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Lewin A, Goldman M, Busch MP, Davison K, van de Laar T, Tiberghien P, Shinar E, O'Brien SF, Lambert G, Field S, Hervig T, Tan DHS, Custer B, Drews SJ, Lanteri MC, Klochkov D, Widmer E, Domingue MP, Renaud C, Germain M. End of selection criteria based on sexual orientation: An international symposium on alternatives to donation deferral. Vox Sang 2024; 119:388-401. [PMID: 38270352 DOI: 10.1111/vox.13587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND AND OBJECTIVES Until recently, gay, bisexual and other men who have sex with men (MSM) were deferred from donating blood for 3-12 months since the last male-to-male sexual contact. This MSM deferral has been discontinued by several high-income countries (HIC) that now perform gender-neutral donor selection. MATERIALS AND METHODS An international symposium (held on 20-04-2023) gathered experts from seven HICs to (1) discuss how this paradigm shift might affect the mitigation strategies for transfusion-transmitted infections and (2) address the challenges related to gender-neutral donor selection. RESULTS Most countries employed a similar approach for implementing a gender-neutral donor selection policy: key stakeholders were consulted; the transition was bridged by time-limited deferrals; donor compliance was monitored; and questions or remarks on anal sex and the number and/or type of sexual partners were often added. Many countries have now adopted a gender-neutral approach in which questions on pre- and post-exposure prophylaxis for human immunodeficiency virus (HIV) have been added (or retained, when already in place). Other countries used mitigation strategies, such as plasma quarantine or pathogen reduction technologies for plasma and/or platelets. CONCLUSION The experience with gender-neutral donor selection has been largely positive among the countries covered herein and seems to be acceptable to stakeholders, donors and staff. The post-implementation surveillance data collected so far appear reassuring with regards to safety, although longer observation periods are necessary. The putative risks associated with HIV antiretrovirals should be further investigated.
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Affiliation(s)
- Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
| | - Mindy Goldman
- Donation Policy and Studies, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California in San Francisco, San Francisco, California, USA
| | - Katy Davison
- NHS Blood and Transplant/UK Health Security Agency (UKHSA) Epidemiology Unit, UKHSA, London, UK
| | - Thijs van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
- Laboratory of Medical Microbiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Pierre Tiberghien
- Établissement Français du Sang, La Plaine Saint Denis, France
- UMR 1098, Inserm, Établissement Français du Sang, Université de Franche-Comté, Besançon, France
| | - Eilat Shinar
- National Blood Services, Magen David Adom, Tel Aviv, Israel
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Gilles Lambert
- Direction régionale de santé publique - Montréal, Montréal, Québec, Canada
- Institut national de santé publique du Québec, Montréal, Québec, Canada
| | - Stephen Field
- Irish Blood Transfusion Service, Dublin, County Dublin, Ireland
| | - Tor Hervig
- Irish Blood Transfusion Service, Dublin, County Dublin, Ireland
| | - Darrell H S Tan
- Division of Infectious Diseases, Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California in San Francisco, San Francisco, California, USA
| | - Steven J Drews
- Donation Policy and Studies, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Marion C Lanteri
- Department of Laboratory Medicine, University of California in San Francisco, San Francisco, California, USA
- Scientific Affairs, Creative Testing Solutions, Tempe, Arizona, USA
| | - Denis Klochkov
- Research and Development, CSL Behring, Bern, Switzerland
| | | | - Marie-Pier Domingue
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
- Faculté des Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
| | - Marc Germain
- Medical Affairs and Innovation, Héma-Québec, Montréal and Québec, Quebec, Canada
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Goldman M. MSM and blood donation: shifting to individualized risk assessment. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:294-298. [PMID: 38066878 PMCID: PMC10727087 DOI: 10.1182/hematology.2023000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Deferring donors at higher risk for transfusion transmissible infections is an important part of ensuring blood safety. The deferral for gay, bisexual, and other men who have sex with men (gbMSM) was implemented in the 1980s in many countries, since they were identified as a high-risk group for AIDS/HIV. With the introduction of increasingly sensitive HIV antibody testing, augmented by nucleic acid testing, the window period for HIV infection-when a donor may be infectious but have negative test results-has shrunk dramatically. In Canada, this has led to progressively shorter deferral periods for gbMSM, decreasing from a permanent deferral for sex with another male since 1977 to a 5-year, 12-month, and eventually 3-month deferral period. These time-based deferrals maintained safety; however, they are seen as stigmatizing by many and still result in the deferral of sexually active gbMSM. More recently, several countries have moved to a donor screening approach based on assessing sexual risk behaviors in all donors. This article outlines research supporting changes in policy, current eligibility screening policies in several countries, and preliminary results postimplementation of new eligibility policies in Canada in September 2022.
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Affiliation(s)
- Mindy Goldman
- Medical Affairs & Innovation, Canadian Blood Services, and Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
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3
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Gahan L, Seed CR, Hammoud MA, Prestage G, Hoad VC, Kaldor JM. Perceived risk of HIV transmission by blood transfusion among gay, bisexual, and other men who have sex with men (gbMSM) in Australia. Transfusion 2023; 63:1528-1537. [PMID: 37300281 PMCID: PMC10953370 DOI: 10.1111/trf.17456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/18/2023] [Accepted: 05/18/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND In Australia, men who have sex with men (MSM) are deferred from blood donation for 3 months from last sexual contact. Internationally, deferral policies for MSM are evolving in the direction of expanded inclusivity in response to community expectations. To inform future policy options, we assessed perceptions of the risk of HIV transmission from blood transfusion among Australian MSM. STUDY DESIGN AND METHODS Flux is an online prospective cohort of Australian gay and bisexual men (cis or trans, regardless of their sexual history) and other men who have had sex with men (gbMSM). We included questions on blood donation rules, window period (WP) duration, infectivity of blood from people with HIV on treatment and attitudes to more detailed questioning of sexual practices in the regular survey of Flux participants and conducted a descriptive analysis of responses. RESULTS Of 716 Flux participants in 2019, 703 responded to the blood donation questions. The mean age was 43.7 years (SD 13.6 years). Overall, 74% were willing to confidentially respond to specific sexual behavior questions, such as the last time they had sex and the type of sex they had, in order to be considered eligible to donate blood. The majority (92%) of participants correctly assessed the duration of the WP as less than 1 month. When asked whether transfusion of blood from a donor with HIV and an undetectable viral load could transmit HIV, just under half (48%) correctly said yes. CONCLUSION Our study suggests Australian gbMSM are generally comfortable with answering more detailed questions regarding sexual activity during the assessment to donate, indicating they would do so honestly. gbMSM are knowledgeable about the WP duration, important for their ability to correctly self-assess their HIV risk. However, half of participants incorrectly assessed the transmissibility by blood transfusion from an HIV positive person with an undetectable viral load, suggesting the need for a targeted education campaign.
