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[[David Gisselquist]], Ph. D.{{PhD}}, who has studied health care practices in sub-Saharan Africa, finds that much of health care, especially injection practices, in Africa is non-sterile, and is likely the cause of the high incidence of HIV infection. He notes that the consensus to make sex the primary cause of infection was determined in the 1980s and is likely to be inaccurate, because it does not give sufficient weight to medical transmission of HIV infection.<ref name=”gisselquist2002”>{{REFjournal