EN Official Journal of the European Union CE 33/74

(2004/C 33 E/071)

WRITTEN QUESTION E-0739/03

by Erik Meijer (GUE/NGL) to the Commission

(11 March 2003)

Subject: Increasing spread of AIDS in countries with a low standard of living through poor medical practice for injections and blood transfusions

1. Is the Commission aware of the article published in the February 2003 issue of the International Journal of STD and AIDS, a medical journal covering sexually transmitted diseases, in which David Gisselquist, John Potterat and others say that the spread of AIDS in Africa differs significantly from the spread of sexually transmitted diseases, that there is also a high incidence of AIDS in children between five and 10 years old whose mothers are not infected, and that AIDS occurs remarkably frequently in population groups with the highest level of education and health care?

2. Does the Commission agree with the authors of the article referred to in paragraph 1 that poor practice in blood transfusions and injections rather than sexual promiscuity may be contributing to the further spread of HIV/AIDS?

3. Does the Commission have comparable data from the applicant countries where, as a result of relative isolation, the spread of HIV/AIDS initially lagged behind that in Western Europe, but where there has subsequently been a sharp increase ever since cuts in the spending required to ensure good medical care or restrictions on access to health care for lower income groups as a result of the collapse of national health insurance systems for all?

4. To what extent is the EU involved in programmes in non-member countries to combat HIV/AIDS which have so far focused exclusively on sexually transmitted diseases and paid virtually no attention to poor practice and other shortcomings in medical treatment?

5. What can the Commission to do to ensure that the real causes of the rapid spread of HIV/AIDS throughout the world are better understood and that any changes required in methods of combating this disease are introduced as soon as possible?

Source: Netherlands newspaper, De Volkskrant, 25 February 2003.

Answer given by Mr Nielson on behalf of the Commission

(16 April 2003)

The Commission does not agree with the conclusion of a series of articles that appeared in the March 2003 issue of the International Journal of sexually transmitted diseases (STD) and acquired immunodeficiency syndrome (AIDS) that ‘health care exposures caused more human immunodeficiency virus (HIV) than sexual transmission’ (in Africa). Rather, the Commission concurs with the main conclusion of a recent World Health Organisation (WHO) and UNAIDS expert consultation on this subject that ‘unsafe sexual practices continue to be responsible for the overwhelming majority of infections’ with HIV in Africa (1).

The Commission is of the opinion that the purported high incidence of HIV infection found in children aged 5-10 years highlighted by Gisselquist and his collaborators was spurious, being caused by high rates of false positive HIV test results. This was due to the lack of accurate and valid assays in sub-Saharan Africa during the mid-1980s. Where children are subject to accurate and rigorous diagnostic testing, HIV infection has not been found in the absence of maternal HIV infection — except when the child has received a contaminated blood transfusion or has been breast fed by a HIV+ wet nurse. While the articles referred to findings of a statistical relationship between HIV infection and higher socio-economic status, this is not necessarily evidence against sexual transmission — as the authors themselves acknowledge.

This research, which is based on old data sets and outdated methods, is simply not consistent with the modern epidemiological picture of HIV infection in Africa, where infection rates are very low in children but then rise steeply with the onset of adulthood. The Commission is concerned that the publicity surrounding publication of these papers may cause undue alarm and might discourage parents from taking their children for routine immunisations and other health care. Furthermore, there is a risk that it could undermine current activities aimed at prevention of HIV transmission by promoting safe sex practices.

WHO have estimated that unsafe injection practices only account for about 2,5 % of HIV infections in Africa. The Commission agrees that this is the best available estimate, but accepts that there is still need for vigilance in monitoring the HIV/AIDS epidemic and for increased efforts to improve bio-safety in health care systems. In addition to Community support for national blood safety programmes in several African countries (including Malawi, Niger, Uganda, Zambia, and Zimbabwe) we will continue to work with governments to improve health care practices and ensure adequate provision of sterile medical supplies.

The Commission policies and priorities on fighting the HIV/AIDS epidemic in developing countries are enumerated in the Programme for Action on Accelerated action on HIV/AIDS, malaria and TB in the context of poverty reduction adopted on 20 February 2001 (2). This was updated in the Commission's Communication to Council and Parliament dated 26 February 2003 (3).

According to available data, the prevalence of HIV infection is rising rapidly in Eastern Europe. In the Caucasus and Central Asia, there is a great danger that the prevalence will soon increase to dangerous levels. The TACIS Indicative programmes for 2002-2003 and 2004-2006 identify the measures the Commission intends to undertake to assist partner governments in this region to prevent and fight HIV/AIDS. Prevention and control of HIV/AIDS is a particularly high priority in its cooperation with Ukraine and Russia, including the Kaliningrad enclave. In these areas, Community activities have a special focus on the problem of HIV transmission through intravenous drug use and mother-to-child HIV transmission. For example, in Russia, a new project to prevent and combat HIV/AIDS will be financed from the 2002 TACIS national programme. This will support a comprehensive public awareness and information campaign targeted at the population at large, with specific attention paid to the so-called ‘bridge population’ which contributes to the spread of HIV/AIDS from the risk groups to the general population. In this case, the main risk group consists of intravenous drug users, who may also be commercial sex workers, and the ‘bridge population’ is their sexual partners.

HIV prevalence in Accession Countries remains low. Data on HIV/AIDS in applicant countries are collected by the EuroHIV project, funded by the Commission. They can be downloaded from http://www.eurohiv.org/sida.htm. The reduction of the risk of HIV transmission by blood transfusion in the Union is one of the main aims of Directive 2002/98/EC of the Parliament and of the Council of 27 January 2003 setting standards of quality and safety for the collection, testing, processing, storage and distribution of human blood and blood components and amending Directive 2001/83/EC (4), which will have to be applied by the accession countries in the future. This Directive includes requirements for donor deferral criteria, and HIV testing for each blood donation.

(1) http://www.who.int/mediacentre/statements/2003/statement5/en/.

(2) COM(2001) 96 final.

(3) COM(2003) 93 final.

(4) OJ L 33, 8.2.2003.