BLOOD DONORS AND BLOOD COLLECTION The rates, perceptions, and willingness of men who have sex with men to donate blood Walter Liszewski,1 Jordan Becerril,2 Christopher Terndrup,1 Nathan West,3 Bridget C. Lavin,4 Danny Schieffler,5 and Nicholas Van Sickels6

BACKGROUND: Since 1983 in the United States, any man who has had sex with another man (MSM) at any time since 1977 has been deferred from donating blood for life. Although there has been a push to change the deferral, there is a paucity of information on both the rates of MSM blood donation and the willingness of MSMs to donate if the deferral were changed. STUDY DESIGN AND METHODS: A 15-question survey was given at two lesbian, gay, bisexual, and transgender festivals in Chicago and New Orleans. Participants were asked about a previous history of blood donation and whether they would be willing to donate were the lifetime deferral changed. Participants were also asked to determine whether it was safe for hypothetical MSMs with varying sexual practices to donate blood and whether they believed that it was safe for them to donate their own blood. RESULTS: Our study found that 42.0% of all participants had not complied with the deferral policy and have donated blood at least once, with a mean number of donations of 4.84. Additionally, 85.9% of participants would be willing to donate blood if the deferral were changed. CONCLUSION: Despite the lifetime deferral, many MSMs have previously donated blood, and many more are willing to donate. Given this, along with the safe implementation of temporary deferral policies in other nations, the United States should consider adopting a temporary deferral policy for MSMs.

S

ince 1983, the US Food and Drug Administration (FDA) has implemented a lifetime blood donation deferral for all men who have had oral and/or anal sex with another man (MSMs) at any time since 1977. The human immunodeficiency virus (HIV) was discovered in 1984, and the first diagnostic test for HIV infection was developed in 1985. When the deferral was created in 1983, the lifetime MSM blood donation deferral was practical. Currently, donated blood is screened twice for HIV. First, blood is screened for antiHIV-1/2 immunoglobulin (Ig)M and IgG antibodies.1 This test has a sensitivity of 99.81% to 100%, a specificity of 100%, and a 22-day mean window period.2-5 Second, blood from six to 16 donors is pooled, and a nucleic acid test is used to detect HIV-1 RNA.1 This test has a specificity of 99.9% and an 11-day mean window period.6,7 In the United States, the current estimated risk of HIV transmission by transfusion is 1 in 1.5 million units.8 Given these advances, several industrialized nations have shifted from a lifetime deferral to a temporary deferral period, and multiple professional organizations, including the AABB,

ABBREVIATIONS: LGBT = lesbian, gay, bisexual, and transgender; MSM(s) = men who have sex with men. From the 1Tulane University School of Medicine, the 4Payson Center for International Development, Tulane University, and the 6Division of Infectious Disease, Tulane University School of Medicine, New Orleans, Louisiana; 2Rush Medical College and the 3University of Chicago School of Medicine, Chicago, Illinois; and 5Steinhardt School of Culture, Education, and Human Development, New York University, New York, New York. Address correspondence to: Walter Liszewski, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112; e-mail: [email protected]. Received for publication May 18, 2013; revision received October 22, 2013, and accepted November 7, 2013. doi: 10.1111/trf.12535 © 2014 AABB TRANSFUSION 2014;54:1733-1738. Volume 54, July 2014

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American Red Cross, and America’s Blood Centers, support ending the lifetime deferral.9,10 Despite the lifetime deferral, previous studies indicate that MSMs are currently donating blood. Observational studies in North America suggest 1.2% to 1.4% of male blood donors are MSMs,10,11 and in a survey of MSMs in San Francisco, 23.4% admitted to donating blood since 1977.12 As limited data and divergent opinions exist regarding MSM blood donation, we sought to further the discourse on the lifetime MSM blood donation deferral in this crosssectional study. We polled MSMs at two public lesbian, gay, bisexual, and transgender (LGBT) festivals to collect data on the percentage of MSMs who have donated blood, whether MSMs would donate blood were the deferral changed, whether MSMs could differentiate the risks that various behaviors might pose to blood donation safety, and whether participants believed that it would be safe to donate blood based on their own health and sexual practices.

