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Martinez EZ, Galdino G, Zucoloto ML. Should men who have ever had sex with men be allowed to donate blood in Brazil? Hematol Transfus Cell Ther 2024; 46:549-552. [PMID: 38719720 DOI: 10.1016/j.htct.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 09/20/2024] Open
Abstract
Many countries have modified their policies on banning or deferring blood donation by men who have sex with men (MSM) in light of ethical concerns and new evidence about transfusion risks. In Brazil, MSM were not eligible to donate blood unless they had been celibate for the previous 12 months. However, in May 2020, the Brazilian Federal Supreme Court overturned this restriction. Many authors have attempted to stress possible risks of transfusion-transmitted infection under various scenarios of changes in bans or restrictions on donations by MSM using mathematical models, but we consider that it is a difficult task due to the wide variety of sexual behaviors, attitudes, and practices. Among these factors, we highlight sex under the influence of illicit drugs, and the fact that people with an undetectable human immunodeficiency virus viral load have the potential to transmit should their blood be transfused. Despite these possible risks, we believe that some MSM can donate blood regardless of the time elapsed since their last sexual contact, especially because blood donations by MSM were occurring even when there were time-based deferral rules. Blood banks should always seek to use screening algorithms to identify high-risk sexual behaviors using gender-neutral criteria, and education about transfusion risks should be offered to healthcare workers and MSM.
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Affiliation(s)
- Edson Zangiacomi Martinez
- Faculdade de Medicina de Ribeirão Preto da, Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil.
| | - Guilherme Galdino
- Faculdade de Medicina de Ribeirão Preto da, Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
| | - Miriane Lucindo Zucoloto
- Faculdade de Medicina de Ribeirão Preto da, Universidade de São Paulo (FMRP USP), Ribeirão Preto, SP, Brazil
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Zucoloto M, Galdino G, McFarland W, Martinez E. Influence of risk perception on attitudes toward blood donation among Brazilian men who have sex with men who donated blood. Transfusion 2023; 63:323-330. [PMID: 36540955 DOI: 10.1111/trf.17213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND We hypothesize that awareness of individuals' risk behaviors may influence aspects of attitude toward blood donation (i.e., intentions and self-efficacy). Investigating this association in the population of MSM was the objective of the present study. STUDY DESIGN AND METHODS This is a cross-sectional study based on an open web survey. The online survey was developed and applied on the Research Electronic Data Capture (REDCap) platform. The study's information, invitation to participate, and link to access the online survey were disseminated using social media. Analyses were performed using structural equation modeling. RESULTS A total of 764 young adults MSM participated, with the majority self-reporting as homosexual, single, in good health, and having completed higher education. A total of 297 (39.5%) reported having donated blood at least once in their lives. Among blood donors, 72.0% admitted to lying about their sexual behavior during the blood donation clinical screening interview; 81.0% did not believe that their behaviors put them at risk for HIV infection; 83.7% believed that their blood is safe enough to be transfused. Structural equation analysis provided evidence that the perception of being at risk for HIV and the perception of having non-safe blood to be transfused contributed to an attitude against future blood donation (explained variance 50%). DISCUSSION Attitude plays an important role in blood donation decision-making by young adults MSM. This is the first study to provide evidence that the self-perceptions of being at risk for HIV and having non-safe blood may deter MSM from blood donation.
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Affiliation(s)
- Miriane Zucoloto
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Guilherme Galdino
- Department of Psychology, University of Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Willi McFarland
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Edson Martinez
- Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
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Nishiya AS, Ferreira SC, Salles NA, Rocha V, Mendrone-Júnior A. Transfusion-Acquired HIV: History, Evolution of Screening Tests, and Current Challenges of Unreported Antiretroviral Drug Use in Brazil. Viruses 2022; 14:v14102214. [PMID: 36298769 PMCID: PMC9612039 DOI: 10.3390/v14102214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 11/05/2022] Open
Abstract
Prevention of HIV acquisition by blood transfusion from its emergence to the present day is reviewed, and current challenges are delineated. The experience of Fundação Pró-Sangue/Hemocentro de São Paulo, Brazil, is highlighted in the quest for improvements in blood safety and the evolution of increasingly sensitive and specific screening tests. Concerns and establishing stringent criteria in the screening of potential blood donors are emphasized, and the current criteria for identifying and deferring candidates at high risk of acquiring sexually transmitted diseases are summarized. Future challenges relate to the identification of donors with unreported use of antiretroviral drugs for prophylaxis against possible HIV exposure or for treatment of an HIV infection whose viral expression is undetectable by current analyses. There is a need to better understand the motivation of HIV-exposed donors and to educate them about the risk of transfusion-mediated HIV transmission despite having low or undetectable viral loads. In situations in which traditional HIV RNA or antibody detection assays remain negative, more sensitive analyses are needed to identify potential donors at risk for HIV transmission.
