Bulgarian Nurses in Lybia

The following appears in the letters to the editor section within the 10
November 2006 issue of Science magazine, the weekly publication of the
American Association for the Advancement of Science.  If interested,
please pass on the information.

Regards,
Alex Mihailovski


Originally published in /Science/ Express on 24 October 2006
/Science/ 10 November 2006:
Vol. 314. no. 5801, pp. 924 - 925


    Letters


    A Plea for Justice for Jailed Medical Workers

In 2000-01, reports began to surface of an HIV-1 outbreak in
approximately 400 children who were hospitalized or treated as
outpatients in the Al-Fateh Hospital, Benghazi, Libya. The Libyan
government accused six medical workers (five Bulgarian nurses and a
Palestinian doctor) of intentionally infecting these children with
HIV-1. The Libyan Head of State, Moammar Kadafi, speaking at the
HIV/AIDS summit in Abuja, Nigeria, in April 2001, stated that these
children had been deliberately infected as part of a vast international
conspiracy to destabilize his country. The six health care workers were
imprisoned, tortured with electric shocks to extract "confessions,"
tried in a Libyan court, convicted, and sentenced to death by firing
squad. The resulting publicity caused the Benghazi pediatric HIV-1
outbreak to become the focus of international scientific efforts to
understand how it occurred.

The Benghazi Children's Hospital was visited by international experts,
and the records of infected children were compiled. Many of these
children were treated in European hospitals, making it possible to
obtain clinical specimens for virology studies. The examination of
hospital records showed that without question, HIV-infected children
were admitted to several wards of the Al Fateh Benghazi Children's
Hospital in 1997 and early 1998 (with some possibility that HIV-infected
children were present in the hospital as early as 1994), before the
arrival in Libya of the six accused. The results of serology studies (1
<#ref1>) and viral genome sequencing (1 <#ref1>, 2 <#ref2>) established
that the HIV-1 infections in all the children arose from a single source
with very low interstrain variation and the virus was of the CRF02 A/G
subtype that is common in sub- Saharan Africa. A high percentage of the
HIV-1-infected children were also infected with hepatitis C virus, of
several different genotypes, and many also had hepatitis B virus
infection despite an active pediatric immunization program (1 <#ref1>).
All three viruses were present in the children at rates far above those
in the local population. Documentation of HIV-infected children admitted
to the hospital in 1997 and the prevalence of multiple blood-borne
viruses within the children, proves that HIV was present in the Al-Fateh
Hospital by 1997, and the most reasonable explanation is that poor
infection control practices, including the lack of sterile, disposable
injecting equipment, led to the spread of HIV-1, hepatitis B, and
hepatitis C. A change in medical practices at the hospital, including
the introduction of disposable injection materials, stopped the further
spread of HIV-1 infection (1 <#ref1>).

Convicting a small group of individuals of such an appalling crime as
the deliberate infection of 400 innocent children requires a very high
degree of proof. Yet the Libyan court chose to exclude expert testimony
from independent scientists and to prevent access to crucial pieces of
evidence to test for HIV contamination, while relying instead on
"confessions" extracted under torture and making threats of execution
for any noncooperation by the accused. At the same time, the Libyan
government made demands for ever-increasing financial compensation from
Bulgaria for the parents of the infected children. These six innocent
health care workers have been incarcerated in a Libyan prison for nearly
8 years, for what we believe was performing their jobs with inadequate
equipment, after receiving inadequate training and having been exposed
to the same risk of HIV infection as the Libyan children and hospital
staff. What has happened to the accused sends a chilling message to all
heath care workers who choose to work in difficult circumstances to
deliver life-saving care to HIV-1-infected or at-risk people worldwide.

Libya is now seeking closer ties with the Western world. We therefore
request that our governments reach out to the Libyan people and their
political leadership to find a way to release the imprisoned health care
workers, provide means to look after the HIV-1-infected children, and
help with all efforts to detect, treat, and prevent HIV-1 infection
within Libya. If Libya is truly willing to enter into meaningful
dialogues with Western nations, it should take the opportunity to
benefit from the knowledge Western scientists have gained about HIV-1
and AIDS over the past 25 years and not instead create yet more victims
of the AIDS epidemic--in this case, the five Bulgarian nurses and
Palestinian doctor.

