Infections from blood products contaminated with HIV

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In the early 1980s, infections caused by HIV-contaminated blood products occurred worldwide . Only since effective countermeasures have been taken has the importance of this route of infection and thus the risk of infection with the HIV virus from blood transfusions declined significantly. In 2017, for example, the probability of HIV infection through blood supplies in Germany was estimated at 1:10 million. In order to achieve this, it was particularly important to understand the cause of the disease and thus also the various routes of infection .

In 1981 the US Centers for Disease Control and Prevention (CDC) recognized the first signs of the AIDS epidemic. However, it was not until May 1983 that a group of researchers led by the French Luc Montagnier and Françoise Barré-Sinoussi isolated the HI virus so that more targeted countermeasures could then be taken. By quickly and consistently introducing the various measures, many infections with the HI virus through blood products could have been prevented. Even in most of the industrialized nations, the various measures were introduced late or only with little consistency. In various countries, this inconsistent or delayed introduction of countermeasures and the use of blood products known to contain some HIV virus has been referred to as a "blood scandal".

Delayed or inconsistently implemented countermeasures

Delayed exclusion of risk groups from blood donations

Certain groups are classified as risk groups for donating blood . So today in Germany z. B. homo- and bisexual men, prostitutes , drug addicts, prisoners and people with frequently changing sex partners are excluded from donating blood (see exclusion criteria for blood donation ).

In July 1982 the CDC reported three haemophiles (haemorrhea) who had become infected and warned of possible contamination from blood products. On June 20, 1983, the French Directeur Général de la Santé Jacques Roux issued a circular prohibiting the collection of blood in risk groups. Nonetheless, on January 13, 1984, Myriam Ezratty, director general of the prison administration, issued a circular to regional directors asking them to increase the frequency of blood donations in prisons.

In the USA until 1985, companies also took donations of blood from risk groups (homosexuals, drug addicts, prisoners) in order to manufacture coagulation factor products for hemophiles. Nevertheless, around 90% of blood products for haemophiles in Germany were imported from the USA, although in Germany itself risk groups had previously been excluded from donating blood.

Delayed introduction of the heat inactivation of HI viruses

In 1978 Behring developed a complex process for heat inactivating viruses, which was approved by the Federal Health Office in 1981. As early as May 1983 it was reported that heating also inactivated the HI virus. However, blood products in which viruses had not been inactivated continued to be used.

For example, in Germany B. this method of virus inactivation was not introduced across the board until 1984/85. In Japan, 400 haemophiles sued the government in 1989 for continuing to allow untreated blood products, even though the government knew that heat can inactivate HI viruses.

Delays in approving HIV testing in donated blood

In various countries, HIV testing was introduced with a delay, while in other countries it was not very reliable. In February 1985 Abbott and the Institut Pasteur z. B. the approval of their tests in France. However, it was not until August 1985 that France introduced a general requirement for HIV testing of blood donations. However, doubts have also been raised about the reliability of this first Abbott test. In the USA, for example, several people were infected with blood that was not found to be HIV-positive in the Abbott test.

Furthermore, there were companies that did not use the existing tests consistently or as intended. In Germany z. For example, the Koblenz-based company UB Plasma mixed blood donations together (= pooled) as a saving measure and then tested them together for HIV. However, the test method used at the time was not sensitive enough for this procedure, so that despite the tests, HIV-contaminated blood products were sold and three patients were infected. The UB Plasma company was subsequently closed and two managers were arrested.

Export of products that could not be sold in the country of origin

In some cases, products that could not be sold in the country of origin because they did not meet the stricter regulations were exported abroad. In February 1984, Cutter, a US subsidiary of Bayer AG , received a license in the USA to manufacture blood preparations in which HIV was inactivated by heat. Still, according to the New York Times, by mid-1985 Cutter exported untreated products to Taiwan, Singapore, Malaysia, Indonesia, Hong Kong, Japan and Argentina. The reasons given by Bayer were that there was not enough plasma to manufacture the new, heat-inactivated product, that doctors preferred to rely on the old product because of its proven effect, and that registration with the authorities was delayed.

In the US state of Arkansas, Health Management Associates collected blood donations in prisons. When these could no longer be sold in the USA, they were sold to half a dozen other countries (including Canada). The documentary "Factor 8: The Arkansas Prison Blood Scandal" reports about these events and especially about victims in Scotland.

In Austria, the Albovina company declared blood plasma from non-European countries as Austrian plasma between 1993 and 1996. Research indicated the presence of HIV. Although the goods were only released for diagnostic purposes, they were packaged for therapeutic purposes after being re-imported. According to Stern , 47,000 servings of these were sold to India.

Chronology of the most important events for the introduction of countermeasures

date event
February 1981 BGA permits complex procedures for the heat inactivation of viruses in coagulation preparations.
5th June 1981 first cases of AIDS published (in 5 young, homosexual men)
July 16, 1982 AIDS in 3 haemophiles published
March 1983 CDC warn: Blood products responsible for AIDS in hemophiliacs
May 20, 1983 Luc Montagnier and Françoise Barré-Sinoussi isolate the HI virus.
June 20, 1983 Jacques Roux, Directeur Général de la Santé, prohibits the collection of blood in high-risk groups in France: homosexuals or bisexuals who have more than one partner; Drug addicts; Sex partners of these groups and people from Haiti or Central Africa .
February 1985 US companies Abbott and Institut Pasteur each apply for approval of their HIV tests in France.
March 1985 Introduction of the heat inactivation of blood products in Germany.
July / August 1985 Germany and France introduce a general obligation to have HIV tests for blood donations.

Affected

Anyone who needed blood products was potentially affected. In particular, however, it concerned haemophiles (hemophiliacs) who were administered coagulation factors produced from HIV-contaminated blood. At that time, these coagulation factors were still obtained from the blood of 2,000 to 5,000 donors. As a result, the risk of haemophilia was significantly higher than that of recipients of simple blood supplies from a single donor. Therefore, on December 12, 1982 the Federal Health Gazette pointed out that haemophiles were particularly at risk, but no measures were taken to protect them. At that time it was known that AIDS was particularly widespread among homosexuals, so this group could have been excluded from blood donations. Furthermore, in 1981 the BGA introduced heat inactivation of viruses as a method for blood products. In 1982 it was not yet proven that AIDS is caused by viruses. If heat inactivation had been introduced across the board as a precaution against viral infections, many infections could have been prevented.

In France, according to the spokesman for the French Haemophile Association, 1348 of 2500 haemophiles were infected by 1985, of which 625 had died by 1999. In Germany, the HIV Bundestag Committee found that by 1993 43.3% of the hemophiles treated had been infected with contaminated HIV blood products and that 423 of them had died by 1994. The following table shows the situation in various industrial nations.

HIV Infection Among Haemophiles (Mid-1980s)
country number

Hemophilic

of which HIV-infected

(Number)

of which HIV-infected

(percentage)

of people infected with HIV

deceased

Payments / Offers

(til today)

France approx. 2,500 1,34800 approx. 54%00 625 (until 1999)
Germany approx. 4,000 1,84600 43.3%00 423 (until 1994) 250 million DM0000
Great Britain approx. 6,500 approx. 1,35000 approx. 20%00 605 (up to 2000)
Italy approx. 1300 (until 2001)
Spain approx. 1,35000 > 400 (until 1996) $ 25,000 each0000
Portugal > 10000
United States approx. 20,000 about 10,00000 approx. 50 %00 approx. 5,000 (until 2006) $ 100,000 each0000
Canada 2,427 66000 27.2%00 406 (until 2006) $ 55 million0000
Japan approx. 4,500 approx. 1,80000 approx. 40%00 approx. 500 (up to 2000) $ 420,000 each0000

Development in different countries

France

Between 1984 and 1985, the Center National de Transfusion Sanguine knowingly administered HIV-contaminated blood products to haemophiles, as the doctor and journalist Anne-Marie Casteret wrote on April 25, 1991 in L'Événement du jeudi . A total of around 4,000 patients were infected with the HI virus through blood products contaminated with HIV.

The Casteret article initiated the investigation of the French blood scandal. In the course of the investigation, in 1994 Michel Garetta, director of the National Blood Transfusion Center from 1984 to 1989, was sentenced to four years in prison. He was accused by the prosecution of having passed infected blood products "until the camps were emptied".

In 1999, former Prime Minister Laurent Fabius , former Minister of Social Affairs Georgina Dufoix and their former State Secretary Edmond Hervé were finally indicted in court. The Court of Justice of the Republic ( Cour de justice de la République ) found Hervé guilty; Fabius and Dufoix were acquitted.

United States

Most of the HIV-contaminated blood products sold worldwide came from the United States. They were manufactured and sold by Armor, Cutter Biological (a subsidiary of Bayer ), Baxter and Alpha. Although the Centers for Disease Control and Prevention (CDC) had warned against the transmission of HIV through blood products as early as July 1982, the companies sold non-inactivated products worldwide until February 1984. As the evidence of haemophiliac infection grew, the products could no longer be sold in the US and Europe. Nevertheless, they continued to be sold to Latin America and Asia for a year. In contrast, z. B. Bayer that Cutter always behaved "responsibly, ethically and humane". In some cases, the companies around the world have now agreed on compensation with the infected. However, some class actions were still ongoing by 2008.

In the United States itself, around 50% of hemophiles were infected with HIV in the late 1970s to mid-1980s, a total of around 10,000 people. In 1993, Congress appointed a committee to investigate the incidents. It concluded that "a lack of government and blood industry leadership has resulted in several missed opportunities to help protect the public from the threat of AIDS."

Germany

In Germany, the problem with HIV-contaminated blood products began to be investigated in 1993 after infections with such products had become known in the same year. The role of the Hemophilia Center at the University of Bonn , which had previously introduced home self-treatment for a large number of hemophiliacs, is important. At the beginning of October 1993 the then Health Minister Horst Seehofer dismissed the President of the Federal Health Office (BGA) Dieter Großklaus . At the end of June 1994 the BGA was dissolved. Essentially, this was the only way in which the German media turned their attention to this topic, the serious problems of which were or could be more easily identified. Exceptions were early articles in the news magazine Der Spiegel and in the weekly newspaper Rheinischer Merkur . Their science editor Eckart Klaus Roloff received the Theodor Wolff Prize for his numerous reports on the blood scandal in 1994 .

In 1993 the Bundestag set up the committee of inquiry "HIV infections through blood and blood products". In its final report in 1994, the latter stated "that around 60 percent of the HIV infections caused by contaminated blood products could have been prevented". With the HIV Aid Act (HIVHG) of July 24, 1995, the Humanitarian Aid Foundation for people infected with blood through blood products was established, which pays monthly benefits to people infected with HIV and AIDS. Since the summer of 2016, it has been unclear how long the federal government and the pharmaceutical companies affected will continue to make payments and the victims receive compensation. At the instigation of the blood scandal campaign as well as the DHG and the IGH, the law of the HIVHG was changed in 2017, with which the federal government assumed sole lifelong benefits for the foundation and the other responsible parties such as the federal states, the pharmaceutical companies and the German Red Cross released from their responsibilities. From the blood scandal campaign, the Association of Victims of the Blood Scandal was founded on April 1, 2017. V., which has since been responsible for the compensation of the hepatitis victims of the blood scandal, the adjustment of the Foundation's benefits to the inflation-related loss of benefits of the HIVHG Foundation between 1995 and 2018, for the abolition of the January 1, 1988 deadline regulation in the HIVHG and for HIV - Appoints those affected as representatives on the Board of Trustees and the Board of Trustees. In 1998 the Transfusion Act (TFG) was passed to prevent infections caused by blood products.

Other European countries

Switzerland

Up until May 1986, blood products that had not been tested for HIV were processed and given to haemophiles in Switzerland, although the first HIV tests were introduced in 1984. In this context, the former director of the central laboratory of the Swiss Red Cross, Alfred Hässig, was sentenced to a conditional prison sentence of twelve months in 1998.

Italy

Angelo Magrini, chairman of the Italian Haemophilous Association, said in 2001 that 1,300 people (including 150 children) died in Italy as a result of contaminated blood infusions.

In June 2001, a Roman court ordered government compensation to be paid to 351 people who had been infected with HIV and hepatitis C through blood transfusions . The court based its judgment on the fact that the Ministry of Health had been too slow in introducing measures to prevent contagion and had not implemented adequate screening of plasma. Around one hundred of those infected, all of them haemophiles, had died by 2001. In these cases, the court decided to pay the compensation to their families.

