Dr DANAIL BESHKOV, Director of the
National AIDS Laboratory, works in close cooperation with Bisanti. He
is in charge of the medical aspects of the case, studies similar cases
in other countries and conducts the correspondence with foreign experts
Frenchman Luc Montaigner and Geneva-based virologist Luc Perrin.According to Beshkov, research done by Perrin and Montaigner corroborates the theory that the HIV epidemic in Benghazi was the result of an in-hospital infection.
The experts would like to see more research being done to determine the causes for the epidemic and to take measures to prevent such cases in the future.
Citing expert opinions, Beshkov thinks that the influx of citizens of other African countries is among the factors that facilitated the spread of AIDS. Beshkov quoted data according to which 36 per cent of the population of Botswana and 20 per cent of the population of South Africa are HIV positive.
Beshkov elaborates that in-hospital infections and in particular those caused by blood-transmitted agents such as microbes and viruses have been recorded as far back as the early 20th century when the mass use of syringes started. The first recorded case of an in-hospital infection dates to the year 1917 when in England during the treatment of soldiers for syphilis they were infected with malaria. This is the first documented epidemiological outbreak caused by an in-hospital infection.
The first recorded case of an AIDS epidemic caused by an in-hospital infection occurred at the pediatric hospital in the town of Elisa in the Kalmyk Republic. One hundred children were infected after the reuse of syringes.
Some 2,000 children from maternity homes, pediatric hospitals and nursery schools in Romania were infected in 1990 with AIDS due to use of infected blood for transfusions and the reuse of syringes. Beshkov noted other cases of infection that affected fewer people. In 1992, a dentist in Florida infected five of his patients with instruments that were not sterilized properly. A case of AIDS infection was reported in 1993 at a private clinic in Australia. Two cases of AIDS infection were reported in 1999 in Denmark and France which were again the result of in-hospital infections caused by the reuse of instruments and improper sterilization. These cases show that even in the industrialized countries there are no guarantees that an in-hospital infection will not break out.
There is also information on in-hospital AIDS infections in Africa but these cases are not well documented, Beshkov said. The case in Libya is not the first one and will not be the last, he thinks. Poor infection control standards, shortage of consumables and the medical staff’s insufficient knowledge of the mechanism for the transmission of infections are among the main factors for the epidemics.
Ten years after the first case of mass AIDS infection, the issue remains topical for the global medical community, Beshkov said. A lot has been done in the field of prophylaxis but there are still some unresolved problems, he said, noting that 16,000 people around the world are infected with AIDS every day.
The main factors for the transmission of infectious diseases through syringes are the improper sterilization and reuse. Such practices facilitate the transmission of hepatitis B and C, AIDS, ebola, lasa and malaria. Between 20 and 80 per cent of new cases of hepatitis B are the result of syringe-transmitted infection. Almost all cases of hepatitis C are the result of reuse of syringe needles. In the Western World, hepatitis C is referred to as the disease of drug addicts since 70-90 per cent of them are infected.
Experts consider in-hospital infections with blood-transmitted agents to be the main problem of hospital care in countries with limited financial resources. On the basis of representative research, WHO has concluded that every year in developing countries between 8 and 16 million people contract hepatitis B, 2.3-4.7 million contract hepatitis C and 80,000-160,000 are infected with AIDS.
Prof.
LUC MONTAIGNER of the Institut Pasteur in Paris takes credit for
the first publication in world medical literature on the discovery of the
human immunodeficiency virus in 1983. The 67-years-old professor holds the
Prix Rosen for cancer research, the Gallien Prize, the Heineken Prize for
Medicine, the Lasker Prize and a number of other international honours.
He is Commander of the Legion d’Honneur.. Montaigner visited Libya together
with Prof. Stephane Blanche, in whose Paris clinic part of the Libyan children
were tested. Prof. Montaigner has co-founded the New York-based World Foundation
for AIDS Research.The other prominent virologist contacted by lawyer Bisanti is LUC PERRIN of Switzerland. He works at the Geneva University Hospital and is one of the greatest living specialists in the field of retroviruses.
PROF.