MATERIALS AND METHODS To assess the frequency, beliefs, and willingness of MSMs to donate blood, a written 15-question quantitative survey was created (Appendix S1, available as supporting information in the online version of this paper). The assessment was based on previous surveys that investigated characteristics and beliefs of minority populations.13,14 To ensure access to a cross-section of the MSM community, the survey was fielded at two large, public LGBT festivals: Chicago’s North Halstead Market Days August 13 and 14, 2011, and in the French Quarter of New Orleans Halloween weekend October 29 and 30, 2011. On all days, survey data were collected between 11:00 a.m. and 5:00 p.m. The assessment was administered by study coordinators at a booth on the street at both festivals. Study coordinators invited men passing the booth to complete the assessment. To be eligible for the survey, participants had to be born a biologic male, had to be at least 18 years old, and must have had oral and/or anal sex with at least one other male since January 1, 1977. The research coordinators read the purpose, consent form, and instructions to the participants. All eligible participants provided oral consent to participate. Participants completed the written survey in approximately 5 minutes. To maintain anonymity, no names or identifying information was collected, and participants placed their survey into a collection box. At the end of each day, all surveys were collected and stored. This study was approved by the Tulane University Biomedical Institutional Review Board.

from the United States’ 2010 Census. Participants were classified as Caucasian, non-Hispanic; African American, non-Hispanic; Asian American; Native American; two or more races; or Hispanic. Sexual activity in participants was assessed with the “yes” or “no” question: “Since January 1, 1977, have you had oral and/or anal sex with a man?” To assess blood donation history, participants were asked: “After you have had oral and/or anal sex with a man since January 1, 1977, have you later donated blood at any time since 1983?” Men who answered “yes” were subsequently asked: “How many times since 1983 have you donated blood after you had oral and/or anal sex with a man since January 1, 1977?” Due to the complexity of the two questions, survey coordinators briefly explained what these two questions were asking before the participants started the survey. Four scenarios were used to assess whether participants could identify the risk different sexual behaviors may pose to the safety of the blood supply. These were: “Gay/bisexual men who have been abstinent for at least a year and are known to be HIV-negative should be allowed to donate blood,” “Sexually active gay/bisexual men who are in a monogamous relationship where both partners are known to be HIV-negative should be allowed to donate blood,” “Sexually active gay/bisexual men who are not in a monogamous relationship but use condoms 100% of the time should be allowed to donate blood,” and “Sexually active gay/bisexual men who are not in a monogamous relationship and do not use condoms 100% of the time should be allowed to donate blood.” Participants were asked to decide whether the person in each scenario should be allowed to donate blood, using a five-point Likert scale of “strongly agree,” “agree,” “unsure,” “disagree,” or “strongly disagree.” Subsequently, participants were asked to assess whether their own blood donation would be considered safe. On a five-point scale ranging from strongly agree to strongly disagree, participants evaluated the statement: “Based on your number of sexual partners, condom usage, and known/perceived HIV status, you believe it is safe for you to donate blood.” To determine the likelihood of future donation, participants were asked “If the FDA allowed gay/bisexual men to donate blood, would you donate?” Participants who answered “no” were asked about reasons for not donating. Options were “I am afraid of needles,” “I do not want to donate,” “I do not believe it is safe for me to donate blood,” and “Other (please specify).”

Statistical analysis Study measures Participants were asked their age, sex, and sexual orientation. Race and ethnicity were assessed using categories 1734

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All surveys were included in the final data set provided that the participant met the eligibility criteria and completed the entire questionnaire. However, participants

MSM BLOOD DONATION

TABLE 1. Demographics and respondents by survey site* Characteristics Age Race/ethnicity Caucasian African American Asian American Native American Two or more races Hispanic Sexual orientation Gay Bisexual Straight Other Have you donated? Yes No Number of donations Total

Chicago 36.5 ± 12.5 (19-77)

New Orleans 38.5 ± 11.2 (18-76)

Total 37.6 ± 11.9 (18-77)

113 (72.0) 9 (5.7) 7 (4.5) 3 (1.9) 3 (1.9) 22 (14.0)

137 (81.1) 10 (5.9) 1 (0.6) 1 (0.6) 3 (1.8) 17 (10.1)

250 (76.7) 19 (5.8) 8 (2.5) 4 (1.2) 6 (1.8) 39 (12.0)

152 (96.8) 4 (2.5) 1 (0.6) 0

160 (94.7) 7 (4.1) 1 (0.6) 1 (0.6)