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Affiliation(s)
- Luke Gahan
- School of Humanities and Social Sciences, La Trobe UniversityMelbourneVictoriaAustralia
| | - Clive R. Seed
- Australian Red Cross LifebloodMelbourneVictoriaAustralia
| | - Mohamed A. Hammoud
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | - Garrett Prestage
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
| | | | - John M. Kaldor
- Kirby Institute, Faculty of Medicine, UNSW SydneySydneyNew South WalesAustralia
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4
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Davison KL, Reynolds CA, Andrews N, Brailsford SR. Blood donation by men who have sex with men: using evidence to change policy. Vox Sang 2021; 116:260-272. [PMID: 33400285 DOI: 10.1111/vox.13033] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/28/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2011 in the United Kingdom (UK), excluding Northern Ireland, the deferral of men who have sex with men (MSM) changed from lifetime to 12 months. We describe MSM who donated before and after this to inform further policy reviews. MATERIALS AND METHODS Characteristics and sexual behaviours of donors identifying as male from routine surveillance are described. Rates of infections are compared pre- and post-implementation of a 12-month deferral. Donors are compared with screen negative male donors responding to a large-scale survey during 2013/2014. RESULTS Comparing the five years pre- and post-change, the rate of confirmed positives for markers of HBV, HCV, HIV and syphilis decreased by 6·9% from 14·1 to 13·1/100 000 donations. The rate of recent infections was unchanged (1·72/100 000). Of 22 776 survey responses identifying as male, MSM disclosed sex between men over 12 months ago giving 99·35% compliance among male donors. Two-thirds of the 72 non-compliant MSM reported one to two partners and one-third had no new partners within 12 months. The most commonly reported reason for non-compliance from MSM both positive and negative for infection was 'not important to declare' (37·2% and 40·7%). Test seeking was rare (9·3% and 2·1%). CONCLUSION Compliance with the 12-month MSM deferral policy was very high. The very low rates of infections post-change demonstrated the effectiveness of the policy. These data were an important part of the 2017 review of all sexual behaviour deferrals.
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Affiliation(s)
- Katy L Davison
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK
| | - Claire A Reynolds
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK.,Microbiological Services, NHS Blood and Transplant, London, UK
| | - Nick Andrews
- Statistics, Modelling and Economics Department, Public Health England, London, UK
| | - Susan R Brailsford
- NHS Blood and Transplant/Public Health England Epidemiology Unit, Public Health England, London, UK.,Microbiological Services, NHS Blood and Transplant, London, UK
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5
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O'Brien SF, Goldman M, Robillard P, Osmond L, Myhal G, Roy É. Donor screening question alternatives to men who have sex with men time deferral: Potential impact on donor deferral and discomfort. Transfusion 2020; 61:94-101. [PMID: 33616949 DOI: 10.1111/trf.16165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/05/2020] [Accepted: 10/05/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Alternative screening questions could permit low-risk men who have sex with men (MSM) to donate blood without a time deferral. We performed a study to determine the proportion of current donors who may be deferred by various questions and their comfort with them. STUDY DESIGN AND METHODS Donors attending collection sites in Canada in January and February 2018 were offered one of two questionnaires but not both. Questionnaire 1 asked about risk behaviors; Questionnaire 2 rated comfort with the questions. Volunteers uncomfortable with questions participated in short qualitative telephone interviews to understand reasons. Quantitative data were analyzed using χ2 statistics. RESULTS Of 36 241 donors attending, 31 904 (88%, Period 1) completed Questionnaire 1; of 34 947, a total of 30 278 (87%, Period 2) completed Questionnaire 2; 294 completed an interview. In the past 3 months 3.1% (95% confidence interval [CI], 3.1%-3.6%) had more than one partner; 6.0% (95% CI, 5.7%-6.2%) had a new partner; 6.7% (95% CI, 6.4%-6.9%) were in a nonexclusive relationship; 11.2% (95% CI, 10.9%-11.6%) had at least one of these; 3.7% (95% CI, 3.4%-3.9%) had anal sex; and 62.8% (95% CI, 62.2%-63.3%) had condomless sex. More than 6% were uncomfortable with each question, but more (17.2%; 95% CI, 16.8%-17.7%) were uncomfortable with anal sex. Key reasons for discomfort were questions being too personal and unclear safety benefit. CONCLUSION Most donors are comfortable answering alternative questions (except very personal ones) but question the benefit. Implementing alternative questions would result in substantive deferrals. Other policies such as using an MSM capture question to ask additional questions only to MSM should be considered.
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Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Lori Osmond
- Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Élise Roy
- Faculty of Medicine and Health Sciences, Sherbrooke University, Longueuil, Quebec, Canada
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6
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Lau JYC, Lee CK, Chan CP, Leung JNS, Poon CM, Lee SS. Compliance and attitudes of blood donors following transitioning from permanent to 12-month deferral of men who have sex with men in Hong Kong. Vox Sang 2020; 116:504-512. [PMID: 33196117 DOI: 10.1111/vox.13025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 10/15/2020] [Accepted: 10/15/2020] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Janice Ying-Chui Lau
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong, People's Republic of China
| | - Chin-Pok Chan
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Jennifer Ngar-Sze Leung
- Hong Kong Red Cross Blood Transfusion Service, Hospital Authority, Hong Kong, People's Republic of China
| | - Chin-Man Poon
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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7
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Van Remoortel H, Matthysen W, Avau B, Compernolle V, Vandekerckhove P, De Buck E. Is sexual risk behaviour associated with an increased risk of transfusion-transmissible infections in blood donors from Western and Pacific countries? A systematic review and meta-analysis. Vox Sang 2019; 115:107-123. [PMID: 31823386 DOI: 10.1111/vox.12874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/13/2019] [Accepted: 11/14/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES The donor medical questionnaire is designed to aid blood establishments in supporting a safe blood supply. According to blood donor deferral policies, sexual risk behaviour (SRB) leads to a (temporary) deferral from blood donation. This systematic review aimed to scientifically underpin these policies by identifying the best available evidence on the association between SRB and the risk of transfusion transmissible infections (TTIs). MATERIALS & METHODS Studies from three databases investigating the link between SRB (excluding men who have sex with men (MSM)) and TTIs (HBV, HCV, HIV, Treponema pallidum) in donors from Western and Pacific countries were obtained and assessed on eligibility by two reviewers independently. The association between SRB and TTIs was expressed by calculating pooled effect measures via meta-analyses. The GRADE methodology (Grades of Recommendation, Assessment, Development and Evaluation) was used to assess the quality of evidence. RESULTS We identified 3750 references and finally included 15 observational studies. Meta-analyses showed that there is a significant (P < 0·05) positive association between the following SRB and HBV and/or HCV infection: having sex with an intravenous drug user (high-certainty evidence), receiving money or goods for sex (moderate-high certainty evidence), having a sex partner with hepatitis/HIV (moderate-certainty evidence) and paid for sex or anal sex (low-certainty evidence). CONCLUSION Sexual risk behaviour (including having sex with an intravenous drug user, receiving money or goods for sex or having a sex partner with hepatitis/HIV) is probably associated with an increased risk of HBV/HCV infection in blood donors from Western and Pacific countries.