*Sunil K. Ahuja*
University of Texas Health Science Center
San Antonio, TX, USA

*Fernando Aiuti*
University of Rome "La Sapienza,"
Rome, Italy

*Ben Berkhout*
University of Amsterdam
Amsterdam, The Netherlands

*Peter Biberfeld*
Karolinska Hospital/Institute
Stockholm, Sweden

*Dennis R. Burton*
The Scripps Research Institute
La Jolla, CA, USA

*Vittorio Colizzi*
University of Rome "Tor Vergata,"
Rome, Italy

*Steven G. Deeks*
University of California, San Francisco
San Francisco, CA, USA

*Ronald C. Desrosiers*
Harvard Medical School
New England Primate Research Center
Southboro, MA, USA

*Manfred P. Dierich*
Innsbruck Medical University
Innsbruck, Austria

*Robert W. Doms*
University of Pennsylvania
Philadelphia, PA, USA

*Michael Emerman*
Fred Hutchinson Cancer Research Center
Seattle, WA, USA

*Robert C. Gallo*^*
Institute of Human Virology
University of Maryland at Baltimore
Baltimore, MD, USA

^* To whom correspondence should be addressed. E-mail:
gallo@... <mailto:gallo@...>

*Marc Girard*
Lyon, France

*Warner C. Greene*
Gladstone Institute of Virology and Immunology
University of California, San Francisco
San Francisco, CA, USA

*James A. Hoxie*
Penn Center for AIDS Research
University of Pennsylvania
Philadelphia, PA, USA

*Eric Hunter*
Emory University
Atlanta, GA, USA

*George Klein*
Karolinska Hospital/Institute
Stockholm, Sweden

*Bette Korber*
Santa Fe Institute
Santa Fe, NM, USA

*Daniel R. Kuritzkes*
Harvard Medical School
Cambridge, MA, USA

*Michael M. Lederman*
Center for AIDS Research
Case Western Reserve University/University Hospitals of Cleveland
Cleveland, OH, USA

*Michael H. Malim*
King's College London School of Medicine
London, UK

*Preston A. Marx*
Tulane National Primate Research Center
Covington, LA, USA

*Joseph M. McCune*
University of California, San Francisco
San Francisco, CA, USA

*Andrew McMichael*
Weatherall Institute of Molecular Medicine
John Radcliffe Hospital
Headington, Oxford, UK

*Christopher Miller*
California National Primate Research Center
University of California-Davis
Davis, CA, USA

*Veronica Miller*
The George Washington University
Washington, DC, USA

*Luc Montagnier*
World Foundation for AIDS Research and Prevention
Paris, France

*David C. Montefiori*
Duke University Medical Center
Durham, NC, USA

*John P. Moore*
Weill Medical College of Cornell University
New York, NY, USA

*Douglas F. Nixon*
University of California, San Francisco
San Francisco, CA, USA

*Julie Overbaugh*
Fred Hutchinson Cancer Research Center
Seattle, WA, USA

*C. David Pauza*
Institute of Human Virology
University of Maryland at Baltimore
Baltimore, MD, USA

*Douglas D. Richman*
University of California, San Diego
San Diego, CA, USA

*Michael S. Saag*
UAB Center for AIDS Research
Birmingham, AL, USA

*Quentin Sattentau*
University of Oxford
Oxford, UK

*Robert T. Schooley*
University of California, San Diego
San Diego, CA, USA

*Robin Shattock*
University of London
London, UK

*George M. Shaw*
University of Alabama at Birmingham
Birmingham, AL, USA

*Mario Stevenson*
University of Massachusetts Medical School
Worcester, MA, USA

*Alexandra Trkola*
University Hospital Zurich
Zurich, Switzerland

*Mark A. Wainberg*
McGill University AIDS Centre
Montreal, Canada

*Robin A. Weiss*
University College London
London, UK

*Steven Wolinsky*
Northwestern University
Chicago, IL, USA

*Jerome A. Zack*
David Geffen School of Medicine at UCLA
Los Angeles, CA, USA

*References*

   1. S. Yerly /et al., J. Infect. Dis./ *184*, 369 (2001).
   2. U. Visco-Comandini /et al., AIDS Res. Hum. Retroviruses/ *18*, 727
      (2002).

------------------------------------------------------------------------

Published online 24 October 2006;
10.1126/science.1136578
Include this information when citing this paper.



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