Blood Donation and COVID-19: Reconsidering the 3-Month Deferral Policy for Gay, Bisexual, Transgender, and Other Men Who Have Sex With Men.

LGBTQ+ inclusivity in blood donation: Sexual behavior-based screening is the first step to getting it right.

Chapter 5 - The Blood Donor, Donation Process and Technical Aspects of Blood Collection

See article on page 525–534, in this issue

As part of its responsibilities to protect the safety of the American public, the United States Food and Drug Administration (FDA) regulates activities associated with blood donation. One FDA policy concerns the deferral period of blood donation by men who have sex with men (MSM), and their sexual partners. The policy risks reinforcing stigma against people in the lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ) community. The 2019 novel coronavirus pandemic created an urgent need for blood products; hence, the FDA shortened the deferral period for MSM and their sexual partners. Yet, the public’s support of the deferral policy remained unclear. U.S. community adults (N = 829, Mage = 46.83, 50.3% women, 9.5% lesbian, gay, bisexual (LGB) individuals) rated their approval of the FDA’s deferral policy and attitudes toward blood donations from people across various sexual orientations and gender identities. Approximately 78% of participants reported positive attitudes toward receiving blood from heterosexual donors, whereas 54% reported positive attitudes toward receiving blood from LGBTQ donors. Participants were inclined to believe that the 2020 policy revision was motivated by an increased demand for blood donations amid the coronavirus pandemic rather than an intent to reduce discrimination. Relative to LGB participants, heterosexual participants were less willing to receive blood from LGBTQ donors, more likely to endorse the FDA’s deferral policy, and less likely to consider this policy to be discriminatory. Grounded in a minority stress framework, understanding public opinion can contextualize the possible negative impact on LGBTQ health and inform future FDA policies.

<p>Background</p> <p>Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months.</p> <p>Methods</p> <p>To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada’s three largest cities: Vancouver, (<em>n</em> = 17), Toronto (<em>n</em> = 15), and Montreal (<em>n</em> = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men’s preferred policy directions and their opinions about a policy change proposed by Canada’s blood operators: <em>a 3-month deferral for all sexual activity between men.</em> We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada.</p> <p>Results</p> <p>Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the “same for everyone” and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple “gender blind” and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) <em>step in the right direction</em>; (2) <em>ambivalence and uncertainty</em>; and (3) <em>not an improvement.</em></p> <p>Conclusion</p> <p>A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.</p>

BackgroundResearchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months.MethodsTo better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada’s three largest cities: Vancouver, (n = 17), Toronto (n = 15), and Montreal (n = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men’s preferred policy directions and their opinions about a policy change proposed by Canada’s blood operators: a 3-month deferral for all sexual activity between men. We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada.ResultsMost participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the “same for everyone” and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple “gender blind” and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) step in the right direction; (2) ambivalence and uncertainty; and (3) not an improvement.ConclusionA predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.

<p>Background: Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months.</p> <p>Methods: To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada’s three largest cities: Vancouver, (<em>n</em> = 17), Toronto (<em>n</em> = 15), and Montreal (<em>n</em> = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men’s preferred policy directions and their opinions about a policy change proposed by Canada’s blood operators: <em>a 3-month deferral for all sexual activity between men.</em> We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada.</p> <p>Results: Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the “same for everyone” and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple “gender blind” and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) <em>step in the right direction</em>; (2) <em>ambivalence and uncertainty</em>; and (3) <em>not an improvement.</em></p> <p>Conclusion: A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.</p>

