During the HIV
epidemic in the 1980s, more than half of the hemophiliac patients living in
many countries, including the United States, France, Denmark, and Japan, became
infected with HIV as a result of blood transfusions with contaminated blood or
blood products.[1,2] Since the clotting factor needed to treat hemophiliacs was
manufactured by pooling plasma from thousands of donors, even one HIV-infected
donor could contaminate the entire supply, infecting hundreds.
Several developed countries faced civil litigation that
resulted in the indictment and imprisonment of government officials and
industry leaders for their role in the mismanagement of the blood supply.
Investigations of these individuals revealed that they delayed the
implementation of donor screening policies and/or technologies used to screen
donors and blood supplies for HIV.
Fear of future litigation combined with the development and
implementation of blood donor screening policies and screening tests in the
last 17 years have helped to ensure the safety of the blood supply in developed
countries. Many developing countries, however, have been struggling to adopt
similar safety measures.
Most developing countries cannot afford, nor do they have
the infrastructure required, to implement the effective yet costly methods to
ensure safety employed in developed countries. Some 13 million units, or up to
45% of blood donations in developing countries, are never tested for infections
transmissible by transfusion.[3,4]
In addition, donors in developing countries are often
compensated monetarily, attracting people living in poverty who have a high
risk of carrying HIV, hepatitis C virus, or hepatitis B virus. These people
often donate frequently without regard to the status of their health and the
risk to others.
Thus, 10% of new HIV infections in developing countries are
estimated to result from transfusions using infected blood and blood
1. World Health Report 1996Executive Summary. World
Health Organization (WHO), 1996.
2. Grmek MD: History of AIDS: Emergence and Origin of a
Modern Pandemic. Princeton, NJ, University Press 1990.
3. Weinberg PD, Hounshell J, Sherman LA, Goodwin J, Ali S,
Tomori C, Bennett CL: Legal, financial, and public health consequences of HIV
contamination of blood and blood products in the 1980s and 1990s. Ann Intern
Med 136:312-319, 2002.
4. Blood Safety . . . For Too Few. WHO. Press release. April
5. Jayaraman KS: HIV scandal hits Bombay blood centre.
Nature 376:285, 1995.
6. The World Bank Group: India’s national AIDS control
program. Available at www4.worldbank.org/sprojects/project.asp?pid=P045051. September 1999.
7. Kapoor D, Saxena R, Sood B, Sarin SK: Blood transfusion
practices in India: Results of a national survey. Indian J Gastroenterol
8. The Panos Institute: Safe blood: An affordable right?
Available at http://www.aegis.com/news/panos/1996/PS960601.html. June
9. Vietnam says dozens of blood donors are HIV positive.
Reuters. October 17, 1997.
10. Tomlinson R: Chinese clamp down on blood products.
BMJ 314:93, 1997.
11. Pomfret J: The high cost of selling blood: An AIDS
crisis looms in China, Official response is lax. Washington Post January
12. Keeping China’s blood supply free of HIV. U.S. Embassy
Beijing sixth of seven reports. Available at http://www.usembassy-china.org.cn/english/sandt/webaids5.htm.