South African
race-based blood policy may have cut HIV transmissions

A controversial policy in AIDS-ravaged South Africa that barred many blacks and even the country's president from donating blood led to a substantial drop in HIV-tainted blood supplies, a study found. "Hundreds or more would have gotten infected from blood transfusions" without the race-based policy, said senior author Michael Busch of the Blood Systems Research Institute in San Francisco.

Even so, Busch said that's not an argument in favor of it. Rather, it underscores "the dilemma of trying to maintain a safe blood supply in the challenging arena of epidemic infectious disease and social expectations," he said.

The policy barring many blacks from donating blood was in effect from 1999 to 2005. The research looked at nearly 900,000 blood donations collected from the policy's first year as it was phased in and compared that with almost 800,000 donations collected during 2001-2002, when the policy was in full swing.

HIV was detected in 0.17% of donations in the earlier period, but that dropped by half, to 0.08%, in the second year, the researchers reported.

Anthon du P. Heyns, the top executive of the South African National Blood Service, and colleagues collaborated on the study, published in Wednesday's Journal of the American Medical Association. The study looked at donations in the Blood Service's inland region.

The World Health Organization estimates that up to 10% of HIV infections globally are acquired from blood transfusions. The risks are highest in countries such as South Africa, where it's believed 5.3 million to over 6 million people are infected, the highest number worldwide.

Evidence suggests that 24 HIV-infected units of blood entered that nation's blood supply in 1999, the JAMA article said. Concern over tainted blood and the country's AIDS epidemic prompted the policy, which included "enhanced donor selection" and education, the authors said.

Under the old and new policies, prospective donors are asked to answer a questionnaire about their medical history, sexual practices, and drug use.

Using potential donors' race as a marker of risk was the policy's most controversial component, and it prompted an outcry after President Thabo Mbeki's donated blood was discarded in 2004, due in part to his race.

More recently, the blood bank's policy of excluding donations from sexually active gay men also has come under fire in a country where AIDS is an overwhelmingly heterosexual disease. Officials say that too is now under review.

The old policy involved closing blood donation sites in high-risk regions, a practice that severely skewed the donor pool "so that black individuals, who comprise 79% of the population, contributed only 4.2% of the blood supply in 2001-02, down from 10% in 1999," the authors said.

The South African health ministry in December 2004 declared that race was not an acceptable risk indicator, and officials decided last February to adopt a new policy. Now individual blood samples are tested.

"We do not defend the past practice at all," Heyns said. "We also will not resume the previous risk management policy where race was used."

The researchers predict that the newest testing methods will greatly reduce the risk of getting HIV-tainted donations. (AP)