Evidence is needed to understand whether any eligibility or policy changes can be put into operation by the blood operators (operational feasibility) and how specific policy changes would be perceived by men who have sex with men (MSM) and other stakeholders. This project gathered evidence to inform the possible introduction by Héma Québec of a source plasma donation program aimed specifically at MSM. This would likely involve apheresis collection of source plasma, which would be held for a quarantine period and sent for fractionation into plasma protein products upon re-testing of donors. This approach safeguards against transfusion-transmitted infections. The study focused on the acceptability and feasibility of this type of program for MSM in the Montréal gay community using an online survey and focus groups held in community settings.
What was done?
Focus groups were conducted with MSM in 2018 in order to understand beliefs underlying their intention to participate in a program of plasma donation for fractionation. These focus groups assessed attitudes, subjective norms (e.g. perceived approval or disapproval of others; personal standards regarding a behaviour) and perceived behavioural control (e.g. facilitating or limiting factors; perceived ability to adopt a behaviour despite the barriers). Based on the beliefs that surfaced in the focus groups, an online survey in French and English was developed to understand MSM’s intention to take part in the program, what impacts this decision, and their preferences (e.g. for location and conditions of participating in the program). In light of the results of the focus groups, some original objectives were deemed irrelevant or were integrated into phase 2 of the project.
What was found?
Focus groups with MSM (N=47, across 7 focus groups) revealed mixed opinions: many considered the program to be a step forward and an opportunity for MSM to contribute to blood donations. However, many also viewed it as a form of exclusion that avoids the issue of access to whole blood donation for MSM and fails to meet MSM’s needs. Participants showed some interest in plasma donation but wanted to be treated like any other donor and not feel discriminated against. Participants agreed upon the importance of volunteers and nurses receiving proper training to better understand the perspectives of the donors (Caruso et al., 2019).
In total, 933 participants were recruited to take the online survey, with 589 (63 per cent) completing it. When asked about their intention to give plasma in the next 6 months as part of the plasma donation program for MSM, 34 per cent had a strong intention to participate. A multiple linear regression analysis explained 55 per cent (p<0.001) of the variation of intention. Intention was predicted by attitudes, perceived behavioural control, aged under 35 years, history of blood donation, subjective norm, income above $40,000, moral norm and, to a lesser degree, higher level of involvement in various issues the LGBTQ+ community is fighting for (Veillette-Bourbeau et al., 2021). The most important barriers to taking part in a plasma program were related to accessibility, acceptability and openness of staff and the distinct characteristics of the plasma donation program (i.e. the quarantine period, having to come back after 3 months, differential treatment from general population). Factors that would facilitate participation included accessibility, receiving on-site services and circumstances of participation. Participants preferred to donate at a site for the general population, or a site for MSM, but open to the general population. A site in a gay friendly health clinic could also be conceivable.
Opportunities for change
The findings suggest some interest in a plasma for fractionation donation program, but this interest is tempered by the social context of the program (i.e. perceived injustice and discrimination against the MSM community) rather than by barriers pertaining to the program itself. Two scenarios for a possible site for the implementation of the program have been identified: 1) a new donation site open to everyone, or 2) an existing health clinic attended by MSM. Regardless of the chosen site, two conditions seem to be crucial: 1) everybody must be able to donate, whether they are MSM or not, and 2) all donations must be quarantined, regardless of the sexual orientation of the donor. Our results highlight the importance of involving MSM in the process to change practices and review eligibility criteria; community acceptability of the plasma donation program would probably be higher if MSM felt respected and party to the decisions.
Before setting up an entirely new plasma donation centre in Montreal where MSM can participate, it is important to assess the acceptability of this type of program with all of the people who are involved in the process in order to accurately predict such a project’s viability.
Research publications and resources
Caruso et al, 2019: ‘One step closer’: Acceptability of a programme of plasma donation for fractionation from men who have sex with men. Vox Sang. 114(7); 675-86. DOI: 10.1111/vox.12827.
Article available free online
Veillette-Bourbeau et al, 2021: Determinants of the intention to participate in a programme of plasma donation for fractionation among men who have sex with men. Vox Sang 2021. DOI: 10.1111/vox.13110.
Article available free online