312 (95.7) 11 (3.4) 2 (0.6) 1 (0.3)

61 (38.9) 96 (61.1) 4.2 ± 5.6 (1-30) 157 (48.2)

76 (45.0) 93 (55.0) 5.3 ± 6.3 (1-40) 169 (51.8)

137 (42.0) 189 (58.0) 4.84 ± 5.98 (1-40) 326

* Data are reported as mean ± SD (range) or as a count (%).

who did not answer whether they would donate blood if the FDA ban were ended and participants who admitted to donating blood but did not write an exact number of donations were included in the final data set provided all other questions were completed. Two Chicago and four New Orleans surveys were excluded because sections of the survey were left blank; two Chicago and one New Orleans survey were excluded because the participants had never had sex with another man. Data were entered into computer software (EpiInfo, http://wwwn.cdc.gov/ epiinfo/index.htm) and analyzed using a computer spreadsheet program (Excel, Microsoft Corp., Redmond, WA) for univariate analyses and statistical software (IBM SPSS Statistics, IBM Corp., Armonk, NY) for bivariate analyses. A Pearson’s chi-square test was used to compare the frequency of responses across categories for the perceived safety to donate blood scenarios and to compare the frequency of blood donations between the location, race, age, and sexual orientation of participants who have previously donated. The same comparison was also used for the responses to whether individuals believed that it was safe to donate their own blood, comparing men who have never donated and men who have previously donated blood. All generated p values were confirmed by the Wilcoxon rank-sum test. A p value less than 0.05 was deemed significant.

RESULTS Table 1 shows the demographics and prevalence of blood donation among respondents. A total of 326 individuals were enrolled: 157 in Chicago and 169 in New Orleans. A majority of participants identified as white/Caucasian and gay. The age of participants ranged from 18 to 77

years. Overall, 42.0% admitted to donating blood since 1983 after having oral and/or anal sex with at least one other man since 1977. On average, respondents had donated 4.84 times (SD, 5.98 times), with a range of 1 to 40 donations. Among men who had donated, approximately one-fourth donated once, one-third donated two to three times, and one-third donated between four and nine times (Table 2). No significant differences in the frequency of donation were detected based on location, age, race, or sexual orientation. Figure 1 displays the extent to which participants believed that it was safe for men in four hypothetical situations to donate blood. Most men “strongly agree” (80.4%) or “agree” (12.6%) that it is safe for abstinent men to donate blood, and a majority also “strongly agree” (81.0%) or “agree” (15.3%) that it is safe for men in monogamous relationships where both partners are HIV negative to donate blood. A slightly lower majority of men “strongly agree” (57.1%) or “agree” (22.1%) that it is safe for men who are not monogamous and use condoms 100% of the time to donate blood. Nearly onethird of men “strongly disagree” (16.9%) or “disagree” (16.3%) that it is safe for men who are not in monogamous relationships and do not use condoms 100% of the time to donate blood, approximately one-third (33.4%) were unsure whether it would be safe, and one-third “strongly agree” (23.9%) or “agree” (9.5%) that it would be safe. The frequency of responses for these four scenarios were compared, and the results showed that MSMs could differentiate to some extent the varying levels of risks that these situations presented to the safety of the blood supply. There was no difference (p = 0.29) in the responses comparing abstinent and monogamous men. However, the other five comparisons were all significant at a p value of less than 0.0001. Volume 54, July 2014

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TABLE 2. Demographics of participants who have previously donated blood* Characteristics Location Chicago New Orleans Age (years) 18-29 30-39 40-49 50-59 60-69 70-76 Race Caucasian African American Asian American Native American Two or more races Hispanic Sexual orientation Gay Bisexual Straight

1 time

2-3 times

4-9 times

10-19 times

20 or more times

Did not specify

Total

19 (31.1) 14 (18.4)

19 (31.1) 26 (34.2)

15 (24.6) 20 (26.3)

3 (4.9) 12 (15.8)

3 (4.9) 3 (3.9)

2 (3.3) 1 (1.3)

61 (44.5) 76 (55.5)

11 (28.9) 16 (32.0) 5 (16.7) 1 (7.1) 0 0

15 (39.5) 15 (30.0) 8 (26.7) 5 (35.7) 2 (50.0) 0

7 (18.4) 10 (20.0) 12 (40.0) 6 (42.9) 0 0

3 (7.9) 0 2 (6.7) 1 (7.1) 0 0

1 (2.6) 0 2 (6.7) 0 0 0

38 (27.7) 50 (36.5) 30 (21.9) 14 (10.2) 4 (2.9) 1 (0.7)

22 (21.0) 1 (14.2) 1 (33.3) 0 1 (33.3) 8 (47.1)

21 (20) 2 (28.6) 2 (66.7) 1 (50.0) 0 6 (35.3)

41 (39) 3 (42.9) 0 0 2 (66.7) 2 (11.8)

13 (12.4) 1 (14.2) 0 1 (50.0) 0 0

5 (4.8) 0 0 0 0 1 (5.9)

3 (2.9) 0 0 0 0 0

105 (76.6) 7 (5.1) 3 (2.2) 2 (1.5) 3 (2.2) 17 (12.4)

31 (24.2) 1 (14.3) 1 (50.0)

42 (32.8) 3 (42.9) 0

35 (27.3) 0 0

13 (10.2) 2 (28.6) 0

5 (3.9) 1 (14.3) 0

2 (1.6) 0 1 (50.0)

128 (93.4) 7 (5.1) 2 (1.5)

1 (2.6) 9 (18.0) 1 (3.3) 1 (7.1) 2 (50.0) 1 (100.0)

* Data reported as count (%).

90.0

Percent of all respondents

Abstinent

70.0

Monogamous 60.0

Condoms

50.0

No condoms

40.0 30.0 20.0

80 70 60 50 40 30 20 10 0

10.0 0.0

Strongly agree

Agree

Unsure

Disagree

Strongly disagree

Fig. 1. Frequency of responses from participants regarding whether they believe that it is safe for men in the four hypothetical scenarios to donate blood. Abstinent versus monogamous (p = 0.29), abstinent versus condoms (p < 0.0001), abstinent versus no condoms (p < 0.0001), monogamous versus condoms (p < 0.0001), monogamous versus no condoms (p < 0.0001), and condoms versus no condoms (p < 0.0001).

Upon reflecting on their own sexual practices, participants were asked whether they “strongly agree,” “agree,” “unsure,” “disagree,” or “strongly disagree” that it was safe to donate their blood. The frequency of responses was compared between men who have donated blood and men who have not (Fig. 2). Although 90.5 and 81.4% of men who have previously or never donated blood “strongly agree” or “agree” that it is safe for them to donate, only 2.2% of men who previously donated “disagree” or “strongly disagree” that it is safe to donate their 1736

Percent of all respondents

90

80.0

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Strongly agree

Agree

Unsure

Disagree

Strongly disagree

Fig. 2. Frequency of responses from men who have previously donated blood (■; n = 137) and those who have not ( ; n = 189) regarding whether they believe it is safe to donate their own blood (p = 0.0359).

blood compared to 11.1% of men who have never donated (p = 0.0359). When asked about willingness to donate blood were the lifetime deferral changed, 85.9% of participants would donate while 12.9% would not (Table 3). Of the 42 participants who would not donate, 19.0% indicated a lack of desire to donate, 26.2% indicated a fear of needles, and 28.6% did not think that it is safe for them to donate. The remaining 26.2% selected the free response option “other (please specify).” In Chicago, participants wrote “Hepatitis B positive,” “I have hepatitis,” “Never been able to successfully finish the process,” “I am HIV positive,” and “Carrier for beta-thalassemia,” and one participant did not write a response. In New Orleans, three participants wrote “I am

MSM BLOOD DONATION

TABLE 3. Willingness of participants to donate if the FDA deferral were changed* Would you donate if the ban were lifted? Yes Did not answer No I am afraid of needles I do not want to donate blood I do not believe it is safe for me to donate blood Other/did not specify

Chicago 131 (83.4) 1 (0.6) 25 (15.9) 7 (28.0) 5 (20.0) 7 (28.0) 6 (24.0)

New Orleans 149 (88.2) 3 (1.8) 17 (10.1) 4 (23.5) 3 (17.6) 5 (29.4) 5 (29.4)

Total 280 (85.9) 4 (1.2) 42 (12.9) 11 (26.2) 8 (19.0) 12 (28.6) 11 (26.2)

* Data are reported as number (%).

HIV positive,” one wrote “Uncertain of the effects on me,” and one participant did not write a response.

