Let Jharkhand HIV cases be a turning point for blood banking reform in India: PHO

Mumbai: Rattled by the HIV transmission to six thalassaemic children in Jharkhand through blood donation, the Mumbai-headquartered People’s Health Organisation-India (PHO) has called for wide ranging blood banking reforms.

Only screened blood should be used under all circumstances, said PHO.

The PHO had filed public interest litigation (PIL) in the Bombay High Court in 1989, for blood safety and against its commercialisation, at a time when the term PIL was non-existent in legal parlance.

On the directions of the Bombay HC, the states of Maharashtra and Goa had started HIV screening in blood banks in 1989. It required a long-drawn battle in making it a national policy. In 1998, the Supreme Court of India had mandated Blood Safety that resulted in the operation 'clean-up' of the Blood Banks by National AIDS Control Organisation (NACO) by providing staff, kits and equipment.

“Though blood safety has contributed significantly in HIV prevention, whereby, HIV transmission through blood among total HIV cases in India is down to less than 1% now, from 10% before 1998, but the commercialisation in the blood banks remained cause for concern,” said Dr Ishwar Gilada, the Secretary General of PHO and one of India’s foremost HIV/AIDS expert.

Dr Gilada is the President Emeritus, AIDS Society of India and Governing Council Member, International AIDS Society.

“The blood sellers charge Rs.500 to 1500. Patients feel harassed and get financially exploited, in addition to exposing themselves or others to nearly 22 transfusion-transmitted infections; most aren’t screened before transfusion, so establishing when they were infected becomes difficult if not impossible in case of frequent transfusions,” he said.

In pre-transfusion mandatory tests only five infections are screened routinely – HIV, Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis and Malaria. “The donors aren’t even informed of their HIV, HBV or HCV status whether positive or negative and therefore they keep donating in future. In fact the HBV negative people should receive Hepatitis B vaccines; which are inexpensive and can prevent them from HBV, around 100 times more transmissible than HIV, for the entire life. Thousands of people, including several VVIPs have succumbed to HBV or gone through liver transplants as

a consequence of HBV infection like Liver Cirrhosis and Hepato-Cellular Carcinoma (HCC). They can be saved if vaccinated against HBV,” said Dr Gilada.

According to him, India’s first HIV positive blood donor was detected in July 1987. “Professional blood donors (blood sellers) meet an estimated 30% of supply and remaining 70% voluntary and replacement donors. Blood sellers are vulnerable to several sexually transmitted infections (STIs) as they frequent sex workers and abuse alcohol as well as recreational drugs, so pose a threat to the blood safety. They also tend to donate frequently at different blood banks and under different names. The blood sellers are also potential organ (kidney, eye, skin) sellers,” he said, pointing out that a make kidney trade between India, Middle East and Europe, with fullest involvement of medical establishments, was also exposed by PHO.

“Saving people from HIV infection through blood and saving children getting HIV through pregnancy requires a very strong policy and system in place. You don’t need to work on behavioural change, as you need to prevent sexual transmissions - that requires behavioural change and medicines. Such ‘bloody’ instances in parts of India have been a blot on the blood-banking services that are considered ‘life-saver’. The solace - HIV is now a manageable disorder. On antiretroviral therapy(ART) the person becomes undetectable, thus untransmittable (means U=U) to others within 3 months, without shortening in life-span,” he said.