A  research paper on the teaching of HIV/AIDS to medical students using "virtual, computer aided anatomy" instead of real cadavers at the  Zimbabwe Medical Teaching Hospital.Anatomy, a word derived from the Greek words “ava” (across) and “tomin” (section), is the study of the composition of the body by cutting and separating its structures one from the other in order to examine their shapes, relations and connections to one another. Therefore, most lecturers involved in medical education will agree that dissection of human cadavers is the best method of teaching and learning anatomy. This method allows one to personally dissect the cadaver. During this process, one sees, touches and handles anatomical structures. This experience leads to a better understanding and long term remembrance of the subject. In addition to this, the observations made on several cadavers enable the student and the teacher to appreciate the presence of variations of the human structure; an experience which assists medical practitioners in physical diagnosis

Asala, S.A.

Mawera, G.

Zivanovic, S.

Central African Journal of Medicine

English

IDS OpenDocs

Vol. 43, No. 2
ORIGINAL ARTICLES
Attitudes of Zimbabwean medical students to future
practice............................................................................
Fluoxetine and Moclobemide versus Amitriptyline in 
major depression: a single blind randomized clinical
trial in Zimbawe.............................................................
Clinico-pathological features of oesophageal 
carcinoma cases diagnosed between 1 August 1993 and
31 December 1995 .........................................................
- -  How appropriate are referrals from urban clinics to
Central Hospitals in Bulawayo, Zimbabwe?.................
A study of multiple births among Kanuri women of 
north-eastern Nigeria......................................................
CASE REPORTS
Osgood-Schaltter disease in Nigerian Africans ............
Annular subvalvular left ventricular aneurysm: a case 
report................................................................................
REVIEW ARTICLES
HIV/AIDS and the teaching and learning of anatomy
BOOK REVIEWS
A book for midwives by Susan Klein
LETTERS TO THE EDITOR 
Formation of an International Federation of Human 
Genetics Societies..................................................... .
CONTENTS February, 1997
GB Woelk..................................... ..................................32
MI Suleman, MB Sebit, SW Acuda, S Siziya............... 38
EJ Lancaster, T Kekana, T Matlala............................... 41
—
M Tshimanga, D Peterson, RA Dlodlo, G Woelk.........45
FE Mbajiorgu, SA Asala, AB Ejiwunmi,
OW Hamman..................................................................48
AM Abubakar, AG Abdul-Rahman............................... 51
JG Hakim, IT Gangaidzo, DChimuka........................... 55
I
Asala, G Mawera, S Zivanovic............................... 58
F Majoko........................................................................ 61
B Henderson................................................................... 62
REVIEW ARTICLES
HIV/AIDS and the teaching and learning of anatomy
SA ASALA, G M AW ERA, S ZIVANOVIC.
Objectives: To assess the level of risk of contracting HIV from HIV infected cadavers by staff and students 
who may use them for teaching and learning anatomy. Similarly, the risk of transmission of HIV between 
surgeons and surgical patients was assessed.
Design: Literature review.
Setting: Department of Anatomy and the Medical Library at the Medical School of the University of 
Zimbabwe, Harare, Zimbabwe.
Subjects: Journal articles, letters to editors of journals and books published between 1905 and 1996.
Main Outcome Measures: Distribution of HIV in the human body; survival period of the HIV in the human 
body after the death of host tissue; routes of HIV transmission; transmission of HIV from HIV infected 
surgeons to their patients or contraction of HIV from HIV infected surgical patients by the surgeons and the 
effect of embalming chemicals on HIV.
Results: HIV is distributed in body fluids, tissue transplants such as kidneys and bones. The HIV survives for 
up to 16.5 days post mortem. The routes of HIV transmission include sexual contact, tissue transplantation, 
body fluids but exclude surface-to-surface contact. The risk of transmission of HIV between surgeons and 
surgical patients is low. Commonly used embalming chemicals are effective against the HIV.
Conclusion: The risk of transmission of HIV from HIV-infected cadavers to users of such cadavers appears 
to be limited to the pre-embalming stages and within the first three weeks post mortem. The risk of 
transmission of HIV between surgeons and surgical patients is minimal. Therefore, if we are to achieve the 
fulfilment of the affirmation that dissection of cadavers remains the best method for teaching and learning of 