<p>Background: Researchers and activists have long called for changes to blood donation policies to end what is frequently framed as unjustified bans or deferral periods for men who have sex with men (MSM). Since 2016, in Canada, a man had to be abstinent from all sexual contact (anal or oral sex) with other men for at least 12 months in order to be an eligible blood donor. As of June 3, 2019, this deferral period was reduced to 3 months.</p> <p>Methods: To better understand the acceptance of existing deferral policies and possible future policy, we conducted 47 in-depth interviews with a demographically diverse sample of gay, bisexual, queer, and other men who have sex with men (GBM) in Canada’s three largest cities: Vancouver, (<em>n</em> = 17), Toronto (<em>n</em> = 15), and Montreal (<em>n</em> = 15). Interviews were coded in NVivo 11 following an inductive thematic analysis. We focus on men’s preferred policy directions and their opinions about a policy change proposed by Canada’s blood operators: <em>a 3-month deferral for all sexual activity between men.</em> We interviewed GBM approximately one-year before this new deferral policy was approved by Health Canada.</p> <p>Results: Most participants were opposed to any deferral period in relation to MSM-specific sexual activity. A fair and safe policy was one that was the “same for everyone” and included screening for several risk factors during the blood donation process with no categorical exclusion of all sexually active MSM. Participants believed that multiple “gender blind” and HIV testing-related strategies could be integrated into the blood donation process. These preferences for a move away from MSM-specific exclusions aligned with their opinions concerning the possible change to a 3-month MSM deferral, for which participants shared three overarching perspectives: (1) <em>step in the right direction</em>; (2) <em>ambivalence and uncertainty</em>; and (3) <em>not an improvement.</em></p> <p>Conclusion: A predominant assertion was that a change from a 12-month to a 3-month deferral period would not resolve the fundamental issues of fairness and equity affecting blood screening practices for GBM in Canada. Many participants believed that blood donation policy should be based on more up-to-date scientific evidence concerning risk factor assessment and HIV testing.</p>

BackgroundAlthough 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.MethodsWe 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.ResultsOut 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.ConclusionsHigh-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.

Introduction: In May 2020, the Brazilian Supreme Court ruled that men who have sex with men (MSM) should be eligible to donate blood. Objectives: This study aims to describe the epidemiological, sociodemographic, and serological profile of MSM donors in the haemotherapy centre of a university hospital. Methodology and Resources: A cross-sectional study was conducted between June 2020 and June 2023. The study was approved by the Ethics Review Board of the Pedro Ernesto University Hospital. Results: There was a predominance of young people, single, and with higher education (complete or incomplete). Regarding gender specification, 46 (92%) identified as cis. In the sample, 64% (32) of candidates had taken at least one rapid test in the 12-month period. Most of the individuals analysed were donor eligible (90%), non-reactive for the serology of interest in the research (91.3%). Discussion: Among MSM donors, the prevalence of homosexual orientation and the regular use of condoms were observed. Even with the prior restriction of Resolution No. 399/2020, a proportion of these candidates donated blood. The reactivity for syphilis (6%) among the volunteers is below expectations, while for hepatitis B (2%) it is above the target, considering that the indicator presented by the state blood bank network, and there was no HIV reactivity. Conclusions: The importance of using risky sexual behaviour, rather than sexual orientation, as a criterion for donor eligibility was observed. This change allowed for the possibility of including minorities in the blood donation process.

