Attitude and practice of blood donation by men who have sex with men and the effects of restrictions flexibilization due to the Covid-19 pandemic on transfusion risk

Abstract

The Brazilian regulations in force until April 2020 regarding blood donation by men who have sex with men (MSM) were implemented in 2004 considering that MSM were classified as unfit for donation temporarily for a period of 12 months after the last sexual intercourse considered risky. Despite the scientific evidence that sexual practice among MSM is associated with an increased risk of infection by sexually transmitted agents and the total lack of studies to support the current discussions on the subject, a flexibilization of the current Brazilian rules was voted in the Superior Court Federal in May 2020. This was motivated by the strong pressure due to the drop in the number of donations because the COVID-19 pandemic and the evolution of studies involving new therapies to control the epidemic through blood plasma transfusion. Thus, the temporary restriction was revoked with the majority of the votes of the STF ministers, who considered it unconstitutional and discriminatory. No Brazilian study has been carried out investigating the MSM population with regard to attitudes and practices towards blood donation and estimating the effects of the total absence of MSM restrictions on transfusion safety. In addition, there is a complete lack of evidence about the epidemiological and demographic profile and health conditions of the MSM population in Brazil, which prevents technical discussion and decision-making based on scientific knowledge. Objectives: the objectives of this proposal are 1) to evaluate the attitude and practice of blood donation by MSM considering the regulation of Brazilian blood services, the risk behavior profile for sexually transmitted infections and the prevalence of test-seeking behavior in blood banks and their associated factors among MSM users who use Voluntary and Counseling Testing Centers (VCT) in the municipality of Ribeirão Preto - SP (study 1) and among members of the LGBT community who use social networks (study 2); and 2) to estimate the effects of flexibilization of restrictions for blood donation among MSM on transfusion risk using a mathematical model. Methods: three studies were planned. Study 1 will be a cross-sectional study to be conducted at a VCT in Ribeirão Preto, in which all VCT users will be interviewed, even those who are not MSM, in order to compare attitudes and practices regarding blood donation, the search for serological tests in blood banks, as well as the risk behavior profile for sexually transmitted infections. The data collection for study 1 will be carried out at the Central Reference Center in Specialties of Ribeirão Preto, responsible for more than 60% of the testing services in the municipality. Study 2 will be carried out with MSMs members of LGBT communities who use social networks (web survey). Both collections will be carried out through an electronic self-filling questionnaire, to be made available on a tablet (study 1) or through an online link (study 2), using the REDCap electronic data capture tool. Data from studies 1 and 2 will be analyzed using logistic regression models to study the association between dependent variables (a) blood donation practice; (b) test-seeking behavior in blood banks; (c) sexual risk behavior score and independent variables. Study 3 will be conducted to estimate the impact of flexibilization on the 12-month postponement policy for MSM on the risk of introducing contaminated units into the blood supply and the benefit of obtaining additional donations through a mathematical model. For this purpose, the prevalence of HIV among MSM, the period of immunological window, the rate of errors in laboratory tests and the occurrence of other system failures will be considered. (AU)