anatomy, it would appear to us that there is an urgent need to formulate precautionary measures that will 
greatly reduce the risk of acquiring the HIV from donated, HIV infected cadavers.
Faculty of Medicine, Correspondence to:
Department of Anatomy Dr SA Asala
University of Zimbabwe
POBox MP 167, Mount Pleasant
Harare, Zimbabwe
CENTRAL AFRICAN JOURNAL OF MEDICINE Vol. 43 -No.  2 •  1997 58
Introduction
Anatomy, a word derived from the Greek words “ava” (across) 
and “tomin” (section), is the study of the composition of the 
body by cutting and separating its structures one from the 
other in order to examine their shapes, relations and 
connections to one another.1 Therefore, most lecturers involved 
in medical education will agree that dissection of human 
cadavers is the best method of teaching and learning anatomy. 
This method allows one to personally dissect the cadaver. 
During this process, one sees, touches and handles anatomical 
structures. This experience leads to a better understanding 
and long term remembrance of the subject. In addition to this, 
the observations made on several cadavers enable the student 
and the teacher to appreciate the presence of variations of the 
human structure; an experience which assists medical 
practitioners in physical diagnosis.2
The method of teaching and learning of anatomy by 
dissecting human cadavers is closely followed only by the 
provision of prosected specimens for careful examination.2 
However, attempts have been made at some centres to replace 
the use of cadavers with electronic and computer aided 
instructions for reasons of escalating cost of cadaver 
procurement or non-availability of suitable ones. These 
methods use simulated cadavers (“virtual cadavers”) which 
are at best anonymous and more importantly, not human; and 
lack the traditional dissection experience that is required by 
students for the appreciation of natural variations of human 
structure.2
Furthermore, in addition to the current trend of trying to 
move away from the use of cadavers in the teaching and 
learning of anatomy for the slated reasons, there are other 
factors that militate against their use. These include religious 
beliefs, emotional effects of dissecting human cadavers and 
the possible transmission of communicable diseases. An 
im portant dim ension to the la tter is the Human 
Immunodeficiency Virus (HIV) that causes the Acquired 
Immune Deficiency Syndrome (AIDS).
Not only has effective treatment of this clinical syndrome 
evaded scientific efforts, but there are still doubts as to how 
completely we know the mode of transmission of the virus 
from infected persons to their uninfected neighbours. As a 
result of this, anatomy students, technicians and lecturers 
alike, are weary of handling cadavers of people whose past 
medical history and specific cause of death are not known. 
The seriousness of the situation can only be fully appreciated 
when it is realized that the percentage of deaths occurring due 
to HIV/AIDS related medical conditions is on the increase3 
and that time may soon come when the only cadavers that are 
available to departments of Anatomy may be those of people 
who had died from the effects of AIDS.
If the use of cadavers in the teaching and learning of 
anatomy is to be sustained, the problem associated with HIV/ 
AIDS and the use of cadavers of known HIV/AIDS victims 
must be examined scientifically with the hope that a 
recommendation may be made that may ensure an acceptable 
level of safety for handlers of all categories of cadavers. 
Viability of HIV in Cadavers of AIDS Victims. 
Assessment of the viability of HIV in cadavers requires that 
some basic questions be answered. These include:
1. What is the distribution of HIV in the human body?
2. How is the virus transmitted?
3. For how long does the virus survive after the death of the
host tissue?
4. Does the virus survive the chemicals that are used for
embalming cadavers?
1. Distribution of HIV in the hum an body: The virus is 
present in body fluids such as blood, pleural fluid, pericardial 
fluid4, vitreous fluid and bile5 and tissue transplants such as 
those of kidneys6 and bones.7 However, cartilage transplants 
from known HIV/AIDS victims were found to be free of the 
virus.8
2. Routes of transmission of HIV infection: It has been 
established that HIV is transmitted by sexual contact, through 
tissue transplants and body fluids.9 In surgical practice, 
however, where surgical intervention, whether for diagnostic 
or therapeutic purposes continues to play a major role in the 
management of HIV/AIDS patients10 .ae issue of HIV 
transmission between the surgeon and his/her patient remains 
controversial. Retrospective studies conducted on surgical 
patients who had been operated upon by HIV infected surgeons 
suggested that no HI V transmission occurred from the surgeons 
to the patients.1112 On the contrary, in one report which 
involved an HIV infected dental surgeon, five out of 1 100of 
the patients operated upon by him were found to be HIV 
