Cover Image
close this bookSafe Blood in Developing Countries - The Lessons from Uganda (EC, 1995, 151 p.)
close this folderSection One - Introduction and summary
close this folderChapter One - Safe blood and HIV/AIDS: The Uganda achievement
View the document(introduction...)
View the documentThe tragedy of the haemophiliacs
View the documentInfections carried by blood
View the documentThe unique features of Africa
View the documentThe global blood safety initiative
View the documentThe Uganda blood transfusion service: A portrait
View the documentThe wider contribution of the UBTS
View the documentThe view from an up-country hospital
View the documentThe matter of costs
View the documentThe dynamics of the project
View the documentA complex organisation
View the documentA view from Mulago hospital, Kampala
View the documentFour questions about AID
View the documentThe first visit for the EC
View the documentDr John Watson-Williams enters the scene

The tragedy of the haemophiliacs

Blood transfusion as we know it today began during World War Two, when so-called 'battlefield medicine' mastered the use of blood and products derived from blood. Since then, blood and blood products have become a major international industry, with the USA for example accounting for 60 per cent of the world trade in blood plasma. Blood products include cells in the blood, platelets, plasma, and products derived from the plasma itself, one of which, factor VIII, is important for haemophiliacs and came to have its own tragic place in the history of safe blood.

It was in 1982 that the US Centers for Disease Control first reported cases of AIDS among people with haemophilia. Indeed, the recognition, as early as 1983, that HIV could be carried by blood transfusion sprang from this association with haemophiliacs, and it was the haemophiliacs that were to pay a heavy price for this discovery.

Haemophilia is a hereditary bleeding disorder, and occurs almost everywhere in the world. It affects 20 out of every 100,000 males born. By the early 1970s, blood clotting concentrates became a standard way of treating haemophiliacs, improving and prolonging their lives. Many, in the USA at least, took 40 to 60 blood infusions a year. But some of this blood was HIV-contaminated, in the years before the presence of the virus was recognised.

As a terrible consequence, AIDS is now the leading cause of death among haemophiliacs. From haying one chronic and sometimes lethal disorder, they have, unknowingly, been inflicted with another, almost always lethal disease. About 50 per cent of all people with this hereditary blood clotting disorder in the USA have HIV.

There have been numerous court cases in the USA, in an effort to pin down the blame. Most of the law suits brought by haemophiliacs or their survivors against US drug companies have failed. But one litigant who contracted HIV in 1984 has won around half a million US dollars in a case brought against the American Association of Blood Banks, and a fund of around US$ 150 million is being set up by the industry to compensate HIV-infected haemophiliacs-possibly 6,000 of them.

In the UK, after a political row, a similar compensation fund was set up for haemophiliacs. In France, the former director of the French national blood transfusion service was sent to prison for four years, and the service's former head of research and development was sent to prison for two years, for allegedly allowing HIV-contaminated blood to go into distribution in the mid-1980s.

There was a serious scandal in Germany over supply of contaminated blood, allegedly as late as 1993, leading to officials of a blood products company being put on trial on charges of fraud and causing bodily harm. In both France and Germany, where over 40 per cent of haemophiliacs have the HIV virus, there have been attempts to determine the responsibilities of senior politicians, serving or former, in the blood scandals. There have been enquiries in Switzerland and in Canada, where it has led to proposals for a drastic reorganisation of the blood service.

The point of rehearsing these often sad facts is that safe blood did not come easily even to the richer countries of Europe and the Americas. It came only after scandal, recrimination, punishments, deaths of the innocent, and widespread political pressure. How much more difficult and painstaking must it be to establish a safe blood supply in countries with far fewer resources and skilled people?