Impact of injection drug use and sexual activity

Since it was recognized in late 1982 that blood transfusions could transmit HIV, there has been increased international attention on the link between sexual activity, injecting illicit drugs, and blood safety. Epidemics related to high-risk sexual activity, such as sex work and trading sex for drugs, are discussed in Chapter 2, and epidemics related to intravenous drug use are discussed in Chapter 3. Both types of behavior are known to impact the safety of the blood supply, especially when donors are paid. Blood is an ideal medium for harboring, growing, and transmitting the agents that are spread by these behaviors, such as HIV, the hepatitis B and C viruses, HTLV CMV and others. To combat this problem, the Federation of Red Cross and Red Crescent Societies has called for expanded drug abuse prevention, harm reduction, and public education. They believe that "National Societies, with their unique combination of volunteer support and community membership alongside their status as auxiliaries to the public authorities in the humanitarian field, have a special contribution to make to the best approach to the challenges at the national and community level" (Kopketzky, 2005). For more than two decades international attention has been on the AIDS epidemic, where HIV, like the hepatitis B virus, is known to spread by sexual contact and IVDU. Of note is that five countries in the former Soviet Union and Asia that have combined populations of almost 2 billion are seeing HIV epidemics of more than 50,000 registered cases per country (Wolfe and Malinowska-Sempruch, 2007). These epidemics are associated with high-risk human sexual activity and injection drug use, and these nations also have limited safety controls on blood banking. Even with improved laboratory screening, the front-line defense in these states, as in developed nations, is effective public health screening. The US guidelines that relate most directly to uncovering high-risk sexual activity and IVDU also exclude any individual with AIDS or a positive HIV test. In addition, they exclude individuals that have:

• a history of injecting illicit drugs, including steroids and other medications not prescribed by a physician

• any man who since 1977 has had sex with another man, even once

• anyone who since 1977 who has ever taken money, drugs, or other payment for sex

• anyone who since 1977 was born in, lived in, or received a transfusion or medical treatment in Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, or Nigeria, or had sexual contact in the past 12 months with anyone described above.

Type O is a rare form of HIV found primarily in West Africa. As of this writing, there is no laboratory test approved in the United States to detect Type O in donated blood. In 1996, the United States Food and Drug Administration promulgated rules that prohibit blood donation by individuals born in these West African States after 1977, and persons that have had sexual contact with someone born in one of these nations since 1977.

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