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Last Updated:  Tuesday, 25 February, 2003, 08:44 GMT

Aids crisis: Are dirty needles to blame?

The spread of HIV infections in Africa may be more closely linked to unsafe medical care than previously thought.

New research by US experts estimates that two-thirds of the people with HIV in Africa become infected through contaminated needles rather than sexual contact.

The UNAids organization disputes the findings, and says there have not been adequate studies to support the conclusions that are drawn.

Do you agree with the new findings? Can the Aids epidemic be stopped? Should drug companies be forced to provide cheaper medicines to developing countries? 

Q&A: Aids in Africa

BBC News Online examines why Aids has spread so fast in Africa amid claims that it has more to do with unsafe medical care than unsafe sex.

Read Comments

Aids crisis: Are dirty needles to blame?

This debate is now closed. Read your comments below.

Your reaction:

This discussion has more in common with religion than science. HIV can be introduced into a heterosexual environment and then be sexually spread where it otherwise wouldn't. That's how Paul Michael Glaser (of Starksy And Hutch fame) lost his family in the US. So to say that this research has to either be embraced or rejected is a nonsense. On the other hand, if one of the main reasons for the heterosexual spread of HIV originates with injections in hospitals or vaccination programs and the re-use of disposable needles, that has to brought to attention. And the phrase "dirty needles" obscures the plethora of other possible ways HIV can be spread through the healthcare system (transfusions, transplants, even dentistry).
Alex van Deelen, The Netherlands

It is not the HIV/Aids that is killing the people in Africa, but it is the hunger and poverty that ravage the continent that kill the people. Looking at the areas where this disease is more common, it is realized that it is more common to the poor who cannot provide a day's meal and their daughters ending up in prostitution. So my advice to the international aid agencies is share the continent's cake equally which will help to eradicate this epidemic.
John Saccoh, Canada

The spread of Aids/HIV infections are caused not only by contaminated needles used by people and unlawful sexual contact by people, but also due to poverty of individual nations and communities, lack of education, and unfairness of richer nations and communities to distribute their wealth fairly among nations and communities in need. The solution is not distributing condoms or supplying clean needles to social beings as prevention, which will of course encourage more unlawful sexual contacts, hence, the spread of deadly diseases. The only and best solution is abstinence and faithfulness.
Ismail N'Dow, U.S.A./ The Gambia

 It is all a frame up
Ayodeji Odunewu, Nigeria

I feel it's just another way the West is trying to undermine health services in Africa. It is all a frame up! In Nigeria, all government hospitals use disposable needles. In my view the report is false.
Ayodeji Odunewu, Nigeria

I have worked in Africa for many years and the dirty needle theory has been suggested for many years. I have never heard of Africans taking drugs intravenously and there seems to be fewer cases of gay men in African communities than in other societies. Also the cases of STD have not risen in proportion with the number of Aids cases. There are more sex workers in SE Asia than Africa. The Aids epidemic coincides with the mass vaccinations in Africa in the 70s and 80s
Graham Jubb, UK

 Don't these people deserve more after so much exploitation?
Carole, USA

Long ago, in the early days of the epidemic, there was discussion about HIV spreading due to smallpox and other types of inoculations; the speculation being that the vaccines had been grown unknowingly on tissue cultures infected with the Aids virus. The medical practice at the time, repeated using of needles without sterilisation, spread the disease. This discussion, about the origin of infection and how it spread, died out with the hysteria about sexual practices etc and probably diverted a huge lawsuit as well. It is worth re-examining this time. The best and the brightest are dying. Some of the billions thrown at the chaos created by the Middle East could help solve these and other problems all over the African continent today. Don't these people deserve more after so much exploitation?
Carole, USA

