Because cases of transfusion-acquired HIV infection occur independently of a recipient's personal behavior, the international public-health community has rightly taken responsibility for minimizing the number of cases. These efforts have been successful in North America and Europe and in parts of Asia and Latin America, where the incidence of transfusion-associated HIV is now less than 0.1%. In contrast, programs for screening potential donors for HIV have been more difficult to establish in most developing countries, particularly in areas of tropical Africa, where as many as one in four potential donors may be HIV-seropositive. The high prevalence of malaria and other parasite-induced anemia has contributed to a large transfusion requirement [1], This high rate of transfusion, combined with the high HIV prevalence in potential blood donors, explains why approximately 10–15% of incident HIV cases in this region are transfusion-associated [2]. In Zaire, the high transfusion requirement has been met primarily by establishing small, almost technology-free, transfusion centers. The requirement for a constant source of electricity, refrigeration, expensive blood-bank equipment and a pool of voluntary donors for maintaining blood stocks in advance of need have generally prevented the establishment of conventional blood banks. In these transfusion centers the responsibility of finding a blood donor is frequently placed on the family of a patient requiring a transfusion. In the absence of a suitable family donor, the family must resort to a group of paid donors (US$5.00 for 500 cm3 blood) who 'work' in the environs of the transfusion center. Before transfusion, ABO and rhesus factor may be used for cross-matching, when available. In the absence of these reagents, failure of donor and recipient blood to agglutinate on a slide may be used for cross-matching. The family must also purchase blood collection apparatus (usually at a cost of approximately US$5.00). Because of shortages and the limited funds of a recipient's family, blood collection is frequently carried out using a container not designed for blood collection or a blood collection bag that has already been used. Given that the annual income of many heads of households is less than US$200.00, it is not surprising that many families, when offered HIV testing for potential donors, are unwilling or unable to pay the USIl.00–3.00 cost. Once a suitable donor is identified, transfusion can take place very rapidly; blood may literally pass out of the donor's arm into a blood collection device and, still warm, into the recipient's arm. This well-established method was frequently life-saving until the onset of the HIV epidemic.