VITTORIO COLIZZI is one of the most eminent researchers of HIV/AIDS
in Europe. He heads the Laboratory of Immunochemical and Molecular Pathology
with the Biology Department of Tor Vergata University in Rome, Italy. Together
with his French counterpart Prof. Luc Montagnier, in 2002 he begins working
on a report about how and when nearly 400 Libyan children in the Benghazi
chidlern's hospital came to be infected with the AIDS visrus. The final
report drawn by the two scholars is submitted to the Libyan authorities,
who have commissioned it, in April 2003. By the middle of 2003, Colizzi
has visited Libya three times. He explores the modifications of HIV isolated
from the organisms of Libyan children in three hospitals - in Rome, Geneva,
and France. The general conclusion is that all modifications bear a close
similarity and that they even have a common origin. According to Colizzi, the AIDS infection in the Benghazi hospital is of an iatric character. Its source is a child who was a HIV carrier but was hospitalized for the treatment of another disease.
Dr PAOLO LUSSO, head of and AIDS testing department at the San Raffaele Hospital in Milan, and Dr PAOLA NASCA, member of the National Anti-AIDS League, came to the limelight in a major article about the treatment of some 200 HIV-infected Libyan children in clinics in Rome and Milan, which appeared in the Italian magazine Diario on February 2, 2001. The two Italian doctors told the magazine that the AIDS epidemic at the Benghazi children’s hospital was most probably caused by multiple use of syringes and non-sterile instruments.
Professor
GEORGE JOFFE is an expert at the Center for International Studies
at Cambridge, the UK. He specializes in the problems of Northern Africa
and the Middle East and is known for his commentaries and scientific theses
on the problems of terrorism and international politics. In an interview for BBC Professor Joffe suggests that the decisions of the court in Benghazi on Case 213/2002 indicate that the Libyan authorities probably realize that the Bulgarian medical professionals are not responsible for the outbreak of AIDS in Libya in 1997-1998.
INTERNATIONAL
OBSERVERS
At the invitation of Bulgarian members of the International Association
of Democratic Lawyers, two international observers attended several of
the hearings of the People’s Court in Tripoli: Mohammad Baqar of Tunisia,
Secretary General of the Mediterranean Bar Association, and Zubeida Amrani
of Algeria, Secretary General of the Association of Arab Jurists. The
presence of international observers sets a precedence in Libyan administration
of justice. The two observers found that the trial was conducted according
to the law and that the Bulgarians were not subjected to harsher treatment
on account of being foreigners. Baqar and Amrani are convinced that the
Bulgarians will not be convicted because there is no sufficient incriminating
evidence.
Open Letter on Death Sentence for Bulgarian Nurses, Palestinian Doctor
Physicians for Human Rights (Boston)
June 23, 2004
Posted to the web June 28, 2004
His Excellency Mu'ammar al-Gaddafi, Leader of the Revolution, Office of the Leader of the Revolution, Tripoli, Great Socialist People's Libyan Arab Jamahiriya
Dear Your Excellency al-Gaddafi:
As leading virologists and other scientists and physicians, we join
our health professional colleagues internationally in calling on you
urgently to commute the death sentences imposed by the Benghazi Criminal
Court in Libya on five Bulgarian nurses and one Palestinian physician.
We also respectfully ask your government to review the procedures that
have led to the targeting of these foreign health workers in this affair.
The individuals have been charged and convicted of deliberately infecting
more than 400 children with HIV while working in al-Fateh Children's
Hospital. Prominent independent scientific experts have concluded,
however, that the systematic infection was not perpetrated by those
accused. Many of the children were infected prior to the arrival of
these health practitioners, and the evidence further shows that unsanitary
health conditions are to blame. It is an unfortunate reality that in
many countries throughout the world, particularly those in Africa and
Asia, inadequate health conditions, training, and care can hasten the
spread of HIV/AIDS.
Those sentenced to death are Kristiana Malinova Valcheva, Nasya Stojcheva Nenova, Valentina Manolova Siropulo, Valya Georgieva Chervenyashka, Snezhanka Ivanova Dimitrova, and Ashraf Ahmad Jum'a. Libyan authorities took an appropriate step in investigating the cause of the nosocomial HIV infection at al-Fateh Children's hospital when the Gaddafi Foundation appointed Professor Vittorio Colizzi, who is with the Tor Vegatta University in Rome, and Professor Luc Montagnier, co-discoverer of HIV, the virus that causes AIDS, as international scientific consultants. However, we believe the Benghazi Criminal Court has disregarded the explicit findings of these prominent physicians and has proceeded without a firm grasp of the scientific realities.
