HIV Risk Behavior Profiles Among Men Who Have Sex with Men Interested in Donating Blood: The Assessing Donor Variability and New Concepts in Eligibility (ADVANCE) Study

Abstract

Importance: Blood donor selection policies should be evidence-based. Individual risk assessment allows potential donors to be evaluated based on their own behaviors. Objective: The Assessing Donor Variability and New Concepts in Eligibility (ADVANCE) study examined behavioral and biomarkers of HIV risk in sexually active men who have sex with men (MSM) to estimate the proportion of the study population who would not be deferred for higher risk HIV sexual behaviors and might be eligible to donate. Design: A cross-sectional assessment of sexually active MSM interested in blood donation. Setting: An 8-city study of MSM aged 18-39 years assigned male sex at birth. Interventions or Exposures: Participants completed surveys during 2 study visits to define eligibility, self-reported sexual and HIV prevention behaviors. Blood was drawn at study visit 1 and tested for HIV and the presence of tenofovir, 1 of the drugs in oral HIV pre-exposure prophylaxis (PrEP). Main Outcomes and Measures: Associations between HIV infection status or HIV PrEP use and self-reported HIV risk behaviors, including number of male sex partners, new partners, and anal sex. Results: Among 1788 screened MSM, 1593 were eligible and 1566 completed the visit 1 HIV risk questionnaire and blood draw. A median of 22 days later, 1197 completed the visit 2 follow-up questionnaire. Four individuals tested HIV positive (0.25%). Among HIV-negative participants, 789 (50.4%) reported no PrEP use in the past 3 months. The number of sex partners in the past 3 months was significantly higher among PrEP users versus non-users, as was the number reporting a new male sex partner in the same period. Among HIV-negative, non-PrEP using participants, 66.2% reported only 1 sexual partner or no anal sex and 69% reported no new sexual partners or no anal sex with a new partner in the past 3 months. Conclusion and Relevance: Among sexually active MSM, there are subgroups who self-report no new sexual partners and only 1 sexual partner within the past 3 months. These individuals are likely at lower risk of HIV infection than other MSM and would meet proposed individual risk assessment criteria for blood donation in the U.S.

FDA’s 2023 Policy Update—Promoting Safety and Inclusivity in Blood Donation

“…The Assessing Donor Variability and New Concepts in Eligibility (ADVANCE) study provided preliminary data to support blood donation by MSM who are at low risk of HIV infection and not taking PrEP. 10 Additional research is needed to more closely examine the risk of HIV transmission in the setting of PrEP usage and update donation guidelines as new evidence emerges. The FDA's 2023 blood donation recommendations reflect a substantial advancement toward eliminating stigmatizing blood donation barriers while protecting the safety of the country's blood supply.…”