Libya frees health care workers accused of intentional HIV infection

August 2007

Five Bulgarian nurses and one Palestinian doctor were freed July 24 after more than eight years of imprisonment in Libya under accusations that they deliberately infected hospitalized children with HIV and hepatitis C.

The health care workers were sentenced to death after they were found guilty by a Libyan court following a seven-minute hearing on December 19. The court found them guilty of intentionally infecting 426 children with HIV in an act of bioterrorism while working in a hospital in Benghazi, Libya. Fifty-six of the children have since died.

The verdict was deemed scientifically faulty by a group of international scientists who used advanced molecular dating to demonstrate with 99% accuracy that the health care workers arrived in Libya just in time to diagnose the strain, which was present in the hospital long before workers arrived in 1998. Researchers worked around the clock to produce the scientific data clearing the health care workers of intentional infection before the trial, which was likely ignored by Libyan officials.

The workers’ sudden pardon and release was satisfying news to the researchers who worked to free them with scientific data.

“We are happy, because although they were accused of a specific crime, molecular dating and sophisticated science exonerated them,” Marco Salemi, MD, an assistant professor of pathology at the University of Florida College of Medicine, told Infectious Disease News.

Salemi, a specialist in molecular evolution and DNA sequencing, worked with colleagues and another team in the United Kingdom to time-date the strains involved in the Libya case. Their efforts were reported in the February 2007 edition of Infectious Disease News. The study data were published in Nature.

“We felt frustrated because as scientists, we did our job, but then it became political, not medical,” Salemi said. “The most interesting implication is that these molecular techniques are valuable.”

Cooperative effort

Because HIV mutates so quickly, doctors were able to pinpoint the time of the arrival of the particular strain to the Libyan hospital to more than five months before the health care workers arrived. When charges were first brought against the health care workers, defense lawyers asked a team of Italian scientists to examine the case. The team ran exhaustive tests and noted rampant use of dirty needles in the hospital as the cause of infection. The report was ignored by the Libyan courts.

Defense lawyers then called for additional advanced statistical analysis molecular epidemiology from teams at Oxford University and the University of Florida. Using a “molecular clock,” scientists working in two independent laboratories found the HIV subtype in question was already circulating and prevalent in the hospital years before workers arrived.

“It was a scientific challenge, and the pressure was on, but through an international collaboration, we were able to do the calculations in only three weeks,” Salemi said. “There was overwhelming agreement among scientists on this, and it was one of few cases in science where there was no controversy among scientists.”

The decision to free the workers was heralded by many HIV/AIDS organizations who protested the original court ruling, including HIVMA and UNAIDS.