Between 1991-1995, a plasmapheresis campaign was organized by the Henan provincial government in China to have residents give plasma in exchange for money. The campaign called “Blood Plasma Economy” attracted over 3 million people, who were mostly peasants. The program’s success was due to the high demand by biotech companies.

Despite the success, a terrible scandal brought an ugly end to this campaign. Because of poor safety standards, an estimated 40-60% of people have subsequently contracted AIDS in the mid ’90s. And almost after a decade since it broke out, an estimated 1.2 million people had been infected with AIDS in Henan Province alone in 2003.

But how did China come to a terrible fate that affected a huge number of its population? Who should be blamed for it and how can they recover from such health scandal that scarred the country’s reputation?

How AIDS has spread in China

History of the Blood Plasma Trade in China
China adopted a paid blood system from 1949 to the late 70′s in which during those years, blood from clinics was acquired through a sell-and-buy relationship. It was only in the 1980s that China started to encourage people to donate blood for free. But it seemed that people are more motivated to give a pint when there’s money involved. Though this practice effectively reduced the transfer of infectious diseases, it was unsuccessful and failed to bring in more donors.

Less local blood donors meant more imported blood products. Because of this, almost all blood products used in Chinese hospitals were imported before the 1990′s. But health issues in developed countries prompted the Chinese government to limit or halt blood products importation such as human blood albumin, plasma, globulin and hemoblast.

Therefore, China saw an out-pour of foreign investment, technology and equipment to establish and support blood product enterprises into the country in the early 1990s. The province that took a leading position in establishing plasmapheresis stations was Henan, which was China’s poorest and most populous province.

The first decade of the 90′s saw the booming of plasma economy in China. From 1993-1994, the plasmapheresis industry in Henan served as the way for peasants make money and fight poverty.

Promises of extra penny lured the residents to tap their veins and thus lined up almost every day for years to make donations. Vans were turned into mini-clinics; people sold extra if there was an upcoming marriage or if they wanted to build a house. One local resident admitted to making four donations in a single day.

Money had truly driven these people to push themselves to their limits. Little did they know there was a consequence waiting and a price to be paid.

Spread of AIDS through Plasmapheresis
And because selling plasma was the only sensible way for peasants to earn money during those times, more and more people queued in plasma centers and rolled up their sleeves as often as they could.

When selling plasma, the donor undergoes a process called “plasmapheresis”, where blood plasma is taken from the body, while the remaining blood parts such as platelets and red blood cells are sent back to the body. First, the whole blood enters the centrifuge, the machine separates the blood into its different parts (plasma, red blood cells and platelets), takes the plasma then returns the remaining parts into the donor’s body.

The blood plasma taken will be sold to pharmaceutical companies to produce life-saving plasma-derived therapies for a range of chronic, rare and genetic diseases. Since most of the donors were uneducated farmers, the plasma centers had low health and safety standards, and lacked proper sterilization procedures. To cut costs, some stations mixed many bloods in the same centrifuge and the needles, blood bags and other instruments and containers which had direct contact with human blood were recycled. This poor sanitation practice resulted to blood contamination that led to the advent of the AIDS outbreak in China.

Nobody gets the blame
The infamous AIDS epidemic outbreak in some provinces in China was worthy of a serious investigation, but what angered most victims and affected families were the Chinese government’s indifference towards the issue.

Activists and victims complained that not a single official was penalized for his role in the plasma trade. Instead, anyone who would come out in the open to voice their grievance are the ones who got punished.

An article from The Guardian dating back in 2003 revealed that some HIV-positive villagers were arrested and beaten for attempting to draw attention to their dilemma, health officials were harassed and sued for disclosing information, and local print reporters were fired for struggling to publish the truth.

A Chinese activist by the name of Li Xige, who was infected by HIV from a transfusion during caesarean operation, was placed under house arrest in December 2006 after protesting outside the health ministry in Beijing in July. A famous writer named Yan Lianke wrote a semi-fictional novel based on visits to an AIDS village in Henan but his book was banned in a secret order issued by the government as soon as it arrived in bookstores in 2006. A 79 year-old retired doctor, Gao Yaojie, who was helpful in exposing the extent of Henan’s HIV infection and now takes a big role in private relief efforts for Henan’s HIV carriers, said she believed her telephone was tapped and was worried that someone might kill her.

Criticism of Chinese Government’s Lack of Action
The Chinese government was criticized for being passive and having little concern about the AIDS outbreak in the early 1990s.

In February 2003, the country received $30 million from the Global Fund to Fight tuberculosis, malaria and AIDS, but the budget allocated was used only for the prevention of TB and malaria because the sleeping giant insisted on having only about 30,000 AIDS victims in its population.

A blogger also questioned the Chinese government’s lack of interest and political will to enforce proper regulation requirements and standard health protocols on blood collection units even if they have the power and resources to do it. Instead of taking immediate action, it took almost 6 years for local governments to close the illegal blood and plasma centers in the area.

More plasma centers closed in China
An article on South China Morning Post published in August 2012 reported that Guizhou province has closed 80% of its blood collection. The closure of plasma centers in the province, which supplies almost 30% of China’s blood plasma, raises assumptions of pre-emptive measure to keep history from repeating itself.

Chang Kun, an AIDS activist, supported the government’s action and said it’s better to lock them down before something serious happens. But a local health department official said that the adjustment was a regular change that happens every 3 years and the significant reduction in the number of blood collection sites was purposely done to keep the Guizhou residents in better health. It has been reported earlier that county governments had planned to close plasma centers because there had been irregularities in the province such as too much plasma collection, frequent collection and low criteria for plasma donors.

Conclusion
The AIDS epidemic in China is something that could have been avoided if plasma centers had been responsible and careful enough in implementing proper health sanitation. There’s nothing we can do now to alter the situation. Many have already died from a disease they never knew they had and many are still suffering from a fate they never chose to take. The best we can do is to learn from the lessons “Plasma Economy Campaign” has taught us: that plasma centers must prioritize the safety of its donors over profit and plasma donors must learn their limitations in plasma donation.

With this, we have come to the conclusion that proper education among plasma donors is imperative. Plasma centers must give lectures or explain to the donors the benefits and effects of plasma donation to their bodies before signing them up for donation. Donors must be fully aware where their plasma will be used – that it’s for creating life-saving products for patients with blood disorders – in that way, they would donate plasma not just for monetary reasons but because they know they could help.

We are not discouraging potential and regular plasma donors to give plasma, we are just here to stress the importance of practicing safe plasma donation procedures to protect both the donors and the recipients. After all, health is still wealth.