The World Health Organization's long-held position that dirty needles cause 2.5 percent of African HIV exposures is actually "conservative," said a leading researcher at WHO, prompting questions about a global AIDS bill focused mainly on unsafe sex. Health and Human Services Secretary Tommy Thompson has launched a review of all research linking AIDS and medical injections, possibly laying the groundwork for changes in how the legislation's $15 billion in funding is distributed.

Sen. Jeff Sessions (R-Ala.), who is on the Senate's health panel, requested the review after he turned up a WHO report listing four separate studies that found dirty needles responsible for 8 percent, 15 percent, 41 percent and 45 percent of exposures in sub-Saharan Africa. The report, dated Dec. 19, 2002, concludes "the lowest attributable fraction calculated on the basis of the data provided by the authors (8 percent) exceeds our 2.5 percent modeled attributable fraction, suggesting that our estimate is conservative."

Yvan Hutin, a WHO researcher who authored the report, acknowledged the 2.5 percent number was probably low, although just how low remains a point of debate. Regardless, he said it would be wise to consider an education campaign on unsafe needles, perceived by many as an easier and cheaper problem to correct than unsafe sex. "It remains a very good investment to do injection safety," said Hutin. "It doesn't matter whether it's 2.5 percent or more or less."

Sessions, however, contends it would have mattered while Congress was balancing the spending priorities in the AIDS bill, which was signed by President Bush last month. If the widely recognized figure was even a little higher, Sessions said Congress would have poured far more money into needle education -- and possibly even a clean needle exchange program.

Sessions' interest in the connection between AIDS and injections was heightened in March after he invited Dr. David Gisselquist to testify before the Senate's health panel. After reviewing some 19 years of research, Gisselquist concluded that at least a third of AIDS exposures in sub-Saharan Africa are due to contaminated needles in medical treatment.

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