India announces plan to inform HIV infected blood donorsBMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7377.1380/d (Published 14 December 2002) Cite this as: BMJ 2002;325:1380
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.