34 167. By reason of the aforementioned considerations, the Commission believes there are sufficient elements to show a clear causal nexus between the blood transfusion originating at the Azuay Red Cross Blood Bank on June 22, 1998, and the HIV infection suffered by TGGL. 3.2 As to whether the State of Ecuador is responsible for the events 168. The Commission accepts the premise that infection with the HIV virus presents an obvious adverse effect on the health of an individual which, in turn, has an impact on personal integrity and may also generate a serious risk to life. This effect takes on special intensity and gravity when it concerns a child. In this sense, the Commission considers that it is unnecessary to go into detail as to TGGL’s current state of health or into the development of her illness, since the fact of infection on its own constitutes the source of the breach of her right to personal integrity vis-à-vis the right to health. 169. From the evidence it appears that the two institutions associated with the proven facts are: the Azuay Red Cross Blood Bank, from where both the blood as well as the platelets provided to TGGL originated; and the Humanitarian Clinic, where the blood transfusion was performed. The Commission notes that both the Red Cross of Ecuador – to which the Azuay Red Cross belongs – as well as the Humanitarian Clinic are institutions of a private nature. 170. However, as was indicated in the section relating to the State’s obligations towards the right to physical integrity in the context of health, the duty of regulation, supervision and control devolves upon the State with regard to all entities offering health services. In this sense, if a breach of the right to humane treatment or to life occurs in a private health facility operating without an appropriate regulatory framework, without supervision and adequate and timely control, the State will be responsible for the failure to fulfill the duty of ensuring those rights. Moreover, there are certain activities in the same ambit of the health that, for the risk that imply for the life and personal integrity, impose on the States a strong duty to regulate, supervise and inspect the activity. The Commission considers that the Blood Banks, for its own nature and functions, are within this category. 171. The State of Ecuador presented no response to the merits of the instant case nor presented information, despite the repeated requests by the IACHR. Therefore, the Commission has not have information on the part of the State regarding compliance with the requirements of regulation, supervision and inspection. In that sense, the Commission will analyze the case based on the information available in the file. 172. In this sense, the Commission observes at the outset that at the time the events, the regulations were set out in Articles 168 and 169 of the 1971 Health Code which provide that the Health Authority shall establish laws and requirements to be observed by medical health facilities, and shall periodically inspect and evaluate them. The medical health facilities must also submit their annual programs and regulations for the approval of the Health Authority. 173. In the Case of Suárez Peralta v. Ecuador, the Inter-American Court examined this regulation and stated, in general terms, that “the above-mentioned norms established (...) a regulatory framework for the provision of medical services, granting the corresponding State authorities the necessary competence to control these, with regard to both the supervision and control the functioning of public and private facilities, and the supervision of the exercise of the medical profession.” In this sense, in the above case, the Court considered that the State had failed to fulfill its duty of regulation, and focused its analysis on the failure to fulfill the duties of supervision and control. 174. In the present case, the Commission observes that beyond this general regulation of the “medical services” offered by public and private institutions, there was no information in the case file indicating that at the time of the events, the Blood Banks -due to the specificity of their functions and the risks inherent therein- were regulated in such way that minimum standards and obligations susceptible to supervision and control by the competent State authorities were present, in order to protect the public from