KEEPING CHINA'S BLOOD SUPPLY FREE OF HIV

U.S. Embassy Beijing April 1997 Sixth of seven reports

Summary. Contaminated blood has been an important route for the spread of HIV and other blood-borne diseases in China. Inadequate laboratory tests often results in the entry of contaminated blood sold by unhealthy donors into the blood supply. The eighty percent of the blood test kits used in China do not meet Chinese Ministry of Health standards give an excessively high number of false negatives. As a result contaminated blood is sometimes not detected. During the last two years, in many areas blood donation centers have been inspected and some closed. Several provinces now require physical examinations of all blood donors. Chinese blood banks must often rely on blood sold by professional blood donors and migrant workers in order to meet their needs. Truly voluntary blood donation does not exist in China. Work unit inducements and new legislation such as the Sichuan Provincial law that requires all citizens to give blood once every five years, may, however increase the quality of the blood entering Chinese blood banks. End summary.

HIV Contaminated Blood Often From Poor Who Sell Blood

Incidents of HIV infections through blood given by HIV-infected donors or HIV infection given to blood donors by unsterilized needles occur throughout China. Cases of blood borne diseases spread by improper practices at blood collection centers has brought considerable government and public attention on the safety of the blood supply. Truly voluntary blood donation is unknown in China. Even where blood donation is ostensibly voluntary, in practice blood donation is expected by the work unit and often rewarded with two or three weeks of paid leave. Some people who earn money by giving blood are in poor health. These blood donors sometimes include drug addicts and prostitutes who may have STDs or other blood-borne diseases. Contaminated blood products, diseases transmitted to blood donors by dirty needles and other poor medical practices have spread the HIV virus and other illnesses.

Poor Laboratory Techniques, Inconsistent Attention to Standards

According to a Western physician with considerable experience in China, blood is tested using Chinese-made blood test kits that are often of poor quality. Pipettes used in lab work are washed and reused even where test accuracy and safety dictates that pipettes should be disposed. Standard procedures are not followed. In some Beijing hospitals lab technicians are afraid to test blood for HIV. Blood in the elite system might be tested five times in this way to assure quality, but five poor quality tests do not equal one good test, the physician said.

Poor Quality HIV Test Kits, Poorly Trained Medical Workers

A Chinese public health official told Embassy Environment, Science and Technology section officer that only five Chinese made blood-testing kits have been quality certified by the Chinese health authorities. Recent studies done by Beijing Municipality public health officials have shown, said the official, that the Chinese government certified HIV test kits are comparable to imported kits in their low rate of false negatives and false positives. These high quality blood testing kits, however, comprise only 20 percent of the blood testing kits used in Chinese hospitals and clinics, said the official. The approved kits are much more expensive than the unapproved Chinese-made blood testing kits. Clinics involved in blood transfusion are required to use the certified kits but the uncertified kits are widely used in Chinese hospitals and clinics said the official.

Blood Center HIV Contamination in Beijing Suburb

One of the worst incidents took place in mid-1996 in the Beijing suburb of Langfang where blood collected from poor people for payment contained HIV which infected at least several dozen blood recipients. One official said that this incident shocked the Chinese central leadership since the Langfang hospital supplies blood for some Beijing hospitals used by the official elite. As a result of this incident, which was never reported in the Chinese press, a high Ministry of Health official was nearly fired.

Paid Donors Forced Into Groups by Blood Pimps

According to a front page report in the March 21, 1997 Nanfang Zhoumou weekly newspaper, in the Guangdong Province city of Xunde, groups numbering about blood donors each are kept together in rented hotel rooms by blood pimps [xietou]. The 'donors' pay one-sixth of their payment plus 10 RMB rent per day. To raise productivity, the blood pimp gives the blood donors medicines (which donors take up to three times daily) to increase blood volume and disguise disqualifying medical conditions. The professional blood donors told the journalist that many circulate among blood centers in Guangdong and Fujian provinces in order to give blood more frequently. The donors give 400 - 500 ml of blood five or more times each month. The Chinese government Price Bureau sets the price of blood at 50 RMB (about US$6.50) per 100 milliliters after deductions for the blood pimp and rent, so a professional blood donor giving blood five times monthly would clear RMB 500 (US$63) per month.

