The risks and benefits of accepting men who have had sex with men as blood donors

Should men who have ever had sex with men be allowed to donate blood in Brazil?

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.

Modeling US blood donor deferrals under a policy of individual risk assessment for HIV risk sexual behavior

BACKGROUND

In May 2023, the Food and Drug Administration (FDA) released final guidance for blood donor eligibility that recommended the elimination of 3-month deferral for men who have sex with men (MSM) and the related deferral for women who have sex with MSM. In its place, FDA introduced an individual risk assessment policy of asking all presenting blood donors, regardless of sex or gender, if they have had a new partner or more than one sexual partner in the last 3 months and deferring those who also report anal sex (penile-anal intercourse) during this period. We modeled the possible impact of this policy on the US blood donor base.

STUDY DESIGN AND METHODS

We developed a computational model to estimate the percentage of blood donors who would be deferred under a policy of individual HIV risk assessment. The model incorporated demographic information about donors and national survey data on HIV risk behaviors and included age and sex distributions and dependencies.

RESULTS

Our model estimates that approximately 1.2% of US blood donors would be deferred under the individual HIV risk assessment paradigm.

DISCUSSION

The model predicts a relatively minor effect of replacing the time-based deferral for MSM with individual risk-based deferral for sexual behavior. As US blood centers implement this new policy, the effect may be mitigated by donor gains, which warrant further study. The new policy is unlikely to adversely affect the availability of blood and blood components.

Compliance and attitudes of blood donors following transitioning from permanent to 12-month deferral of men who have sex with men in Hong Kong

BACKGROUND AND OBJECTIVES

Blood safety hinges not just on the scientific rationale for deferral period but potential donors' compliance with the prevailing policy. This study aimed to investigate donors' awareness, attitudes and compliance with the two-phased policy implementation of time-limited deferral for men who have sex with men (MSM) in Hong Kong.

MATERIALS AND METHODS

Three rounds of questionnaire survey were conducted between July 2017 and June 2019 covering the periods of pre-implementation (Round A), post-implementation without and with pre-donation questionnaire revision (Round B and C). Chi-square test and multivariable regression analysis were performed.

RESULTS

Of 3085 donors recruited, 968, 1036 and 1081 completed the surveys in Round A, B and C, respectively. The non-compliance rate of MSM remained stable at 0·6% (3/497), 0·4% (2/551) and 0·5% (3/587) among male donors in Round A, B and C, respectively. Two MSM donors from Round C complying with the prevailing policy were identified. About two-thirds (60·7%) of respondents from Round B and C were unaware of the policy change. Overall, over 80% were either neutral or positive about the change.

CONCLUSION

Our study showed a consistently low non-compliance rate of MSM over the three periods. The generally high level of acceptance of time-limited deferral among donors lends support to science-based policy development to protect blood safety. The identification of compliant MSM donors suggests that the 12-month deferral is effective and acceptable to MSM. With a deferral period far exceeding the window period, it is a step towards a more equitable policy.

HIV residual risk in Canada under a three-month deferral for men who have sex with men

BACKGROUND AND OBJECTIVES

In Canada, the deferral for men who have sex with men (MSM) was decreased from a permanent deferral to a 5-year then a 12-month deferral. Current HIV testing can detect an HIV infection in donated blood within 2 weeks of exposure; thus, a 12-month deferral may be unnecessarily restrictive. We aimed to estimate the residual risk of HIV if the deferral were further decreased to 3 months.

MATERIALS AND METHODS

Using a deterministic model with stochastic Monte Carlo simulation, residual risk of HIV was the sum of testing error, assay sensitivity and window-period risks. Data inputs were estimated from donor surveillance, donor surveys and published data. Residual risk was modelled at baseline and using three scenarios: (1) most likely - non-compliance, HIV prevalence and incidence rates of MSM are unchanged; (2) optimistic - non-compliance improves by 50%; and (3) pessimistic - non-compliance, HIV prevalence and incidence rates of MSM all double.

RESULTS

HIV residual risk at baseline was 1 in 36·0 million donations (95% CI 1 in 1 504 907 million, 10·5 million); in the most likely scenario 1 in 34·2 million (1 in 225 534 million, 8·7 million); in the optimistic scenario 1 in 36·0 million (1 in 282 618 million, 9·5 million); in the pessimistic scenario 1 in 16·7 million (1 in 39 469 million, 6·0 million). All confidence intervals overlapped.

CONCLUSION

With very low modelled risk under a 12-month deferral, the additional risk with a 3-month deferral is very low. This is true even with a pessimistic scenario.

Changing the deferral for men who have sex with men - an improved model to estimate HIV residual risk

BACKGROUND AND OBJECTIVES

Eight published studies modelled the impact of changing from a lifetime to time-limited deferral for men who have sex with men (MSM); each predicted greater risk impact than has been observed. This study uses these previous efforts to develop an 'optimized' model to inform future changes to MSM deferrals.

MATERIALS AND METHODS

HIV residual risk was calculated using observed HIV incidence/prevalence prior to the change in MSM deferral, then with the additional MSM expected under a 12-month deferral for five compliance scenarios, and finally using data observed after implementation of the deferral. Monte Carlo simulation calculated 95% confidence intervals (CI).

RESULTS

The architecture of reviewed models was sound, and two were selected for combination into the optimized model. HIV risk estimated by this in the UK under MSM lifetime deferral was 0·102 (95% CI: 0·050-0·172) per million. The model predicted from a 27·8% decrease to a 47·6% increase depending upon compliance pre-implementation of the 12-month deferral. A decrease of 0·9% was observed post-implementation. For Canada, HIV risk under a 5-year deferral was 0·050 (95% CI: 0·00003-0·122) per million. Pre-implementation of the 12-month deferral, the model predicted from 30·2% decrease to 10-fold increase. A decrease of 47·0% was observed after implementation.

CONCLUSION

The optimized model predicted HIV risk under 12-month MSM deferral in UK and Canada would remain low, and this was confirmed post-implementation. While the model is adaptable to other deferral scenarios, improved data quality would improve precision, particularly estimates of incidence in individuals likely to donate.

Blood’s ontologies-entangled: Qualitative inquiry into the enactment, representation, and organizational modes of coordination of blood’s multiplicity in a Belgian blood establishment

Since British sociologist Titmuss authoritatively conceived blood donation as an altruistic ‘gift relationship’, blood establishments have adopted blood’s highly symbolic status as a core professional belief. However, important developments since the 1970s have resulted in blood’s bio-objectification, making blood a renewed object of concern. Because different versions of this bio-object are simultaneously present and interfere with one another, we ask how the organization renders this multiplicity workable? Studying how ontological versions are enacted in a specific blood establishment and how the organizational model of a blood establishment functions as a mode of coordination, we develop a praxiographic appreciation of blood in the context of a specific Belgian blood establishment. We show how the organizational mode of coordination allocates versions of blood in specific departments along functional and chronological dimensions. Blood remains the object of a gift relationship but is accompanied by blood’s enactment and representation as the object of suspicion, management, research/biology, and a blood economy. Furthermore, the organizational mode of coordination also allocates personalized and depersonalized enactments according to the level of contact with the donor population. This reflects a third dimension: (de)personalization of blood. Whereas the organizational mode of coordination is successful in rendering blood’s multiplicity workable, at times, it causes suboptimal practices. Moreover, we showed how sometimes a focus on intra-departmental modes of coordination is necessary to understand how blood’s multiplicity complicates the practices of the blood establishment.

