Donor screening question alternatives to men who have sex with men time deferral: Potential impact on donor deferral and discomfort

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.

A mixed methods investigation of the relationship between blood donor policy, interest in donation, and willingness to donate among gay, bisexual, and other men who have sex with men in Ontario, Canada

“…They saw these policies as heterosexist and discriminatory because they exclude sexually active MSM from donating blood, leading to feelings of shame and marginalization. Indeed, GBMSM take issue with deferral policies that prohibit sex for any length of time [ 11 ]. Since the existing time-based deferrals are interpreted as discriminatory, many GBMSM favor a policy based on individual-level behavioral risk — a policy that is “gender neutral” — and do not consider a 3-month deferral to be a significant improvement from the previous 12-month deferral given that it seems discriminatory and out of step with scientific evidence [ 5 , 12 ].…”

Staff perspectives on barriers and enablers to implementing alternative source plasma eligibility criteria for gay, bisexual, and other men who have sex with men

“…For example, sexual behavior‐based screening has been implemented in the UK 36 and is being considered in Canada 9 . This involves asking questions about anal sex which may be uncomfortable for some donors 28,37 and may be experienced as differential treatment of gbMSM even if the questions are asked of all donors 28 . Others have suggested that staff may require cultural competency training when using individual risk assessments that include sensitive questions 38 .…”

Sexual risk behavior questions: Understanding and mitigating donor discomfort

“…These results are consistent with prior research that shows that only a very small minority of Canadian donors would be deterred from donation because of discomfort with new sexual behavior questions. 20 While many blood operators and regulators view the move to sexual behavior-based screening as a significant paradigmatic shift, donors may not perceive additional sexual behavior questions as a significant change to their donation experience.…”