After several trips to Libya, which included a comprehensive and thorough investigation of the al-Fateh Children's hospital, Drs. Montagnier and Colizzi highlighted the unlikelihood of a deliberate injection by the accused health workers and concluded that "all the genetic analyses performed strongly indicate that the nosocomial infection in Benghazi Children's Hospital has been caused by a single. . . subtype of A/G HIV-1...by one. . . HIV infected child who was originally infected by his mother through vertical transmission. This infection was already present in the Benghazi Hospital in April 1997 [before the foreign health workers arrived]. . . and was still operating in March 1999."
Dr. Montagnier's assertion that the infections were caused by poor medical conditions is consistent with the international community's recognition that unsterile medical equipment can and does transmit HIV. Outbreaks with similar causes have been documented in Egypt, Romania, and the Kalmyk Autonomous Region of Russia. In fact, according to the World Health Organization, it is estimated that 260,000 HIV infections occur each year because of medical injections given with unsterile needles and syringes.
When HIV infections are transmitted through medical procedures or other unsterile conditions at health facilities, the transmissions do not occur because of ill will on the part of health care workers. Rather, the causes tend to be systemic to the health facility or health systems, including improper training of health workers, a high workload, insufficient supplies, or inadequate infection prevention and control procedures.
That more than 400 children at al-Fateh Children's Hospital were infected with HIV is truly tragic. However, accusing health professionals of deliberately infecting the children with HIV, contrary to the evidence, and sentencing these health professionals to death, will not help protect other patients from a similar fate. Policies that promote strong infection prevention and control regime will provide significant protection. We believe it is critical that Libyan authorities, with international assistance as needed, investigate and determine the conditions at al-Fateh Children's Hospital that enabled these children to become infected, and ensure that such conditions no longer exist at that or any other Libyan health facility. The World Health Organization's Regional Office for the Eastern Mediterranean can be contacted to assist with the investigation or direct the Libyan authorities to those who are best positioned to do so.
We are glad to hear that most of the children infected with HIV at al-Fateh Children's Hospital are still alive, and that Libyan authorities are providing for their treatment at home and abroad. Children, like adults, can be successfully treated with anti-retroviral medication, keeping them alive for many years.
Due to the scientific evidence and to credible reports that the health workers were tortured into false confessions, we believe that the defendants have suffered extreme prejudice in their case. Accordingly, we urge the Libyan authorities to dismiss the case, and to release to their home countries the imprisoned medical personnel who were invited to your country to help treat the sick. We urge you to ensure that these health professionals are protected, given any medical attention they may need, and are not further abused while still in detention.
Sincerely,
Michael Adler, MD, FRCP Professor of Medicine University College London ENGLAND
Arash Alaei, MD Co-director, Pars Curative Researchers Institute for HIV/DU/STI Shaheed Beheshti University of Medical Sciences Co-director, TB/HIV International Programs National Research Institute of Tuberculosis and Lung Disease Tehran & Kermanshah IRAN
Kamiar Alaei, MD Co-director, Pars Curative Researchers Institute for HIV/DU/STI Shaheed Beheshti University of Medical Sciences Co-director, TB/HIV International Programs National Research Institute of Tuberculosis and Lung Disease Tehran & Kermanshah IRAN
John G. Bartlett, MD Johns Hopkins University Baltimore, MD USA
Stephane Blanche, MD Unite d Immunologie-Hematologie Departement Hospital Necker-Enfants Malades Paris FRANCE
Rafael E. Campo, MD Infectious Diseases Research Unit Division of Infectious Diseases University of Miami School of Medicine Miami, FL USA
Vittorio Colizzi, MD, PhD Professor, University of Tor Vergata Rome ITALY
Douglas T. Dieterich, MD Vice Chair and Chief Medical Officer The Mount Sinai Medical Center New York, NY USA
Jan Desmyter, MD, PhD Rega Instituut Leuven BELGIUM
Aida Seif El-Dawla, MD Professor of Psychiatry, Ain Shams University Founding Member, El Nadim Center for Psychological Rehabilitation of Victims of Violence Chairperson, Egyptian Association against Torture Cairo EGYPT
