China's HIV/AIDS outbreak among blood donors is arguably the worst medically-caused HIV/AIDS epidemic in the world. The outbreak started among the rural poor who sold their blood in an unregulated industry in the 1990s. Today, at least four provinces are known to be involved, including Henan, Hubei, Anhui, and Shaanxi. Tragically, the HI V/A ID S crisis in China is iatrogenic, caused by medical intervention itself Furthermore, official denials, suppression of scientific evidence, and government harassment of those attempting to respond have caused this public health and human disaster to be only partially understood. While the full scale of this tragedy is unclear, what is known has implications for China that go well beyond the already serious HIV/AIDS problem. China's stalled responses to the outbreak, and its treatment of those few courageous citizens who have exposed it, reflect the state of civil society, rule of law, rights of citizens, and emerging center-periphery dynamics of the new China. The rural blood donor epidemic cannot be understood without taking into account such diverse forces as corruption, complex interactions of for-profit enterprises run by rural officials, and the hopes of China's huge cash-poor rural majority. Beijing has yet to allow a thorough investigation of the problem, and urgently needed treatment and prevention programs have not been implemented in the affected provinces. Even if effective programs begin immediately, the death toll in some provinces will likely be in the millions. Transmission of HIV from infected donors to their partners and children is almost certainly ongoing, making outreach to hard-hit communities a priority. China must respond, however belatedly. The prognosis for action, though, is poor. Official denial and restrictions on science continue in 2003, at what is likely to be a very high cost for the country.