A Plea for Justice for Jailed Medical Workers

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) and viral genome sequencing (1, 2) 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). 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).

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{at}umbi.umd.edu

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
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