主题：80-90年代的美国：输血引起的艾滋病 -- 南之

Introduction

A nation's blood supply is a unique life-giving resource and an expression of its sense of community. In 1993, voluntary donors gave over 14 million units of blood in the United States (Wallace, et al. 1993). However, the characteristic that makes donated blood an expression of the highest motives also makes it a threat to health. Derived from human tissue, blood and blood products can effectively transmit infections such as hepatitis, cytomegalovirus, syphilis, and malaria from person to person (Institute of Medicine 1992). In the early 1980s, blood became a vector for HIV infection and transmitted a fatal illness to approximately half of the 16,000 hemophiliacs in the United States and to over 12,000 blood transfusion recipients (CDC, MMWR, July 1993).

AIDS emerged as a threat to the safety of the blood supply in the early 1980s because of a unique confluence of events. Medical breakthroughs in cardiac surgery and other areas resulted in greater use of whole blood and its components. A new treatment for hemophilia, home infusion of AHF concentrate, grew rapidly and significantly improved the health and increased the life span of individuals with hemophilia. In addition, much of the medical community, as well as the country as a whole, believed that epidemics of infectious disease were a thing of the past. There were also many changes occurring in the government and society, such as a presidential mandate to lessen the regulatory role of government and increased public awareness that the homosexual population was enduring stigmatization and discrimination (Bayer 1983).

As evidence for blood-borne transmission of AIDS accumulated in 1982 and 1983, the Public Health Service had to deal with a very difficult problem. On the one hand, the U.S. blood supply was barely adequate to meet the urgent needs of day-to-day patient care. On the other hand, there was growing evidence that a blood transfusion posed a risk of causing a disease that was proving to be fatal for many. However, both the magnitude of the risk and the prognosis were still unknown. An examination of the efforts of the Public Health Service and others to cope with this problem provides a remarkable window into the making of public policy under duress and uncertainty.

Perhaps no other public health crisis has given rise to more lasting anger and concern than the contamination of the nation's blood supply with HIV. In response, blood recipients and individuals with hemophilia who were infected during this period, their families and their physicians, and public and private officials with responsibility for blood safety have asked a series of questions: Could this tragedy have been averted? What institutions, policies, or decision processes, had they been in place in the early 1980s, could have helped to

HIV INFECTION VIA BLOOD TRANSFUSION

Transmission of HIV occurred via fresh blood (whole blood, packed cells) and fresh blood components (platelets, fresh frozen plasma, etc.) as well as AHF concentrate. Most of the individuals were tested when the HIV test became available in 1985 and thus, the number of those that became infected is well documented. In December 1987, the CDC reported that of the estimated 15,500 hemophiliacs in the United States, approximately 9,465 (63 percent) were infected with HIV (CDC, MMWR, 1987b). Estimates of HIV infection in other patients (medical and surgical) due to transfusion are more difficult to obtain. A study by the CDC summarized data up to June 1992, by which time 4,619 persons (excluding hemophilia patients) had been reported with transfusion-associated AIDS. This number is thought to be an under-reporting because patients die from their basic disease before developing AIDS (as 50 percent of patients receiving transfusions die within six months) (Barker and Dodd 1989). On the other hand, some patients that are infected may not have been tested up to this day.