Safety issues in didactic anatomical dissection in regions of high HIV prevalence.
Ruggiero et al. (2009) have recently reviewed the importance of dissection in the training of physicians, the role played by students' fears of infection, and the evidence that those sometimes extreme fears are unwarranted even respecting HIV and AIDS, whose dangers continue to be featured prominently in popular media as though everyone were at constant risk. It is not especially surprising that the risk of accidental infection by HIV is negligibly low in random dissections in Italy where, as in Europe generally, the prevalence of HIV is only a fraction of a percent. The question arises, however, what the risk might be in regions where the prevalence of HIV is considerably higher. South Africa is an obvious candidate for investigating this issue since the prevalence of HIV there is among the highest reported by UNAIDS and other official bodies. Furthermore, its recordkeeping system is more reliable than that of most other countries in sub-Saharan Africa, the global region that is universally regarded as the epicenter of the HIV/AIDS epidemic. In addition, South Africa has a globally recognized reputation in the teaching of human anatomy. Perhaps surprisingly, the risks in South Africa also seem to be much less than might be anticipated on the basis of the conventional wisdom. One reason for this counter-intuitive conclusion is that estimates of HIV prevalence and of AIDS deaths issued by international bodies are significantly overblown, with some estimates being 20 times or more greater than locally recorded numbers. A second basis for the unexpected conclusion is that the possibility of false-positive HIV tests has been ignored despite the considerable range of evidence that false-positives can be a significant part, perhaps even a major part, of positive tests in certain groups or certain regions, saliently among people of African ancestry.
Prayer Galletti
Matteo
M
Department of Experimental Pathology and Oncology, University of Firenze, Viale Morgagni 50, 5134 Firenze, Italy.
Bauer
Henry H
HH
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D002102:Cadaver; D003469:Culture; D004210:Dissection / Q000009:adverse effects* / Q000592:standards; D004866:Equipment Contamination / Q000517:prevention & control / Q000706:statistics & numerical data; D005189:False Positive Reactions; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology*; D006679:HIV Seropositivity / Q000453:epidemiology; D015528:HIV Seroprevalence / Q000639:trends; D006801:Humans; D016273:Occupational Exposure / Q000592:standards / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012449:Safety / Q000592:standards / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology