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AIDS Care: Psychological and Sociomedical Aspects of AIDS/HIV Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/caic20

Perceptions about blood donation, transfusion and the risk of HIV infection: implications for the blood transfusion service a

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R. S. Bhopal , R. T. Mcewan , R. Madhok & A. Mccallum

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Division of Epidemiology and Public Health , University of Newcastle upon Tyne , UK Published online: 25 Sep 2007.

To cite this article: R. S. Bhopal , R. T. Mcewan , R. Madhok & A. Mccallum (1992) Perceptions about blood donation, transfusion and the risk of HIV infection: implications for the blood transfusion service, AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV, 4:1, 43-52, DOI: 10.1080/09540129208251619 To link to this article: http://dx.doi.org/10.1080/09540129208251619

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AIDS CARE, VOL. 4, NO. 1, 1992

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Perceptions about blood donation, transfusion and the risk of HIV infection: implications for the Blood Transfusion Service

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R. S. BHOPAL,R. T. MCEWAN, R. MADHOK & A. MCCALLUM Division of Epidemiology and Public Health, University of Newcastle upon Tyne, UK

Abstract To assess perceptions of risk of AIDSHIV infectionfiom donation to, and receipt of, blood fiom the British Blood Transfusion Service, we undertook self completion surveys (n=1874, response rate 74%) and an interview survey (n=300, response rate 77%) of students in three highergurther education establishments in the North East of England. In the postal survey 20.9% perceived a risk of acquiring HIV/AIDS afer blood donation, and 4.8% perceived the risk to be moderate or high. Explanations for the perceived risk were usually inaccurate. Most people (62.3%) perceived that blood transfusion had a risk of HIV infection, and 13.4% reported this risk to be moderate or high. The explanations for the risk were generally correct. The interview survey largely conjrmed the results of the postal survey. The perceived risk of contracting HZV infection on blood donation is not an artefact of survey method; a substantial minority perceive a risk where there is none. Some people remain unaware of the risk of HIV infection afer blood transfusion and among others the risk is perceived as higher than is realistic. Further research and educational initiatives to help safeguard the efficient gathering and use of blood are warranted.

Introduction The efficiency and self-sufficiency of the British Blood Transfusion Service requires that people who donate blood continue to do so and new donors are recruited in increasing numbers. Before the Gulf war the number of new donors was decreasing (Macaskill et al., 1989). Autologous transfusion is important (Kay, 1987) but is suitable only for elective surgery and cannot, therefore, substantially reduce the need for more donors, though repeated, frequent donation (Slater, 1987) and more careful selection of those who need blood might (Rutherford, 1988). The AIDS epidemic has affected adversely the blood transfusion service (Nutbeam et al., 1989), and could jeopardize it, particularly if donors who cause infection are sued (Dyer,

Address for correspondence: Professor Rajinder S. Bhopal, The AIDS Education for Young People Progamme, Division of Epidemiology and Public Health, School of Health Care Sciences, The Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4HH, UK.

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44 R. S. BHOPAL ET AL. 1990). Transmission of HIV through blood or blood products had accounted for a cumulative total of 316 cases of AIDS in the United Kingdom by December 1990, and 30 cases had received blood in the United Kingdom (AIDS News Supplement, 1991). The publicity surrounding these tragic cases may have contributed to negative attitudes towards the donation and receipt of blood. MacAskill and colleagues (1989) reported that 75% of their Scottish subjects thought it unlikely that donation entailed a risk of developing AIDS. The perceptions of donors were not significantly different from non-donors and lapsed donors. They concluded that the fear of infection of AIDS/HIV was not directly important in discouraging blood donation; rather, blood donation raised other emotional issues linked to the examination of personal risk. Nutbeam and colleagues (1989) assessed the risk perception of Welsh adults with respect to contracting AIDS and concluded that their perceptions might affect blood donation, but that other factors were more likely to inhibit donation. Surprisingly, 20% of current donors believed there to be a risk associated with donation. They recommended sensitive AIDS education programmes in collaboration with the blood transfusion service. Other studies both in Britain (Smithson, 1988; DHSS, 1987; West Midlands Regional Health Authority, 1988), and abroad (Strunin & Higson, 1987; Taylor et al., 1989), have recorded substantial perceived risk of developing AIDS after blood donation. Alarmingly, Smithson (1988) reported that simply having an injection was associated with a risk of AIDS by 8% of health staff and 13% of the public. The risk of AIDSIHIV after blood transfusion remains despite routine screening, as antibody may not develop for 3-6 months and antigen change may make antibody undetectable by routine testing (Kay, 1987). Fortunately, the prevalence of HIV positivity amongst blood donors is extremely low: 1.29/100,000 since screening began (V. Rawlinson, personal communication); and 4.3/100,000 and 0.8/100,000 in first-time and regular blood donors respectively (AIDS News Supplement, 1990). If the number of heterosexual cases continues to increase at its present rate, however, the problem of donations from seronegative but HIV infected people will become serious. The aims of this study were to assess perceptions of the risk of acquiring AIDSIHIV on blood donation and transfusion, to seek to understand their basis to guide educational initiatives, and to consider whether misperceptions of risk on blood donation were an artefact of study method and question wording. The latter objective was achieved by doing both postal questionnaire and interview based surveys on similar populations.

Methods 1. Postal questionnaire study

Sampling and recruitment. The 28 further and higher education establishments in the Tyne Tees geographical area were categorized as universities (n =2), polytechnics ( n =3), colleges with more than 800 students (n=8) and colleges with less than 800 students ( n = 15). The University of Newcastle was selected as the larger, more typical university, located in the major city of the North East. One establishment was randomly selected from the other three categories, but the college with more than 800 students withdrew, for reasons unrelated to our study. A systematic sample of 666 full-time students was drawn from the university and the polytechnic (50% were in first-year). All 542 full-time students at the college were recruited to the study (74.9% were in first-year). The names of students were drawn from academic registers and students were sent questionnaires by post. As no unique identifying details

IMPLICATIONS FOR THE BLOOD TRANSFUSION SERVICE

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were collected the replies were anonymous, as previously described (Madhok et al., 1990). Two remainders were sent to all 1874 students. Data collection. Previous studies used different wording for questions on blood donation and transfusion, and some did not specify the location of transfusion (Nutbeam et al., 1989; DHSS, 1987; West Midlands Regional Health Authority, 1988; Gillies et al., 1990; DiClemente et al., 1986) or asked about the combined risk of donation and transfusion (Gillies et al., 1990). New questions were therefore devised and tested in a pilot study of 20 students. The questions on blood donation and receipt were as follows: What is the risk of catching the AIDS virus through donating (giving) blood to the British Blood Transfusion Service? Downloaded by [New York University] at 08:37 08 January 2015

and, What is the risk of catching the AIDS virus through receiving blood from the British Blood Transfusion Service?. We chose the colloquial wording ‘risk of catching’ for compatibility with previous surveys (Nutbeam et al., 1989; Smithson, 1988; DHSS, 1987). For both questions the reply options were: high risk, moderate risk, low risk, no risk, and don’t know/not sure. Respondents were also asked to ‘Please explain briefly why you feel this way’. Similar questions were asked about other activities including kissing, shaking hands, and sexual behaviour. 2. Interview study

Sample. One establishment was studied, the university. A quota sample of 300 students was drawn based on the gender and faculty of full-time undergraduates. Students involved in the postal survey were excluded. Students were selected from six sites around the university complex by 11 market research interviewers trained by the research team. Data collection. The postal questionnaire was adapted for the interview study. The wording used by interviewers for questions concerning blood donation, for example, was placed on a card and was ‘Which of the statements on this card describes the risk of catching the AIDS virus through donating, or giving, blood to the British Blood Transfusion Service?. The interviewer then asked ‘Why do you feel this way?’. They were instructed to probe the answer fully and to establish the source of this information. 3. Analysis

The answers to open questions from 50% of the postal questionnaires and all the interview questionnaires were numerically coded by the research team working in pairs. The data were entered onto computer by data preparation staff, checked, and analysed with the computer programme SPSSpc (Norusis, 1988). Knowledge scores were constructed by giving 1 point for a correct answer to each of 11 knowledge related questions. 4.

Timing of the studies

The postal survey was conducted between December 1989 and March 22nd 1990. The interview study took place between the 19th and 22nd March 1990.

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5. Ethics Ethical permission was obtained from the relevant medical research ethical committees after we guaranteed total anonymity of respondents (Madhok et al., 1990) and reduced the number of questions concerning personal characteristics (Madhok et al., 1991).

Results

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Quality of data Twelve duplicate replies in the postal survey were identified (Madhok et al., 1990). Missing data and spoilt questionnaires ( n = 7 ) were few. The response rate in the postal study was 74% (1388/1874), but was higher in the university (82%) and the polytechnic (78%) than in the college (60%). The response rate in the interview study was 77% (194/253), based on data from seven of the interviewers (the others apparently misplaced the tally). Interviewers judged most students to be truthful (99%), helpful (82%), forthcoming (57%) and few to be shy or embarrassed (22%). Our question concerning the year of study requested the duration of study in years and months. Some students gave their reply rounded to the nearest year and then separately in months. This prevents crosstabulations by year of study.

Perceptions of risk Table 1 shows 72.6% of students perceived no risk of AIDS after donating blood, but about one in twenty a high or moderate risk, and about one in five any risk. By comparison only 3.9% of students perceived any risk of infection after shaking hands with a person with AIDS. Most students (62.3%) perceived a risk from receiving blood. Injecting drugs with a shared needle and vaginal sexual intercourse without the use of condoms were perceived as activities carrying much higher risk than transfusion of blood. Uncertainty, as reflected by ‘don’t know’ responses, was highest for the risk associated with donation, receipt of blood and kissing. Table 2 compares, for university students, the risk perceptions reported at interview and the postal survey, and supports the hypothesis that students’ perception of a risk of HIV infection on blood donation is not an artefact of survey method. The reasons given for the perceived risk are presented in Table 3. Most comments associating the donation of blood with risk of HIV were either non-specific, irrational or wrong but those indicating no risk were mainly factual. A few respondents clearly did not grasp the difference in the processes of transfusion and donation, even at interview as indicated by the comments that haemophiliacs and others have caught HIV this way, and the HIV test is not conclusive initially. Comments about the receipt of blood were mostly specific and correct, the major exceptions being ‘previously there was a risk but not now’, and, ‘not all blood is screened’. Sub-group differences are shown in Table 4. College and polytechnic, women, and younger students were most likely to perceive a high or moderate risk of infection from donating and receiving blood. When 18 year-olds were compared, college (39.7%) and polytechnic students (26.8%) were more likely to perceive a risk of infection on donation than university students (14%). Those who reported not knowing enough about AIDS/HIV, perceived a greater risk from both donation and transfusion than those who ‘knew enough’. Those who perceived no risk on donation were also more likely to perceive no risk on transfusion.

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Table 1. Students’ perception of risk in relation to blood donation, blood transfusion, and other activities: postal survey ,$pies are percentages: n =1388) Perceived risk

Question

High

Moderate

Low

No risk

Don’t know

1.7

3.1

16.1

72.6

5.2

2.2

11.2

48.9

28.8

7.1

1.5

6.1

43.2

41.9

6.1

0.1

0.1

3.7

94.7

0.4

94.7

. 3.5

0.1

0.2

0.4

6.5

39.9

46.4

3.9

2.2

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What is the risk of catching the AIDS virus through donating (giving) blood to the British Blood Transfusion Service? receiving blood from the British Blood Transfusion Service? kissing someone who has the AIDS virus? shaking hands with someone who has the AIDS virus? injecting with a needle used by someone else? having vaginal intercourse with someone who has the AIDS virus, using a condom?

*Percentages do not add up to 100 because of a few missing values.

Table 2. University students’ perceptions of risk: comparison of postal and intemiew studies (percentages) Perceived risk

High

Moderate

Low

No risk

Don’t know

(n=299) (n=539)

1 .o 0.7

1.7 0.9

19.4 11.5

76.3 83.9

1.3 3.0

(n=300) (n=536)

2.7 1.1

7.0 8.4

53.0 49.6

33.6 34.9

4.0 6.0

( n =299) (n=538)

0.3 1.3

5.0 4.8

37.7 50.6

50.7 37.5

6.0 5.8

Theme of question and type of study 1. Blood donation Interview survey Postal survey 2. Blood transfusion Interview survey Postal survey 3. Kissing Interview survey Interview survey

Table 5 shows perceived risk on blood donation and transfusion in relation to knowledge on other HIVIAIDS issues. High knowledge scores were associated with an appreciation that blood donation is risk free, and also, unexpectedly, with a perception that blood transfusion entails no risk. Similar analyses were done for other modes of transmission but in no instance was high knowledge associated with more inaccurate perception of risk. Table 6 shows statistically significant associations between a perception of risk of infection from donating blood and stating that television advertisements and the press were

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R. S. BHOPAL ET AL.

Table 3. Common explanations given for perceived risk of HIV/AIDS afer donation or receipt of blood (rank order, number of citations of explanation in brackets) Receipt of blood question

Donation of blood question Postal study

Postal study

Interview study

Interview study

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(a) Comments indicating that there is a risk of infection Staff carelessness and human error

There is no such thing as no risk

There is no such thing as no risk

Staff neglect and error leading to dirty needles Small possibility/ very unlikely

Haemophiliacs and others have caught AIDS this way Blood can contain HIV Donors may be HIV positive

(18)

Haemophiliacs and others have caught AIDS in this way (98)

Haemophiliacs and others have caught

There is no such thing as no risk (95)

There is no such thing as no risk

Donors can be HIV positive

Staff carelessness and error

AIDS in this way

(13) (10)

Haemophiliacs and other have caught AIDS in this way

(6)

HIV test is not conclusive initially

(2)

Not all blood is screened

HIV test is not conclusive initially Not all blood is screened

(32)

(23)

(17)

HIV test is not conclusive initially Donors may be HIV positive

Staff carelessness or error (17) Blood may contain HIV (9)

Small possibility/ very unlikely

Blood is screened (258) Donors are teated for HIV (17) Staff are careful and aware (16) Blood is heattreated (14)

Blood is screened Staff are careful and aware Confidence in the British service Previously there was a risk, not now New/clean sterile equipment is used

@) Comments indicating that there is no risk of infection

Cleanlnew sterile equipment used (362) Staff are careful and aware now (58) Blood is screened (40) No risk from donation (40) No fluid exchange/ contact with the virus in donation (23) News/publicity says there is no risk (10)

Cleanlnew sterile equipment used (183) Blood is tested and screened (56) Staff are aware/ take precautions (48) I am a blood donor and I am not concerned (35) There is no risk from donation (28) Previously there was a risk, not now

Previously there was a risk, not now

(13) Blood is heattreated

(5)

an important source of information. No such associations were found for stating that leaflets, friends, school, student welfare officers or doctors were important sources of information. Discussion Students are of above average intelligence and would be expected to be adept at assimilating information on the relative importance of different means of transmission of HIV infection.

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Table 4. Subgroup diferences in the perceived risk of infection porn blood donation and transfusion (percentages) Perceived risk from donation High/ moderate

Variable Establishment University (n=523) Polytechnic (n=488) College (n=288)

Low risk

Perceived risk of tranfusion

No risk

High/ moderate

1.8 11.9 86.4 3.3 18.9 77.9 14.7 24.3 61.1 =98.1, d.f. =4, ptO.OO1

x2 Gender

Male Female

(n =556) (n =742)

x2= Downloaded by [New York University] at 08:37 08 January 2015

Age

16-17 18-19 20-21 22

+

Perceived knowledge

(n=202) 16.3 23.8 (n=443) 2.7 17.6 (n=378) 3.4 16.9 (n =275) 3.3 12.4 x2=77.2, d.f.=6, ptO.001

Enough (n =908) Not enough (n=146) Not sure (n=223)

x2=

Perceived risk on donation

2.7 15.1 82.2 7.0 18.9 74.1 16.7, d.f.=2,p

Perceptions about blood donation, transfusion and the risk of HIV infection: implications for the blood transfusion service.

To assess perceptions of risk of AIDS/HIV infection from donation to, and receipt of, blood from the British Blood Transfusion Service, we undertook s...
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