I was a youth councillor in Jinja, Uganda in the mid to the late 90s and I used to distribute condoms supplied by the government to youths. Many Ugandans are now more open to talking about sexuality than any other region on the continent of Africa. And the government has tried to supply condoms to urban youths as well as making media announcements on many FM stations and newspapers. However the truth about all the praises on Uganda's declining Aids figures does not reflect the true reality on the ground. The fact is that the figures are more urban than rural. They are based on conclusions from a few urban areas in Uganda where people are more open about HIV/Aids. A great majority of people in rural areas die of the scourge than from any other fatality and a great majority of them are not diagnosed to confirm otherwise.
Hussein K. Bosser, UK, Uganda

As you probably know, South Africa has one of the highest rates of infection in the world. It also has a reasonable healthcare system where needles are not reused, and fairly good sterile conditions are in place. From this I'd deduce that infection takes place in another location other than the hospital or health centre.
R McGrath, S Africa

 The West is also under no moral obligation to help those who refuse to help themselves
C. Frizell, UK/Zimbabwe

The primary cause of Aids in Africa is bad governance. All the subsidiary causes such as poverty, lack of education and starvation stem from this. On a national scale, all of Africa's problems are self-inflicted. The only guilt the West should feel is over their spinelessness and lack of commitment to remove dictatorships and promote genuine democracy in Africa. Once that has been done, fair trade is far better than financial aid. Aids is not a huge problem in prosperous countries. The West is also under no moral obligation to help those who refuse to help themselves.
C. Frizell, UK/Zimbabwe

There is no way Aids can be prevented in Africa other than by creating equal opportunities for all. The leaders should be more serious in closing the gap between the poor and the rich.
Sitta Turay, Sierra Leone

I work and live in Tanzania. For more than 10 yrs now I have seen so many HIV prevention programs and most of them are based on advising on safe sex as the major factor of controlling HIV spread. A lot of condoms are available and used, but the HIV is spreading more than before despite all these efforts taken since then. About the new findings of contaminated needles I can say that it is true according to my experience in Tanzania. Lot of people in our country are poor that they can't afford to have safe but expensive medical treatment so they receive a cheaper medical treatment which includes using of one needle for several injections.
Kishiki, Tanzania

If AIDS was only an STD, it would mean that Africans are more promiscuous than all other people in the world, which is not true.
Dr Peter Waiswa, Uganda

I think there is some truth in it. If AIDS was only an STD, then it would mean that Africans are more promiscuous than all other people in the world, which is not true. The UNAIDS accepts that needles spread only 5% of AIDS in Africa, but 5% of millions is already a huge figure, the truth might actually be 80%
Dr Peter Waiswa, Uganda

We will have no chance of stopping AIDS in Africa so long as people like the President of South Africa continue to go on national television and tell those watching (80% of whom are HIV-positive) that AIDS is a myth the White man invented to stop the Black man from procreating.
Inna Tysoe, USA

This is a further attempt by the excessively liberal to detach peoples responsibility for their actions and lifestyle from the consequences and shift blame elsewhere
John Lavender, England

I definitely have not carried out a study on the transmission of HIV/AIDS but I know for sure that the people I know who are/were infected were not because of needles. It is mainly from sexual contact. Maybe the research was done in a part of Africa where infections are through needles. I know for sure is that most people believe that they can not be infected and that AIDS 'came' for others. One thing I wish Government could do is for the President to openly declare AIDS a national disaster and take a leading role in the fight against. Having ministers talk about it is not enough, let Levy Mwanawasa add his weight behind this fight. Ultimately, I believe AIDS can be stopped. If Uganda did it, why can't we do it?
Kabwe Chilufya, Zambia

 The spread is more due to cultural practices
Barbara, USA

I worked in Botswana for four years; the AIDS epidemic isn't believed to be true by schoolchildren - they say "people don't die of AIDS". I would venture the spread is more due to cultural aspects, as the practice of having 'nyatsi'- girlfriends and boyfriends is so widespread.
Barbara, USA

I do not only disagree with these findings, but also begin to question the reliability of the the research report. Yes it can be stopped, depending on how "stopping the epidemic" is defined. At the end of the day drug companies are run by people for profit, which could be reduced insignificantly by providing cheaper medicines to developing countries.
Lovemore Mandizha, Zimbabwe

Yes. HIV/AIDS can be stopped. Through (1) political will, (2) education/IEC, (3) easy access to condoms. (In my country access to condoms in rural areas is hard) (4) Free ARVs for all in need of them, (5) mulri-sectoralism in tackling the problem. Unfortunately, from an African perspective, what has hampered development in the 40 years post colonialism is what is hampering tackling the HIV/AIDS epidemic. Kaphetsa Kalanda, Liverpool, UK.
Kaphetsa Kalanda, UK/ Malawi.

I agree, "dirty" needles could well be a very important cause for significant numbers of HIV cases. Poverty and lack of financing simply force doctors and nurses to use injection needles more than once. This does not exactly help convince the public of the necessity for safe sex, but it should definitely be an important item for the WHO. No one should ignore the necessities - send money for injection needles!
Daniela, Berlin, Germany

The High HIV Infection rate in Africa has got to do with ignorant through the lack of education, which results in unsafe sex and the virus spreading.
John Sterianos, South Africa(Living in London)


I lived in Uganda when the AIDS epidemic broke out. What is happening in Southern Africa is similar to what was happening in Uganda in the 1980s and 1990s. I lost almost 30 relatives and at least 50 schoolmates to the disease. Now however, deaths are substantially reduced. So what saved Uganda? Good government! The Uganda government realised quickly that they had to tackle African attitudes towards sex (cultural especially) and give women more rights and influence in society. I doubt this 'dirty needle' theory because of what I have seen in Uganda. Men there are now more willing to use condoms and treat women equally in relationships - there was a substantial rise in the number of church marriages! In schools the government flooded students with sex education leaflets and lessons, so that many of them are now more aware and protect themselves. Large posters were also erected in parts of the cities warning people every minute of everyday. Southern African countries need to adopt a similar attitude. Trying to find excuses (ie dirty needles) will not help.
Andrew, UK

Having worked as an AIDS program manager in Nigeria for 3 years I can confidently say it is not the USE of dirty needles. The spread of AIDS in Africa is due to promiscuity. Initially the blame was on women and for the past 15 years the campaign "just say no" was directed at women. Now many workers have realised that women in Africa have no right to refuse a man sex. So now the men are targeted. In fact the last world AIDS day Dec1 2002 was directed at men. This will require a major behaviour change on the part of men who have traditionally had many sexual partners As for drugs, if a country like India can provide drugs at a cost of $350 per patient per year then the US and Europe can afford to lower its cost from$35000 to what India is providing
Sandra, USA

Whether or not the findings are entirely accurate we should be providing the people of Africa with cheaper (or free) medicines. It is capitalism at its worst if we can continue with selling the world's most impoverished countries with medicines at a profit to these multi billion dollar pharmaceuticals.
Lizzie, Scotland

While visiting a town in Zaire (DR. Congo), I was horrified to watch immunizations in which the Zone Medical Officer used the same needle on twenty children before refilling the syringe and continuing on the next twenty. The towns in DRC are 45% HIV while the "healthcare" deprived hinterlands are 2%.
Jim, USA

Helen and Marie from UK are misguided¿ Do they realise how much it costs to develop one drug?? It can be up to a billion GBP and this is for one that gets approved for use, never mind all the ones that have to be scrapped during development. The answer to these diseases is education in the developing world and a more moral lifestyle in the West.
Kev, UK

Having spent most of my life in South Africa I can say I have never experienced or witnessed an injection with a dirty needle. However, tribal norms dictate dangerous sexual promiscuity.

I am not sure whether the US experts are right or not. What I do know is that 13 million people are sure to have already contracted Aids in Africa and who knows how many will not take the test because they think there is no cure (and mind you there probably isn't in their country). What I know for sure is that condoms won't do much to save them: they need the whole HEART treatment and a little extra food to support it.

