In South Africa both lay people and medical professionals can benefit from the knowledge that avoiding blood exposure is protective.
The low prevalence of injection drug abuse in Southern Africa has meant that information about bloodborne HIV transmission has not been adequately communicated. For example, fewer than one in three adults in Africa recognise that HIV can be spread by sharing razors.
Research suggests that those who know that it is important to ‘avoid sharing razors” are 25% less likely to be HIV positive than other adults in Southern Africa (Brewer 2010, analysis of data available from www.MeasureDHS.com).
Adults who do not know this may be at risk of shaving with a shared razor. Children are at risk when sharing scarification tools. Children with scarification marks in the Free State were 60% more likely to be HIV positive than children without scarification, a recent study by the Human Sciences Research Council found.
Similarly, in the South African healthcare sector, epidemiologists expect to see few cases of healthcare-associated HIV because of the high standard of blood supply safety that has been achieved in this country.
But the ethical imperative to prevent all forms of healthcare-associated HIV requires greater attention to universal precautions in other areas of invasive healthcare. Injections are perhaps the most common form of invasive healthcare and should always be given with a new sterile needle and syringe.
Dangerous practices, such as reusing a syringe after changing the needle, are still sometimes observed in South Africa and a few children may have been infected with HIV in hospitals as a result of this practice. A national registry for unexpected HIV infections in children exists at Tygerberg Hospital to investigate such cases.
Given new research that suggests everyday practices continue to spread HIV, public education would seem to be a powerful tool to promote infection control. A public educated about blood-borne HIV can avoid exposure to blood in instances such as using unsterile hairdressing equipment, shaving with shared razors, or unsafe traditional cutting.
The importance of using only non-reusable syringes is another policy intervention that can reduce the spread of blood-borne HIV. This has been done in Burkina Faso to ensure that untrained practitioners giving injections have access only to non-reusable injection equipment.
Autodisable syringes are used exclusively for immunisations in most parts of Africa — as recommended by the World Health Organisation — but this policy has not been adopted in South Africa yet.
Savanna Reid is a graduate assistant at the University of Nevada, Las Vegas. Suraya Dawad is a research fellow at the health economics and HIV/Aids research division at the University of KwaZulu-Natal Durban. Both authors write in their personal capacities