positive.13 Unfortunately, it would be difficult to accurately 
identify the source of the HIV infection in these cases since 
their HIV status was not previously known. Therefore, these 
studies suggest that the risk of HIV transmission during ai 
operative procedure from a surgeon to his/her patient is very 
low. This observation justifies the result of surveys of the 
attitudes of surgeons to HIV/AIDS patients, which showed 
that most surgeons are willing to continue to operate on these 
patients,14 Some surgeons have, in fact, supported the idea 
that an HIV infected surgeon should continue to operate oa 
his/her patients despite his/her HIV status.15 This is because 
they believe that taking precautions and using safe surgical 
procedures when operating on HIV/AIDS patients markedly 
decreases the risk of HIV transmission between them and 
their patients.1618 However, there has been no study I 
demonstrate the existence of HIV transmission from surgic 
patients to surgeons.
Other modes of transmission such as liquids other tha 
blood (water), aerosols (airborne transmission) and surfac 
contact, have previously been investigated. Although son 
of the investigations were by indirect methods, it has bee 
shown that HIV can survive for up to 11 days in unchlorinale 
water especially in the presence of organic matter.19 Therei 
yet, however, no evidence for the transmission of HI V througl 
treated drinking water.9 The survival of HIV in aerosols an 
on inanimate surfaces was observed to depend on (he natun 
of the liquid medium, the ambient temperature, relatiw 
humidity and exposure to light and chemicals.20,21 Althougl 
some unexplained cases of HIV infection among heald 
workers have been ascribed to one or the other of these no* 
parenteral suspected methods of transmission22,23, it is ala 
impossible to completely exclude the more convention! 
routes of transmission in these cases.
3. Survival period of HIV in the body after death: The Hill 
has been isolated from a pericardial effusion obtained 151
CENTRAL AFRICAN JOURNAL OF MEDICINE Vol. 43 • No. 2 •  1997
days post mortem and also from blood obtained 16.5 days 
postmortem.34
4HTVsurvival in chemicals used for embalm ing cadavers: 
Suspension tests have shown that 25% ethanol and 0.5% 
fannalin are effective against HIV.25 However, extrapolation 
of these results to embalmed cadavers is difficult because 
otherfactors such as concentration gradient of the embalming 
chemicals and the tissue barrier which these chemicals have 
topenetrate in order to reach the intracellular location of the 
vims would come into play when considering their effect on 
HIV in cadavers.
Summary of Present State of Affairs.
The HIV is known to be transmitted parenterally from blood 
and other tissue fluids, tissue transplants and by sexual 
contact However, the risk of transmission from an HIV 
infected surgeon to his/her patient during a surgical procedure 
is uncertain. In addition to this, it has not been shown 
conclusively that the virus can be transmitted in aerosol form, 
in water or by surface-to-surface contact. The HIV survives 
in unembalmed human cadavers for up to 16.5 days after 
death andcould be destroyed by low concentrations of common 
embalming chemicals such as ethanol, formaldehyde, 
jjutaraldehyde, phenol and chlorine-producing disinfectan ts. 
The Way Forward.
Asaresultof the fear expressed earlier about the safety or lack 
dfit, when handling and/or using cadavers of known HIV/ 
AIDS victims in the teaching of anatomy, two options are 
Open to Departments of Anatomy. Either :- 
1 They abandon the use of real human cadavers and turn 
to the use of “virtual cadavers” if non HIV infected 
cadavers cannot be obtained in required numbers 
l  They formulate precautionary measures that will greatly 
reduce the risk of acquiring the infection.
Ifweare to achieve the fulfilment of the earlier affirmation 
tot dissection of cadavers remains the best method for 
tochingand learning of anatomy, the way forward will have 
lobe the second option.
Conclusion.
ilappears that there is a potential risk of HIV transmission 
Hsociated with the handling of HIV infected cadavers within 
to first three weeks post mortem and before they are 
inbalmed. If appropriate precautionary measures are put in 
pbee especially during embalming of cadavers, the risk of 
Wecdon could be greatly reduced if not eliminated. Therefore, 
Iffbfts should be made to study the viability of the HIV in 
tobalmed cadavers after using various chemical agents at 
toying concentrations.
Acknowledgements
he authors would like to thank Mrs J Gatawa of the 
tpartment of Anatomy, University of Zimbabwe, Harare, 
nbabwe for her clerical assistance.
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HIV/AIDS and the teaching and learning of anatomy

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HIV/AIDS and the teaching and learning of anatomy

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