Tainted Blood Supply Spreads
HIV/AIDS In Poor Nations

By Alan Mozes

NEW YORK (Reuters Health) - A combined fear of disease and lawsuits have led most wealthy developed nations to adopt a "zero tolerance" policy regarding HIV contamination of the blood supply, researchers have found. But 10% of all new HIV infections in developing countries, they say, are now due to transfusions of tainted blood.
Meanwhile, governments of these developing nations are struggling to develop and enforce measures to make their blood supplies safer.
"In the developed countries I think the blood supply situation is well handled," said study co-author Dr. Charles Bennett of Northwestern University in Chicago, Illinois. "But in the developing countries it's a completely different story. It's just a tragedy."
Bennett and his colleagues reviewed over 20 years of blood safety records, testing standards and legislative histories in several developed countries, including the US, France, Great Britain, Japan, Canada and Germany, and developing countries including India, Pakistan, China, Vietnam and Thailand.
The research team found that in developed nations the initial lack of coordination among competing public health agencies has for the most part given way to an increasingly centralized process for blood screening for HIV, hepatitis C virus (HCV) and other infectious diseases.
They note that recent criminal investigations have revealed that in most nations the organizations responsible for blood safety made many mistakes when the AIDS epidemic began in 1981. Delays in recognizing the risks and implementing adequate testing resulted in thousands of HIV infections among hemophiliacs who received tainted transfusions.
The investigators found that more than 20 developed nations have acknowledged such mistakes and have provided financial compensation to victims and their families. And in their report published in the Annals of Internal Medicine, Bennett's team concludes that cutting-edge screening technology has made the risk of such infections extremely low today.
But the authors paint a very different picture when it comes to blood safety in the developing world. Upwards of 45% of all blood donations in poor nations go unscreened for HIV, HCV or hepatitis B, they note. Such donations, the researchers say, are directly responsible for the infections of hundreds of thousands of transfusion recipients.
Bennett and his colleagues note that as recently as 1996, roughly 95% of the blood supply in India was deemed unsafe. And they point to the problem of paid blood donors, who supply a major portion of the blood pool in many developing nations. These donors, the authors note, have an incentive to donate as much and as often as possible regardless of their health status.
China is particularly vulnerable, they point out; 60% of that nation's blood supply comes from paid donors. The researchers observed that HIV infections in China often result from the use of old needles to draw blood, as well as the mixing of multiple donations and readministration of the potentially tainted blood to donors so they can give blood again more quickly.
"The China story is really one of the most tragic stories you can identify," Bennett told Reuters Health. "And at the end of the day it could be hundreds of thousands who become infected with HIV."
Bennett stressed that countries that have achieved a safe blood supply need to reach out to help those who have yet to do so. "The blood supply system in the developing countries need a partnership with richer nations to develop the infrastructure," he said. "They just can't do it on their own."
SOURCE: Annals of Internal Medicine 2002;136:312-319.
Copyright © 2002 Reuters Limited. All rights reserved.

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