The release last month of the mainland's most extensive research into its HIV/Aids situation was regarded by most as a positive step. Filed in conjunction with the Ministry of Health, the Joint UN Programme on HIV/Aids and the World Health Organisation, the assessment report was a milestone in the mainland's drive to improve its response to a disease that, until only recently, it refused to acknowledge. Yet it's only one step up a very steep slope, on terrain made all the more difficult by the mainland's dark days of HIV/Aids denial, back when Beijing was more likely to blame homosexuality and promiscuity for this so-called 'western' affliction. Then came the revelation that top leaders covered up an outbreak in central China caused by a tainted government-sponsored blood-selling programme. Thousands of Chinese peasants - up to 300,000 according to some reports - who sold their blood to government-sponsored 'blood stations' had contracted HIV/Aids. More people in China have contracted the disease through the sale of blood drawn with unsterilised equipment than through any other means. Such unsafe blood donation practices led to as many as 35 per cent to 45 per cent of donors in some areas of Henan in north China becoming infected, feeding fears that a country with a vast need for blood, without a history of successfully donating it, was facing a devastating health crisis. And yet the mainland's gross mismanagement of the Sars epidemic in November 2002 is usually credited with being the turning point for its new, open-minded policy on seeking international help in health matters. At the very least, these efforts have led to some unlikely partnerships with non-government organisations. Ten years ago, the very idea that a US company would be entrusted with kick-starting a full-scale revolution in China's blood safety procedures would have been laughable. Yet Jeffrey Busch, a 48-year-old former investment banker from New York who established a global blood safety foundation, Safe Blood International Foundation, now finds himself on the frontline of the mainland's greatest health battle. 'In China, prior to Sars, the Ministry of Health requested to talk to us. They had a public crisis in the news about the country's blood service,' he said from his office in Washington. 'We had a mutual goal to secure a safe blood supply inside China, to basically take international standards of safety and help China apply them. We sat down with the ministry and decided to target areas that needed immediate help - Henan and Yunnan - and then expand throughout the country.' The aim of Mr Busch's organisation is to introduce western standards and controls to improve the blood supply in the two provinces, with the goal being to take such practices to other parts of the country. 'The greatest problem was bad blood-safety practices - reuse of needles, bad quality-control systems and poor training,' he said. Since last year's formalisation of its operations in China, Safe Blood has held training sessions in the country in a bid to stop the spread of HIV/Aids through the transfusion of unsafe or untested blood, with the help of other organisations such as the Hong Kong Red Cross. Under the name Safe Blood for China Foundation, it offers training in blood testing, provides equipment for transfusion services and introduces software systems to track donors. Safe Blood has implemented a programme already in use in 34 sub-Saharan African countries, including hard-hit Nigeria, and is expanding throughout the continent. It is also setting up in Ukraine, currently Europe's HIV/Aids epicentre. 'I went to the WHO and other organisations and talked with them about blood safety in Africa,' Mr Busch said of the foundation's inception. A UN delegate under the presidency of George Bush Snr in 1990, he experienced something of a turnaround in 1999 when he was inspired to leave behind the cutthroat world of finance to oversee the installation of safe blood donation practices in the world's hardest-hit HIV hot spots. 'People started springing a plan that they'd ask all the countries to implement blood safety in the next five years. I asked them who was going to do it, and in the end there was really nobody. So I established the foundation.' Spending five years without a salary launching large-scale projects in Africa under the banner Safe Blood for Africa, Mr Busch was then approached by Chinese officials to help implement a top-to-bottom shakedown of the mainland's blood donation, storage and usage practices. Henan was the first province in which the organisation set up, in an effort to save hundreds of thousands of lives against the spread of HIV/Aids and hepatitis B and C - an even more rampant threat. In November last year, Vice-Minister Huang Jiefu participated in the opening of the area's first blood safety training centre, and endorsed plans to create a network of blood safety centres throughout the country - all with the help of Safe Blood. The access Mr Busch's organisation has enjoyed in China is remarkable. 'There was some resistance at first,' he said. 'Interior ministers in Henan hadn't really seen international safety trainers before us. We had approval from about 30 governments around the world - the more you do, the easier it is for a new country to see the good that you can do for them. 'But China was not the hardest, by any stretch of the imagination. I've been in scenarios where I've needed tribal leaders in Africa to approve our work before the government has approved it. China wanted a lot of information before they approved us and there was a lot of negotiating. After that, things then went pretty fast. The biggest challenge in China is how you get the 50 million units of blood the country needs each year.' A challenge that is still being met, as the nation faces a critical blood shortage as its economy grows and its people accumulate greater wealth. In turn, the onus is on the government to provide health care that matches these rising standards. While it may be producing a figure similar to that of the US' 20 million units per year, its population is six times greater. The recent drastic downgrade of the mainland's infection rate from 840,000 to 650,000 - which, according to WHO figures, constitutes 0.05 per cent of the population - barely conceals the fact that the nation faces an epidemic whose proportions cannot be underestimated. Some activists have cast doubt on the accuracy of the joint assessment report, citing their belief that such data relies on groups - namely prostitutes and gay men - that are typically unwilling to reveal their HIV-positive status. Other frontline workers question such a drastic downward revision: the report estimates that only 55,000 former blood donors are currently infected with HIV, as opposed to a figure of 199,000 reported in 2003. Some organisations put the figure at 1.5 million. Mr Busch, however, regards it as a hugely positive indication of progress. 'Many of those who were infected with HIV-positive blood in the 1990s have died from the disease and are no longer counted in the recent survey. It is exciting to see progress in the fight against HIV/Aids in China, with our programmes contributing to the decrease in the HIV rate. 'Worldwide, infection from contaminated blood accounts for between 5 and 10 per cent of new HIV infections, and with China implementing Safe Blood programmes this will result in almost zero infections attributed to blood in China.' Much has been achieved since Mr Busch joined other NGOs who have worked feverishly to stave off the spectre of Aids haunting the mainland. Authorities have banned the kind of blood trading that saw unscrupulous 'bloodheads' pool donated blood and put recipients at risk of disease. Yet blood donation centres outside the more sophisticated major cities still suffer from poor quality control, and Mr Busch maintains that reuse of equipment without sufficient hygiene practices is all too common. 'A person in one of the northern provinces gave 15 donations in two years, and that person was HIV-positive. Fifteen people became infected. It should have been a red flag if someone is allowed to give blood that often anyway, regardless of their health; and yet the blood wasn't being tested properly. 'Putting it simply,' he said, 'if you're testing [blood] and finding people who are HIV-positive, you're not screening properly beforehand.' Mr Busch hopes to get the HIV infection rate as close as possible to zero in five years. 'The only reason I'm aggressive on this is because China's aggressive on this in its wish to move quickly. It's never going to be zero, but you need to get it as close as you can.' Yet greater challenges will remain. Education is the key weapon in fighting the threats of unsafe sex and needle use. Commercial blood gathering has been overtaken by dirty needles among drug takers, particularly in the southern provinces bordering the drug producing countries of Myanmar, Laos and Vietnam. By 1993, one of these, Yunnan, had more Aids cases than any other part of China. Meanwhile, the so-called 'floating' population of 140 million people who left rural poverty in search of jobs in the cities represents a high-risk transmission belt. So before anyone gets too optimistic over the decline in cases, remember the words of Vice-Health Minister Wang Longde . 'Almost 200 people are infected every day in China,' he said in response to the report. 'The situation is grave.'