The Bill & Melinda Gates Foundation has created a unique blood-buying program in 14 cities throughout China that encourages organizations to establish makeshift blood collection centers in bars, bathhouses and apartment buildings to test for syphilis and HIV, The New York Times reports. The initiative, launched in 2007, will spend $50 million during five years to curb the spread of HIV in China. Since it began, more than 110,000 people have been tested.

Some AIDS advocates have criticized the program, arguing that by offering a financial incentive to donors and to organizations collecting and testing blood—about $9 per sample and an additional $44 for those who test positive—the Gates Foundation is supporting shady, money-driven collection groups.

In Tianjin, for example, two-dozen organizations have popped up in the last year, run by bar owners or government-affiliated bureaucrats. Some of these groups offer no pre- or post-test counseling and do not direct those who test HIV positive to treatment and support.

“Gates has created a huge blood-buying operation that only cares about money, not about people,” said Ma Tiecheng, who runs an AIDS service organization in the northwest city of Shenyang. “I’ve seen people getting four HIV tests a day.”

Ray Yip, MD, former director of the Centers for Disease Control and Prevention office in China, who now heads the Gates Foundation’s blood-buying program, acknowledged that the program is facing some early obstacles.

“We don’t expect every grant in every city to be spectacularly successful,” he said. “That’s like buying 30 stocks and expecting them all to go up.”

But Yip remains hopeful.

“We are experiencing some of the hiccups of a less-than-perfect arrangement, but we expected that,” he said. “If you look historically at arranged marriages, some of them last.”

In the mid-1990s, thousands of people in China’s rural provinces contracted HIV through untested blood products obtained through government-backed programs.