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Affiliation(s)
- Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Wout Matthysen
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Bert Avau
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Cochrane Belgium, Belgian Centre for Evidence-Based Medicine (Cebam), Leuven, Belgium
| | - Veerle Compernolle
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Blood Services, Belgian Red Cross, Mechelen, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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8
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Salomon T, Gomes I, Ozahata MC, Valente Moreira CH, Lorenzo Oliveira CD, Gonçalez TT, Duarte ME, Miranda C, de Freitas Carneiro Proietti AB, Sabino E, de Almeida Neto C, Custer B. Social and behavioral characteristics of male blood donors and their sexual partners: an analysis to define risk subsets. Transfusion 2019; 59:2584-2592. [PMID: 31158312 PMCID: PMC6679786 DOI: 10.1111/trf.15388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Men who have sex with men in Brazil are deferred from donation for 1 year since their last sexual contact. Legal proceedings in front of the Brazilian Supreme Court could compel blood collection agencies to discontinue use of sexual orientation questions. METHODS Data from male participants in a completed HIV risk factor case-control study were used to evaluate whether it is possible to differentiate donors at lower and higher risk for HIV using two analytical approaches: latent class and random forest analyses. RESULTS Male blood donors were divided into three distinct risk profile classes. Class 1 includes donors who are heterosexual (96.4%), are HIV negative (88.7%), have a main partner (99.4%), and practice unprotected sex (77.8%). Class 2 includes donors who are men who have sex with men /bisexuals' (100.0%), are HIV positive (97.4%), and were not aware of their sexual partners' HIV status (80.3%). Class 3 includes donors who are heterosexual (84.1%), practice unprotected vaginal/anal heterosexual sex (66.8% vs. 40.9%), and were both HIV positive and HIV negative (49.5% vs. 50.5%). We also found that asking donors about their partner(s)' HIV serostatus could replace asking about donors' sexual orientation and types of partners with relatively minor shifts in sensitivity (0.76 vs. 0.58), specificity (0.89 vs. 0.94), and positive predictive value (0.85 vs. 0.88). CONCLUSION Sexual orientation questions on the donor questionnaire could be replaced without great loss in the sensitivity, specificity, and positive predictive value. Social and sexual behaviors of donors and their partners are proxies for HIV risk and can help to develop modified questions that will need controlled trials to be validated.
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Affiliation(s)
- Tassila Salomon
- Hemominas, Minas Gerais – Brazil,Institute of Tropical Medicine, University of São Paulo, Brazil
| | - Isabel Gomes
- Faculdade Ciências Médicas – Belo Horizonte – Minas Gerais – Brazil
| | | | | | | | | | | | | | | | - Ester Sabino
- Institute of Tropical Medicine, University of São Paulo, Brazil
| | - Cesar de Almeida Neto
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, Brazil,Disciplina de Ciências Médicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute and University of California San Francisco
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9
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Negotiating risk-group categorization and the co-production of blood safety: the evolution of sociotechnical imaginaries mobilized in the public debate on the deferral of men who have sex with men as blood donors in Belgium. BIOSOCIETIES 2019. [DOI: 10.1057/s41292-019-00161-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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10
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Levy I, Olmer L, Livnat Y, Shalhavi R, Hizki O, Shinar E. Attitudes and perceptions among men having sex with men towards a new non-deferral blood donation policy in Israel. Vox Sang 2019; 114:310-316. [PMID: 30854673 DOI: 10.1111/vox.12766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/19/2018] [Accepted: 12/31/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In June 2017, Israel lifted the ban on blood donations from men who have sex with men (MSM) and accepts donations if 12 months have passed since the last sexual contact. Recently, the National Blood Services suggested a novel approach that involves acceptance of MSM blood donations without deferral, keeping solely the frozen plasma in quarantine and releasing it for transfusion if a subsequent donation, at least 4 months later, is found negative for transfusion-transmitted agents. In this study, we examined the attitudes and perceptions of MSM to the new Frozen Plasma Quarantine Policy (FPQP). METHOD A survey was published on gay-oriented websites, collecting anonymous demographic data, history of blood donations and attitudes towards the new policy. RESULTS We analysed responses from 1233 MSM. Of these, 13·4% had donated blood at least once during the previous year, almost all of them (89·7%) not complying with the current 12-month deferral. Most respondents (64·5%) supported the suggested new approach and would consider donating blood if it were introduced. Of MSM who had donated blood in the previous year, 85% stated they would agree to reveal their sexual practice in the donor health questionnaire (DHQ) in order to be included in the programme, compared with 8·5% under the current 12-month deferral policy. CONCLUSION The suggested Plasma Quarantine Policy may be more acceptable to MSM than a 12-month deferral and increase their compliance with the blood services policy. This and retesting of donors may increase blood safety.
