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Goldman M, Lewin A, Renaud C, O'Brien SF. Implementation of sexual risk behavior donor screening in Canada. Transfusion 2024; 64:1254-1261. [PMID: 38757763 DOI: 10.1111/trf.17878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/02/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The two Canadian blood suppliers, Canadian Blood Services and Héma-Québec, removed the time-based deferral for men who have sex with men and adopted criteria assessing sexual risk behaviors. We report the impact of these changes on the safety and adequacy of the Canadian blood supply. STUDY DESIGN AND METHODS Since 2022, all donors are asked if (1) they have had a new partner and (2) more than one sexual partner in the last 3 months. Donors answering yes to either question are asked if they had anal sex in the last 3 months; if yes, they are deferred for 3 months. We followed HIV rates for the 18 months before and 14 (Héma-Québec) or 18 months (Canadian Blood Services) post-implementation and interviewed HIV-positive whole blood donors. We assessed the number and characteristics of whole blood donors answering yes to the two first questions with or without deferral. RESULTS There were four HIV-positive donations out of 1,492,355 donations pre-implementation and four out of 1,447,772 post-implementation (0.27/100,000 vs. 0.28/100,000, p = 1.00). Post-implementation, one HIV-positive donor was non-compliant with multiple criteria, no risk factors were identified in the others. 3.2% of donors answered yes to questions (1) and/or (2); 0.17% were deferred for a new partner and/or more than one partner and anal sex. Deferral rates were highest in first time, younger donors, and similar in males and females. CONCLUSION Implementation of sexual risk behavior donor screening resulted in unchanged HIV rates to date and a manageable deferral rate.
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Affiliation(s)
- Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Pathology & Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, Québec, Canada
| | - Christian Renaud
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, Québec, Canada
- Department of Microbiology, Infectious Diseases and Immunology, University of Montreal, Montreal, Québec, Canada
| | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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2
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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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Rubini K, Al-Bakri T, Bridel W, Clapperton A, Greaves M, Hill NE, Labrecque M, MacDonagh R, Miguel G, Orvis S, Osbourne-Sorrell W, Randall T, Reid M, Rosser A, Presseau J, Vesnaver E. Engaging community members to ensure culturally specific language is used in research: should I use gay, queer, MSM, or this other new acronym? RESEARCH INVOLVEMENT AND ENGAGEMENT 2023; 9:75. [PMID: 37667325 PMCID: PMC10478417 DOI: 10.1186/s40900-023-00463-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 07/05/2023] [Indexed: 09/06/2023]
Abstract
Researchers often use terminology to define their participant groups that is rooted in a clinical understanding of the group's shared identity(ies). Such naming often ignores the ways that the individuals who comprise these populations identify themselves. One oft-cited benefit of patient-oriented or community-engaged research is that language is local and relevant to impacted communities. This paper aims to contribute to the literature on how this local and relevant language can best be established. We ask how researchers can identify and implement accurate terminology, even when divergent perspectives exist within the communities involved. We draw from our experience with the Expanding Plasma Donation in Canada study, a community-engaged research study, which explored the views of people impacted by the "men who have sex with men" (MSM) blood donation policies in Canada. We describe the collaborative process through which we came to a consensual naming of this population, the challenges we faced, and a set of guiding principles we used to address them. We did not find an all-encompassing term or acronym that worked for all stages of research. Instead, we offer a set of guiding principles that can aid researchers engaging in a similar process: harm reduction, consent and transparency, collaboration and community involvement, recognition of missing voices, and resisting and/or restructuring oppressive standards.