Spain

In Spain, 1,350 haemophiles were infected with HIV-contaminated blood. By 1996 a third of them had died. In 1993, Baxter, one of the North American companies responsible for this, offered the infected and their families $ 25,000 each in compensation to avoid a lawsuit.

Portugal

In the 1980s, more than 100 Portuguese hemophiles became infected with HIV from contaminated blood products. The blood products had been imported and distributed by the state health system. This was investigated by the court and the former health minister, Leonor Beleza, was convicted for spreading contagious diseases.

Other countries worldwide

Canada

The blood donations from the prisons of Arkansas were sold to Canada, among others, when they no longer met the stricter regulations in the USA. There they were distributed via the Red Cross, which infected 660 Canadians. In the course of the judicial investigation, the Secretary General of the Canadian Red Cross, Pierre Duplessis, apologized to the victims. The Canadian Red Cross also put $ 55 million into a compensation fund.

People's Republic of China

On August 23, 2001, the Chinese government admitted that 30,000 to 50,000 Chinese people could have contracted HIV through illegal blood products. The Chinese Minister of Health, Zhang Wenkang, said that people in 23 of the 30 Chinese provinces have been infected with the HI virus in this way. Above all, poor farmers are affected by the disregard of elementary hygiene rules. In Henan Province alone, 280,000 farmers sold their donated blood to supplement their low incomes. The blood was mixed and, after the plasma was withdrawn, they were injected again so that they could donate again soon without any health problems, as they were told. In 2004 it became known that in Henan Province alone, according to official figures, 25,000 people were infected with HIV in this way. The Chinese doctor Shuping Wang played a key role in uncovering the HIV and HCV scandal .

Japan

In Japan, the infection rate with HIV is comparatively low. Of those few infected, nearly 59% were infected through blood products imported from the United States. Of around 4,500 haemophiles, around 1,800 were infected with untreated, HIV-contaminated blood products in the 1980s, even though the heat inactivation of HI viruses was already known at the time. In a trial in 2000, three managers of the pharmaceutical company responsible were sentenced to prison terms ranging from 16 months to two years.

Current situation

In most industrialized nations, the risk of infection from HIV-contaminated blood products is now negligible. In 2003 z. In the USA, for example, the risk of HIV infection is estimated at 1: 1.4 to 1.8 million. In Germany, too, the likelihood of HIV infection through blood supplies is estimated at around 1: 4.3 million (as of 2010).

The situation is less favorable worldwide: of 191 member countries of the WHO, only 43 countries test blood donations for HIV. It is still believed that 80,000 to 160,000 HIV infections from blood transfusions occur every year. This means that they are responsible for 2 to 4% of all new infections with HIV (as of 2003).

For haemophiles , too, the likelihood of getting an HIV infection in the course of life has decreased significantly in industrialized nations. In the industrialized countries there are now factor VIII preparations manufactured using biotechnology . These can also be produced without human or animal blood plasma, so that the risk of HIV infection can almost be ruled out. But even with treatment with factor VIII preparations made from human blood plasma, the risk of infection is significantly lower in industrialized countries than in developing countries: for a lifespan of 60 years with monthly treatment with factor VIII, this is 2% in the USA, but in Venezuela at 40% (as of 2001).

literature

  • German Bundestag (Ed.): Report of the 3rd committee of inquiry of the 12th German Bundestag. HIV infection through blood and blood products. (= On the matter 1/95.) Bonn 1995. 672 pages. ISBN 3-924521-93-X .
  • Gerhard Scheu : Product responsibility for hepatitis C infections in haemophilic patients. Baden-Baden: Nomos 1999. ISBN 978-3-7890-6385-5 (The author was the chairman of the committee of inquiry of the 12th German Bundestag on this subject.)
  • Egmont R. Koch , Irene Meichsner : Bad blood. The story of a medical scandal. Hamburg: Hoffmann and Campe 1990, 3rd edition 1993. ISBN 3-455-10312-X
  • IT MADE A CLICK . In: Der Spiegel . No. 41 , 1993 ( online ).
  • Christiane Schmitt: The development of the "AIDS blood scandal" 1993. Master's thesis in Faculty 12 (Social Sciences) at the University of Mainz. 119 pages and appendix. Mainz 1994.
  • Gudrun Wegner: Blood taboo - tabooing of life: a historical-anthropological investigation into dealing with the feminine from the Greek myths to the genetic age . sn, 2001 ( PDFs - Dissertation at the Institute for Sociology).
  • Wolfgang Kaes : Death Friends. Novel. Reinbek: Rowohlt Taschenbuch Verlag 2004. ISBN 978-3-499-23515-3
  • Eckart Roloff and Karin Henke-Wendt: The hemophiliacs: therapies with fatal consequences - and many media look the other way. In: dies., Damaged instead of cured. Major German medical and pharmaceutical scandals. Hirzel, Stuttgart 2018, pp. 93-108, ISBN 978-3-7776-2763-2 .