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Affiliation(s)
- Itzchak Levy
- Unit of Infectious Diseases, Sheba Medical Center, Ramat Gan, Israel
- Sackler Medical School, Tel Aviv University, Tel Aviv, Israel
| | - Liraz Olmer
- The Department of Statistics, The Gertner Institute for Epidemiology and Health Policy Research, Tel HaShomer, Israel
| | | | | | - Ohad Hizki
- Israel's LGBT Task Force, Tel Aviv, Israel
| | - Eilat Shinar
- Magen David Adom National Blood Services, Ramat Gan, Israel
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11
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Importance of information provision in the acceptance of blood donation criteria by the general public in Belgium. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2018; 16:475-482. [PMID: 29328906 DOI: 10.2450/2017.0151-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 10/05/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND Blood transfusions save lives, but carry the risk of causing transfusion-transmitted diseases. This risk is limited by strict donor selection criteria, the most controversial being the exclusion of men who had sex with men (MSM). This cross-sectional study investigated knowledge and beliefs of the general public concerning donor exclusion criteria, with emphasis on MSM. MATERIALS AND METHODS A representative sample of the population of Flanders, Belgium was questioned using a web-based questionnaire. The effect of additional information on people's opinions was tested. RESULTS People were less aware of the exclusion of MSM than of other risk populations, e.g. prostitutes. Correspondingly, they were more willing to accept blood from MSM than from other risk populations. MSM were also considered appropriate donors. Interestingly, prior knowledge about the exclusion of MSM appeared to be the strongest predictor for not accepting blood from MSM or a more stringent attitude on MSM exclusion. Receiving information on reasons for exclusion shifted opinions towards more stringency. Nevertheless, most people think that exceptions for MSM should be made under certain circumstances. This study identified several demographic factors associated with opinions concerning the exclusion of MSM for blood donation and the potential to change opinions after receiving information, e.g. age or socio-economic status. DISCUSSION Blood collecting services can gain understanding from the general public about their exclusion policies by providing clear information. Communication efforts targeting specific audiences in function of their knowledge and likeliness to change their opinion, might improve the effectiveness of information campaigns.
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12
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Kellens A, De Buck E, Emonds MP, Vandekerckhove P, Lagae L. Worldwide policies on epilepsy and blood donation: a survey among blood services. Vox Sang 2018; 113:104-109. [PMID: 29314064 DOI: 10.1111/vox.12618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/22/2017] [Accepted: 11/04/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Epilepsy is a common neurological disorder characterized by the appearance of seizures. Often, epilepsy patients are temporarily or permanently excluded from blood donation. To gain a better understanding of the policies that are currently applied, we performed a survey among blood services. METHODS A cross-sectional, Web-based questionnaire using the online Questback tool was developed and distributed to 46 representatives of blood services worldwide. The questionnaire was composed of nine questions. RESULTS A total of 27 respondents, representing blood services in 26 countries on five continents, participated in the survey. Current policies range from permanent acceptance over temporary exclusion to permanent exclusion. Rationales for these different policies are diverse. The majority of blood services (59·3%) apply temporary exclusion as their policy, though no consensus exists on the length of time that epilepsy patients have to be medication-free or seizure-free. None of the respondents could provide data about adverse events in epilepsy patients during the blood donation process. CONCLUSIONS The results of this survey indicate a large discrepancy in policies applied worldwide. A lack of scientific evidence could be one of the underlying reasons. Therefore, it is of paramount importance to further research the potential risks for donors and recipients regarding blood donation by people with epilepsy. This can then serve as a base for evidence-based policymaking and lead to safer and more effective blood transfusion programmes.
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Affiliation(s)
- A Kellens
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - E De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - M-P Emonds
- Department of Microbiology and Immunology, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium
| | - P Vandekerckhove
- Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - L Lagae
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
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13
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Haire B, Whitford K, Kaldor JM. Blood donor deferral for men who have sex with men: still room to move. Transfusion 2017; 58:816-822. [PMID: 29250781 DOI: 10.1111/trf.14445] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 11/04/2017] [Accepted: 11/11/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Like a number of other countries, Australia mandates that a man who has had sex with men is deferred from donation until 12 months has elapsed since the sexual activity. This review examined whether this deferral period is justified by current evidence. STUDY DESIGN AND METHODS Databases (Medline, EMBASE, Scopus) were searched using terms "blood donation" and "gay" or "MSM" and "HIV risk" from the mid-1980s to the present to investigate the history of donor deferral policy and its rationale in Australia. RESULTS Gay and bisexual men in Australia face a higher risk of human immunodeficiency virus and other blood-borne viruses (BBVs) than other populations. All blood donations, however, are tested for BBVs, and with current testing technologies the window period during which infection may be present but not detected is now less than 1 week. While there is a moral imperative to maintain blood safety, there is also a moral imperative to ensure that differential treatment of population groups with regard to donation eligibility is scientifically justified. Potential social harms that may flow from a dissonance between deferral policy and its evidence base include loss of trust and increased nonadherence to policy. CONCLUSIONS A 12-month deferral for gay and bisexual men exceeds what is required to maintain blood safety. This disparity potentially causes social harm without any additional benefit to public health. Reducing the deferral period to 3 months will not increase health risk to recipients and may have the social benefit of increasing inclusiveness.
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Affiliation(s)
- Bridget Haire
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kate Whitford
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - John M Kaldor
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
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14
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Goldman M, W-Y Shih A, O'Brien SF, Devine D. Donor deferral policies for men who have sex with men: past, present and future. Vox Sang 2017; 113:95-103. [DOI: 10.1111/vox.12623] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/14/2017] [Accepted: 11/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- M. Goldman
- Canadian Blood Services; Ottawa ON Canada
| | - A. W-Y Shih
- Vancouver General Hospital; Vancouver BC Canada
| | | | - D. Devine
- Canadian Blood Services; Vancouver BC Canada
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15
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Tiberghien P, Pillonel J, Toujas F, Vallet B. Changes in France's Deferral of Blood Donation by Men Who Have Sex with Men. N Engl J Med 2017; 376:1485-1486. [PMID: 28402774 DOI: 10.1056/nejmc1700740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - François Toujas
- Etablissement Français du Sang, La Plaine Saint-Denis, France
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16
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Blood donor deferral policies across Europe and characteristics of men whohave sex with men screened for human immunodeficiency virus in bloodestablishments: data from the European Men-who-have-sex-with-men Internet Survey (EMIS). BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2017; 16:7-16. [PMID: 28488974 DOI: 10.2450/2017.0109-16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 01/31/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND The predominant mode of transmission of human immunodeficiency virus (HIV) in Europe is male-to-male transmission. Men who have sex with men (MSM) are deferred from donating blood in many countries, but nevertheless do donate blood. Based on data from 34 countries, we estimated the proportion of MSM screened for HIV in the context of a blood donation and identified individual factors associated with this HIV screening in order to propose possible public health interventions. MATERIALS AND METHODS In 2010, the first European MSM Internet Survey (EMIS) collected self-reported data on HIV testing from >180,000 MSM in 38 European countries. Using logistic regression, demographic and behavioural factors associated with screening for HIV in blood establishments were identified. Stratified by European sub-region, we analysed the proportion of MSM screening in blood establishments by time elapsed since last negative HIV test. RESULTS Donor eligibility criteria for MSM vary across Europe with most countries using permanent deferral. The Western region had the lowest (2%) proportion of MSM screened in blood establishments and the Northeastern region had the highest (14%). Being <25 years old, not disclosing sexual attraction to men, never having had anal intercourse with a man, having a female partner, living in a rural area, and certain European sub-regions or countries of residence increased the likelihood of being screened in blood establishments. DISCUSSION In spite of deferral policies, MSM are screened for HIV in the context of blood donations. Gay-friendly testing services are rare in rural areas, and young men might be reluctant to disclose their sexual orientation. Recent developments, such as home sampling, might offer new testing possibilities for those not reached by established services yet wishing to know their HIV status. Donor selection procedures should be improved. Both interventions might help to further reduce the risk of transfusion-transmitted infections.
