Sexual risk behaviour and donor deferral in Europe

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.

The beliefs and willingness of men who have sex with men to comply with a one‐year blood donation deferral policy: a cross‐sectional study

“…16 However, rates of HIV-positive blood donation have increased in both MSM and heterosexual Italian men. 17 In Spain, it is debated whether increased rates of donated HIV-positive blood are due exclusively to MSM being allowed to donate.…”

“…17 In Spain, it is debated whether increased rates of donated HIV-positive blood are due exclusively to MSM being allowed to donate. 16 Increased rates of HIV-positive blood donation likely reflect, at least in part, a failure of screening practices. In Italy, all potential blood donors are screened by a questionnaire and a specially trained physician to determine if they should be deferred or allowed to donate.…”

Good Feasibility of the New German Blood Donor Questionnaire

“…Therefore, a precise definition of heterosexual risk behavior would be desirable. Attempts to make this definition failed with exception of highrisk behavior like sex work [14]. Therefore, in the conception of the UDQ, we decided to address heterosexual exposure (unprotected sexual contact with a new partner prior to the donation) rather than making an arbitrary definition of heterosexual risk behavior.…”

“…Therefore, in the conception of the UDQ, we decided to address heterosexual exposure (unprotected sexual contact with a new partner prior to the donation) rather than making an arbitrary definition of heterosexual risk behavior. This procedure is well established in other countries like Spain or Italy [14]. Further advantages of this approach are that a question about sexual contact with a new partner is clear and non-judgmental and leaves little room for interpretation by the donor [3].…”

Human Immunodeficiency Virus (HIV)

“…There is currently an intensive discussion on a national and international level whether lifetime deferral of MSM and of sex workers could be replaced by a sufficient temporary deferral, taking into account the last sexual contact between men or in sex work, respectively [142,143,144]. …”