TONG BUJI, China -- Every few weeks, farmer Long Zhu Xiang walks about 30 minutes down the rubble-strewn path that connects her remote impoverished village in Guizhou Province to a county road and then takes a bus ride into the nearest county town to sell the one precious commodity she has -- her blood.
"I've sold my blood so many times I can't remember -- about twice a month for the last three years," Long, 36, said with a wave of her hand. "You get [about $10] for a bottle, and I'm using the money to pay for my three children's school fees."
Her plight reflects the desperation of many poor Chinese in rural areas, where economic opportunities are few. It also illustrates the growing lengths Chinese pharmaceutical companies are going to meet their rising demand for blood plasma, used to manufacture drugs such as immunoglobulin.
Chinese AIDS activists say the growth of blood-collection centers in such places as Guizhou poses a rising health risk to vulnerable populations. Since the companies rely on local "blood brokers," they say, local officials are often financially involved in the blood business and fail to enforce safety regulations, exposing donors to AIDS and other blood-borne illnesses.
"In China, there are a lot of high profits to be made from the blood-selling business," said Li Dan, an AIDS activist in Beijing. "Even though the government says it is fixing things, it is not."
In the 1990s, the massive mismanagement of blood-collection centers in central Henan Province caused an AIDS epidemic that affected about a million people, according to the activists. That brought official promises of reform and China's Health Ministry says it now maintains strict oversight of blood-collection centers.
The ministry says it shut down about 150 illegal blood collection and supply agencies across China in 2004, the last year for which official figures are available.
But an activist who contracted AIDS from the botched blood-collection campaign in Henan said that while the blood-collection industry is steering clear of Henan, it is expanding in poorer and more remote regions, such as Guizhou, where regulatory oversight is weak.
"It's really a tragedy," said the activist, who asked to be identified only as Zhang because he feared reprisal from authorities. In Henan, he said, "We didn't know what we were doing. You could make more money selling blood than working, so people lined up in the centers all day. Now we know the problems with these blood-collection programs but yet they are allowed to operate [because] many local officials are involved in the business."
The growing demand for drugs derived from human plasma -- which are used in the treatment of hemophilia, immunity disorders, and burns -- is driving the blood trade.
While a donor like Long receives about $10 for a bottle of blood, the blood-collection centers usually sell a bottle of plasma to middlemen for about $45, a manager with a Beijing-based pharmaceutical company said on the condition of anonymity.
These brokers then sell the plasma for about $60 to various pharmaceutical companies, who then make between 10 and 20 times that amount off the plasma, depending on the drug they convert it into, the manager said.
Many of the Chinese-made, plasma-based drugs are also exported around the world and local commercial Internet sites often offer buyers products such as IVIG (Human Immunoglobulin for Intravenous Injection).
A peek into a closed blood-collection center near Long's village revealed sparsely furnished rooms with tiled walls, rusty metal furniture, and aging equipment. Rows of plastic seats were lined in front of the collection desk.
Long said all sellers are given a logbook in which to record the date and amount of blood they sell.
Chinese pharmaceutical companies defend the collections, saying they take measures to ensure donor safety and that Chinese blood-collection regulations are among the most thorough in the world.
"A seller is only allowed to give blood twice a month, 600 milliliters of plasma each time," said Liu Junshan, the chief administration officer at the Hui'tian Pharmaceutical Company in Xi'an in central Shanxi Province that operates three blood-collection centers. "Before a donor is approved, he has to be tested for hepatitis, AIDS, syphilis, etc. Moreover, his blood has to reach certain standard. Otherwise, he will be rejected."
But Louisa Schein, associate professor of anthropology at Rutgers University, who is originally from Cambridge, Mass., and who has researched and provided developmental aid to communities in Guizhou for many years, said testing at many clinics in the province is not very strict, increasing the chances for transmission of AIDS and other diseases.
She also said that collection centers routinely take more blood than they should from sellers, making "them very weak and unable to live a healthy life."
This problem is compounded in Guizhou because the province has a growing population of heroin addicts, according to the World Health Organization's Beijing office. Zhang said the addicts, who are often HIV-positive because they prostitute themselves to pay for their fix and share needles, are very likely to sell their contaminated blood for money. Thus, even a small snag in the blood-collection system could unleash a widespread epidemic.
"Our concern is that AIDS could soon become an epidemic here, too," Zhang said of Guizhou.
Wu You Yi, a doctor in Tongren, a town near Long's village, said the incidence of AIDS was rising in Guizhou but that local blood-collection centers are using much better safety systems than were employed in Henan.
The Guizhou government says it is investing in AIDS education and soaring billboards about the disease abound in provincial towns. Officials would not respond to criticism of the collection centers in the province.
In the scattered villages spread across this province's famously mountainous landscape, mention of the Henan tragedy or even AIDS elicits quizzical looks.
Long, the blood seller in Tong Buji, said she's never heard of AIDS and laughed at the idea that selling her blood could seriously damage her health.
"You only feel a bit tired," she said. "And anyway, I don't care about that. All I care about is the money."