Prioritising health equity alongside donation safety – Authors' reply

Significance. The shortage of donor blood remains a global problem, relevant to Russia as well. Blood donation promotion requires studying the public attitude towards donation, in particular among young people, as the most promising group. In recent years, there has been an increase in the number of donors, but the proportion of young people among them is still low. Purpose. To develop recommendations to increase the popularity of donation among young people aged 16-23, including a description of the intervention group (social portrait), the current effect of interventions and zones for interventions (attitudes towards donation and important factors influencing it). Material and methods. The all-Russian sociological research was conducted in July 2022 among young people aged 16-23. 1030 people were interviewed online. The sex and age distribution of the sample corresponds to the Rosstat data on the number of representatives of the target group. Results. The conducted research shows that the majority of young Russians have no experience in blood donation (80%). Among blood donors, the proportion of men who are receiving or have already received medical or pharmaceutical education, employed in private or public organizations is significantly higher. Also, the involvement in donation is associated with the experience in blood donation among close friends and acquaintances. Only 1% of the respondents absolutely correctly answered the questions about preparation for donation, which indicates a low level of knowledge among young people. About a third of the respondents (29%) note that they know how the blood donation process goes. A large number of the respondents are not familiar with the work of mobile blood donation centers and donor campaigns, and up to half of the respondents are not familiar with the existence and activities of NGOs in the field of blood donation. The attitude towards blood donation among young people is purely positive, while negative perception is associated with concerns for health and dissatisfaction with material incentives. The blood service was rated as 8.32 out of 10. Such a high rating is rather due to the positive image of donation in general. Major fears and myths associated with blood donation were identified as follows: the risk of contracting dangerous diseases, harmful effects of blood donation on donor's health, long recovery after blood donation, and painful blood donation procedure. Poor territorial accessibility of blood donation centers, as well as the need to undergo a significant number of preliminary examinations are the most common ideas about organizational problems of blood donation. Less than a third of the respondents say that there is not enough information about donation now, while young people prefer to be informed through online channels. As to slogans, the preference is given to simple, yet bombastic and heroic images, as well as simple and understandable slogans without abstraction and "poetry". Conclusion. The study offers recommendations for promoting donation among young people, aimed at bridging information gaps about various aspects of blood donation and debunking the myths and misconceptions identified. Scope of application. The results can be used to develop information policy on young people in order to retain and attract them to blood donation. Keywords: blood donation; youth; donor; survey; Blood Service

Blood substitutes: where do we stand today?

Recruitment Strategy for Potential COVID-19 Convalescent Plasma Donors

Donor history questionnaires for the determination of blood donor eligibility are a critical layer of blood safety. Early in the course of the AIDS epidemic in North America homosexual men with multiple partners were identified as one of the segments of the population with the highest risk of infection. Voluntary deferral of this group from blood donation led to a dramatic decrease in transfusion-transmitted HIV even before testing was introduced. In the early 1980s blood donors were deferred in England, the US and other nations, if they were ‘homosexual males with multiple partners’. After the implementation of HIV testing in 1985, the majority of the HIV-positive donors identified revealed ‘men having sex with men’ (MSM) behavior, leading the US Food and Drug Administration (FDA) to recommend indefinite deferral of all men who ‘have had sex with men, even once since 1977’; many other regulators and jurisdictions have enacted similar criteria. Three decades later, despite the recognition of other modes of transmission, MSM donors are still among the population segments with the highest prevalence and incidence of HIV in countries around the world. No other donor eligibility criterion has generated as much controversy or public discourse [1,2]. Proponents for change point out that in many countries other key components of blood safety such as donor testing and blood center process control have improved vastly, reducing the contribution of donor questioning to safety. Gay advocates in particular argue that donor selection policies based on MSM are discriminatory against gay and bisexual men in that they amount to a de facto permanent exclusion on the grounds of sexual preference, and are unfair, as other groups with similar risks of HIV infection are allowed to donate blood after shorter time-period deferrals designed to cover the seroconversion window. On the opposite side of the discussion, recipient advocacy groups and regulators are understandably adverse to any change that is not centered on improving safety. Recipient groups argue that they have suffered greatly due to transmission of HIV and HCV by transfusion, and they will be the bearers of any increase in risk that may result from policy changes. Because both MSM and recipients are vulnerable groups that have suffered in the past, the debate over possible changes in criteria has ethical, societal, and emotional dimensions not seen in discussions concerning other donor selection criteria. Of particular concern to blood operators is the prospect that young eligible donors may be dissuaded from donating blood to institutions that are perceived to act in a discriminatory and unfair fashion. This International Forum seeks to describe approaches to this issue and challenges to the status quo, in a snapshot in time. Since it is extremely difficult to obtaindatatoevaluatethepossibleimpactofpolicy changes made to address concerns expressed by advocacy groups, comparison of international practice is particularly valuable, since we may learn from approaches implemented in other jurisdictions. We received responses from 24 respondents representing countries on six continents. In most, but not all, the MSMpolicy isdetermined atthe national level. The following questions were asked of the respondents: