C%202007,the%20virus%20that%20causes%20AIDS. (accessed 8 November 2020).

[xvii] Lillis J. Kazakhstan: Shymkent’s HIV scandal, six years later. Eurasianet [internat]. Available at: https://eurasianet.org/kazakhstan-shymkents-hiv-scandal-six-years-later (accessed 8 November 2020).

[xviii] Shersen D. Kyrgyzstan: Officials grapple with HIV outbreak. EurasiaNet, 30 October 2007. Available at: http://uqconnect.net/signfiles/Archives/SIGN-POST00419.txt (accessed 1 November 2007).

[xix] Thome C, Ferencic N, Malyuta R, Mimica J, Niemiec T. Central Asia: hotspot in the worldwide HIV epidemic. Lancet Infect Dis 2010; 10: 479-488.

[xx] The Telegraph. Kyrgyz officials say another 70 children are infected with HIV/AIDS virus. 6 February 2012. Available at: https://www.telegraph.co.uk/news/worldnews/asia/kyrgyzstan/9063987/Kyrgyz-officials-say-another-70-children-are-infected-with-HIVAIDS-virus.html (accessed 12 October 2018).

[xxi] AP/Houston Chronicle examines HIV outbreak among 72 children, 16 mothers through tainted blood and used needles. Kaisernetwork.org, 11 April 2008. Available at: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?hint=1&DR_ID=51472 (accessed 27 March 2009).

[xxii] The secret of Namangan-2008: two years since mass HIV inspection at children’s hospital.  Fergana.News [internet] 23 March 2010. Available  at: http://enews.fergananews.com/article.php?id=2611 (accessed 24 September 2020).

[xxiiii] Rouet F, Nouhin J, Zheng D-P, et al. Massive iatrogenic outbreak of human immunodeficiency virus type 1 in rural Cambodia, 2014-2015. Clin Infect Dis 2017; epub ahead of print. Available at: https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/cix1071/4689456?redirectedFrom=PDF (accessed 12 February 2018).

[xxiv] Mean Chhi Vun et al. Cluster of HIV infections attributed to unsafe injections  – Cambodia December 1, 2014-February 28, 2015. Morbidity and Mortality Weekly Report 2016: 65:  142-145. Available at: http://www.cdc.gov/mmwr/volumes/65/wr/mm6506a2.htm (accessed 28 March 2016).

[xxv] Bedford Lab. Evolutionary and epidemiological analysis of Roka HIV outbreak. Available at: https://bedford.io/projects/roka/HIV/bayesian_timetree/ (accessed 12 October 2018).

[xxvi] Millar P. How the residents of Cambodia’s “HIV village” are coping more than two years on. Southeast Asia Globe, 15 March 2017. Available at: http://sea-globe.com/how-the-residents-of-cambodias-hiv-village-are-coping-more-than-two-years-on/ (accessed 14 August 2017).

[xxvii] Wahid B. An update on the severe outbreak of HIV in Kot Imrana, Pakistan. Lancet Infect Dis 2019; 19: 241. Available at: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(19)30038-6/fulltext?rss=yes (accessed 4 March 2019).

[xxviiii] Ahmed T. Ratodero HIV stats continue to rise 19 months after outbreak. Samaa 1 December 2020. Available at: https://www.samaa.tv/news/2020/12/ratodero-hiv-stats-continue-to-rise-19-months-after-outbreak/ (accessed 12 December 2020).