Cahill Sean, Wang Timothy
Health Policy Research, The Fenway Institute, Boston, USA.
Curriculum and Policy, National Center for Innovation in HIV Care, Boston, USA.
Isr J Health Policy Res. 2017 Mar 23;6:15. doi: 10.1186/s13584-017-0139-2. eCollection 2017.
In recent years, countries around the world have revised their blood donation policies regarding gay and bisexual men, and other men who have sex with men (MSM). The United States lifted the lifetime ban on MSM from donating blood in 2015, replacing it with a 1 year deferral policy allowing MSM to donate if they abstain from sex for 12 months. Other countries followed suit, while Italy and Spain have implemented deferral policies based on individual risk assessments regardless of sexual orientation. If Israel were to adopt a one year deferral policy for MSM, as recommended by Drs. Ginsberg et al. in this issue, the increase in risk to the blood supply would be minimal. Moving to a 1 year deferral policy would be an important step forward, but it could still be seen as stigmatizing to gay and bisexual men. We recommend that Israel consider a deferral policy based on individual risk assessment rather than a blanket deferral for all MSM. MSM can engage in low- and high-risk sexual behaviors. Those who consistently engage in low-risk behaviors, such as using condoms and pre-exposure prophylaxis consistently, pose little risk to the blood supply. An individual risk assessment policy would screen potential donors of all sexual orientations for low-, medium-, and high-risk behaviors. Potential donors identified as high-risk, such as injection drug users, would justifiably be subject to lengthy or permanent bans. MSM who engage in low-risk sexual behaviors would be allowed to donate without deferral. Medium-risk donors, such as men who have recently had unprotected anal sex with another man, would be subject to a deferral period of 1 month, which is in line with the window period of current HIV screening technology. Most fourth generation HIV tests can detect HIV within a month, and the nucleic acid test used to screen blood can detect HIV in just 9-11 days. Various studies have developed questions for ascertaining HIV risk among MSM which could be used in blood donor questionnaires. Using tablets or other technology that enhances privacy to conduct the blood donor questionnaire could improve collection of this sensitive information.
近年来，世界各国纷纷修订了针对男同性恋者、双性恋男性以及其他与男性发生性行为者（MSM）的献血政策。美国于2015年取消了对MSM终身禁止献血的规定，取而代之的是一项为期1年的延期献血政策，即如果MSM禁欲12个月，就可以献血。其他国家也纷纷效仿，而意大利和西班牙则实施了基于个人风险评估的延期献血政策，无论其性取向如何。如果以色列按照本期金斯伯格博士等人的建议，对MSM采取为期1年的延期献血政策，那么血液供应风险的增加将微乎其微。转向为期1年的延期献血政策将是向前迈出的重要一步，但这仍可能被视为对男同性恋者和双性恋男性的污名化。我们建议以色列考虑基于个人风险评估的延期献血政策，而不是对所有MSM一概而论地延期献血。MSM可能会有低风险和高风险的性行为。那些始终坚持低风险行为的人，比如始终正确使用避孕套和进行暴露前预防，对血液供应造成的风险很小。个人风险评估政策将筛查所有性取向的潜在献血者的低、中、高风险行为。被认定为高风险的潜在献血者，如注射吸毒者，将理所当然地被长期或永久禁止献血。从事低风险性行为的MSM将被允许直接献血。中等风险的献血者，比如最近与另一名男性发生过无保护肛交的男性，将被延期1个月献血，这与当前艾滋病毒筛查技术的窗口期一致。大多数第四代艾滋病毒检测可以在1个月内检测出艾滋病毒，而用于筛查血液的核酸检测仅需9至11天就能检测出艾滋病毒。各种研究已经开发出用于确定MSM中艾滋病毒风险的问题，这些问题可用于献血者调查问卷。使用平板电脑或其他增强隐私性的技术来进行献血者问卷调查，可以改善这类敏感信息的收集。
