Medical students in Africa need not fear HIV
Posted by Henry Bauer on 2010/05/31
I drew attention in March (Medical students in Italy need not fear “HIV” when dissecting cadavers, 2010/03/06) to the demonstration that there is negligible risk of HIV infection or AIDS during dissections that are part of medical education (“On the risk of contracting AIDS at the dissection table”, Italian Journal of Anatomy and Embryology, 114 (2-3, Apr-Sep 2009) 97-108, by M. Ruggiero, M. P. Galletti, S. Pacini, T. Punzi, G. Morucci, & M. Gulisano). The data reviewed there pointed to the lack of any documented cases of such infection during the whole AIDS era, by now about three decades; the fact that “HIV-positive” — the presence of antibodies regarded as associated with HIV — does not necessarily denote active infection; and the related fact that many “HIV-positive” individuals never get AIDS. Although there are undoubted risks associated with medical dissection from other sources, the fear of contracting HIV and developing AIDS is not warranted.
The significance of this article is underscored by its publication in a mainstream venue, the Italian Journal of Anatomy and Embryology, official journal of one of the most prestigious Italian and international scientific societies, the Italian Society of Anatomy and Histology. The Society’s founders in 1929 included such distinguished individuals as Professor Giulio Chiarugi, scion of Vincenzo Chiarugi, the founder of modern psychiatry. The journal is in English, is peer reviewed, and is listed in major indexing systems including PubMed.
Of course in Italy, as in the rest of Europe and indeed the rest of the world outside southern Africa and the Caribbean, the rate of “HIV-positive” is quite low, well within 1% and frequently even an order of magnitude less. So it seemed worth considering whether medical students in regions of higher “HIV-positive” frequency should perhaps worry about contracting HIV/AIDS even as students in Italy need not.
South Africa is a most appropriate locale for such an investigation on at least two counts: The prevalence of “HIV-positive” people is high, and the status of medical practice, medical education, and medical statistics is better, more reliable, than in most other high-prevalence regions.
The conclusions of such a study have now been published, again in the Italian Journal of Anatomy and Embryology: “Safety issues in didactic anatomical dissection in regions of high HIV prevalence”, 114 #4  179-92, by Matteo Prayer Galletti & Henry H. Bauer. It turns out that South African medical students have no need to fear contracting HIV and AIDS, just as in Italy. To the arguments and data presented in the article by Ruggiero et al., this publication adds estimates of the rate of false positives, with special attention to the racial bias of existing “HIV” tests, a bias that stems from a failure to base the tests on appropriate control groups. That bias causes Africans to test “positive” about 20 times more often than they would under properly calibrated tests, and people of recent African ancestry also test positive about an order of magnitude more frequently than they would with appropriately calibrated assays.
Another feature of this article is an estimate of the proportion of long-term non-progressors or elite controllers among “HIV-positive” individuals. Official data indicate that this proportion is much higher than commonly assumed, perhaps as great as 50%.