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A zero prevalence of anti-HIV in blood donors in Gaza: how can it be sustained?

Yassin, Khaleda; Awad, Riyadb; Tebi, Abd Jabbarc; Queder, Alic; Laaser, Ulricha

Research Letters

aSection of International Public Health, School of Public Health, University of Bielefeld, Bielefeld, Germany, bManagement Information System, Ministry of Public Health, Palestinian National Authority, Palestine; and cDepartment of Primary Health Care, Ministry of Public Health, Palestinian National Authority, Palestine.

Received: 14 December 2000; accepted: 25 January 2001.

In 1998, three cases of AIDS were notified to the Ministry of Public Health in Palestine; one case was in the West Bank and two cases were in the Gaza Strip. The three cases were homosexual men with a history of intravenous drug use. Paradoxically, no cases of HIV infection were notified in the same year. This has raised several questions about the completeness and the quality of the reporting system, and has raised concerns that HIV might be more prevalent than expected. The concerns were also supported by a severe lack of knowledge about the size of the classic high-risk groups for HIV infection in Palestine.

We carried out this study in order to investigate the prevalence of anti-HIV in blood donors in Gaza. The study population consisted of 16 493 unpaid, apparently healthy blood donors, enrolled throughout 1999 (7375 participants) and the first 8 months of 2000 (9118 participants). Blood donors were predominantly men and their ages ranged between 18 and 45 years, with 80% being younger than 35 years. Blood samples were obtained in three blood banks in the Gaza Strip by trained nurses in vaccutainer plain tubes, and were immediately transported to the central laboratory of the Ministry of Health. There, sera were separated from cellular blood components, coded and stored at −20°C. Serum testing for HIV-1/2 was carried out using enzyme-linked immunosorbent assay kits. The screening strategy intended to test the initially positive in duplicate and to retest them with other kits. Western Blot was planned to confirm enzyme-linked immunosorbent assay-positive samples. None of the blood samples were positive for anti-HIV.

The results of our study are congruent with other surveys in neighbouring countries, namely Egypt, Jordan and Israel. For example, the US Naval Medical Research Unit tested 29 261 high-risk individuals and blood donors over a 5 year period in Egypt [1]. The overall prevalence of HIV-1 was 0.18%; of which 4.8% were blood and factor VIII recipients, 0.15% were drug addicts, 0.18% were fever of unknown origin patients, 0.23% were sexually transmitted disease patients, 1.9% were HIV-1 contacts, 0.07% (7/9778) were international travellers, and 0.02% (2/12 070) were blood/product donors. In Jordan, sera from 1124 rural and urban residents were examined for HIV and only two patients with hepatitis were positive for HIV by enzyme immunoassay and Western blot [2]. In Israel, where the reporting of AIDS cases is accurate but the completeness of HIV surveillance is unknown, the incidence of HIV was estimated using the back-calculation method [3]. This method revealed a very low cumulative number of HIV infections (922 cases), which was consistent with the reported cases (1011). The study excluded Ethiopian migrants who had higher prevalence rates [4,5].

The importance for Palestine of the epidemiology of HIV in these countries is well known, because Palestinians are basically moving backwards and forwards between these countries for the purposes of work, trade and tourism. We believe that this very low level of HIV infection in Gaza can be sustained if a sincere national effort is made to educate the public about HIV transmission and prevention, to maintain meticulous blood screening, and control high-risk groups for HIV infection. The only remaining challenge is to control infection among the hundred of thousands of Palestinian returnees, expected to pour into the West Bank and Gaza if a final peace settlement is reached with Israel.

Khaled Yassina

Riyad Awadb

Abd Jabbar Tebic

Ali Quederc

Ulrich Laasera

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© 2001 Lippincott Williams & Wilkins, Inc.