We interviewed Dr Selma Khamassi, a physician in charge of Injection Safety at the World Health Organization (WHO) and coordinator of the Safe Injection Global Network (SIGN), a native of Tunisia.
Nance U. M.
Question: As the person in charge of injection safety at the World Health Organization (WHO) you have put HIV/AIDS on the agenda in the SIGN meetings, why?
Dr Selma Khamassi: Simply because the issue of AIDS transmission through injections has not been settled yet. In fact, this issue is coming back into the news media. I am not speaking about simply injections among intravenous drug users, but rather I am referring to injections carried out in health care. This is growing evidence that unsafe injections are not limited to solely developing countries. The hepatitis C epidemic in the United States Nevada clinic two years ago revealed the importance of unsafe injections carried out in developed countries such as the USA. To simply change the needle but reuse the syringe is very widespread in developed countries especially when using multidose vials of medicines. Contrary to what many people believe, including among international experts working on AIDS, the issue of unsafe injections is far from dead, and may only be beginning.
Question: What would be the share of dirty injections in the causes of AIDS/hepatitis in the new Burden of Disease (GBD) analysis?
Dr Selma Khamassi: Since 2002 it has been firmly established that injections given in health care by contaminated needles and syringes largely contributed to the hepatitis B and C as well as HIV related morbidity and mortality. The GBD published by WHO is 2004 showed that unsafe injections were the direct causes of 21 million cases of hepatitis B, 30% of the total, 2 million cases of hepatitis C, 40% of all new cases, and 2 to 5% of all new HIV cases. These figures are being re-evaluated by the WHO injection safety program and will be published shortly.
Question: what do you think about the UNAIDS website summary for World AIDS Day?
Dr Selma Khamassi: This summary makes me wonder. Of course it speaks of the major advances in the struggle against AIDS of the past few years, but keeps totally silent on the cases of AIDS where transmission occurred during health care. There is a passing mention of an increase in AIDS among children in Central Asia, Eastern Europe, Middle East and North Africa, but without dwelling on this phenomena or its causes. Yet, just to point to countries in Central Asia, several investigations were undertaken on cases of HIV positive - infected - children of HIV negative mothers. These investigations have proven that while the mother to child transmission of HIV (in utero or during birth) is decreasing in these countries, the number of children under 5 who are infected by HIV is increasing in a very worrying manner and the researchers have conclusively shown a link with hospitalisation, length of stay in hospitals, and especially the number of injections received during health care, or blood transfusions. Another worrying fact, in my opinion, is that the new framework for indicators of progress just published by UNAIDS “Global AIDS response progress reporting 2012” totally ignores HIV prevention in health settings.
Question: What are your plans for the future?
Dr Selma Khamassi: To pursue advocacy so that injection safety is not forgotten and to continue to undertake initiatives both on country level and globally to decrease the number of unnecessary injections and to make sure that the injections that are really unavoidable be totally without any risk of contamination for the patient, for the health giver and for the community as a whole.