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17
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Attitudes, perceptions and knowledge among men who have sex with men towards the blood donation deferral policy in Israel. PLoS One 2017; 12:e0170364. [PMID: 28152072 PMCID: PMC5289429 DOI: 10.1371/journal.pone.0170364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 01/04/2017] [Indexed: 11/20/2022] Open
Abstract
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.
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18
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Germain M. The risk of allowing blood donation from men having sex with men after a temporary deferral: predictions versus reality. Transfusion 2016; 56:1603-7. [PMID: 26948287 DOI: 10.1111/trf.13541] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/10/2016] [Accepted: 01/17/2016] [Indexed: 12/15/2022]
Abstract
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.
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19
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O'Brien SF, Osmond L, Fan W, Yi QL, Goldman M. Impact of a 5-year deferral from blood donation for men who have sex with men. Transfusion 2015; 56:1598-602. [PMID: 26717893 DOI: 10.1111/trf.13445] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/04/2015] [Accepted: 11/11/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The deferral for men who have sex with men (MSM) changed from a permanent deferral since 1977 to a 5-year deferral on July 22, 2013, in Canada. We assessed the impact on safety and adequacy of the blood supply at Canadian Blood Services. STUDY DESIGN AND METHODS Human immunodeficiency virus (HIV) rates were monitored from January 1, 2010, to July 21, 2015. Risk factors were assessed in notification interviews. Anonymous online surveys of male whole blood donors assessed compliance before and after implementation. RESULTS HIV rates were 0.2, 0.5, and 0.51 per 100,000 donations in 2010 to 2012; they were 0.54 and 0.22 in the first and second years after implementation (p = 0.8). Of four male HIV-positive donors after implementation, three denied risk factors and one knew he had HIV. Before implementation 9669 of 19,437 (49.7%) donors participated in the survey, and after implementation, 6881 of 18,934 (36.3%). Before implementation 0.67% of male donors were noncompliant, and after implementation, 0.44%. There was no difference before versus after implementation in male donors with MSM history in the past 5 years (0.37% vs. 0.43%, p = 0.54). After implementation, eligible MSM donors increased (0.42% vs. 0.66%, p = 0.04), with approximately 500 more donors in 2014. CONCLUSION Implementation of a 5-year deferral for MSM had no impact on HIV rates in 2 years of postimplementation monitoring. Donor compliance improved after implementation due to MSM donors who were previously ineligible becoming eligible. There was no change in the percentage of male donors with recent male partners but there was a modest increase in eligible MSM in the donor pool.
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Affiliation(s)
- Sheila F O'Brien
- Canadian Blood Services, Ottawa, Ontario.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Wenli Fan
- Canadian Blood Services, Ottawa, Ontario
| | - Qi-Long Yi
- Canadian Blood Services, Ottawa, Ontario.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mindy Goldman
- Canadian Blood Services, Ottawa, Ontario.,Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
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20
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Hughes S, Sheon N, Siedle-Khan B, Custer B. Saving lives, maintaining safety, and science-based policy: qualitative interview findings from the Blood Donation Rules Opinion Study (Blood DROPS). Transfusion 2015; 55:2835-2841. [PMID: 26271755 DOI: 10.1111/trf.13268] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/14/2015] [Accepted: 07/15/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Indefinite deferral from donation for any man who discloses having had sex with another man even once since 1977 (MSM77) is the US FDA's standing policy. This qualitative component of the Blood Donation Rules and Opinion Study was designed to provide insight into the perceptions and practices of current or previous donors with MSM history. STUDY DESIGN AND METHODS Forty human immunodeficiency virus (HIV)-negative MSM completed an online survey, indicating that they had donated blood and were willing to be interviewed. Semistructured, individual interviews with these key informants covered donation experience and motivations, perceptions of MSM77, policy change preferences, and possible impact of a change to a time-limited deferral. Transcripts were coded deductively and inductively, following a modified Grounded Theory approach. Analysis identified recurrent and divergent themes. RESULTS Ninety-five percent of participants endorsed modifying MSM77. Preferred deferral length ranged from none to 5 years; a common opinion was that a science-based deferral period would be less than 1 year. Other policy change recommendations included incorporating questions about specific HIV risk behaviors to the donor questionnaire for all potential donors. Interviewees recognized HIV infection rates are higher in MSM than the general US population, but participants considered themselves low-risk for HIV, donated blood "to save lives," and justified their recommendations as being more effective ways to identify donors at risk for HIV. CONCLUSION Results suggest that MSM donors are concerned with blood safety; they can be appealed to as such. Communications about a new deferral policy should include scientific explanations and acknowledge altruistic motivations of potential donors.
