HIV infection due to unsafe medical injections may have fallen by almost 90% worldwide in decade after 2000

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The number of HIV infections in low- and middle-income countries acquired due to unsafe medical injections fell by 87% between 2000 and 2010, investigators report in PLOS ONE. The authors describe this as “a remarkable public health achievement”. The number of new hepatitis B virus (HBV) and hepatitis C virus (HCV) infections attributable to unsafe medical injections also fell by 83% and 91%, respectively.

Injections made using a syringe and/or a needle previously used on another patient involve a risk of transmission of bloodborne infections when the equipment is re-used without adequate sterilisation. In 2000, the World Health Organization (WHO) estimated that in low- and middle-income countries, unsafe injections were the source of 5% of new HIV infections, a third of new cases of HBV and 40% of new HCV transmissions. The Safe Injection Global Network was set up in response, to reduce the number of infections due to injections.

Canadian investigators repeated the 2000 analysis and used prevalence and incidence data collected from a variety of sources to estimate the number and proportion of new HIV, HBV and HCV infections acquired via unsafe medical injecting practices through to 2010.


hepatitis B virus (HBV)

The hepatitis B virus can be spread through sexual contact, sharing of contaminated needles and syringes, needlestick injuries and during childbirth. Hepatitis B infection may be either short-lived and rapidly cleared in less than six months by the immune system (acute infection) or lifelong (chronic). The infection can lead to serious illnesses such as cirrhosis and liver cancer. A vaccine is available to prevent the infection.

middle income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. There are around 50 lower-middle income countries (mostly in Africa and Asia) and around 60 upper-middle income countries (in Africa, Eastern Europe, Asia, Latin America and the Caribbean).

low income countries

The World Bank classifies countries according to their income: low, lower-middle, upper-middle and high. While the majority of the approximately 30 countries that are ranked as low income are in sub-Saharan Africa, many African countries including Kenya, Nigeria, South Africa and Zambia are in the middle-income brackets. 

Their findings were highly encouraging.

The estimate for the number of HIV infections acquired due to unsafe medical injections in 2000 remained unchanged at between 133,000 and 266,000 cases. Therefore, between 4.6 and 9.1% of all new HIV infections in 2000 were caused by unsafe injections.

However, in 2010 the number of new HIV infections acquired in this way had fallen to between 17,000 and 34,000 cases. Therefore, compared to 2000, the number of medical injection-related HIV infections decreased by 87%. In 2010, just 0.7 to 1.3% of new infections were due to this mode of transmission.

There was also good news for HCV and HBV infections.

The authors estimated that in 2000 between 950,000 and 1,868,000 new HCV infections were due to unsafe medical injections. By 2010, the number had fallen by 83% to between 157,600 and 315,100 new cases. There were an estimated 19,700,000 new HBV infections caused by unsafe medical injections in 2000. In 2010, the estimate was 1,680,000 cases, a 91% reduction.

“The main finding of this study is that, between 2000 and 2010, there has been a reduction of respectively 87% and 83% in the estimated number of HIV and HCV infections transmitted through unsafe injections,” write the authors. “In the case of HBV, the reduction was more marked (91%) due to the additional impact of rolling out vaccination in most of the world.”

The investigators urge that efforts to prevent medical injection-associated HIV, HBV and HCV infections should be maintained. “Elimination of these risks could become a reasonable goal in sub-Saharan Africa and Latin America,” they conclude. “Such an achievement in Africa could remove half of the remaining burden of injection-related HIV infections worldwide.”


Pépin J et al. Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010. PLOS ONE 9(6):e99677. doi:10.1371/journal.pone.0099677, 2014.