We have heard that the BBC reported that Swaziland HIV AIDS victims are 1 in 4. My father, Dr Samuel W. Hynd CBE (1999), operates his clinic here in Manzini, the hub of Swaziland. His reaction was that this figure may be even higher. The Swazi nation continues to ignore the threat of AIDS. Out of all the patients that come to my father's clinic 85% are HIV AIDS victims.
Audrey Hynd, Swaziland

Having just read the BBC report on how Cuba has effectively dealt with AIDS surely the rest of the world can control it? It takes political will, tough decisions and money. Many poor countries cannot feed healthy people so is unreasonable of us to expect them to prolong the suffering of the malnourished as well as the chronically ill? We rich nations can help, the problem is we are too blinkered on spending money for weapons.
Suzanne Stockman, Paris France

This allegation should not be welcome at all from any source. If HIV is spread from using dirty needles in Africa, does that also means that the HIV victims in America and any other developed countries also uses dirty needles to inject patients? If the uses of dirty needles were to be the issue, definitely there should not be any HIV candidates in America.
Ziggy, US/UK

What is more important is the way the epidemic is treated. Why has it taken over 20 years to decide that HIV/AIDS is a problem in Africa? Why was something not done before now, now it is going to be the biggest human disaster? Call me a cynic but is this the Western world's way of cutting down the overpopulated countries?? The drug companies need to be made to give drugs to all of these millions of people suffering in silence.
Helen Peplow, UK

It doesn't matter whether or not the percentage is correct. We should be able to guarantee that everybody in the world has access to clean needles and clean blood products.
Anthony , Germany (UK)

Those people who have contracted HIV and AIDS need every assistance from the West, but African leaders on BBC news over the last few days say themselves that it is sexual promiscuity which is causing the AIDS epidemic. What are the African nations doing to change their own destructive patterns of behavior? If they don't change then the epidemic will continue with vast numbers on medication.
Peter Farrington, England

More fiddling while Rome burns. Millions of children are dying and we debate an argument over the cause! We should invade Africa with medical help and if any African leaders on the take get in the way they should be brushed aside and nuts to the consequences. We (the West) have the power to force people to live and we should use it.

The biggest problem of all is education. With a virus that has now been around and in the public eye for many years, third world countries still lack the necessities to explain how to protect against such a killer.
R Peacock, UK

No one can claim to have an immediate solution to the HIV/AIDS pandemic that is destroying so many of our people's lives. However, the reason why Africa has become more susceptible to it than any other region is that African rulers (including Mandela's own successor!) have adopted a nauseatingly escapist attitude towards it. Whether the infection comes from needles or from sex, African rulers are to blame for not educating the people sufficiently, and for wasting scarce resources on arms, rather than on healthcare.
UE, UK/Nigeria

The needles used are new. There can be other transmission of aids through the barbers clippers for example. Especially in the new age of the Shaulin cut where the clippers are moved forwards and backwards until there is no trace of hair. The injuries from this kind of cut should be sufficient to transmit aids and other blood bone diseases, I think.
Mikairi, Uganda

I am originally from a developing country, and I know for sure we share needles more than we share women in Africa.

This was not new research - just a review of past studies - and should therefore not be treated too seriously. Whilst the report will doubtless be seized upon by the Catholic Church and used to justify their shameful opposition to condoms we must just hope that the people who matter in Africa, the voice of the UN experts will prevail. Cuba's success in keeping the epidemic at minimal levels should serve as a lesson to the world on the importance of a coherent government-led strategy.
Stuart W, UK

Drug companies should definitely be made to provide developing countries with cheaper medicines, as these are the countries that are worst affected and in the worst position to do anything about it. We need to bring the epidemic under control, through better health education or better medical care in Africa if that is what it really is down to which I doubt. People really need to open their eyes to this, it's real and it's happening. Drugs shouldn't be about profit for the companies, they should be available for anyone affected so that Aids can finally be halted once and for all, before it claims even more lives.
Marie, UK