Important note: Information in this article was accurate in 2002. The state of the art may have changed since the publication date.
BBC News - Tuesday, 5 November, 2002
US researchers examined the pattern of HIV infection in sub-Saharan Africa.
It has been estimated that sexual transmission is responsible for more than 90% of HIV infections in Africa.
However, a review of research into the topic uncovered much evidence of HIV infection in adults with no sexual exposure to HIV and in children with HIV-negative mothers.
In addition, they found high rates of unexplained HIV infection in African women during the period surrounding childbirth.
Some studies estimated that as many as 40% of HIV infections in African adults were linked to injections.
The researchers, writing in the International Journal of STD & Aids, said: "Our observations raise the serious possibility that an important portion of HIV transmission in Africa may occur through unsafe injections and other unsterile medical procedures."
They are calling for action to minimise the use of potentially dangerous medical equipment.
Underplayed risk
Researcher Dr David Gisselquist told BBC News Online it was possible the risk of infection during medical treatment had not been widely publicised for fear of deterring people from visiting their doctor for immunisations and other important care.
He said: "There are still millions of unsafe injections.
"It may be due to lack of knowledge, or to people being told that the risk of infection is very, very low so they don't need to be all that careful.
"Or it might be that some health workers are not in situation where their managers are supporting them to give safe care."
HIV can survive in syringes at room temperature for more than four weeks. The risk of contracting HIV following injection with a contaminated needle has been estimated at 2% to 7%.
It is estimated that the average person in the developing world receives 1.5 injections a year.
Previous cases
The problem of infection during medical treatment - known technically as iatrogenic infection - was graphically illustrated more than a decade ago in Romania.
Scientists carried out tests on children in 1989 after a 12-year-old girl who had received treatment at a Bucharest hospital was found to be unexpectedly HIV-positive.
A total of 1,086 children less than four years old were found to be carrying the virus.
It was found that more than half probably contracted HIV following unsafe medical injections.
More recently, nearly 400 children attending a single hospital in Libya apparently contracted HIV in 1998.
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