Reevaluating Canada's policy for blood donations from men who have sex with men (MSM)

During the HIV/AIDS epidemic of the 1980s, most of the developed world instituted a permanent ban on blood donations from men who have sex with men (MSM). In recent years, public health agencies across Europe and North America are reconsidering and rescinding these restrictions. We examine the Canadian climate, where MSM may donate blood only after a 5-year deferral period. We review circumstances of the initial ban on MSM blood donations and recent social, legal, and economic changes that have encouraged Canadian public health officials to consider policy reform. We also review international evidence about the impact of reforming MSM blood donations. Given improvements in HIV screening technology, results from mathematical modeling studies, and empirical data from Italy, the UK, and Australia, we conclude that changing Canada's MSM blood donation policy from a 5- to a 1-year deferral would not increase the number of transfusion-transmitted HIV infections. We provide empirical support to the recently elected Liberal Canadian government's political promise to decrease restrictions on MSM blood donations.

Attitudes, perceptions and knowledge among men who have sex with men towards the blood donation deferral policy in Israel

BACKGROUND

Men who have sex with men (MSM) are permanently deferred from donating blood in Israel. Pressure to change this policy exists, despite data showing higher prevalence and incidence of HIV in MSM. A survey was conducted to evaluate current knowledge, attitudes, perceptions and compliance if deferral was changed.

STUDY DESIGN AND METHODS

Anonymous survey was published in a gay-oriented website, collecting demographic information, history of blood donation, attitudes, knowledge and compliance with permanent versus temporary deferral. Responses were analyzed given 1 point for every "yes" response (0-7 points). Student's t-test was applied to compare differences between continuous variables. Correlations were described with the Pearson correlation coefficient.

RESULTS

Responses from 492 MSM were analyzed. Average age was 31±9 years. 76% donated blood at least once, mostly for social solidarity (score of 3.2 on 1-5 scale). Tests seeking or protest scores were 1.7 and 1.6, respectively. 66% were unaware of the higher risk of HIV transmission by MSM, or the potential to infect 3 recipients. Knowledge regarding HIV transmission by blood positively correlated with knowledge regarding other routes of HIV transmission (r = 0.11; p = 0.03), age (r = 0.10; p = 0.04), and higher rate of non-compliance with the current deferral policy (OR = 1.9; p = 0.02). Activism for LGBT rights was associated with lower risk for non-adherence (OR = 0.5; p = 0.03). If temporary deferral is introduced 66% will comply with the new policy, but 23% will continue to donate as long as MSM deferral policy is in place.

CONCLUSION

A high proportion of MSM do not comply with the current lifetime deferral. This may partially change if temporary deferral is introduced.

Should Men who have sex with Men be allowed to donate blood in Israel?

Background

The present permanent deferral policy in Israel for MSM was established in 1977 and was based on the previous (now outdated) USA Food and Drug Administration standards. This study analyses epidemiological data regarding blood donations among MSM, in order to estimate the risk for HIV transfusion transmitted infection (TTI) if the policy is changed to allow at-risk MSM to donate blood.

Methods

An Excel based spreadsheet model integrated demographic, epidemiological data from the HIV National Register, laboratory, blood donation and testing data in order to calculate TTI due to false-negatives in known HIV+ donors, windows period donations, asymptomatic carriers and laboratory misclassification errors. A sensitivity analysis of our estimated TTIs for deferral periods for MSM was performed based on a literature review regarding this overall policy issue worldwide.

Results

MSM in Israel have a considerably higher relative risk (RR) of both prevalence (115) and incidence (143) of being HIV+ than persons without a risk factor. Allowing MSM to donate blood, without any deferral period, will add an additional five HIV TTI cases over the next decade. Imposition of a 1 or 5 years deferral of abstinence will increase the number of HIV TTI cases only by 0.10 and 0.05 cases, respectively.

Conclusion

A 1 year deferral period for blood donations from MSM in Israel is recommended.

The risk of allowing blood donation from men having sex with men after a temporary deferral: predictions versus reality

BACKGROUND

In most industrialized countries, men who had sex with men (MSM) are permanently deferred from blood donation. Some countries have adopted a temporary deferral after the MSM behavior, thus avoiding donations made during the window period of human immunodeficiency virus (HIV) infection. However, one concern with this approach is the possible increase in the number of HIV-positive donations obtained from unknowingly infected, abstinent MSM; such donations might inadvertently be made available for transfusion, a risk that was previously estimated through mathematical modeling.

STUDY DESIGN AND METHODS

Model predictions were compared to the actual donor rate of HIV in three countries that went from a permanent to a temporary deferral: Australia, the United Kingdom, and Canada.

RESULTS

Depending on the model, a temporary deferral should have increased the rate of HIV in the male donor pool by 73% to more than 3400%. In reality, the very low baseline rate of HIV before the change in these three countries (22 cases/year) remained unchanged 2 years after the revised policy (16 cases/year).

CONCLUSION

These observations strongly suggest that a temporary deferral for MSM incurs zero risk to recipients, at least in jurisdictions where HIV epidemiology is comparable to that of countries where the change happened.

Sexual risk behaviour and donor deferral in Europe

One of the most controversial policies in blood transfusion worldwide is the permanent deferral from donating blood of men with sexual contacts to other men (MSM). This policy was implemented for safety reasons as sex between men is known to be a high risk factor for acquiring severe infectious diseases transmissible by blood transfusion. Sexual contacts among heterosexual persons may hold similar risks but a clear-cut discrimination between different individual risks is impossible. Nevertheless, the current blood donor deferral periods defined by European Union (EU) legislation depend on a distinction of different grades of risk with respect to sexual behaviour. Under the aegis of the Steering Committee on Blood Transfusion (CD-P-TS) of the Council of Europe (CoE), an international working group evaluated epidemiological and behavioural data, modelling studies on residual risk and spread of infections, and studies on adherence to donor selection criteria. The aim was to distinguish sexual behaviour of different risk categories. It was concluded, that existing data confirm that MSM and commercial sex workers (CSW) are groups at high risk. Any further grading lacks a scientific data base. Modelling studies indicate that adherence to deferral policies is of major relevance suggesting that good donor adherence may outweigh the small negative effects on blood safety postulated for changing from permanent to temporary deferral periods for high risk sexual behaviours. The fact that a considerable percentage of donors are MSM - despite the permanent deferral policy - demonstrates the need to increase donor understanding and adherence.

The rates, perceptions, and willingness of men who have sex with men to donate blood

BACKGROUND

Since 1983 in the United States, any man who has had sex with another man (MSM) at any time since 1977 has been deferred from donating blood for life. Although there has been a push to change the deferral, there is a paucity of information on both the rates of MSM blood donation and the willingness of MSMs to donate if the deferral were changed.

STUDY DESIGN AND METHODS

A 15-question survey was given at two lesbian, gay, bisexual, and transgender festivals in Chicago and New Orleans. Participants were asked about a previous history of blood donation and whether they would be willing to donate were the lifetime deferral changed. Participants were also asked to determine whether it was safe for hypothetical MSMs with varying sexual practices to donate blood and whether they believed that it was safe for them to donate their own blood.

RESULTS

Our study found that 42.0% of all participants had not complied with the deferral policy and have donated blood at least once, with a mean number of donations of 4.84. Additionally, 85.9% of participants would be willing to donate blood if the deferral were changed.

CONCLUSION

Despite the lifetime deferral, many MSMs have previously donated blood, and many more are willing to donate. Given this, along with the safe implementation of temporary deferral policies in other nations, the United States should consider adopting a temporary deferral policy for MSMs.

Three decades of MSM donor deferral policies. What have we learned?

In the early 1980s, donor deferrals targeting men who have sex with men (MSM) and other high-risk groups were implemented in response to the outbreak of HIV/AIDS. It has now been three decades since the implementation of these deferrals. We review the international experience with developing these policies, which involves combining scientific evidence with ethical and moral concerns and the challenge of moving from precautionary to risk management policies as scientific knowledge and technology evolves. We provide key lessons that can guide blood policymakers as they confront potential new threats to the safety of the blood system and also provide lessons to the wider public health community on how best to incorporate precaution into the policymaking process.