Movie

Web links

German

Other languages

Individual evidence

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  4. ^ A b Françoise Barré-Sinoussi, Luc Montagnier, et al .: Isolation of a T-lymphotropic retrovirus from a patient at risk for acquired immune deficiency syndrome (AIDS). Science. 1983 220 (4599): 868-71, PMID 6189183 .
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  6. ↑ a b c d e f Walt Bogdanich and Eric Koli: 2 Paths of Bayer Drug in 80's: Riskier One Steered Overseas New York Times , May 22, 2003.
  7. ↑ a b 20 Juin 1983 L'Humanité , November 6, 1992.
  8. ↑ Un deni de Justice L'Humanité , November 10, 1992.
  9. ↑ a b c Lawsuits by Persons with Hemophilia ( Memento of the original from March 29, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Newsletter of the law firm Lieff Cabraser Heimann & Bernstein, LLP, 2003/04. @1@ 2Template: Webachiv / IABot / www.hemophilia-litigation.com
  10. ↑ a b [1] Motion for a resolution by the SPD parliamentary group on June 28, 1995.
  11. ↑ a b c d e f g h i The history of the blood AIDS scandal in Germany ( Memento of the original from November 14, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Interest group haemophiles e. V. @1@ 2Template: Webachiv / IABot / www.igh.info
  12. ↑ Peter R. Foster: The Discovery of Heat-Treatment Conditions for the Inactivation of HIV in Coagulation Factor Concentrates  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. Scottish National Blood Transfusion Service, September 2001.@1@ 2Template: Dead Link / www.scotblood.co.uk  
  13. ↑ Situation of hemophils (hemophiliacs) infected with the hepatitis C virus by blood products (PDF file; 62 kB).
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  15. ↑ a b Catherine Smadja and Philippe Froguel: Political Economy of an AIDS Scandal  ( page can no longer be accessed , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. Le Monde diplomatique , February 12, 1999.@1@ 2Template: Toter Link / www.monde-diplomatique.de  
  16. ^ A b c d Jon Henley: French politicians on trial for mass Aids infection guardian.co.uk , February 6, 1999.
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  19. ↑ New Documentary Film Chronicles Arkansas Prison Blood Scandal ( Memento of the original from November 23, 2011 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. The Sunday Herald, October 30, 2005 cited from the National Hemophilia Foundation, 2006. @1@ 2Template: Webachiv / IABot / www.hemophilia.org
  20. ↑ Blood scandal in Austria (PDF file; 18 kB) Inquiry from MPs Mag. Haupt, Dr. Pumberger and colleagues.
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  22. ↑ A bloody mess ( Memento of the original dated May 3, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. The Hindustan Times, November 12, 2000. @1@ 2Template: Webachiv / IABot / www.essentialdrugs.org
  23. ^ A b c Gerard Naville: France's HIV infected blood trial set to conclude this week WSWS, March 3, 1999.
  24. ↑ a b AgV: Statement on the Green Paper on Defective Products ( Memento of the original of July 13, 2007 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. January 25, 2000. @1@ 2Template: Webachiv / IABot / ec.europa.eu
  25. ↑ HIV Aid Act (HIVG) (PDF file; 44 kB) July 24, 1995
  26. ^ [2] Scottish National Blood Transfusion Service, May 2001
  27. ↑ a b c d e Aids scandals around the world BBC News , August 9, 2001.
  28. ↑ a b Juan Carlos de la Cal: Un laboratorio norteamericano intenta comprar el silencio de los hemofílicos infectados de sida El Mundo, September 9, 1996
  29. ^ A b Steve Sternberg: A legacy of tainted blood USA Today July 11, 2006
  30. ^ A b HIV / AIDS National Hemophilia Foundation, 2006.
  31. ↑ a b Donal M. Arnold et al .: Mortality rates and causes of death among all HIV-positive individuals with hemophilia in Canada over twenty-one years of follow-up Blood, 108 (2): 460-4. July 15, 2006.
