30 December 2009

Africa: HIV Transmission Via Transfusions in Continent Remains High

Despite the contraction of HIV through blood transfusions in Africa being extremely high, there are several organizations working to reverse this reality by educating potential donors about blood safety.

HIV-tainted blood is being used to transfuse African patients when there are no other options left. Oftentimes, the choice is to let a patient die, or knowingly infect them with the virus that is oftentimes a death sentence.

At present, the World Health Organization (WHO) estimates that five to ten percent of all new HIV cases in Africa are caused by contaminated blood used in transfusions. That translates to anywhere between 250 and 500 patients every single day.

Some of the worst health issues on the continent are currently treated with blood transfusions: anemia from malaria or malnutrition, and childbirth complications. Considering that there are an average of 425 million malaria cases annually, plus an additional 14 million hemorrhages due to childbirth, there is a severely high portion of the population at risk for HIV infection, not to mention hepatitis and/or syphilis.

The majority of African countries (87 percent) do not have the blood needed to meet blood transfusion needs; there are approximately three million units of blood collected each year despite eight million being needed. Of the hospitals and clinics that have blood banks, many tend to lack the necessary equipment and finances to test each unit for HIV.

Dr. Neelam Dhingra, coordinator for WHO Blood Transfusion Safety, told MediaGlobal, "Unsafe blood transfusions have significantly contributed to the burden of HIV infections worldwide. This risk of transmission of HIV infection through infected blood transfusions is exceptionally high (95-100 percent) compared to other routes of HIV transmission (11-32 percent for perinatal HIV transmission, 0.1-10 percent for sexual contact)."

Dhingra continued, saying, "In most African countries, the risk of transfusion-associated HIV infection continues to be higher than in industrialized countries, due to the following main reasons: a higher incidence and prevalence of HIV infection in the general population and among blood donors; inadequate screening of blood donations for HIV; [and] higher rates of transfusion in some patient groups, particularly in women and children."

While Dhingra attested that quantifiable data on "transfusion-associated HIV infection in Africa is difficult to quantify," he added that "blood safety is known to be particularly compromised where blood shortages pose pressure on services to collect and issue blood without adequate donor recruitment, donor selection and blood screening."

Fortunately, more and more African countries are putting policies in place for mandatory blood screening for each donated unit. Unfortunately, according to Dhingra, "implementation is hampered by a number of factors, including lack of adequate infrastructure, facilities and supplies (e.g. interruptions in supply of reagents and test kits), and inadequate systems for quality-assured screening (e.g. lack of standard operating procedures and external quality assessment). Moreover, some countries are unable to monitor implementation of their HIV screening policies due to weak national data management systems."

A general lack of HIV transmission data and variable qualities of screening in some African countries "makes it difficult to reliably estimate the number of transfusions that occur without adequate HIV screening," Dhingra said.

Going back to 2007, WHO's Global Database on Blood Safety determined that there were at least 400,000 blood donations in Africa (in 44 of 46 countries reporting) that were not tested or for which the test results were unknown for HIV, hepatitis B, hepatitis C and syphilis.

Dhingra noted that WHO is doing what it can to combat this issue by promoting "an integrated strategy for achieving a safe and sustainable national supply of blood and blood products sufficient to meet the transfusion requirements of patients...Key elements of the strategy include: collection of blood from the safest possible voluntary non-remunerated blood donors; quality-assured screening of all donated blood; [and] appropriate clinical use of blood and blood products."

There also needs to be more blood coming into the African blood bank system every year. Dhingra explained, "In 2007, for a population of around 753 million people, only about 2.9 million units of blood were collected in the African region. Of those reporting, 37 countries in the African region have a blood donation rate of less than that generally considered as necessary to meet a nation's basic requirements for blood, namely one percent of the population."

Thus, WHO's goal is to increase donated blood to 7.5 million units annually, bridging a 4.6 million unit gap.

MEDIAGLOBAL is the global news agency, based in the United Nations Secretariat, creating awareness in the media for the countries of the global South, with a strong focus on South-South Cooperation. The media company is one of the leading providers of information on global development issues facing vulnerable countries. MediaGlobal's news stories are read by leaders of developed countries, the global media, policymakers in donor countries, non-governmental organizations and key personnel in the United Nations Secretariat, its agencies and managers in the field worldwide.

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