Using basic ethical principles to evaluate safety efforts in transfusion medicine

Pursuit of pharmaceutical purity of the blood in the bag has led to a shrinking donor base and a significantly more expensive product. Decisions regarding new infectious marker testing and donor deferrals have typically been made emphasizing decreasing one specific risk without considering the effect the intervention will have on the overall safety and availability of blood transfusion. Regulations have been formulated by governmental agencies with limited input from the medical community. The decision making process has lacked risk benefit analyses and has not had the robustness associated with spirited discussions. Policies made in this manner may result in certain risks being decreased but can also have adverse unintended consequences. Being guided by the ethical principles of nonmaleficence, beneficence, autonomy, and justice, we need to evaluate our actions in the context of overall blood safety rather than narrowly focusing on any one area.

Public health research: lost in translation or speaking the wrong language?

Public health leaders, like physicians, need to make decisions that impact health based on strong evidence. To generate useful evidence for public health leaders, research must focus on interventions that have potential to impact population-level health. Often policy and environmental changes are the interventions with the greatest potential impact on population health, but studying these is difficult because of limitations in the methods typically used and emphasized in health research. To create useful evidence for policy and environmental interventions, other research methods are needed, including observational studies, the use of surveillance data for evaluation, and predictive mathematical modeling. More emphasis is needed on these types of study designs by researchers, funding agencies, and scientific journals.

Surveillance of transfusion-transmissible infections comparison of systems in five developed countries

Most industrialized countries maintain surveillance programs for monitoring transmissible infection in blood donations, revising approaches to methodology and risk assessment as new threats emerge. A comparison of programs in the United States, Canada, France, the UK, and Australia indicates that they have similar function, although the structure of blood programs vary as does the extent and nature of formal ties with public health. The emergence of HIV in the late 1970s and early 1980s was key in recognizing that surveillance systems specific to blood transfusion were essential. Hence, most industrialized countries monitor transfusion-transmissible infections in donors and evaluate the impact of new testing and of predonation screening strategies. Emerging infections since HIV have had different transmission pathways and challenged blood programs to draw upon resources for a rapid and effective response, with recognition that the original focus on sexual/drug-related risk of HIV and hepatitis was inadequate. The focus of surveillance programs on new and emerging pathogens fulfills a key role in risk assessment and policy formulation. The precise nature of such activities varies by country because of the structure of the blood programs and surveillance systems, the strategic focus of the blood programs, and the epidemiology of disease in each country.

Estimating the risk of blood donation associated with HIV risk behaviours

A blood donor questionnaire and declaration, with deferral of potential donors at a higher risk of blood-borne infections, was introduced in Australia in the mid-1980s to reduce the risk of donation of HIV-infected blood. However, the absolute risk of HIV transmission through blood donation from high-HIV-risk donors has not been estimated. This study presents a new method of assessing the risk posed to the blood supply by selected HIV risk behaviours. A model was developed to estimate the probability of blood donation during the window period for HIV infection. Five scenarios for blood donors were considered: (1) men who have sex with men (MSM), (2) men who have sex with women in Australia, (3) women who have sex with partners from countries with a high HIV prevalence, (4) men who have sex with commercial sex workers in Australia and (5) people injecting drugs used once in a year. Those estimated to be at highest risk of becoming infected and donating in the window period were MSM. Women who have sex with men from countries of high HIV prevalence are at greater risk than men who have sex with female sex workers from Australia. These three groups under current Australian guidelines are deferred from donating blood for 12 months. In Australia, a single episode of injecting drug use is associated with very low risk of HIV transmission. The model presented in this study can be used to assess the impact of selected individual risk behaviours on the safety of the blood supply.

Risk factors for human immunodeficiency virus infection among blood donors in Sao Paulo, Brazil, and their relevance to current donor deferral criteria

BACKGROUND

The objective of this study was to investigate risk factors of human immunodeficiency virus (HIV)-seropositive blood donors in Brazil and to determine if current donor deferral criteria are appropriate.

STUDY DESIGN AND METHODS

Demographic and behavioral data among cases with confirmed HIV seropositivity (n = 272) were compared with those who had a false-positive serology (n = 468) between January 1999 and December 2003 in a case-control analysis with logistic regression.

