Reconnaissance assessment of risks for HIV transmission through health care and cosmetic services in India

Available information shows frequent unsterile medical injections in India, but less is known about other invasive procedures. To assess the variety and frequency of blood exposures in health care and cosmetic services, we interviewed people living with HIV/AIDS in four districts with high HIV prevalence. Eighty percent reported from 1-300 injections in the five years before testing HIV-positive. Common lifetime exposures include dental care (31%), surgery (20%), blood tests (100%), and tattooing (47%). Through observation and interviews with doctors, dentists, and others, we found evidence for common to routine re-use of unsterilized equipment for blood tests (lancets), dental care, tattoos, and surgery. Health-care professionals and the public are misinformed about HIV survival outside the body and underestimate HIV transmission efficiency through blood exposures. The challenge to implement infection control for all invasive procedures remains undefined, while attention focuses on partial solutions, including single use of disposable syringes.