MOTION: Experts have not just been 'seeing what they wanted to see' by 'ignoring' health care transmission of AIDS in Africa. Sexual transmission is indeed the major mode of transmission PROPOSAL: Initiatives to prevent sexual transmission of HIV in Africa should not be over-shadowed by current debate

In a recent series of papers Gisselquist and colleagues challenge the consensus that heterosexual transmission has accounted for 90% of HIV infections in African adults. They argue that nearly half of HIV infections have resulted from health care exposures mainly through contaminated injections. This is not just a theoretical debate among epidemiologists. Its conclusion has farreaching implications for HIV prevention in Africa. But have experts just been ‘seeing what they wanted to see’ as is claimed or does the work of Gisselquist and colleagues lack scientific credibility? In this article we consider Gisselquist et al.’s review entitled ‘Let it be sexual: how health care transmission of AIDS in Africa was ignored’ and summarize points that arose in a subsequent debate between Dr David Gisselquist and Dr Barry Evans. This is simply not the case in Africa. Countries that have very high rates of HIV infection such as Kenya and South Africa have low rates of HCV. While the prevalence of HIV continued on an upward curve in South Africa throughout the 1990s HCV prevalence has remained low. Gisselquist and colleagues argue that HCV data derived in a systematic review are not robust enough to show this conclusively. In countries with a relatively high prevalence of both HCV and HIV infections proportionally more health care-associated HIV infection may have occurred. However without further studies this cannot be assumed nor quantified as individuals with HIV may not be those also infected with HCV; if individuals are coinfected HCV infection may have arisen from receiving health care for HIV-related symptoms— reverse causality. (excerpt)