RESULTS

Risk factors that should have resulted in predonation deferral were reported by 48.9 percent of HIV-positive and 9.4 percent of false-positive donors. In multivariate analysis, male cases were significantly more likely to report male-male sex (adjusted odds ratio [AOR], 26.2; 95% confidence interval [CI], 7.8-87.4), a previous sexually transmitted disease diagnosis (AOR, 3.2; 95% CI, 1.5-6.9), exchanging money for sex (AOR, 2.1; 95% CI, 1.0-4.2), and at least two partners in the past 12 months (AOR, 2.3; 95% CI, 1.4-3.6). HIV-positive male donors were also more likely to be reactive for the presence of hepatitis C virus antibody (AOR, 4.0; 95% CI, 1.3-12.0) and hepatitis B virus core antibody (AOR, 3.8; 95% CI, 1.9-7.7). Female cases were more likely to report an intravenous drug user partner (AOR, 12.4; 95% CI, 1.3-120.2), a sexual partner with multiple sex partners or who had a history of sex with a sex worker (AOR, 13.0; 95% CI, 2.7-63.2), and at least two partners in the past 12 months (AOR, 2.2; 95% CI, 1.0-5.3).

CONCLUSION

A substantial number of HIV-infected donors reported a risk factor that could have been identified in the predonation screening. Male-male sexual behavior was still the strongest determinant of HIV status in the studied population.

Face-to-face interviewing in predonation screening: lack of effect on detected human immunodeficiency virus and hepatitis C virus infections

BACKGROUND

Predonation screening has become more elaborate over the years, while human immunodeficiency virus (HIV)- and hepatitis C virus (HCV)-positive donations have declined. The impact of face-to-face interviewing and of the format of the Donor Health Assessment Questionnaire (DHAQ) have not been evaluated.

STUDY DESIGN AND METHODS

Canadian Blood Services DHAQ records between 1990 and 2004 were examined, and changes in them were tracked. The proportion of first-time donors permanently deferred for HIV or HCV risk, and the HIV and HCV rates per 100,000 donations, were calculated annually. Time-series analysis was used to determine whether major predonation screening changes had any effect on the HIV or HCV rates or permanent deferrals.

RESULTS

In 1992, receiving money or drugs for sex was added to the DHAQ; otherwise, the content of high-risk questions changed little between 1990 and 2004. In 1997, the method of administration of the DHAQ changed from donor-completed to face-to-face interviewing for high-risk questions. Permanent deferrals for HIV or HCV risk factors and HIV and HCV rates in first-time donors decreased over this period. The HIV rates were close to 0 before 1997, whereas HCV rates decreased steadily through 2004. There was no interruption in rates in 1997 when the method of administration changed.

CONCLUSION

Face-to-face interviewing for high-risk questions had no effect on HIV or HCV rates in first-time donations over 15 years of observation (during the latter 8 of which face-to-face interviewing was in place), and it did not increase permanent deferrals for HIV or HCV risk factors.

Unique donor-suitability issues

On occasion, there arise questions or situations involving blood-donor eligibility determination, which are not adequately addressed by the existing regulations and standards. In such instances, even the most experienced blood collector may be uncertain regarding the best course of action and unable to find adequate guidance in the standard blood banking references, regulations and literature. In order to examine this area in greater depth, the American Association of Blood Banks (AABB) sponsored a short topic session on 'Unique Donor Suitability Issues' at their 2004 annual meeting. The invited speakers were four seasoned physician medical directors, with a combined experience of over 40 years in blood collection at both regional and national levels. They were tasked with identifying and researching problematic areas in donor-suitability determination, and suggesting an overall approach to dealing with such issues. They determined that three of the most problematic areas of eligibility evaluation included donors with: (1) disabilities, (2) disorders of haemostasis, and (3) trans-sexual, homosexual and other unusual gender-related issues. Each of these topics was presented in a 10-min lecture, followed by an open format consisting of audience participation and panel discussion by the speakers. The session was additionally enhanced by a representative of the United States Food and Drug Administration (FDA) who participated as a member of the audience. This review presents the contents of the short topic session in an expanded form.

