Review of ban on MSM blood
Living with AIDS 252
KHOPOTSO: In the mid-1980s, the United States’ Food and Drug Administration (FDA) imposed a lifetime ban barring men who have sex with men from donating blood. But at a workshop held earlier this month the American Red Cross, the American Association of Blood Banks and America’s Blood Centres, recommended that the policy be changed. The recommendation is that the permanent ban be reduced to one year. The ban came about at a time when concerns regarding the spread of HIV and the ease with which it is spread were high and uncertainties abounded about the reliability of testing and screening methods. But since then, the tests that are being used, including in South Africa, are more accurate than they were two decades ago. Dr Robert Crookes is the Medical Director of the in-land region of the South African National Blood Service.
Dr ROBERT CROOKES: South Africa, now since October last year, in addition to testing’¦ for HIV using an anti-body test a second test is performed on every donation, which is aimed at identifying the actual genetic material, the actual RNA in the case of HIV. So, the tests are very accurate’¦ But unfortunately, no test that’s available anywhere in the world can detect every infectious blood donation. There is still the
so-called window period’¦ where, unfortunately, even the most sensitive or accurate test cannot detect the infection. So, that is the reason that even though we have these sensitive tests that any person who’¦ is at increased risk for such an infection must please, please not donate blood.
KHOPOTSO: Internationally, blood service organisations view men who have sex with men as a high-risk group for transmitting HIV. The FDA in the US says ‘if there is hard evidence in place that changing the policy’ that permanently bans the acceptance of blood donations from this group, ‘would not endanger the blood supply they are open to it’. Is South Africa likely to follow the lead?
Dr ROBERT CROOKES: The answer is yes. The blood service wants to do things in a scientific and an evidence-based manner. Certainly’¦ the blood services in this country are also reviewing the data, the information, which is primarily from overseas. And based on that data and that information and based on the improvement in the sensitivity of the tests, the first step would be to recommend to the National Blood Committee that the period of exclusion be reduced. The next step, which is also in progress is really to, again, scientifically look at the prevalence, the incidence, and perform the statistical calculations as to’¦ any increased risk to the blood supply should the criteria of excluding men who have sex with men be discontinued altogether.
KHOPOTSO: Dr Crookes concedes that it is problematic that there is no available South African data on the prevalence of HIV amongst men who have sex with men. He says that the SANBS is in talks with the Human Sciences Research Council to carry out such a study.
The blood service in South Africa has based its safety policies on what’s happening in other parts of the world. But while the United States has a lifetime ban on blood donations from men who have sex with men, South Africa rejects blood from men who have had sex with other men in the last five years at the time of donation.
Dr ROBERT CROOKES: Certainly, the information that comes out of the United States is helpful. And certainly, based on the improvement of the sensitivities of the tests that the blood service is now using, I believe that it’s very likely that a recommendation will be made in South Africa to reduce the period down to one year, and certainly, very possibly, as a first stage down to six months.
KHOPOTSO: How soon would changes such as these actually take place in South Africa?
Dr ROBERT CROOKES: The question of reducing the period of donation, such as being considered by the FDA in the United States, could certainly be considered and scientifically evaluated before the end of the year.
KHOPOTSO: This, however, says Dr Crookes, does not mean that the question ‘have you had male to male sex?’ in the blood donor questionnaire will be removed. The only difference will be the reduction in the cut-off period from the current five years.
Dr ROBERT CROOKES: The policy remains and the question will remain. And that goes too, as to whether the individual has engaged either in anal or oral sex with or without a condom.
KHOPOTSO: Dr Francois Venter of Wits University’s Reproductive Health and HIV Research Unit sees no scientific reason in still using the criterion as an exclusion.
Dr FRANCOIS VENTER: I think it’s in everybody’s interest to have a safe and secure blood supply. I don’t think anyone disputes that. And I think that if we’re going to identify groups who we think are high-risk that should be done. However, I’m questioning the science behind the identification of these groups. I think that the blood supply service’s use of sexuality data to try and identify high-risk people is actually quite flawed. I think in this country the predominant people who actually have HIV are actually heterosexual. I don’t think that there’s sufficient evidence to specifically say it’s people who have one or other sexual orientation that should be excluded from donating blood.
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