The natural assumption was that he must have picked up the disease from his mother in the womb, but her HIV test came back negative. So where did Sipho catch the virus? No one can be sure, but it is most likely that he was infected in hospital, perhaps by a needle that had not been sterilised after being used on an infected patient.

The World Health Organization thinks that tragedies like Sipho's are very much the exception. It estimates that unsafe injections during healthcare account for just 2.5 per cent of HIV cases in Africa, and that the vast majority of infections are via sex. But some researchers believe the role of dirty needles has been greatly underestimated. If they are right, relatively simple measures could save millions of people worldwide.

This week, the group Physicians for Human Rights based in Washington DC sent an open letter to the WHO and UNAIDS. It calls for more resources to be spent on preventing infection by dirty needles. The letter says people should be educated about the dangers, and measures taken such as providing syringes that cannot be used more than once.

But the WHO and UNAIDS have long resisted the suggestion that injections are an important driver of the epidemic. "It has been a huge struggle to make the case that this is a significant part of the epidemic," says Ernest Drucker, an AIDS expert at Yeshiva University in New York. "We've run into a firestorm of protest." "The worry is that if too much attention is paid to unsafe injections it will take away from the message about sexual transmission," says James Whitworth at the London School of Hygiene and Tropical Medicine, who backs the WHO position.

Another fear is that vaccination programmes will be und
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Contact: Claire Bowles
44-207-331-2751
New Scientist
3-Dec-2003