Deferral from donating blood of men who have sex with men: impact on the risk of HIV transmission by transfusion in France
J. Pillonel1, V. Bousquet1, B. Pelletier2, C. Semaille1, A. Velter1, C. Saura1, J.-C. Desenclos1, B. Danic3, F. Cazein1, for the Blood Donor Epidemiological Surveillance Study Group
1Institut de Veille Sanitaire, Saint-Maurice, France, 2Etablissement Français du Sang, Saint-Denis, France, 3Etablissement Français du Sang de Bretagne, Rennes, France
Background: In France, men who have sex with men (MSM) are permanently excluded from blood donation. This policy is felt to be discriminatory by MSM activists. In addition, this deferral policy is not fully respected since some MSM do not report their sexual orientation before donating.
Methods: First, we estimated the fraction of the current risk of transfusion-transmission of HIV attributed to MSM, since some MSM are regularly found HIV positive when donating blood despite the deferral policy. We then constructed a model based on data obtained from behavioural and epidemiological surveys among MSM to assess the impact of a new strategy in which MSM would only be deferred if they report more than one sexual partner in the last 12 months.
Results: Thirty-one HIV seroconversions occurred among blood donors from 2006 to 2008, accounting for an incidence of 1.3 per 100,000 person-years which translates to an HIV residual risk of one in 2,400,000 donations. Among these seroconversions, 16 (52%) were MSM (information obtained during post-donation medical interview). If all MSM had abstained from donating blood during the study period, the risk would have been 1 in 4,700,000 donations, a twofold reduction in the current risk. The new strategy would result in an overall HIV residual risk of 1 in 3,750,000 to 1 in 800,000 donations which corresponds to a maximum of two additional donations potentially infected with HIV each year.
Conclusions: Changing the current MSM deferral policy would probably increase the risk of transfusion-transmission of HIV. However, it does not take into account a likely better compliance of MSM with a less stringent policy. As some MSM currently consider “life-time deferral” discriminatory, they give blood wittingly. A less stringent policy would be perceived to be more equitable and should enhance responsibility. Then, further qualitative assessment is needed in addition to our quantitative analysis.
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