Assessment of the relevance of implementing selection criteria for blood donors based on an analysis of sexual behaviors at risk of transmitting infectious agents

A regulatory change in the selection criteria for blood donors is currently under review in France and aims to lift for the year 2022 the contraindication to blood donation, as opposed to men who have sex with men ( MSM).

The High Council of Public Health (HCSP) was contacted by the General Directorate of Health (DGS), in order to assess the relevance of the implementation of selection criteria for blood donors based on an analysis of sexual behavior. at risk of transmission of infectious agents.

After taking into account the epidemiology of HIV infection in France and the impact of the pandemic linked to Covid-19, the incidence of HIV infection and the residual risk linked to HIV in blood donors , various studies carried out in MSM blood donors, recommendations on blood donation by MSM in France and in other countries, information relating to hearings carried out with user associations and HIV epidemiologists, the current pre-donation questionnaire used for the selection of blood donors, the HCSP notes:

  • that it is not possible to guarantee a level of residual risk equivalent to the current risk in the event of modification of the pre-donation questionnaire. In the context of deleting questions 43 and 44 relating to MSM, the estimated residual risk of selecting an HIV-infected donor would be multiplied by a factor of 1.5 at most, but would remain low;
  • that the working group is divided on three scenarios discussed:
  • Option 1: status quo on the current pre-donation questionnaire,
  • Option 2: deletion of questions 43 and 44 from the pre-donation questionnaire and addition of questions on sexual practices,
  • Option 3: deletion of questions 43 and 44 from the pre-donation questionnaire without adding additional questions outside the multi-partnership in the 4 months preceding the donation, question already included in the current questionnaire.

Therefore, the HCSP does not recommend either of the two predominantly expressed options (options 1 and 3), as this is a matter of social acceptability.

However, he draws attention to the following points of vigilance:

  • in the event that additional questions on risky sexual practices are proposed at the end of the work in progress at the DGS, a reference to sexual orientation should not be retained;
  • different formulations of questions must be tested with blood donors, ensuring the acceptability of the questionnaire;
  • training of health professionals who administer the pre-donation questionnaire must be implemented;
  • an update of the pre-donation interview preparation document for donors should be considered;
  • if questions relating to sexual orientation are removed from the pre-donation questionnaire, this choice must be evaluated by the permanent monitoring system for positive donations, reserving the right to question these provisions depending on the evolution knowledge, safety devices and health risks.

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