Blood transfusion services were poorly developed until the mid 1980s in most of sub-Saharan Africa, and were unable to provide adequate supplies of blood with acceptable safety. The pandemic of HIV was recognized seroepidemiologically from 1985 onwards. Blood transfusion was contributing from 10 to 15% to transmission in Africa. Groups at highest risk are children with malaria and anaemia, women with pregnancy-related haemorrhage or anaemia, victims of trauma and subjects with sickle-cell disease. Haemophiliacs are not a major risk group in comparison. Blood transfusion services have undoubtedly benefitted from the international, national and regional responses to the AIDS epidemic. Organizational structures have been established. There have been concerted moves to recruit voluntary unremunerated blood donors, selected from population groups with low seroprevalence. Serological screening for HIV, hepatitis viruses and syphilis has been introduced or strengthened. Standards for blood group serology, blood storage and handling have been improved. Guidelines for the appropriate use of blood have been formulated and adopted. There have been many training and retraining programmes. Much remains to be completed, however, using national and international resources, before the blood supply reaches acceptable standards of safety and is adequate in remote as well as in central areas of Africa.

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