During the last two weeks, there has been much discussion in the Swazi
press about the research we conducted on HIV transmission in Swazi and
Kenyan children. Our work and its implications have not been
accurately described, especially by critics, and we appreciate this
opportunity to set the record straight.
specifically accuse Swazi nurses or hospitals of accidentally
spreading HIV to children. The Daily Telegraph (UK) was the first
newspaper to report on our work. The Telegraph reporters never
contacted us and they misreported several aspects of our
research. The coverage in the Swazi press appears to be based on
the inaccurate Daily Telegraph story.
of the Swazi children, we analysed data from the Swaziland
2006-07 Demographic and Health Survey (DHS). This survey was
carried out by the Swaziland Central Statistical Office. The
survey was funded by USAID, several United Nations organisations, and
other domestic, foreign, and non-governmental agencies. The DHS
data is publicly available to researchers throughout the world for
further analysis of factors related to health in Swaziland.
selected respondents in such a way that the survey
results are representative of the nation as a whole. The survey
involved testing persons aged two to 49 years for HIV infection.
Mothers were interviewed about all children living in their households
and asked to indicate which were their offspring by birth. In our
analysis, we included only those children who lived with their
between the ages of two and 12, 50 were infected with
HIV. Eleven of these children had mothers who were HIV negative;
the youngest of these 11 was two years old and the oldest was 12 years
old. From these results and population figures for the nation, we
estimated that approximately 1 800 Swazi children are infected but have
did not include information on factors that might be
related to children getting infected with HIV. However, using
information from a published UNICEF survey of Swazi youth about sexual
abuse of children, we showed that such abuse could not account for more
than a very small fraction of children’s HIV infections.
also studied HIV infected Kenyan children who had HIV negative
these children to their uninfected siblings. The
infected children were much more likely to have had skin punctures in
formal and informal healthcare. No other study of HIV infected
children with HIV negative mothers in sub-Saharan Africa has been as
detailed or comprehensive as our Kenyan study.
the Kenyan study and the age of the infected Swazi
children strongly imply that the HIV infected Swazi children with
uninfected mothers became infected through unhygienic skin puncturing
exposures. Scientific and media reports in recent years also indicate
and informal healthcare in Swaziland is not reliably safe. With
the available information, it is impossible to know precisely when,
where, and how the children became infected, although clearly they were
infected sometime between 1994 and 2005.
the publication of
our article, a physician at a pediatric HIV clinic in Swaziland
informed us that infected children with uninfected mothers continue to
be found. For
25 years, HIV infected children with uninfected mothers have been
repeatedly reported by doctors and researchers throughout sub-Saharan
Africa, including South Africa in 2009.
ethical and scientific response to our results would be to
investigate the possibility of blood-borne HIV transmission in both
children and adults in Swaziland as well as elsewhere in sub-Saharan
Africa. This is precisely what we called for in our article and
is also what Senator Prince Kusa Dlamini has recently demanded. To
both public and scientific confidence, these investigations
must be rigorous, comprehensive, transparent, and independent of
individuals and organisations that have denied the potential importance
of blood-borne HIV transmission in Africa. Investigations should
also be designed to identify problems and correct them, and not to
assign blame or prosecute.
It is not sufficient
to claim that
healthcare is mostly safe. Healthcare providers
must demonstrate that healthcare is always safe, patients must insist
that it is so, and governments must ensure that it is. In the
meantime, the public must be educated about the full spectrum of risks
of blood-borne HIV transmission and how to avoid them.