Dr Lieve Fransen's report

As we have seen, Dr Lieve Fransen was hired as a consultant in April 1987 by the EC to go to Uganda to investigate and make recommendations. This was only a few months after Commissioner Natali's declaration and immediately prior to the important donors' meeting to be held in Kampala in May of that year, already referred to in Chapter Three. Here is the crucial except from her report:

'Heterosexual activity is the major route of transmission [of HIV] accounting for as much as 80 per cent of all new cases. However, blood transfusions with HIV infected blood is also a very effective mode of transmission to a group of the population which would not be infected otherwise.

'For several reasons the importance of transfusion as a mode of transmitting HIV infection is much greater in Uganda than in most industrialised countries. First, the seroprevalence of HIV infection in the general population is very high [then put at 15 to 20 per cent], transfusions are given much more frequently in Uganda than in industrialised countries, and more than 50 per cent of the transfusions go to children with malaria.'

The Nakasero blood bank under reconstruction

The Ugandan government had stressed that the prevention of AIDS in high risk groups and among young children before the age of sexual intercourse was a priority strategy. But the significance of this proposal to help Uganda clean up its blood supply went wider.

'The prevention of this mode of transmission is technologically feasible and the high rate of seropositivity among blood donors makes this intervention more cost-effective than in Europe. In addition, the improved medical use of blood transfusions, and the greater availability of properly stored and screened blood, will have a positive effect on health and health systems in general.'

The central recommendation (quickly accepted) was that: 'the area of choice for long-term support by the European Commission would be to rehabilitate the blood transfusion facilities in Kampala and its surroundings, as a first phase, and provide HIV negative blood for these regions. This would achieve protection from HIV infection for the young, children, and the as yet uninfected, and therefore be a major contribution in prevention of AIDS among the future generation.'

There can be no denying the emotive force of this appeal to save 'the future generation', just as there can be no denying the financial appeal of a cost-effective intervention. Also, it is interesting that this was defined, even then, as a first phase. Later, as phase two, the safe blood programme was extended to the whole of Uganda.

So it came about that the restoration of a safe blood supply for Uganda became the EC's first major project in the AIDS field; formed the immediate impetus for the setting up of the AIDS Task Force to help the EC in its new task; and provided a candidate for the job of director of the new AIDS Task Force, namely Dr Fransen herself, who held that post for the next 6 years, until she joined the new Health and AIDS Unit within the Commission.

But a recommendation was all very well. An agreement to fund the project was even better. But who was actually going to do it? Without someone to do it, any plan is mere paperwork. Here coincidence played its part, for in Kampala at the same time was Dr John Watson-Williams, whose presence and purpose for being there on behalf of the Red Cross are explained on page 38. Dr Watson-Williams soon emerged as the choice for EC technical assistant to carry out the project on the ground. His personal account of what he did, and how.