SHYMKENT, Kazakhstan — For weeks now, Kanat Alseidov has been sitting only a few feet from the doctor on trial for prescribing a blood transfusion for Mr. Alseidov’s 2-year-old son, who had pneumonia.

 

Two months after receiving the transfusion, the boy, a ruddy, playful toddler named Baurzhan, who tangles constantly with his twin sister, tested positive for H.I.V., the virus that causes AIDS.

 

“I couldn’t understand why the doctor said my son needed a blood transfusion or he would get worse,” Mr. Alseidov said.

 

Baurzhan’s exposure to H.I.V. was only the beginning of an epidemic that has engulfed Shymkent, an industrial, car-choked city near the Uzbekistan border. Since the summer of 2006, 100 children who were treated at the children’s hospital here have tested positive for H.I.V.

 

Twenty-one doctors are accused of medical malpractice for allowing the H.I.V. outbreak.

And as the trial has progressed, it has become increasingly clear why the doctor who treated Mr. Alseidov’s son had prescribed a blood transfusion to treat pneumonia: the parents of the infected children here in Shymkent say that doctors charged patients $20 for 14 ounces of blood, splitting the proceeds with the local blood bank. A profit of up to $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.

 

While pervasive corruption encourages many unnecessary transfusions, patients frequently demand transfusions. Doctors and patients in Russia and Eastern Europe, Central Asia and parts of China and India truly believe that fresh infusions of blood can fortify a healthy body and remedy diseases that are not blood-related, say Western doctors with extensive experience in the region.

 

One result, Western health experts say, is that throughout Central Asia and much of the developing world, local doctors prescribe tens of millions of unnecessary transfusions, putting people at heightened risk of contracting AIDS or other diseases transmitted by blood.

 

“It’s dumb medicine,” said Dr. Max Essex, chairman of the Harvard AIDS Institute and a professor at the Harvard School of Public Health, in a telephone interview. “One of the reactions that the medical establishment took in this country in the late ’80s, even after H.I.V. blood tests were available, was to drastically cut down the number of blood transfusions given.”

 

All of those 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 regimen was halted only in summer 2006 when he was found to have H.I.V.

 

“It’s insane,” said Dr. Michael O. Favorov, an epidemiologist and Central Asia program director for the Centers for Disease Control and Prevention, based in Atlanta. Dr. Favorov headed an extensive medical investigation by the agency that identified the transfusions of tainted blood as the source of the Shymkent outbreak. “This kid needed no blood,” he said.

 

Mr. Alseidov said doctors told him that no family member could provide the blood, so he went to a private blood bank. He says he was told at the blood bank that the doctor would receive half the $20 price for the blood. “Our hospitals are like a factory line,” Mr. Alseidov said. “The doctors sometimes take not even $10, but they make their money from volume.”

 

Doctors say 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 Dr. Amangeldy Shopaer, deputy chief physician at the Shymkent Infectious Diseases Hospital, where all 100 infected children have received treatment.

 

The children’s families say government neglect has compounded their predicament.

“It’s not popular to blame the government, but the evidence is clear,” Mr. Alseidov said. “Veins are not garbage bins.”

 

Compounding their problems, families of infected children are often forced to move to seek anonymity after they are ostracized by friends and neighbors. More than half the fathers of the H.I.V.-positive children have left their families, according to family members of victims attending the trial here.

 

Despite the detailed American study, Dr. Shopaer maintained that the cause for the outbreak remained “not concretely known” and defended the practice of ordering blood transfusions for non-blood-related illnesses, including treatment for pneumonia.

 

 “In some cases it is required,” he said. “It depends on what kind of pneumonia.”

 

The biggest H.I.V. epidemic in the region is in neighboring Uzbekistan, which straddles major drug-trafficking routes and where the number of reported cases has more than doubled since 2001 to 31,000, according to the World Health Organization.

 

Kazakhstan’s government has responded to the outbreak by firing the health minister and breaking ground on a planned pediatric AIDS facility in downtown Shymkent. Government health officials have also hired a Russian-speaking pediatric AIDS specialist from Israel to oversee treatment of Shymkent’s infected children and have completed the testing of 8,800 children throughout the country who are on record for recently receiving new blood. No new cases were found.

 

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 H.I.V. associated with unnecessary blood transfusions.

 

“We have been screaming and yelling since 2002, but there is limited funding to address the problems,” Dr. Favorov of the Centers for Disease Control and Prevention said.

 

“Unfortunately before you see the thunderstorm, nobody wants to open an umbrella.”