The World Health Organization Global Programme on AIDS (WHO/GPA) and the International Federation of Red Cross and Red Crescent Societies collaborated on a project to conduct a series of studies on blood transfusion activities in selected developing countries to identify the needs and shortcomings of blood donor counseling for HIV and other infectious agents in the blood transfusion setting. In Uganda, Zimbabwe, Botswana, Rwanda, India (Maharashtra State), and Thailand, the national blood transfusion service (BTS) and Red Cross facilities generate safe blood supplies screening blood for HIV, and significant levels of HIV infection were identified. Uganda was the only country doing BTS-initiated blood donor counseling with good links to external counseling agencies. Based on the WHO/GPA definition of counseling, blood donor counseling is feasible in Uganda, Zimbabwe, and Botswana. Blood donor counseling could be feasible in Rwanda, India (Maharashtra), and Thailand if initiated by the Red Cross; if a major shift in resources occurred; and if referral links and staff training existed. A variety of incentives for blood donors were noted: saving lives; helping relatives and friends; getting food and drink; and receiving HIV test results. In Uganda, Zimbabwe, and Botswana, the BTS was a place where one could receive HIV test results. In Zimbabwe blood donors were required to nominate a medical officer to whom they would go to receive their HIV test results. The obstacles to donor counseling included lack of trained staff for counseling, few links with alternative counseling and testing sites, and lack of access for donor referral and donor understanding. Management-based obstacles included the lack of policies on donor counseling and the general lack of awareness about HIV counseling and potential benefits. Policies about donor care within BTS should include standards for information giving and management, confidentiality, and donor referral.