Two months after receiving the transfusion, Alseidov's son, a ruddy, playful boy named Baurzhan who plays constantly with his twin sister, tested positive for HIV, the virus that causes AIDS.
"I couldn't understand why the doctor said my son needed a blood transfusion or he would get worse," Alseidov said.
Baurzhan's exposure to HIV was only the beginning of an epidemic that has engulfed Shymkent, an industrial, car-choked city along the Uzbekistan border. Since last summer, 93 children who were treated at a children's hospital in Shymkent have tested positive for HIV.
And as the trial has progressed, a possible reason why the doctor prescribed a blood transfusion to treat pneumonia has become increasingly clear: The parents of HIV-infected children in Shymkent allege that doctors charged each patient $20 for 415 cubic centimeters, or 14 ounces, of blood, splitting the proceeds with the local blood bank. A profit of as much as $10 on every transfusion may not sound like much, but it is a considerable amount in a country where doctors' salaries begin at $175 a month.
Many doctors and patients in Russia and Eastern Europe, Central Asia and parts of China and India believe that infusions of fresh blood can fortify a healthy body and remedy diseases that are not blood related, Western doctors with extensive experience in the region say. While pervasive corruption encourages many unnecessary transfusions, patients also frequently demand transfusions, which they associate with modern health care.
As a result, Western health experts say, local doctors prescribe tens of millions of unnecessary transfusions throughout the developing world, putting people at heightened risk of contracting AIDS or other diseases transmitted in the blood.
"It's dumb medicine," Max Essex, chairman of the Harvard AIDS initiative and professor at the Harvard School of Public Health in Boston, said in a telephone interview. He said that a measure taken in the United States in the late 1980s, "even after HIV blood tests were available was to drastically cut down the number of blood transfusions given."
"In that region of Asia," he said, "there has been a tremendous expansion of the HIV epidemic. Even if they were doing the state of the art testing there is big danger in overusing blood transfusions."
All of these factors seem to have converged on the children of Shymkent. One 8-month-old boy received 25 unnecessary blood transfusions, according to court documents. The boy's transfusion regime was halted only last summer when he was diagnosed with HIV.
The situation in Shymkent raises echoes of another noteworthy legal case involving the spread of HIV through tainted blood: Five Bulgarian nurses and a Palestinian doctor have twice been sentenced to death in Libya after being judged guilty of infecting more than 400 children. The case has dragged on for nearly eight years.
Speaking about the transfusions in Shymkent, Michael Favorov, an epidemiologist and Central Asia program director for the Centers for Disease Control and Prevention, based in Atlanta, said simply: "It's insane."
Favorov headed an extensive medical investigation by the agency, which identified transfusions of tainted blood as the source of the Shymkent outbreak. "This kid needed no blood," he said, referring to Baurzhan Alseidov.
Kanat Alseidov, the father, said that doctors had told him that no family member could provide the blood, so he went to a private blood bank. He said he had been told at the blood bank that the doctor would receive half the $20 price for the blood.
"Our hospitals are like a factory line," Alseidov said. "The doctors sometimes take not even $10 but they make their money from volume."
Doctors say that their low wages force them to search for ways to generate additional revenue. "Salaries are very low and even increases don't make a difference because of inflation," said Amangeldy Shopaer, deputy chief physician at the Shymkent Infectious Diseases Hospital, where the infected children have received treatment.
Families of the infected say government neglect has compounded their predicament. They say health officials have refused to regulate blood banks or police doctors who routinely prescribed blood transfusions to make a profit. "It's not popular to blame the government but the evidence is clear," said Alseidov, the father of the child who originally had pneumonia. "Veins are not garbage bins."
Families of HIV-infected children are often forced to move to seek anonymity after being ostracized by friends and neighbors. More than half the fathers of HIV-positive children have left their families, according to members of the families attending the trial.
Despite the detailed study by the U.S. agency, Shopaer maintained that the cause for the outbreak remained "not concretely known" and defended the practice of ordering blood transfusions for illnesses unrelated to the blood, including pneumonia. "In some cases it is required. It depends on what kind of pneumonia."
Frequent blood transfusions put people in developing countries especially at risk because of galloping rates of HIV infection.
The biggest HIV epidemic in the region is in neighboring Uzbekistan, which straddles major drug-trafficking routes and where the number of reported HIV cases has more than doubled since 2001 to 31,000, according to the World Health Organization. Kazakhstan may have three times its officially stated number of 7,000 HIV cases, according to the most recent statistics compiled by Unicef.
The Kazakhstan government has responded to the outbreak by firing the health minister and breaking ground on a planned pediatric AIDS facility in downtown Shymkent.
Small outbreaks continue to haunt the developing world, however, especially the former Soviet Union, where corruption in the medical system is rampant and belief in the remedial powers of new blood runs deep. Russia alone has reported more than 200 outbreaks of HIV associated with unnecessary blood transfusions.
"We have been screaming and yelling since 2002, but there is limited funding to address the problems," Favorov said, adding: "Unfortunately before you see the thunderstorm" nobody wants to open an umbrella.
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