A Blood Bank Director's Perspective

Wu Jianning, director of the blood bank at the First People's Hospital in Xunde, Guangdong told the Nanfang Zhoumou journalist (who was accompanied by Guangdong Province health officials), "Ever since we set up blood banks, the system has been organized by the blood pimps (xuetou). The main reason is that we have no blood donors in this area so we have to depend on people who come from other places -- workers and some professional blood donors. These donors have no fixed address and often move so it is very hard to keep track of them. Therefore we asked for "a contact person" to manage them as a group and bring them and to bring them in to give blood."

The Nanfang Zhoumou journalist commented that the situation at the Xunde blood bank, founded in 1988 and the first of three central blood banks in Guangdong Province, is not unique to southern China but is a nationwide phenomenon. According to the Guangdong provincial health authorities, by far the greatest part of the 150 tons of blood used clinically in Guangdong Province during 1996 came from paid blood donors. The Guangdong provincial health authorities want to establish 21 blood collection centers independent of hospitals which will have paid staff that will manage contacts with individual blood donors in order to eliminate the deleterious effect of blood pimps on the quality of the blood supply, concluded the Nanfang Zhoumou article.

Many Unsafe Blood Centers Closed, Physicals for Donors and Increased openness about the HIV/AIDS challenges that China faces

The Ministry of Health closed down 579 blood collection centers and corrected improper practices at 738 others during 1995. Henan Province rejected one-third of its 790,000 paid blood donors after physical examinations were instituted in 1995. The Province issued blood donation permits to 550,000 people who passed the examination. Several provinces now train blood donation center workers to ensure that the donated blood is safe and that people donating blood do not get infected. However, according to a December '96 report in the newsweekly Nanfang Zhoumou, hepatitis infection as a result of blood donation is common in some rural areas of southern China.

Almost No Truly Voluntary Blood Donation in China

Encouraging blood donations is an important part of the Chinese strategy to ensure blood supply safety. Yet these donations are not truly voluntary. Many Chinese work units encourage voluntary blood donations by giving employees one or two weeks of vacation, a bonus, or a higher place on the housing waiting list if they give blood. New Chinese provincial and national legislation strongly encourages blood donations. A December '96 Sichuan Province law requires all adult Sichuan residents under age 55 to give blood at least once every five years.

In this type of 'voluntary' blood donation system, where blood is obtained by a legal requirement imposed upon citizens by law or by work unit inducements. This new system may be preferable to the current one which relies largely on poor people but it is still not a truly voluntary system that would encourage people in poor health to self-select out of the blood pool. While truly voluntary blood donation in which there is no social or economic pressure to give blood and people feel completely free to say 'no' does sometimes occur, this is far from typical. In general, there is very little truly voluntary blood donation in China.

AIDS Series

This is the sixth in a series of seven reports from Embassy Beijing on HIV/AIDS in China available on the Embassy web page at http://www.usembassy-china.org.cn/english/sandt/index.html . The first report summarized the series. The second report examines Chinese official estimates of HIV/AIDS in China and weaknesses in the data upon which official estimates are based. The third report summarizes Chinese Minister of Health Chen Minzhang's views on the HIV/AIDS in China and China's strategy for responding to the challenge of HIV/AIDS. The fourth report discusses what Chinese experts say about the effect of the rapid increase in the numbers of intravenous drug users and in cases of sexually transmitted diseases on the spread of HIV/AIDS in China. The fifth report discusses AIDS and homosexuality in China. This sixth report examines the spread of HIV through the contamination of the Chinese blood supply. The seventh report looks at the Chinese government's response to HIV/AIDS including efforts to clean up the blood supply, education about HIV and STDs, mobilization of Chinese NGOs and increased Chinese cooperation with Australia, the European Union and UN agencies such as UNAIDS in HIV/AIDS prevention, education and research.