Blood transfusion is so routine a medical procedure that is easy to forget that its introduction was fairly recent, beginning in the twentieth century in Europe. In sub-Saharan Africa, blood transfusion, which began during the First World War period and became common during the 1950s and 1960s, has had its own history and health consequences. The author's impetus for researching this unexamined aspect of medical history in Africa was twofold. First, medical researchers have suggested that blood transfusions were responsible, in part, for the early spread of HIV-AIDS in Africa. Second, in order to adequately address this question, Schneider presents a comprehensive history of blood transfusion, although he focuses on selected African countries (Kenya, Uganda, Senegal, and the Congo/Zaire) based on availability of records, program size, and geographical range. By providing a detailed history of blood transfusion in the areas of Africa where the human immunodeficiency viruses were first identified, he argues that, while blood transfusions during the 1930s in the Congo Basin area contributed to development of the disease, ‘there are many reasons to think that adaptation [of the simian source of HIV-1M] to the epidemic form, just as the epidemic itself, was the result of a combination of circumstances' (p. 177). The historical documentation of blood transfusion practices in Africa, as discussed in this book, provides important information for medical researchers evaluating connections between blood transfusion and the emergence of HIV/AIDS in Africa.

The history of blood transfusion in sub-Saharan Africa is also of interest for its relation to the political economies of particular periods. Its beginnings there closely followed the building of hospitals and the presence of medical doctors, whose knowledge of blood transfusion techniques and the testing of blood types contributed to its successful introduction. While Schneider does not include historical accounts of Africans' perceptions of blood transfusion as an example of colonial exploitation, he suggests that the immediate and seemingly miraculous effects of transfusions undermined resistance to this practice by some Africans. In Nairobi, for example, blood donations grew from 5,146 pints in 1959 to 26,684 in 1981. One of the main impediments to early blood transfusions in the 1930s was lack of trained medical doctors and hospitals where transfusion could safely be performed. Another impediment, however, was related to blood donation, collection, and storage. It was not until the Second World War that techniques for storing whole blood were developed so that obtaining fresh blood for transfusion was an ongoing challenge. While a range of methods were employed to attract blood donors, including educational campaigns, posters (several of which are illustrated in this volume), films, and programs run by blood transfusion units in hospitals, family members were often required to supply blood for patients. Additionally, in the early 1950s, the French colonial administrations instituted a program that provided food and even cash payments, although the costs of such compensation proved to be prohibitively expensive. More recently, with the increasing risks of AIDS transmission through blood transfusions, the US President's Emergency Plan for AIDS Relief (PEPFAR) has assisted 12 African countries in facilitating and monitoring blood donations (p. 178). For other countries, reduced budgets for health care has led to a continuing reliance on family members as donors, reflecting the social network of extended kin who are expected to provide support for family and friends.

Schneider discusses the great expansion of transfusion during the post-Second World War years in Africa, which reflects colonial efforts to improve their image with Africans. This expansion continued in the years following independence in many African countries, although by the mid-1980s there was a reduction in blood transfusions. With the implementation of Structural Adjustment Programs and government cutbacks on health care for a range of reasons, government funds for transfusion equipment were greatly reduced. Schneider notes that this reduction in blood transfusion in the 1980s, however, was not due to the first diagnosed case in 1983 of HIV-AIDS in Africa.

While the author acknowledges a dearth of African perspectives on this history of blood transfusion, one can hope that subsequent studies will provide oral historical accounts given by African blood donors and transfusion patients, particularly from the post-Second World War period when blood transfusion greatly expanded. Histories of the experiences of Africans (medical professionals, blood donors, and blood recipients) of blood transfusion in relation to the AIDS epidemic would also be a welcome addition to the literature. Schneider's fine study of the history of blood transfusion in sub-Saharan Africa has provided the groundwork for such research.