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Affiliation(s)
- Shana Hughes
- UCSF Center for AIDS Prevention Studies, San Francisco, CA
| | - Nicolas Sheon
- UCSF Center for AIDS Prevention Studies, San Francisco, CA
| | | | - Brian Custer
- Blood Systems Research Institute, San Francisco, CA.,Department of Laboratory Medicine, UCSF, San Francisco, CA
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21
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Custer B, Sheon N, Siedle-Khan B, Pollack L, Spencer B, Bialkowski W, D'Andrea P, Sullivan M, Glynn S, Williams A. Blood donor deferral for men who have sex with men: the Blood Donation Rules Opinion Study (Blood DROPS). Transfusion 2015. [PMID: 26202349 DOI: 10.1111/trf.13247] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND In the United States, any man who discloses having had sex with another man (MSM) even once since 1977 is currently deferred from donating blood. A study was conducted to assess noncompliance with the policy at four geographically dispersed blood centers. STUDY DESIGN AND METHODS Male donors 18+ years of age with e-mail addresses were randomly selected and invited to complete a confidential online survey between August and October 2013. No additional recruitment e-mails were sent. Survey content included demographics, sexual history, donation history, compliance with the policy, and opinions about current and modified policies. RESULTS Response rate was 11.5% but varied by center (6.3% to 21.7%). Of 3183 completed surveys, 2.6% of respondents (95% confidence interval, 2.1%-3.2%) reported donation after male-male sex. Noncompliance was not statistically different among the centers (p = 0.1), but was related to age with 5.7, 4.6, 2.5, and 1.0% of donors 18 to 24, 25 to 34, 35 to 54, and 50+ years of age, respectively, reporting noncompliance (p < 0.001). Of all respondents, 6.8% reported at least six female and 0.3% reported at least six male sex partners in the past 5 years. Opinions about the current MSM policy were mixed with noncomplying donors more supportive of change than complying donors. Approximatey half of noncompliers indicated they would adhere to a 1-year deferral. CONCLUSION Noncompliance with the MSM policy is evident and may be increasing compared to earlier data. Any change from the current policy will require close monitoring to determine whether it affects residual risk of HIV in the US blood supply.
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Affiliation(s)
- Brian Custer
- Blood Systems Research Institute, San Francisco, California.,Department of Laboratory Medicine, UCSF, San Francisco, California
| | - Nicolas Sheon
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Bob Siedle-Khan
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Lance Pollack
- UCSF Center for AIDS Prevention Studies, San Francisco, California
| | - Bryan Spencer
- American Red Cross, New England Region, Dedham, Massachusetts
| | | | - Pam D'Andrea
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | - Simone Glynn
- National Heart, Lung and Blood Institute (NHLBI), Bethesda, Maryland
| | - Alan Williams
- US Food and Drug Administration, Silver Spring, Maryland
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22
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De Buck E, Dieltjens T, Compernolle V, Vandekerckhove P. Is having sex with other men a risk factor for transfusion-transmissible infections in male blood donors in Western countries? A systematic review. PLoS One 2015; 10:e0122523. [PMID: 25875812 PMCID: PMC4398316 DOI: 10.1371/journal.pone.0122523] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 02/12/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although increased prevalence of transfusion transmissible infections (TTI) among "men who have sex with men" (MSM) has been well documented, the exclusion of MSM as blood donors is contested. The aim of this systematic review is to find studies that describe the risk of TTI in MSM blood donors. METHODS We searched MEDLINE, Embase, The Cochrane Central Register of Controlled Trials, Cinahl, and Web of Science, and used GRADE for determining evidence quality. We included studies comparing MSM and non-MSM blood donors (or people eligible to give blood), living in areas most relevant for our Blood Service. RESULTS Out of 18 987 articles, 14 observational studies were included. Two studies directly compared MSM with non-MSM donors showing that MSM donors have a statistically significant higher risk of HIV-1 infections. In one of these studies it was shown that this was related to recent (< 12 months) MSM contact. In two additional studies no evidence was shown in favour of a certain deferral period for MSM. Ten studies, applying permanent deferral for MSM, compared infected versus non-infected donors. One study found that MSM is a statistically significant risk factor for HIV-1 infection in blood donors. For other TTI such as HBV or HCV, an increased risk of infection could not be demonstrated, because the precision of the results was affected by the low numbers of donors with MSM as risk factor, or because of risk of bias in the included studies. All studies included low level evidence, because of risk of bias and imprecision of the results. CONCLUSIONS High-quality studies investigating the risk of TTI in MSM who donate blood are scarce. The available evidence suggests a link between MSM blood donors and HIV-1 infection, but is too limited to be able to unambiguously/clearly recommend a certain deferral policy.
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Affiliation(s)
- Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Tessa Dieltjens
- Centre for Evidence-Based Practice, Belgian Red Cross-Flanders, Mechelen, Belgium
| | - Veerle Compernolle
- Blood Service, Belgian Red Cross-Flanders, Mechelen, Belgium
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium
| | - Philippe Vandekerckhove
- Belgian Red Cross-Flanders, Mechelen, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine, Catholic University of Leuven, Leuven, Belgium
- Faculty of Medicine, University of Ghent, Ghent, Belgium
- * E-mail:
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23
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Germain M, Delage G. Models used to predict the impact of having less stringent deferral policies for men who had sex with men: can we validate these predictions? ACTA ACUST UNITED AC 2015. [DOI: 10.1111/voxs.12111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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24
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Wong HTH, Lee SS, Lee CK, Chan DPC. Failure of self-disclosure of deferrable risk behaviors associated with transfusion-transmissible infections in blood donors. Transfusion 2015; 55:2175-83. [PMID: 25846739 PMCID: PMC4672705 DOI: 10.1111/trf.13106] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 02/27/2015] [Accepted: 03/01/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND To date, most studies on deferral of blood donors have focused on men who have sex with men (MSM) and/or injecting drug users. Few have examined deferrable risk behaviors relating to transfusion-transmissible infections (TTIs) in general. This study aimed to examine the prevalence of, and factors associated with, nondisclosure of TTI-related risk behaviors in donors. STUDY DESIGN AND METHODS Chinese-speaking donors who had just given blood in Hong Kong were invited to self-complete an anonymous questionnaire. Practices of one or more of seven deferrable risk behaviors associated with TTI were inquired. Factors associated with noncompliance with self-disclosure were evaluated by logistic regression. RESULTS Over a 4-week study period in 2012, a total of 1143 donors were recruited. Overall, 0.2% gave a history of drug injection, 1.7% had had sex with sex worker(s), and 0.3% had had sex with a human immunodeficiency virus–infected partner, while none had been paid for sex. Some 1.5% of male donors reported having same-sex behaviors. Factors associated with noncompliance were male gender (odds ratio [OR] 31.1; 95% confidence interval [CI], 3.7-263.6), having multiple sex partners (OR, 89.7; 95% CI, 28.7-279.9), and previous history of temporary deferral (OR, 11.4; 95% CI, 2.5-53.3). If suspected noncompliance was included, the overall prevalence of nondisclosure of deferrable behaviors could be high at 6.5%. CONCLUSION Albeit uncommon, some donors fail to provide accurate answers to predonation screening questions and are not deferred appropriately. There is room for improvement to make deferral policy acceptable and understandable, so as to minimize the risk of TTI. Efforts are also needed to tackle the paucity of data on noncompliance of non-MSM donors.