DISCUSSION Our survey among a convenience sample of MSMs found that 42% of respondents have donated blood at least once, demonstrating that current FDA policies are not being followed. As MSMs become more accepted within American society and gain more rights, some within the MSM community view blood donation as a denied right.15,16 With the advent of better testing and the decision by several industrialized nations to adopt a temporary deferral policy, it is difficult to argue against modifying the current lifetime deferral. Before adopting a temporary deferral, it is essential to determine the risk resulting from a policy change. Unfortunately, models used to predict the risk of having transfusion-transmissible viral infections, such as HIV and hepatitis B or C, from MSM blood donors after a 12-month or 5-year deferral period are imperfect. These models rely on limited, retrospective data on the rates of transfusion-transmissible viral infections in MSMs who donated blood, or they estimate the rate of HIV in potential MSM blood donors using the rate of HIV in a region or country.11,17-20 In the latter case, the models fail to account for the fact that not all MSMs engage in equally high-risk or low-risk behavior and that there may be self-selection by MSMs to either donate or not donate blood based on their perceived safety of their blood. In our study, participants who had not previously donated blood were less likely to consider their blood safe to donate than men who have. These data suggest that MSMs recognize that individual sexual practices can impact the safety of the blood supply and that the risk of HIV in MSM donors is unlikely to be identical to a regional or national average. However, it is concerning that nearly one-third of participants believed that it was safe for men who are sexually active and do not use condoms 100% of the time to donate blood. Although these responses may partly be due to insufficient attention during completion of the survey, it shows that many MSMs in our study, and perhaps in the broader community, are misinformed about the risks of

introducing infectious agents into the blood supply. These data illustrate the need to better educate the public about the limitations of diagnostic screening tests and the necessity of certain deferral policies. In our study, 42.0% of participants admitted to donating blood. Although this is nearly twice as much as the 23.4% of MSMs who admitted to donating blood in a survey performed in San Francisco,12 both studies demonstrate that MSMs are donating blood despite the lifetime deferral. Similarly, 85.9% of our participants, and 77.3% of the MSMs from the San Francisco study,12 would be willing to donate blood if the lifetime deferral were changed. Interestingly, a recent model in England and Wales found a minimal risk in switching from a lifetime to a 5-year deferral.21 Similarly, when Australian provinces switched from a lifetime or 5-year deferral to a 12-month deferral, there was no associated increased risk of transfusion-associated HIV.22 These studies suggest that adopting a temporary deferral policy and maintaining a safe blood supply may not be mutually exclusive. Our study has several limitations. Since it was performed at major festivals catering to the LGBT community, respondents may have been distracted, social desirability may have influenced participants’ responses, and our results may be biased due to the disproportionate inclusion of MSMs interested in blood donation. Yet, these are the individuals most likely to present to donate blood. Additionally, we sampled a small group of MSMs at only two locations in the country, and our findings are therefore not generalizable to other areas of the country. Participants were also not explicitly asked if they had previously completed the survey, so individuals may have completed the survey more than once at the same site or at both sites. Future studies with larger numbers will be needed to validate our findings. The results of this survey have practical and policy implications for blood donation in the United States. Our results add to published evidence that many MSMs would be willing to donate blood and many already do. As mathematical models and the experiences of other countries demonstrate that a deferral policy can be safely implemented, the United States should consider adopting a temporary deferral policy. However, irrespective of any Volume 54, July 2014

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changes in policy, the public needs to be better educated about the limitations of diagnostic HIV tests and why deferral policies are sometimes necessary. ACKNOWLEDGMENTS

11. Sanchez AM, Schreiber GB, Nass CC, et al. The impact of male-to-male sexual experience on risk profiles of blood donors. Transfusion 2005;45:404-13. 12. Belanger GA, McFarland W, Raymond HF, et al. If the permanent deferral were lifted would men who have sex with men want to donate blood, and if so, who would be eli-

We thank the Center on Halsted of Chicago and the NO/AIDS Task Force of New Orleans for their help in planning this project. We also thank Dr Leann Myers of the Tulane University School of Public Health and Tropical Medicine for her support with the statistical analysis.

gible? Transfusion 2013;53:2729-33. 13. Rhodes SD, McCoy TP, Hergenrather KC, et al. Prevalence estimates of health risk behaviors of immigrant Latino men who have sex with men. J Rural Health 2012;28:73-83. 14. Hightow-Weidman LB, Phillips G 2nd, Jones KC, et al. Racial and sexual identity-related maltreatment among

CONFLICT OF INTEREST

minority YMSM: prevalence, perceptions, and the associa-

The authors report no conflicts of interest or funding sources.

tion with emotional distress. AIDS Patient Care STDS 2011; 25:S39-45.