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Affiliation(s)
- Kyle Rubini
- Local Advisory Group, Toronto Metropolitan University, Toronto, Canada
| | | | - William Bridel
- Local Advisory Group, University of Calgary, Calgary, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | | | | - Justin Presseau
- School of Psychology, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | - Elisabeth Vesnaver
- School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
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Goldman M, Caffrey N, O'Brien SF. Screening for high-risk sexual behavior in Canada. Transfusion 2022; 62:2419-2422. [PMID: 36285751 DOI: 10.1111/trf.17164] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/12/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Niamh Caffrey
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Sheila F O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Hofkirchner A, Kohut T, O'Brien SF, Fisher WA. Assessing unintentional creation of bias against men who have sex with men as a function of exposure to blood donor screening questionnaire: A national randomized controlled trial. Transfusion 2022; 62:1399-1407. [PMID: 35621117 DOI: 10.1111/trf.16930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Canadian Blood Services (CBS) screens donors based on group status (e.g., men who have sex with men, MSM) instead of specific, high-risk sexual practices (e.g., occurrence of condomless sex). The MSM screening question is embedded in a cluster of questions about stigmatized attributes such as history of imprisonment and illicit substance use. This juxtaposition of the "MSM question" and stigmatized attributes may unintentionally cause blood donors to perceive MSM more negatively. The aim of this research is to determine whether the CBS donor eligibility questionnaire generates negative bias against MSM. STUDY DESIGN AND METHODS A national, randomized online study of 903 CBS donors was conducted. Participants completed either the existing blood donor eligibility questionnaire or a modified donor questionnaire that repositioned the MSM question among neutral questions. After completing the existing or modified questionnaire, bias against MSM was measured using the sexuality implicit association test (IAT) and Modern Homonegativity Scale - Gay Men (MHS-G). Lastly, participants estimated prevalence rates among MSM of certain stigmatized behaviors. RESULTS Participants who completed the existing donor eligibility questionnaire more strongly associated gay men with negative attributes on the IAT (pone-tailed = .045), suggesting question position generated implicit negative bias toward MSM. Responses to the MHS-G (pone-tailed = .506) and prevalence estimation task (p = .443) indicated that question order had no significant impact on explicit bias. DISCUSSION Positioning the MSM screening question among stigmatizing questions creates implicit negative bias against MSM. Policy makers should be mindful of question positioning when designing donor questionnaires.
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Affiliation(s)
| | - Taylor Kohut
- Department of Psychology, Western University, London, Ontario, Canada
| | - Sheila F O'Brien
- Department of Epidemiology & Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
| | - William A Fisher
- Department of Psychology, Western University, London, Ontario, Canada.,Department of Obstetrics and Gynaecology, Western University, London, Ontario, Canada
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Veillette-Bourbeau L, Otis J, Lewin A, Godin G, Germain M, Daunais-Laurin G, Lalonde F, Caruso J, Myhal G, Pronovost F. Determinants of the intention to participate in a programme of plasma donation for fractionation among men who have sex with men. Vox Sang 2021; 116:1051-1059. [PMID: 33942322 PMCID: PMC9291483 DOI: 10.1111/vox.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/25/2021] [Accepted: 03/23/2021] [Indexed: 11/27/2022]
Abstract
Background and objectives Several approaches are currently under study to contribute to efforts to allow men who have sex with men (MSM) to donate blood. One of these approaches involves implementing a programme of plasma donation for fractionation, with a quarantine period. The goal of this article is to identify the determinants of intention to participate in the plasma donation programme among MSM in Montreal, Canada. Materials and methods Based on the theory of planned behaviour, a questionnaire was developed to measure MSM’s intention to donate plasma and identify influencing factors. A multiple linear regression analysis was conducted to identify the determinants of intention to donate plasma. Results Respondents’ (N = 933) intention to donate plasma in the next six months was moderate. The multiple linear regression model explained 55% (P < 0·001) of the variation of intention. Intention was predicted by attitudes (β = 0·34, P < 0·001), perceived behavioural control (β = 0·28, P < 0·001), aged under 35 years (β = 0·26, P < 0·001), history of blood donation (β = 0·24, P < 0·001), subjective norm (β = 0·21, P < 0·001), income above $40,000 (β = 0·20, P < 0·001), moral norm (β = 0·18, P < 0·001) and higher level of involvement in various issues LGBTQ+ communities are fighting for (β = 0·09, P < 0·001). Conclusion Our analyses show that intention to donate plasma within the proposed programme is associated with personal, social and structural factors, but more strongly predicted by factors related to the theory of planned behaviour. Our results also highlight the importance of involving MSM; community acceptability of the plasma donation programme would probably be higher if MSM felt respected and party to the decisions.
