South African Blood Policy Using Race as Risk Factor for HIV Reduced Levels of Tainted Blood, Study Says

A South African policy that was in effect from 1999 to 2005 that used race as a donor-selection factor for donated blood significantly reduced levels of HIV-tainted blood in the national supply, according to a study published Feb. 1 in the Journal of the American Medical Association, the AP/Washington Post reports (Tanner, AP/Washington Post, 1/31). The South African National Blood Service previously implemented a policy in which donors who are white or Indian are deemed Category 1 -- or at lowest risk for HIV and other diseases -- while black donors are classified as either Category 3 or Category 4 because HIV and hepatitis are thought to be more widespread among blacks (Kaiser Daily HIV/AIDS Report, 12/7/04). Up to 10% of HIV cases globally are acquired from blood transfusions, according to the World Health Organization. For the study, Michael Busch of the Blood Systems Research Institute in San Francisco and colleagues examined almost 900,000 blood donations collected during the first year that the policy was phased in and compared them with about 800,000 donations collected between 2001 and 2002, when the policy was in effect (AP/Washington Post, 1/31). During the first year, HIV was detected in 0.17% of donated blood, compared to 0.08% of blood collected the second year, a 50% decrease, the study finds (HealthDayNews/Health24.com, 2/1). Under the policy, blood donor clinics in high-risk areas also were closed, and "black individuals, who comprise 79% of the population, contributed only 4.2% of the blood in 2001 to 2002, down from 10% in 1999," the study says. Although Busch said "[h]undreds or more would have gotten infected from blood transfusions" without the policy, he said that does not mean it should be reinstated, and the findings merely highlight "the dilemma of trying to maintain a safe blood supply in the challenging arena of epidemic infectious disease and social expectations." SANBS adopted a new policy in February 2005, eliminating race as a risk factor and testing individual blood samples (AP/Washington Post, 1/31). "In the long term, we believe that education of blood donors will be a key factor for ongoing blood safety. There is a need for a structured program that is culturally attuned and presented in the multiple languages in common use," the study says (HealthDayNews/Health24.com, 2/1).

Related Editorial
In an accompanying editorial, Linda-Gail Bekker and Robin Wood of the Desmond Tutu HIV Centre at the University of Cape Town, South Africa, write that race is an "imperfect surrogate" for "unmeasured risk behavior variables," including language, culture, health beliefs, and particularly in South Africa, socioeconomic status. They add that the controversy over the policy also emphasized the failure of the public health system to address "the societal roots of poor health ... which operate further downstream" (Bekker/Wood, JAMA, 2/1).