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NATURE. 1994 Jun 9; 369(6480):429.Receiving a transfusion of HIV-contaminated blood carries a roughly 95% risk of HIV infection compared with a 0.1-1.0% risk through sexual transmission. Accordingly, industrialized countries began screening blood supplies for HIV ten years ago. Blood screening in the overwhelming majority of developing countries, however, remains patchy. 10% of seropositives in these latter countries are still being infected with HIV through transfusions, with transfusions still accounting for 5-10% of infections worldwide. Nonetheless, blood safety has not been given priority by the international community. Even before HIV was recognized for the infectious agent which it is, most developing countries offered only inadequate and poorly coordinated blood services plagued with no refrigeration, bacterial contaminants, and a lack of basic testing facilities for common agents. The present lack of screening for HIV combines with the high number of infected donors to make clearly unsafe blood supplies. Officials in these developing countries, however, are loathe to admit their blood is unsafe, while international agencies do not want to expose individual countries for fear that they will be accused of failing to provide proper support. There has definitely been a lack of coordination and operational mismanagement among international organizations. Some World Health organization (WHO) officials feel that it is better to invest in preventing the sexual transmission of HIV. This sentiment is manifest in the phasing out of funding for HIV blood screening in the Global Program on AIDS and the failure of the Global Blood Safety Initiative to get off the ground when announced five years ago. The recently approved establishment of a new blood safety unit will hopefully not succumb to the same underfunding and understaffing suffered by its predecessor. In closing, the needs to build production facilities for blood substitutes and to manage blood only after considering local cultures with proper staff training and foreign supervision are stressed.