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Affiliation(s)
- Anna S. Nishiya
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo 05403-000, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
- Correspondence: ; Tel.: +55-11-4573-7525
| | - Suzete C. Ferreira
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo 05403-000, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
| | - Nanci A. Salles
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo 05403-000, Brazil
| | - Vanderson Rocha
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo 05403-000, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
- Disciplina de Ciências Médicas, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo 05403-000, Brazil
- Churchill Hospital, Oxford University, Oxford OX3 7LE, UK
| | - Alfredo Mendrone-Júnior
- Fundação Pró-Sangue Hemocentro de São Paulo, São Paulo 05403-000, Brazil
- Laboratory of Medical Investigation in Pathogenesis and Targeted Therapy in Oncoimmunohematology (LIM-31), Department of Hematology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo 05403-000, Brazil
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Perceptions and practices of the Brazilian LGBT+ population toward blood donation. Transfus Apher Sci 2022; 62:103578. [PMID: 36114122 DOI: 10.1016/j.transci.2022.103578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022]
Abstract
In May 2020, after years of demands by activists and in light of COVID-19-related blood shortages, the Brazilian Federal Supreme Court abolished the rules that demanded a 12-month celibacy period for men who have sex with men (MSM) to donate blood. The objective of this open web survey was to assess the perceptions and practices regarding blood donation and blood donation rules among members of the Brazilian LGBT+ community. The data collection was conducted between October 2019 and March 2020, before the changes in the rules for blood donation and before the onset of the COVID-19 pandemic in Brazil. A total of 1639 adult individuals, self-declared as LGBT+ , participated (54.3 % MSM, 2.2 non-MSM, 43.5 % women). As expected, most of the study participants did not agree with the 12-month deferral period for MSM donate blood. Blood donation was already practiced by MSM, even before the abolition of the restrictions on donation. Among MSM and women, 38.7 % and 41.0 % have already donated blood, respectively. A significant number of participants reported lying in screening interviews at blood banks in order to be able to donate, and many said they knew people who were MSM and disobeyed the rules for donation, even though they knew them. Therefore, the practice of blood donation was already present among these people, even before the restriction policy change, confirming the need for revised rules for blood donation.
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Fisayo T. Science in action? A critical view of UK blood donation deferral policy and men who have sex with men. Int J Health Plann Manage 2021; 36:1207-1222. [PMID: 33834528 DOI: 10.1002/hpm.3167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/30/2021] [Accepted: 03/21/2021] [Indexed: 11/06/2022] Open
Abstract
The rules that govern blood donation vary globally. Some potential blood donors are ineligible for immediate blood donation, and as such are deferred until such time that they become eligible. This practice, the blood donation deferral period, is intended to reduce the risk of blood-borne infections being transfused into a blood product-recipient. As blood screening technologies improve, the risk of an infected blood product remaining undetected decreases-and so too have the deferral periods for certain donors. Much has been made of the importance of an evidence-based, scientific approach to protecting blood product-recipients. However, these deferrals are controversial. What exactly determines the blood donation deferral period? This article argues that blood donation deferral periods are not merely the result of enacting empirical data. Instead, the deferral periods represent a negotiation between scientific evidence, experts, politically expedient narratives, institutionalised risk aversion, as well as more mundane concerns such as operational feasibility. As a case study, I examine how the UK Advisory Committee on the Safety of Blood, Tissues and Organs changed the 12-month deferral period for blood donation from men who have sex with men to a 3-month deferral period.
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Affiliation(s)
- Temitope Fisayo
- King's College London School of Medicine, Guy's Campus, London, UK
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Vesnaver E, Goldman M, O'Brien S, MacPherson P, Butler-Foster T, Lapierre D, Otis J, Devine DV, Germain M, Rosser A, MacDonagh R, Randall T, Osbourne-Sorrell W, Clement-Thorne B, Al-Bakri TB, Rubini KA, Hill NE, Presseau J. Barriers and enablers to source plasma donation by gay, bisexual and other men who have sex with men under revised eligibility criteria: protocol for a multiple stakeholder feasibility study. Health Res Policy Syst 2020; 18:131. [PMID: 33138828 PMCID: PMC7605323 DOI: 10.1186/s12961-020-00643-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background Blood donation policy in Canada for gay, bisexual and other men who have had sex with men (gbMSM) has changed progressively in the last decade from indefinite deferral to 3-month deferral from last male-to-male sex. Driven by safety data and overseen by the national regulator, more inclusive policies continue to redress the disparity in donation for gbMSM. At the same time, the need for source plasma to prepare fractionated blood products is growing worldwide. The collection and processing of source plasma ensures greater safety compared to whole blood donation with respect to transfusion-transmitted infection. This greater safety offers an opportunity to evolve policies for gbMSM from time-based to behaviour-based deferral using revised eligibility criteria. However, changing policies does not in itself necessarily guarantee that gbMSM will donate or that staff in donor clinics are ready to support them to do so. In anticipation of a move to behaviour-based donation screening for gbMSM in Canada, we aim to assess the acceptability of and perceived barriers and enablers to source plasma donation using revised screening criteria for gbMSM among key stakeholders to inform policy implementation strategies. Methods This mixed-methods feasibility study will involve gbMSM and donor centre staff to understand modifiable barriers to implementing more inclusive eligibility criteria. Key informant interviews and surveys will be rooted in the Theoretical Domains Framework to identify modifiable factors associated with source plasma donation motives in gbMSM and training needs in donation centre staff. We will use an integrated knowledge translation approach involving a partnership between researchers, the national blood operator and gbMSM, situating knowledge users as key research team members to ensure their perspectives inform all aspects of the research. Discussion Our integrated knowledge translation approach will provide a more comprehensive and collaborative understanding of blood operator and gbMSM needs while accelerating the implementation of study findings. Given the historical backdrop of the decades of exclusion of sexually active gbMSM from blood donation, this study has the potential not only to inform a process and policy for gbMSM to donate source plasma, a blood product, but also offers opportunities for new relationships between these knowledge users.
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Affiliation(s)
- Elisabeth Vesnaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Sheila O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Paul MacPherson
- Medicine, The Ottawa Hospital, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Joanne Otis
- Department of Sexology, Université du Québec À Montréal, Montreal, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Marc Germain
- Héma-Québec, Medical Affairs, Quebec City, Canada
| | | | | | | | | | | | | | | | | | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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