South Africa Race Policy May Have Cut HIV

A new study suggests a controversial race-based blood donor selection policy that South Africa instituted from 1999 to 2005 cut by 50 percent the number of HIV-infected units of donated blood.

To insulate the blood supply from the nation's high HIV prevalence, the South African National Blood Service (SANBS) launched the more restrictive donor policy, which included "enhanced donor selection" and education, said study authors. In addition to assessing infection risk by taking a prospective donor's medical, sexual, and drug histories, SANBS officials considered donor race a marker for risk. Under the policy, many blacks were excluded from donating blood.

Moreover, SANBS closed donation sites located in high-risk regions. As a result, the donor pool was skewed, the study noted, "so that black individuals, who comprise 79 percent of the population, contributed only 4.2 percent of the blood supply in 2001-02, down from 10 percent in 1999."

Researchers found that among nearly 900,000 blood donations made in SANBS' Inland region during 1999-2000, when the race-based policy was initiated, 0.17 percent were HIV-positive. In comparison, of almost 800,000 donations made in 2001-2002, when the policy was in full effect, just 0.08 percent was HIV-infected.

"Hundreds more would have gotten infected from blood transfusions" without the restrictive policy, said lead author Dr. Michael Busch of the Blood Systems Research Institute in San Francisco. However, Busch said the findings are not an argument for the race-based policy, which South Africa dropped in February 2005. Rather, the study emphasizes "the dilemma of trying to maintain a safe blood supply in the challenging arena of epidemic infectious disease and social expectations," he said.

"We do not defend the past practice at all," said Dr. Anthon du P. Heyns, chief executive of SANBS, who collaborated on the study with colleagues. "We also will not resume the previous risk management policy where race was used." Individual blood samples are now tested. The authors predicted that newer testing methods will greatly reduce the risk of getting HIV-infected donations.

The full study, "Prevalence of HIV-1 in Blood Donations Following Implementation of a Structured Blood Safety Policy in South Africa," was published in the Journal of the American Medical Association (2006;295(5):519-526).

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