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Affiliation(s)
| | - Joanne Otis
- Université du Québec à Montréal, Montreal, QC, Canada
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Vesnaver E, Goldman M, O'Brien S, MacPherson P, Butler-Foster T, Lapierre D, Otis J, Devine DV, Germain M, Rosser A, MacDonagh R, Randall T, Osbourne-Sorrell W, Clement-Thorne B, Al-Bakri TB, Rubini KA, Hill NE, Presseau J. Barriers and enablers to source plasma donation by gay, bisexual and other men who have sex with men under revised eligibility criteria: protocol for a multiple stakeholder feasibility study. Health Res Policy Syst 2020; 18:131. [PMID: 33138828 PMCID: PMC7605323 DOI: 10.1186/s12961-020-00643-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/06/2020] [Indexed: 01/19/2023] Open
Abstract
Background Blood donation policy in Canada for gay, bisexual and other men who have had sex with men (gbMSM) has changed progressively in the last decade from indefinite deferral to 3-month deferral from last male-to-male sex. Driven by safety data and overseen by the national regulator, more inclusive policies continue to redress the disparity in donation for gbMSM. At the same time, the need for source plasma to prepare fractionated blood products is growing worldwide. The collection and processing of source plasma ensures greater safety compared to whole blood donation with respect to transfusion-transmitted infection. This greater safety offers an opportunity to evolve policies for gbMSM from time-based to behaviour-based deferral using revised eligibility criteria. However, changing policies does not in itself necessarily guarantee that gbMSM will donate or that staff in donor clinics are ready to support them to do so. In anticipation of a move to behaviour-based donation screening for gbMSM in Canada, we aim to assess the acceptability of and perceived barriers and enablers to source plasma donation using revised screening criteria for gbMSM among key stakeholders to inform policy implementation strategies. Methods This mixed-methods feasibility study will involve gbMSM and donor centre staff to understand modifiable barriers to implementing more inclusive eligibility criteria. Key informant interviews and surveys will be rooted in the Theoretical Domains Framework to identify modifiable factors associated with source plasma donation motives in gbMSM and training needs in donation centre staff. We will use an integrated knowledge translation approach involving a partnership between researchers, the national blood operator and gbMSM, situating knowledge users as key research team members to ensure their perspectives inform all aspects of the research. Discussion Our integrated knowledge translation approach will provide a more comprehensive and collaborative understanding of blood operator and gbMSM needs while accelerating the implementation of study findings. Given the historical backdrop of the decades of exclusion of sexually active gbMSM from blood donation, this study has the potential not only to inform a process and policy for gbMSM to donate source plasma, a blood product, but also offers opportunities for new relationships between these knowledge users.
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Affiliation(s)
- Elisabeth Vesnaver
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.
| | - Mindy Goldman
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Sheila O'Brien
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Paul MacPherson
- Medicine, The Ottawa Hospital, Ottawa, Canada.,Department of Biochemistry, Microbiology and Immunology, University of Ottawa, Ottawa, Canada
| | | | - Don Lapierre
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Canada
| | - Joanne Otis
- Department of Sexology, Université du Québec À Montréal, Montreal, Canada
| | - Dana V Devine
- Canadian Blood Services, Vancouver, Canada.,Centre for Blood Research, University of British Columbia, Vancouver, Canada
| | - Marc Germain
- Héma-Québec, Medical Affairs, Quebec City, Canada
| | | | | | | | | | | | | | | | | | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
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Leach Bennett J, Devine DV. Risk-based decision making in transfusion medicine. Vox Sang 2018; 113:737-749. [DOI: 10.1111/vox.12708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 11/27/2022]
Affiliation(s)
| | - Dana V. Devine
- Canadian Blood Services; Ottawa ON Canada
- Centre for Blood Research; University of British Columbia; Vancouver BC Canada
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9
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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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Abstract
PURPOSE OF REVIEW The review summarizes recent publications on the contentious issue of donor deferral criterion for men who have sex with men (MSM). RECENT FINDINGS Recent studies from the United States and China demonstrated that MSM is still a frequent risk factor for HIV-positive donors. Noncompliance is an important factor in the overall risk of HIV transmission but does not appear to be affected by the length of the deferral period. A major US study found a 2.6% noncompliance rate with the current indefinite deferral for MSM; similar or lower rates were found in other jurisdictions with shorter deferral periods. Several countries have had a defined deferral period of 1 year or 5 years in place long enough to determine that increases in HIV-positive cases predicted by modeling studies did not actually occur, suggesting that the assumptions made in these models are overly conservative. SUMMARY In summary, MSM eligibility policies are slowly changing around the world, with the US FDA now permitting a 1-year deferral. Transparency, involvement of stakeholders, and careful evaluation of risk and societal benefit should be part of future policy discussions on this issue.
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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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