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Affiliation(s)
- Horas Tze Hoo Wong
- Stanley Ho Centre for Emerging Infectious Diseases, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, the Chinese University of Hong Kong, Shatin, Hong Kong
| | - Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong
| | - Denise Pui Chung Chan
- Stanley Ho Centre for Emerging Infectious Diseases, the Chinese University of Hong Kong, Shatin, Hong Kong
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25
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Garraud O. La transfusion sanguine : une thérapie de paradoxes. Presse Med 2015; 44:160-4. [DOI: 10.1016/j.lpm.2014.06.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/29/2014] [Indexed: 01/17/2023] Open
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26
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Goldman M, Lapierre D, Lemay L, Devine D, Sher G. Donor criteria for men who have sex with men: a Canadian perspective. Transfusion 2014; 54:1887-92. [PMID: 25041149 DOI: 10.1111/trf.12592] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/06/2014] [Accepted: 01/12/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Mindy Goldman
- Medical Services and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
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27
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Offergeld R, Kamp C, Heiden M, Norda R, Behr-Gross ME. Sexual risk behaviour and donor deferral in Europe. Vox Sang 2014; 107:420-7. [PMID: 25040600 DOI: 10.1111/vox.12179] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 06/06/2014] [Accepted: 06/13/2014] [Indexed: 11/26/2022]
Abstract
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.
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28
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Epstein J, Ganz PR, Seitz R, Jutzi M, Schaerer C, Michaud G, Agbanyo F, Smith G, Prosser I, Heiden M, Saint‐Marie I, Oualikene‐Gonin W, Hamaguchi I, Yasuda N. A shared regulatory perspective on deferral from blood donation of men who have sex with men (
MSM
). Vox Sang 2014; 107:416-9. [DOI: 10.1111/vox.12166] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/08/2014] [Accepted: 05/11/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J. Epstein
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MD USA
| | - P. R. Ganz
- Centre for Blood and Tissues Evaluation Biologics and Genetic Therapies Directorate, Health Canada Ottawa ON Canada
| | - R. Seitz
- Division of Haematology/Transfusion Medicine Paul‐Ehrlich‐Institut Langen Germany
| | - M. Jutzi
- Swissmedic, Swiss Agency for Therapeutic Products Bern Switzerland
| | - C. Schaerer
- Swissmedic, Swiss Agency for Therapeutic Products Bern Switzerland
| | - G. Michaud
- Office of Blood Research and Review Center for Biologics Evaluation and Research U.S. Food and Drug Administration Silver Spring MD USA
| | - F. Agbanyo
- Centre for Blood and Tissues Evaluation Biologics and Genetic Therapies Directorate, Health Canada Ottawa ON Canada
| | - G. Smith
- Office of Scientific Evaluation Therapeutic Goods Administration Woden ACT Australia
| | - I. Prosser
- Office of Scientific Evaluation Therapeutic Goods Administration Woden ACT Australia
| | - M. Heiden
- Division of Haematology/Transfusion Medicine Paul‐Ehrlich‐Institut Langen Germany
| | - I. Saint‐Marie
- Division for Advanced Therapies Products from Human Origin and Vaccines French National Agency for Medicines and Health Products Safety Saint‐Denis Cedex France
| | - W. Oualikene‐Gonin
- Division for Advanced Therapies Products from Human Origin and Vaccines French National Agency for Medicines and Health Products Safety Saint‐Denis Cedex France
| | - I. Hamaguchi
- Department of Safety Research on Blood and Biological Products National Institute of Infectious Diseases Musashimurayama Tokyo Japan
| | - N. Yasuda
- Minister's Secretariat Ministry of Health Labour and Welfare Chiyoda, Tokyo Japan
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Kleinman S, Busch MP, Murphy EL, Shan H, Ness P, Glynn SA. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): a research program striving to improve blood donor and transfusion recipient outcomes. Transfusion 2013; 54:942-55. [PMID: 24188564 DOI: 10.1111/trf.12468] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) is a 7-year multicenter transfusion safety research initiative launched in 2011 by the National Heart, Lung, and Blood Institute. STUDY DESIGN AND METHODS The domestic component involves four blood centers, 12 hospitals, a data coordinating center, and a central laboratory. The international component consists of distinct programs in Brazil, China, and South Africa, which involve US and in-country investigators. RESULTS REDS-III is using two major methods to address key research priorities in blood banking and transfusion medicine. First, there will be numerous analyses of large "core" databases; the international programs have each constructed a donor and donation database while the domestic program has established a detailed research database that links data from blood donors and their donations, the components made from these donations, and data extracts from the electronic medical records of the recipients of these components. Second, there are more than 25 focused research protocols involving transfusion recipients, blood donors, or both that either are in progress or are scheduled to begin within the next 3 years. Areas of study include transfusion epidemiology and blood utilization, transfusion outcomes, noninfectious transfusion risks, human immunodeficiency virus-related safety issues (particularly in the international programs), emerging infectious agents, blood component quality, donor health and safety, and other donor issues. CONCLUSIONS It is intended that REDS-III serve as an impetus for more widespread recipient and linked donor-recipient research in the United States as well as to help assure a safe and available blood supply in the United States and in international locations.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada
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Wilson K, Atkinson K, Keelan J. Three decades of MSM donor deferral policies. What have we learned? Int J Infect Dis 2013; 18:1-3. [PMID: 24211477 DOI: 10.1016/j.ijid.2013.09.016] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Revised: 09/17/2013] [Accepted: 09/20/2013] [Indexed: 11/16/2022] Open
Abstract
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.
