Pediatric HIV infection in Elista Russia: interventional strategies.

Unsafe medical procedures have ben commonly practiced in eastern Europe due to the general lack of medical knowledge and basic medical resources in the region. Such practices include the reuse of needles and syringes the use of unscreened blood a dependence upon injectable medication owing to a paucity of oral formulations and the use of blood transfusion as a therapeutic maneuver. As a result a group of children were nosocomially infected with HIV in 1988 and 1989 at the Republican Hospital for Children in Elista Russia. As of July 1990 Elista a city of approximately 100000 had officially listed 91 individuals as infected with HIV of whom 75 were children. The main risk factor was determined to be horizontal infection via contaminated needles catheters and syringes. Prior to 1990 unscreened blood may also have been an important source of infection. The leading risk factor for contracting HIV infection was therefore identified as admission to the municipal hospital during 1988 to 1989. Since 1990 medical teams from the Francois-Xavier Bagnoud Pediatric HIV International Training Program of the Childrens Hospital AIDS Program in Newark New Jersey have been providing ongoing expertise and service in educating and training the health care providers of Elista. No new cases of horizontally acquired pediatric HIV infection have been reported in Elista since 1990 due to education about how HIV is acquired and the establishment of appropriate infection control procedures in the hospitals. The government of Elista provided room board local transportation and translators while the Association Francois-Xavier Bagnoud in Sion Switzerland paid for the approximately $17000 in travel expenses over the three-year course of the project. The authors note the success of this project but also point to the existence of reports of similar nosocomial outbreaks of HIV infection in other eastern European cities. Vertically transmitted HIV infection is also being identified in Elista and elsewhere in the region. Drugs and disposable supplies remain scarce in the context of current adverse economic conditions in Russia.