Paid donation and plasma trade: unrecognized forces that drive the AIDS epidemic in developing countries

The commercial plasma industry and blood trade can fuel the transmission of HIV in a community by the most efficient way in which HIV is transmitted: the parenteral route. Paid donors get infected at the time of donation through practices like the re-use of needles, and/or injecting human blood. Paid donors from developing countries are a major source for plasma used by the pharmaceutical industry, that in 1999 fractionated 26 million litres. Paid donors also constitute an important source of blood for local use, contributing to rapid transmission of HIV through blood transfusion. This happened in Mexico in the 1980s and more recently in China. This route of HIV transmission can be efficiently prevented through a global safe blood programme and there is an urgent need to combat the epidemic.