Prevalence of selected viral infections among temporarily deferred donors who returned to donate blood: American Red Cross blood donor study

BACKGROUND

Health history questions are introduced into the predonation interview to identify blood donors believed to pose a higher risk of infectious diseases to recipients. This study assesses the current impact of some of those questions.

STUDY DESIGN AND METHODS

Donor deferral and donation data were extracted from a research database of the American Red Cross. The prevalence of hepatitis B surface antigen or antibodies to human immunodeficiency virus, hepatitis C virus, or human T-lymphotropic virus was obtained for different groups of donors who were temporarily deferred in 2000 through 2001 and later returned to donate blood in 2000 through 2003. The results were compared with either first-time or repeat donors in 2000 through 2003, while controlling for differences in sex, age, and year of donation.

RESULTS

Of donors temporarily deferred in 2000 through 2001 who had had no donation or deferral during the previous 2 years, only 22.08 percent subsequently returned to donate blood in 2000 through 2003. Donations from returning donors who had been deferred for potential infectious disease risk did not show a higher prevalence for any of the viral markers when those with no donation or deferral during the previous two years were compared with first-time donations, and those with prior donation were compared with repeat donations.

CONCLUSION

Blood donors temporarily deferred in 2000 through 2001 for potential risk of viral infection who later returned to donate blood did not appear to pose a higher risk compared to first-time or repeat donors. The effectiveness of some of the currently used deferral questions in reducing viral risks warrants further study.

The rights of blood recipients should supersede any asserted rights of blood donors

Some gay men have argued that the laboratory testing of blood is so accurate that continued deferrals based upon sexual activity are unnecessary and unjust. They also assert that they have a right to donate blood. There has been much debate over altering the rule barring donation from men who have had sex with other men since 1977, with blood organizations disagreeing over the best course of action. Two studies have indicated that changing the rule would increase the risk of human immunodeficiency virus (HIV) transmission. This dilemma is part of a broader issue, namely: what are the responsibilities of blood services to blood donors and recipients? Blood services should base decisions regarding donor suitability on science rather than on their donors' desires. Blood services must recognize that the rights of blood recipients should supersede any asserted rights of blood donors.

The impact of male-to-male sexual experience on risk profiles of blood donors

BACKGROUND

Men who have had sex with men (MSM) since 1977 are permanently deferred from donating blood. Excluding only men who engaged in male-to-male sex within either the prior 12 months or 5 years has been proposed. Little is known about infectious disease risks of MSM who donate blood.

STUDY DESIGN AND METHODS

Weighted analyses of data from an anonymous mail survey of blood donors were conducted to examine the characteristics of men reporting male-to-male sex during specified time periods.

RESULTS

Of the 25,168 male respondents, 569 (2.4%) reported male-to-male sex, 280 (1.2%) since 1977. Compared to donors who did not report male-to-male sex, the prevalence of reactive screening test results was higher among donors who reported the practice within the past 5 years (< or =12 months odds ratio [OR] 5.3, 95% confidence interval [CI] 2.6-10.4; >12 months to 5 years, OR 7.1, 95% CI 1.2-41.7); however, no significant difference was found for donors who last practiced male-to-male sex more than 5 years ago (>5 years-after 1977, OR 1.4, 95% CI 0.7-2.6; 1977 or earlier, OR 1.6, 95% CI 0.7-3.7). The prevalence of unreported deferrable risks (UDRs) other than male-to-male sex was significantly higher for all donors who reported male-to-male sex with ORs ranging from 3.1 to 18.9 (p < or = 0.01).

CONCLUSIONS

No evidence was found to support changing current policy to permit donations from men who practiced male-to-male sex within the past 5 years. For donors with a more remote history of male-to-male sex, the findings were equivocal. A better understanding of the association between male-to-male sex and other UDRs appears needed.