Wafaa El-Sadr, MD, MPH Harlem Hospital Center Columbia University New York, NY USA
Robert C. Gallo, MD Director, Institute of Human Virology and Division of Basic Science University of Maryland Biotechnology Institute Baltimore, MD USA
Ashley T. Haase, MD Regents' Professor and Head, Department of Microbiology Director, AHC Biomedical Genomics Center Director, Minnesota Division, Great Lakes Regional Center for AIDS Research University of Minnesota Minneapolis, MN USA
Daniel R. Kuritzkes, MD Associate Professor of Medicine Harvard Medical School Vice-President, Board of Directors HIV Medicine Association Cambridge, MA USA
Professor Thomas Lehner, CBE, MD Professor of Basic and Applied Immunology Guy's King's and St Thomas' Hospitals King's College London ENGLAND
Haytham Manna, MD, PhD Board of Directors, Arab Commission for Human Rights FRANCE
Abdallah Mansour, MD Director, El Nadim Centre for Psychological Management and Rehabilitation of Victims of Violence Cairo EGYPT
Moncef Marzouki, MD Associate Professor of Public Health University of Paris FRANCE
Kenneth Mayer, MD Director, Brown University AIDS Program Professor of Medicine and Community Health, Brown University Medical Research Director, Fenway Community Health Boston, MA USA
Luc Montagnier, MD, PhD Co-founder, World Foundation for AIDS Research and Prevention Co-director, Program for International Viral Collaboration FRANCE
Jeffrey Nadler, MD Director, Clinical Research, Division of Infectious Diseases University of South Florida College of Medicine Tampa, FL USA
Dr. Rafael Najera, Chief, Department of Viral Pathogenesis National Center for Microbiology Instituto de Salud Carlos III Madrid SPAIN
Jumana Odeh, MD, MPH Director, Palestinian Happy Child Centre WEST BANK AND GAZA
Mobeen Rathore, MD Chief, Division of Pediatric Infectious Diseases/Immunology Professor and Assistant Chairman for Research and Academic Affairs Department of Pediatrics University of Florida Health Sciences Center Jacksonville, FL USA
Douglas D. Richman, MD Professor of Pathology and Medicine Director, Center for AIDS Research Florence Seeley Riford Chair in AIDS Research University of California San Diego La Jolla, CA USA
Michael Saag, MD Professor of Medicine Director, AIDS Outpatient Clinic University of Alabama at Birmingham Birmingham, AL USA
Robert T. Schooley, MD Tim Gill Professor and Head, Division of Infectious Diseases Director, Colorado Center for AIDS Research University of Colorado Health Sciences Center Denver, CO USA
Valerie E. Stone, MD, MPH Associate Chief, General Medicine Unit Director, Primary Care Residency Program Massachusetts General Hospital Harvard Medical School Boston, MA
Anita Vaughn, MD Medical Director, Homeless Healthcare Clinic NewarkDepartment of Health and Human Services Newark, NJ USA
Paul Volberding, MD Professor of Medicine and Vice Chair of Medicine University of California, San Francisco (UCSF) Co-Director UCSF-GIVI Center for AIDS Research Chairman of the Board, International AIDS Society-USA San Francisco, CA USA
Hans Wigzell, MD, PhD Director, Karolinska Institute SWEDEN
S. Bruce Williams, MD University of New Mexico School of Medicine Albuquerque,
NM USA
Canadian Nurses Association (CNA)
CNA DENOUNCES LIBYAN DEATH SENTENCE OF BULGARIAN NURSES
(Ottawa, 13 May 2004)
The Canadian Nurses Association (CNA) joins the International Council
of Nurses (ICN) in its concern over the fate of five Bulgarian nurses
and a Palestinian physician who have been convicted and condemned to
death by a Libyan court.
"We are troubled by this decision. In face of expert testimony that suggests
these health care providers were only doing their job and are innocent, this
death sentence is unjust and unacceptable," says
CNA President Rob Calnan.
The health professionals were arrested in 1999 for allegedly spreading HIV
infection in a children's hospital in the Libyan city of Benghazi where they
worked in 1998.
Professor Luc Montagnier, the French AIDS expert who co-discovered HIV, testified
during the trial that poor hygiene and the reuse of infected equipment and
materials, such as needles, was the most likely cause of transmission of HIV.
CNA joins Western governments and human rights groups who have denounced the
verdicts and sentences, on the basis the confessions were obtained through
torture and designed to direct attention away from unsafe conditions and practices
in its hospitals and clinics.
"We urge the government of Canada and other international leaders,
including UN Secretary-General, Kofi Annan, to intervene on behalf of the health
professionals and request Libyan leader, Col. Moammar Gadhafi repeal the sentences
and release the health professionals," added Calnan.
CNA is the professional voice of nursing in Canada. It is a federation of 11
provincial and territorial professional nursing associations.