Blood donation deferral policies among men who have sex with men in Brazil

Abstract

Reevaluation of the deferral from voluntary blood donation by men who have sex with men (MSM) is being discussed in several countries, motivated by the need to ensure a blood supply free from transfusion-transmissible infections (e.g., HIV, syphilis). Policies being considered include: permanent exclusion for any male-male sexual encounter, temporary deferral (3 months, 12 months, 5 years) from the last encounter, or specifying behaviors that differentiate MSM at high risk from those at low risk. Current Brazilian regulations defer MSM from blood donation for 12-months after the last male-male sexual encounter. Broad epidemiological evidence indicates that many MSM are at increased risk for HIV in the present era, and few data exist to distinguish which men are likely to be in the immunological window for detection of these infections. A multicenter study developed in Brazil demonstrated that the history of male-male sex was the most strongly associated with being an HIV-positive blood donor. Meanwhile, the blanket deferral of MSM from blood donation has generated considerable controversy. Rejection of the deferral policies stems in part from perspectives defending human rights, promoting equality and citizenship, and alleging bias and discrimination. The objective of this report is to discuss the current situation of blood donation among MSM in Brazil. We highlight the lack of evidence for a true risk profile for male-male sex in the context of blood donation upon which to base sound policy. We recommend research to establish effective and acceptable criteria for blood donation by MSM and other blood donors.

Transfusion-Acquired HIV: History, Evolution of Screening Tests, and Current Challenges of Unreported Antiretroviral Drug Use in Brazil

“…Among initial donors, many expressly seek blood testing over personal concerns of possible infection [ 35 , 36 ]. Current MSM policies were seen as unjustified and discriminatory and led to discussion and pressure by MSM communities for their elimination [ 37 ]. Thus, the legislation that deferred donations from MSM and/or were sexual partners of MSM in the preceding 12 months was reversed in Brazil in 2020 and became based on individual practices [ 33 , 38 ].…”

“…Despite all measures taken to reduce blood-borne infections, there is still a risk of transfusion-mediated transmission of HIV. This mode of transmission was documented to still occur despite the implementation of NAT screening [ 33 , 34 , 35 , 36 , 37 ]. NAT has been implemented in several countries and the sensitivity of the techniques and especially the number of samples in pooled analyses or even in individual NAT can impact the length of the infectious pre-seroconversion window [ 39 , 40 , 41 , 42 , 43 , 44 ].…”

Influence of risk perception on attitudes toward blood donation among Brazilian men who have sex with men who donated blood

“…1,2 Due to the higher prevalence and incidence of HIV among men who have sex with men (MSM), many countries implemented policies that deferred MSM from blood donation. [3][4][5] In Brazil, for example, the majority of reported cases of HIV occur among MSM, who account for more than half (51.3%) of all cases reported to the Ministry of Health. 6 HIV prevalence increased from 12.1% to 18.4% among men who have sex with men (MSM) between 2009 and 2016, 5,6 suggesting on-going transmission.…”

“…However, there was no Brazilian study to support the change in regulations with regard to the potential impact on blood supply and safety. 3,4 Although HIV tests have increased in sensitivity and availability, 9 the clinical screening interview of potential blood donors remains necessary to address a residual risk of transfusion transmission. 10 Because there is a small window period after infection before tests are reactive, because tests are not perfect, and due to the reality of human error, some blood donations from HIV-infected donors may escape detection.…”

Science in action? A critical view of UK blood donation deferral policy and men who have sex with men

“…Research into MSM blood donation tends to consider the effect of deferral period policies, including the views of MSM on such policies and the effect of stigma differential deferral policies are charged with creating 4,11,14,15 . However, little work has addressed the fact that these deferral periods are themselves unstable, dynamic entities, that, while produced via processes that are ostensibly purely scientific, enact multiple other justifications.…”