Plan to inform HIV infected blood donors

[Guest guest]

BMJ 2002;325:1380 (14 December )

News roundup

India announces plan to inform HIV infected blood donors

Ganapati Mudur New Delhi

India's health ministry last week announced that blood donors found

to be HIV positive would be told of their infection and asked to seek

confirmatory tests and counselling.

This will end the existing policy of anonymous testing in which blood

infected with HIV is discarded without repeating the test and without

informing the donor.

However, doctors working in blood transfusion services caution that

the order would be " hard to implement " given the current

decentralised, fragmented state of blood banking services in India.

Public health experts in the country have been concerned that HIV

positive donors have been living without knowledge of their infection

and possibly transmitting it to their sexual partners.

India's National AIDS Control Organisation has estimated that India

has nearly four million people infected with HIV, 90% of whom are

aged 15-45 years. Epidemiologists say that sexual transmission

accounts for nearly 80% of the spread of HIV in the country.

" Informing blood donors who're positive is an important component of

epidemic control and should have been done long ago, " said Dr Subash

Hira, director of the Maharashtra state government's AIDS Control and

Research Centre in Bombay. " In most countries, HIV positive donors

are routinely contacted for counselling, " he said.

Although India's blood banks have been screening blood for HIV since

the early 1990s, health officials say donors could not be informed

because of a lack of infrastructure for counselling.

" This can only be implemented with an efficient counselling

infrastructure established nationwide, " said Dr Usha Baveja, deputy

director at the National Institute of Communicable Diseases, New

Delhi.

A health ministry spokesperson said that 445 voluntary counselling

and testing centres have been set up across India. These centres

would be expected to contact donors who are found to be positive and

offer them confirmatory tests and counselling. The spokesperson

conceded that links between these centres and blood banks have yet to

be firmly established.

But doctors caution that blood transfusion services in India are too

decentralised and fragmented for such an order to be implemented.

India has more than 1500 blood banks spread across large hospitals

and small clinics, and the quality standards vary.

" With inadequate record keeping and with most blood collected from

one-time donors, how are blood banks or counselling centres expected

to contact them? " asked a senior blood bank officer in New

Delhi. " And do we do this just with HIV, and not for hepatitis B and

C, for which we also screen? " she asked.

Medical officers in transfusion centres are also concerned that a

substantial proportion of donors will not attend for confirmatory

tests. When a leading hospital in New Delhi had tried to recall

donors found positive for hepatitis B virus, barely 10% had

responded.

" The delay is also because counselling has been an alien concept in

India, " said Dr Hira. Public health specialists say that the country

lost nearly a decade when it tried to train people qualified in

social work as counsellors. The counsellors are now required to have

degrees in clinical psychology, Dr Hira said.

The health ministry has announced an action plan on blood transfusion

that also seeks to introduce an accreditation scheme for blood banks

to achieve required quality standards by March 2003.

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