Asexual reproduction?

It could have been a sordid tabloid headline for all the commotion it caused. But the scandalous idea-that dirty health-care equipment, not heterosexual sex, fuels rampant AIDS infections in Africa-appeared in a respected scientific journal.

Since Pennsylvania anthropologist David Gisselquist and a team of researchers wrote in March that up to 60 percent-not the accepted 2 percent-of infections arose from unclean needles used in hospitals and medical clinics, the medical world has been in an uproar.

Examining data from the 1980s, when the epidemic first exploded in Africa, the researchers say scientists arbitrarily pinpointed sexual transmission as the main culprit, when unsafe health care was causing just as many AIDS cases. Their articles in the International Journal of STD and AIDS prompted a meeting of United Nations health agencies and a U.S. Senate hearing.

One of the most compelling pieces of evidence the researchers cite is the number of children testing positive for HIV, the virus that causes AIDS, whose mothers test negative. A Congo study showed nearly 40 percent of such children testing positive, having received about 44 injections in their lifetime, compared to 23 injections for those uninfected.

The experts also point out that sex doesn't spread HIV efficiently enough to account for how rapidly the virus swept across Africa. In addition, they say places with the highest levels of risky sexual behavior also show low rates of HIV infection.

Eric Keroack, a member of the medical advisory board for the Abstinence Clearinghouse, said the research merits a reevaluation of the sexual transmission consensus. He said experts should carry out a study to determine if the dirty needle problem is still a factor in new infections or has been cleared up. Sen. Jeff Sessions (R-Ala.) is pressing for just such a study, the results of which could carve up President Bush's $15 billion AIDS relief plan differently.

"I don't think presently the Bush plan to get abstinence and sexual responsibility is misdirected-it's just not complete," said Dr. Keroack. "Why not invest money in needles? It's certainly cheaper than condoms."