A scientific paper just published in the journal Nature provides an in-depth scientific analysis of the evidence in the case of the six medics on trial for their lives in Libya. Scientists obtained RNA sequences from the HIV virus present in 44 victims who had been treated outside Libya. They used well-established techniques for determining evolutionary relationships to see if the infection came from a single source, and they used what we know about the rate at which HIV evolves to determine when the infections began at the hospital.
The analysis demonstrates, beyond even an unreasonable doubt, that the sequences from the victims share a single common ancestor, indicating that the infection came from a single source. The molecular clock analyses indicate that the infection probably began to be spread in the hospital sometime during 1996 (two years before the medics arrived), and that we can be better than 99.5% certain that the infection was spreading through the hospital before the medics arrived. A separate analysis of hepatitis sequences taken from the same individuals indicates that this infection was also spreading through the hospital well prior to the arrival of the six unfortunates that the Libyan government is attempting to scapegoat.
Our state department, unfortunately, appears to have all of the scientific literacy that we've come to expect from the Bush administration. Their spokesman has characterized the research as a "magazine article," and said that they won't bring the article to the attention of the Libyans. That is a mistake, and may prove to be a fatal one for the Tripoli Six.
Write to your legislators. Write to the President. Write to the Secretary of State. I know I've asked you to do these things before. Do it again. We need to let people know that this is not an issue that we care about once, then forget. The more convinced politicians become that this is an issue that people are continuing to watch, the more likely it is that they will do something about it.
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The roots of HIV/AIDS epidemics in Libya
Like many others, I was shocked by the recent decision of the court in Tripoli confirming the death sentences in the retrial of five Bulgarian nurses and one Palestinian doctor, detained since 1999 and convicted on charges of intentionally infecting more than 400 Libyan patients, primarily children, with the human immunodeficiency virus (HIV) at the hospital in Benghazi in 1998. Because of this issue I would like to discuss about some knowledge referring to the risks for transmission of this infection within this country, which I obtained during my duties at the Department of Internal Medicine at the Faculty Hospital in Misurata during the years 1987-1990.
During the first months of my duties at the aforementioned health facility, I had a chance to see some patients which had the typical signs of advanced AIDS. I was very surprised at the attitudes of the chief of the department, by the way, a very experienced and educated doctor from the Sudan, who did not want to accept, that, he would have to deal with this kind of disease which supposedly was not present in Libya. Besides that, he threatened me, that, if in the future I discussed this situation, I could have some serious problems.
This attitude I automatically explained to myself as part of the propaganda of the government's regime which do not wish to admit the presence of AIDS because of cultural, social, and religious norms that discourage alcohol, drugs abuse and promiscuity. Although the Islamic moral code forbids such indulgences, in reality, they are widely practiced among men. This may explain that some governments do not wish to admit the presence of AIDS which reflects the type of society there.
It is important to note, that Libyan citizens had, at this time, the possibility to freely travel to the surrounding countries like Tunisia but also to Western Europe, where the presence of this disease was wide spread. Another imoportant factor that may impact the spread of HIV include a large population of migrant workers, mainly from sub-Saharan Africa, the worst affected region in the word where more than one half of all HIV-infected people live. Moreover, the city of Benhazi, where the university is located, was known for the presence of a significant number of sex workers from Egypt.
Another important mode of infection might be through poor hospital hygiene, which independent investigations of the hospital showed was prevalent. Especially I want to emphasize that spreading of the infection could have been a result of insufficient examination of blood donors at the transfusion station. The data from blood donations is particularly interesting because all blood collected in Lybia's public-health facilities is voluntarily donated by family members of patients. It is possible that this method of gaining blood donors could have led to disparagement of precautions for exclusion infected donors.
Consistent with this assumption is the UNAIDS/WHO Working Group on global HIV/AIDS and STI Surveillance data showing,the HIV seroprevalence in 1998 among blood donors was 0,22%. Furthermore, at the and of 2002, HIV infection had been reported among 5,160 Libyans and 1,159 foreigners. More then 80% of all reported HIV infections have occurred in the past four years, suggesting a sharp increase in incidence has recently occurred. An estimated 90% of recent adult infections are the result of injection drug use.
Without these previous experiences, I would not have any reasonable doubts about charges against these health care workers. The paradox is that not long ago, I was pointing to a quote from The Green Book of the Libyan leader Muammar al-Qaddafi condemning the toleration of boxing in sports. Of interest, the quote states that "The more the people become civilized and sophisticated, the more they are able to ward off both the performance and the encouragement of these practices." I would therefore expect that the Libyan government, instead of scapegoating foreign medical professionals of doubtful accusations from bio-terrorism, rationally and humanly admit the overwhelming evidence that underestimation of preventive practices in the country, led to the spread of HIV-1 and other blood born infections.
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UNAIDS/WHO epidemiological fact sheets on HIV/AIDS and Sexually Transmitted. Diseases. Libyan Arab Jamahiriya http://www.who.int/GlobalAtlas/predefinedReports/EFS2004/EFS_PDFs/EFS20…
Pijak MR. One more reader responds to "boxing should be banned in civilized countries--round 4". MedGenMed. 2005 Oct 14;7(4):12.
al-Qadhafi M. Sport, horsemanship and shows. In: The Green Book: Part Three: The Social Basis of The Third Universal Theory. Tripoli, Libya: Public Establishment for Publishing, Advertising and Distribution. Available at: http://www.geocities.com/Athens/8744/readgb.htm Accessed October 3, 2005.
Michal R. Pijak, MD, consultant in internal medicine, rheumatology and clinical immunology
Slovak Medical University
Bratislava, Slovakia