REFERENCES 1. Roback JD, Grossman BJ, Harris T, et al., editors. Technical manual. 17th ed. Bethesda (MD): American Association of Blood Banks; 2011. p. 242-50. 2. Iqbal HS, Solomon S, Murugavel KG, et al. Evaluation of two indigenous rapid and two ELISA assays for the diagnosis of HIV infection India. Indian J Med Microbiol 2012;30: 397-402. 3. Kucirka LM, Sarathy H, Govindan P, et al. Risk of window period HIV infection in high infectious risk donors: systematic review and meta-analysis. Am J Transplant 2011; 11:1176-87. 4. Perry KR, Ramskill S, Eglin RP, et al. Improvement in the performance of HIV screening kits. Transfus Med 2008;18: 228-40. 5. Yeom JS, Lee JB, Ryu SH, et al. Evaluation of a new thirdgeneration ELISA for the detection of HIV infection. Ann Clin Lab Sci 2006;36:73-8. 6. Assal A, Barlet V, Deschaseaux M, et al. Comparison of the

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analytical and operational performance of two viral nucleic acid test blood screening systems: Procleix Tigris and Cobas s 201. Transfusion 2009;49:289-300. Jackson BR, Busch MP, Stramer SL, et al. The costeffectiveness of NAT for HIV, HCV and HBV in whole-blood donations. Transfusion 2003;43:721-9. Zou S, Dorsey KA, Notari EP, et al. Prevalence, incidence, and residual risk of human immunodeficiency virus and hepatitis C virus infections among United States blood donors since the introduction of nucleic acid testing. Transfusion 2010;50:1495-504. Wainberg MA, Shuldiner T, Dahl K, et al. Reconsidering the lifetime deferral of blood donation by men who have sex with men. CMAJ 2010;182:1321-4. Goldman M, Yi QL, Ye X, et al. Donor understanding and attitudes about current and potential deferral criteria for high-risk sexual behavior. Transfusion 2011;51:1829-34.

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15. Franklin IM. Is there a right to donate blood? Patient rights; donor responsibilities. Transfus Med 2007;17:161-8. 16. Grenfell P, Nutland W, McManus S, et al. Views and experiences of men who have sex with men on the ban on blood donation: a cross sectional survey with qualitative interviews. BMJ 2011;343:d5604. 17. Germain M, Remis RS, Delage G. The risk and benefits of accepting men who have had sex with men as blood donors. Transfusion 2003;43:25-33. 18. Pillonel J, Heraud-Bousquet V, Pelletier B, et al. Deferral from donating blood of men who have sex with men: impact on the risk of HIV transmission by transfusion in France. Vox Sang 2012;102:13-21. 19. Anderson SA, Yang H, Gallagher LM, et al. Quantitative estimate of the risks and benefits of possible alternative blood donor deferral strategies for men who have had sex with men. Transfusion 2009;49:1102-14. 20. Soldan K, Sinka K. Evaluation of the de-selection of men who have had sex with men from blood donation in England. Vox Sang 2003;84:265-73. 21. Davison KL, Brant LJ, Presanis AM, et al. A re-evaluation of the risk of transfusion-transmitted HIV prevented by the exclusion of men who have sex with men from blood donation in England and Wales, 2005-2007. Vox Sang 2011; 101:291-302. 22. Seed CR, Kiely P, Law M, et al. No evidence of a significantly increased risk of transfusion-transmitted human immunodeficiency virus infection in Australia subsequent to implementing a 12-month deferral for men who have had sex with men. Transfusion 2010;50:2722-30.

SUPPORTING INFORMATION Additional Supporting Information may be found in the online version of this article at the publisher’s web-site: Appendix S1. The attitudes and beliefs of gay and bisexual men towards donating blood

The rates, perceptions, and willingness of men who have sex with men to donate blood.

Since 1983 in the United States, any man who has had sex with another man (MSM) at any time since 1977 has been deferred from donating blood for life...
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