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Affiliation(s)
- Kumanan Wilson
- Departments of Medicine and of Epidemiology and Community Medicine, University of Ottawa, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Administrative Services Building, Room 1009, Box 684, Ottawa, ON, K1Y 4E9, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Katherine Atkinson
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Jennifer Keelan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Germain M, Robillard P, Delage G, Goldman M. Allowing blood donation from men who had sex with men more than 5 years ago: a model to evaluate the impact on transfusion safety in Canada. Vox Sang 2013; 106:372-5. [DOI: 10.1111/vox.12109] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - G. Delage
- Héma-Québec; Saint-Laurent QC Canada
| | - M. Goldman
- Canadian Blood Services; Ottawa ON Canada
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Seed CR, Lucky TT, Waller D, Wand H, Lee JF, Wroth S, McDonald A, Pink J, Wilson DP, Keller AJ. Compliance with the current 12-month deferral for male-to-male sex in Australia. Vox Sang 2013; 106:14-22. [DOI: 10.1111/vox.12093] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 09/01/2013] [Accepted: 09/03/2013] [Indexed: 11/27/2022]
Affiliation(s)
- C. R. Seed
- Australian Red Cross Blood Service; Perth WA Australia
| | - T. T. Lucky
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - D. Waller
- Australian Red Cross Blood Service; Sydney NSW Australia
| | - H. Wand
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - J. F. Lee
- Australian Red Cross Blood Service; Perth WA Australia
| | - S. Wroth
- Australian Red Cross Blood Service; Perth WA Australia
| | - A. McDonald
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - J. Pink
- Australian Red Cross Blood Service; Brisbane Qld Australia
| | - D. P. Wilson
- The Kirby Institute; University of New South Wales; Sydney NSW Australia
| | - A. J. Keller
- Australian Red Cross Blood Service; Perth WA Australia
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Lee CK, Lee KCK, Lin CK, Lee SS. Donors' perspectives on self-deferral of men having sex with men from blood donation. Transfusion 2013; 53:2441-8. [PMID: 23927759 DOI: 10.1111/trf.12365] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Revised: 06/04/2013] [Accepted: 06/24/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Self-deferral of men having sex with men (MSM) from blood donation is a means of protecting blood safety. There has recently been a strategy change from permanent to time-limited deferral in some countries. Awareness and attitudes of donors is crucial for effective implementation of MSM deferral or any change of the strategy. STUDY DESIGN AND METHODS A postdonation survey was administered using a Web-based questionnaire, after explanation by trained volunteers, to evaluate donors' awareness and compliance toward the health history enquiry (HHE, the deferral questionnaire) of the Hong Kong Red Cross Blood Transfusion Service, sexual experiences, and opinions on permanent versus time-limited deferral. RESULTS A total of 1373 Chinese donors (male:female 1.28:1), a majority (89.1%) of whom were repeat donors, completed the survey at eight blood donation centers. Almost all (98.7%) were aware of HHE, although only half read it in detail, the latter comprising more experienced donors. Most did not hold strong views on deferral, with more than half (59.4%) concurring with both permanent and time-limited deferral. Seventeen (3.2%) of the sexually active male donors were MSM, of whom six disagreed with permanent deferral while seven agreed with changing to time-limited deferral. A simpler question structure was preferred by 57% of the respondents for screening MSM to achieve self-deferral. CONCLUSIONS Donors generally do not read through the deferral questionnaire in sufficient detail for making an informed decision. Blood safety would eventually depend on donors' compliance with the deferral mechanism, irrespective of whether it is permanent or time-limited.
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Affiliation(s)
- Cheuk-Kwong Lee
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong
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Changing blood donor screening criteria from permanent deferral for men who have sex with men to individual sexual risk assessment: no evidence of a significant impact on the human immunodeficiency virus epidemic in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:441-8. [PMID: 23867178 DOI: 10.2450/2013.0162-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 04/30/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2001, the criteria for blood donor eligibility in Italy were modified by a ministerial decree from a permanent deferral for "men who have sex with men" to an individual risk assessment of sexual behaviours. The aim of this study was to evaluate the impact of this change in donor screening criteria on the human immunodeficiency virus epidemic among blood donors in Italy. MATERIALS AND METHODS We used the data obtained from the Italian blood donor epidemiological surveillance system. We compared data collected in 2009 and 2010, when the individual risk assessment policy was applied, with data collected in 1999 when permanent deferral was applied for men who have sex with men based on a declaration of sexual orientation. We evaluated the change over time in the relative proportion of HIV antibody-positive donors who likely acquired the infection from men who have sex with men vs heterosexual sexual exposure; the relative risk was calculated using 1999 as the reference year. RESULTS In all 3 years, the majority of HIV antibody-positive donors reported sexual exposure as a risk factor for HIV infection; this proportion increased over time, although not statistically significantly. Heterosexuals always accounted for at least 40% of all HIV antibody-positive cases. The rate of HIV antibody-positive donors increased similarly in men who have sex with men and heterosexuals; specifically, the rate of HIV antibody-positive cases per 100,000 donors was more than 2-fold higher among men who have sex with men in 2009-2010 than in 1999 (2009-2010 vs 1999, RR =2.8; P =0.06), and that among heterosexuals was 1.5 fold higher (P =0.18). DISCUSSION When comparing the period before (1999) and after (2009-2010), the implementation of the individual risk assessment policy in 2001, no significant increase in the proportion of men who have sex with men compared to heterosexuals was observed among HIV antibody-positive blood donors, suggesting that the change in donor deferral policy did not lead to a disproportionate increase of HIV-seropositive men who have sex with men.
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Behr-Gross ME, Heiden M, Norda R. Contributions du comité directeur de transfusion sanguine du Conseil de l’Europe à la détermination des règles de sélection des donneurs de sang et de composants sanguins et à l’étude des conduites sexuelles ayant un impact sur la sécurité transfusionnelle. Transfus Clin Biol 2013; 20:127-38. [DOI: 10.1016/j.tracli.2013.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Belanger GA, McFarland W, Raymond HF, Custer B. If the permanent deferral were lifted would men who have sex with men want to donate blood, and if so, who would be eligible? Transfusion 2013; 53:2729-33. [DOI: 10.1111/trf.12124] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2012] [Revised: 12/12/2012] [Accepted: 12/13/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Geoffrey A. Belanger
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - Willi McFarland
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - H. Fisher Raymond
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
| | - Brian Custer
- San Jose State University; San Jose California
- Stanford Blood Center; Palo Alto California
- HIV Epidemiology Section; San Francisco Department of Public Health; San Francisco California
- Epidemiology and Biostatistics and Laboratory Medicine; University of California at San Francisco; San Francisco California
- Blood Systems Research Institute; San Francisco California
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Cascio MA, Yomtovian R. Sex, Risk, and Education in Donor Educational Materials: Review and Critique. Transfus Med Rev 2013; 27:50-5. [DOI: 10.1016/j.tmrv.2012.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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