摘要：Blood transfusions transmit HIV more effectively than other means, yet there has been little examination of their role in the origins and early course of AIDS in sub-Saharan Africa. We review historical data in archives, government reports, and medical literature from African and European sources documenting the introduction, establishment, use, and growth of blood transfusions in sub-Saharan Africa. These data allow estimation of the geographic diffusion and growth of blood transfusions between 1940 and 1990. By 1955, 19 African colonies and countries reported transfusion programs—with national rates of 718 to 1372 per 100 000 by 1964, and urban rates similar to those in developed countries. We estimated 1 million transfusions per year in sub-Saharan Africa by 1970 and 2 million per year by the 1980s, indicating that transfusions were widely used throughout sub-Saharan Africa during the crucial period of 1950–1970, when all epidemic strains of HIV first emerged in this region. THE TRANSMISSION OF blood-borne viruses by unsterile medical practices (including vaccinations, therapeutic injections, blood transfusions, invasive tests, and surgery) are known to be implicated in the contemporary AIDS pandemic 1 and may have played an important role in the origins and emergence of HIV in Central and West Africa in the mid-20th century. 2 The special importance of blood transfusions and blood products for the transmission of HIV was recognized in both Africa and the developed world in the early years of AIDS because they transmit viral infections far more effectively than any other means. 3 According to one recent study, heterosexual transmission has an efficiency of 0.01% to 0.2%; unsterile injections, 0.30%; and maternal–child transmission, less than 30% to 35%. In contrast, blood transfusion is more than 90% efficient. 4 Despite some initial delays in responding to these risks, most countries now strive to protect their blood supplies and to ensure safe medical injection and disposal practices. 5 But this was not always the case—especially in the developing world, where even today the blood supply is often not fully protected. 6 Although the risks associated with transfusion were recognized early, the implications about the origins of HIV in sub-Saharan Africa have been slow to be examined. In part, this followed from the simple fact that the availability in 1985 of the HIV test to screen blood came decades after the emergence of HIV and the onset of the AIDS epidemic in that region in the 1960s. Yet even after the African epidemic was recognized, there has been virtually no examination of the historical role that transfusions might have played in sub-Saharan Africa during this critical period, perhaps because of the common assumption that blood transfusion was not widely practiced there until recently. 7 For example, in a recent review of competing explanations about the crossover of simian immune viruses to humans, the possible role that the new technology of injections played in opening new means of spreading pathogens among humans is included, but no mention is made of blood transfusion. 8 Finding no other reference to transfusions in the literature on the beginning of HIV/AIDS in Africa, 9 we have undertaken this historical overview of the conditions and circumstances surrounding the introduction of blood transfusions into sub-Saharan Africa beginning in the last period of colonial rule (late 1940s to early 1960s), when HIV-1 first emerged in Central Africa. 10 In addition to contributing to the discussion of the origins of HIV, this research also offers a valuable case study of the introduction of new medical technologies in the developing world.
