In Tamil Nadu, a pregnant woman recently tested positive for the human immunodeficiency virus after blood transfusion. The donor had been unaware that he was infected. The man had tested positive or HIV when he donated blood at a government hospital two years ago but was never told about it. Three members of the staff at the government hospital have now been suspended for negligence. But the story points to larger worries about blood safety in India.

As of 2017, India had the third-largest HIV epidemic in the world. According to the National AIDS Control Organisation, infection through blood transfusions accounted for less than 1% of the cases. Given that 2.1 million people were living with HIV in India in 2017, that is still a significant number. Data revealed by the National AIDs Control Organisation showed that 2,234 people reported they had been infected by HIV through blood transfusion across states in India between October 2014 and March 2016. The organisation clarified that the cases were self-reported by the patients and had not been independently verified. Still, it is a worrying number, with states like Uttar Pradesh, Gujarat and Maharashtra occupying the top of the charts. About 84% of all blood collected by the National AIDS Control Organisation came from voluntary, unpaid donations.

As this report in Lancet points out, there are guidelines which stipulate that donated blood be screened for HIV, malaria, Hepatitis B and C, syphilis and malaria. But flaws in the system remain, both for unpaid and professional donations. Campaigns organised by social and community organisations focus more on “quantity rather than quality”. Vital steps such as counselling volunteers before donations and the assurance of proper screening and storage are often skipped, the report said.

While there is a policy for voluntary donations, professional donors seem to inhabit a regulatory wilderness, where there is no way of tracking their previous testing results or verify the information submitted. Then there are flaws in the screening process, which is often shoddily implemented. Even blood banks supported by the National AIDS Control Organisation often lack quality equipment for the screening process, not to mention corrupt practices by the personnel involved. The situation gets more complicated with a bevy of independent and hospital-based blood banks which are monitored by a number of government agencies, with no well-defined guidelines for monitoring.

India has made some progress in battling its HIV epidemic: between 2010 and 2017, AIDs related deaths and new infections went down significantly. According to the National AIDs Control Organisation, HIV infection through blood transfusion accounted for 8-10% of cases about 20 years ago, which means the situation has improved. But in 2017 alone, new infections increased from 80,000 to 88,000 and AIDS related deaths went up from 62,000 to 69,000. The numbers are still too huge for regulatory authorities and the government to rest easy.