  32. ↑ a b First judgments in Japan because of the AIDS scandal - prison sentences for managers ( memento of the original from March 3, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Medi-Report, February 25, 2000. @1@ 2Template: Webachiv / IABot / medi-report.de
  33. ^ Barry Meier, Blood, Money and AIDS: Hemophiliacs Are Split; Liability Cases Bogged Down in Disputes The New York Times, June 11, 1996.
  34. ↑ Anne-Marie Casteret revele l'affaire du sang contaminé ( Memento of the original on 12 December 2008 at the Internet Archive ) Info: The archive link is automatically inserted and not yet tested. Please check the original and archive link according to the instructions and then remove this notice. . @1@ 2Template: Webachiv / IABot / www.linternaute.com
  35. ↑ La justice clôt le dossier du sang contaminé ( Memento of the original from October 17, 2007 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. Radio France, June 18, 2003. @1@ 2Template: Webachiv / IABot / www.radiofrance.fr
  36. ↑ Joachim Fritz-Vannahme: Blood, that was just more money Die Zeit , July 3, 1992.
  37. ↑ Jochen Hehn: “Hang a medal for him” Welt online , March 10, 1999.
  38. ↑ Bayer threatens new drug scandal Spiegel Online , May 22, 2003.
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  40. ↑ Eva Seninghaus: The Institute of Experimental Hematology and Blood Transfusion essence of the Rheinische Friedrich-Wilhelms-University of Bonn. Its creation and work in the period from 1946-1989. Med. Diss., Bonn 2003
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  42. ↑ Wolfgang Hoffmann: Seehofer remains stubborn Die Zeit, January 28, 1999.
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  44. ↑ https://www.blutskandal.de
  45. ↑ https://www.dhg.de
  46. ↑ https://www.igh.info
  47. ↑ Changes to the HIV Aid Act , in particular the change to Section 2 HIVHG
  48. ↑ https://www.nochleben.de/unsere-ziel/
  49. ↑ Annual report 1998 ( Memento of the original of April 24, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. AIDS education Switzerland. @1@ 2Template: Webachiv / IABot / www.aids-info.ch
  50. ↑ Dong, Dong: The Discourse of HIV / AIDS in China: News Construction and Representation of the Chinese HIV Blood Scandal (1998–2002) Annual Meeting of the International Communication Association, New Orleans Sheraton, New Orleans, May 27, 2004.
  51. ↑ Pierre Haski: Sang contaminé: la Chine reconnaît l'ampleur du drame  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. Liberation , December 28, 2002.@1@ 2Template: Dead Link / bpem.survie.org  
  52. ↑ China investigates the blood scandal Frankfurter Allgemeine Zeitung , October 14, 2004.
  53. ↑ Naotsugu Hirabayashi et al .: Psychosocial Factors Associated With Quality of Life in Japanese Patients With Human Immunodeficiency Virus Infection ( Memento of the original from October 20, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. Psychosomatics 43: 16-23, February 2002. @1@ 2Template: Webachiv / IABot / psy.psychiatryonline.org
  54. ↑ Kazumasa Hoshino: HIV + / AIDS RELATED BIOETHICAL ISSUES IN JAPAN. In: Bioethics. 9, 1995, p. 303, doi : 10.1111 / j.1467-8519.1995.tb00365.x .
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  56. ^ A b Elizabeth Donegan: Transmission of HIV by Blood, Blood Products, Tissue Transplantation, and Artificial Insemination HIV Insite, University of California, San Francisco, October 2003.
  57. ↑ Michael K. Hourfar et al .: Experience of German Red Cross blood donor services with nucleic acid testing: results of screening more than 30 million blood donations for human immunodeficiency virus-1, hepatitis C virus, and hepatitis B virus. In: transfusion. 48, 2008, p. 1558, doi : 10.1111 / j.1537-2995.2008.01718.x .
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