Sex for the western male. Human male sexuality.



Sex for the western male

Sex for the western male

There is limited evidence in number and quality from two observational studies from and , that male blood donors who had sex with other men after have a statistically significant higher risk of HIV-1, compared to male blood donors who did not have sex with other men [ 12 , 19 ]. The study of Alpaugh et al. However this is an older test with poor specificity, which means that a high percentage of HBV negatives is incorrectly identified as HBV positives. Because results of this study are influenced by the test that was used to measure the outcome, we did not take the HBV data—in contrast to its HIV data—into account into our final conclusion [ 25 ].

In the study by Sanchez et al. A statistically significant increased risk of infections could not be demonstrated for male blood donors who had sex with other men before 2. In two studies, from and , no statistically significant differences between types of deferral policy were measured [ 20 , 22 ].

In the first study, no statistically significant change in the number of HIV-positive male donors when applying a five versus a one year deferral period could be demonstrated. In the same study, the number of HIV-positive donors with MSM as a risk factor was also measured, however the number of male donors who disclosed risk factors is not known, and thus no conclusions can be made of these data [ 20 ].

In the second study, no statistically significant difference in the number of HIV-positive MSM donors could be demonstrated when a permanent deferral was changed to an individual risk assessment of sexual behaviours [ 22 ]. The results of these studies cannot be considered precise as the number of HIV-infected donors was too low [ 20 , 22 ]. All studies were performed when a permanent deferral strategy for MSM was in place, and thus any cases would have occurred despite this deferral strategy.

There is limited evidence from one observational study, published in , about the correlation between MSM and the risk of HIV-1 infection in blood donors [ 13 ]. However, the results cannot be considered precise because of a low number of events low number of donors with MSM as a risk factor among the cases and controls [ 13 ].

For the risk of HBV infection, we found limited evidence from 2 observational studies from and , but a statistically significant correlation could not be demonstrated between MSM and HBV infection in blood donors. The reason for this is a low number of events and a large variability of the results, reflected in wide confidence intervals [ 14 , 16 ].

In one more recent study it was shown that MSM blood donors have a statistically significant increased risk of HCV, reporting a risk ratio of 8. However this risk ratio is a crude risk ratio, which represents a correlation between HCV data and MSM, not taking into account that the MSM donors could have other risk factors such as intravenous drug use or history of transfusions. Since the latter risk factors are confounding variables and no measures were taken to control for confounding in this study, this crude risk ratio, which we calculated ourselves based on the raw data provided in the study, was not used as part of the evidence base [ 11 ].

In order to determine the final level of evidence, first of all the risk of bias was assessed at the individual study level. In all studies, risk of bias was found because of limitations in study design or execution. For several studies there was no description of possible confounders nor of the method that was used to adequately control for confounding [ 11 , 12 , 14 , 15 , 20 , 22 , 24 ], or it was unclear if measures undertaken to adequately control for confounding were sufficient [ 17 , 18 , 21 , 23 ].

For 5 of the case-control studies inappropriate eligibility criteria were used for the selection of cases and controls [ 11 , 16 , 23 , 24 ]. In 5 studies questionnaires were used [ 14 , 15 , 18 , 19 , 23 ] and in 2 studies interviews were performed [ 21 , 24 ] to obtain information about risk factors, which is prone to recall bias. The studies by Seed et al. In addition in the study by Seed et al. It cannot be excluded that these donors may have different characteristics from men with a history of MSM since who did not donate because of the current policy, but would if it were changed [ 11 , 13 — 19 , 21 , 23 , 24 ].

In addition to the risk of bias, the level of evidence was further downgraded because of imprecision low number of events, large confidence intervals and lack of data.

There was no reason to downgrade for inconsistency or indirectness. An overview of how we obtained the level of evidence for all outcomes is shown in Table 2. We identified 14 studies: Two studies however provided statistically significant data that were not taken into account to formulate our conclusions: In addition, we found 3 studies looking at the risk of HBV infection and 7 studies looking at the risk of HCV infection, but none of these studies could demonstrate an increased risk of infection.

The latter however is based on very low level evidence from only 1 study and should therefore be interpreted with caution. This study showed that 8. In the majority of the studies there was no information available about the period between the last MSM contact and the blood donation. The main limitations of our analysis are: Furthermore, the majority of the studies are older studies, including one study from and 7 studies from the early s, which could result in bias since test specificity and sensitivity has improved significantly since then.

This in itself could compromise the quality of further studies. A recent study from Australia confirmed high compliance to a month deferral for MSM, however compliance was calculated against the total population of male donors and not against the population of MSM donors, and no comparison between different deferral strategies was made [ 26 ]. High quality studies about the impact of different deferral strategies on non-compliance are currently lacking.

Because the epidemiology of STDs which are also transfusion transmissible , sexual risk behaviour and STD prevention is different in developing countries, the results of this systematic review cannot be generalized.

Taking into account the limited evidence available, further higher quality research is necessary. There is a clear lack of studies directly comparing MSM and non-MSM donors, and studies comparing different deferral strategies. When comparing risk factors of infected and non-infected donors, it is important to describe the studied risk factors in detail and to mention the donor selection policy used.

The classic triad of evidence-based work consists of the best available evidence, complemented by expert opinion and by preference of the target population [ 28 ]. In the absence of strong evidence it is not surprising that expert opinion and preference in this case both of patients and donors play a greater role in determining policy than they would if the quality of the evidence were stronger.

Donor preference MSM group is clear: Some do not contest exclusion on the basis of MSM, but rather the lifelong character of the exclusion, noting that it is applied to no other group on the basis of risk behaviour, except for, for example, intravenous drug users or commercial sex workers [ 29 ]. The preference of the patient population is also clear: Expert opinion mostly favours exclusion of MSM as the experts also take into account 1 evidence that is excluded in this systematic review because of its study type e.

The scarcity of high-quality evidence within the field of transfusion medicine together with these choices may explain existing policy differences between countries [ 27 , 34 ].

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Sex for the western male

There is limited evidence in number and quality from two observational studies from and , that male blood donors who had sex with other men after have a statistically significant higher risk of HIV-1, compared to male blood donors who did not have sex with other men [ 12 , 19 ].

The study of Alpaugh et al. However this is an older test with poor specificity, which means that a high percentage of HBV negatives is incorrectly identified as HBV positives. Because results of this study are influenced by the test that was used to measure the outcome, we did not take the HBV data—in contrast to its HIV data—into account into our final conclusion [ 25 ].

In the study by Sanchez et al. A statistically significant increased risk of infections could not be demonstrated for male blood donors who had sex with other men before 2. In two studies, from and , no statistically significant differences between types of deferral policy were measured [ 20 , 22 ].

In the first study, no statistically significant change in the number of HIV-positive male donors when applying a five versus a one year deferral period could be demonstrated. In the same study, the number of HIV-positive donors with MSM as a risk factor was also measured, however the number of male donors who disclosed risk factors is not known, and thus no conclusions can be made of these data [ 20 ].

In the second study, no statistically significant difference in the number of HIV-positive MSM donors could be demonstrated when a permanent deferral was changed to an individual risk assessment of sexual behaviours [ 22 ]. The results of these studies cannot be considered precise as the number of HIV-infected donors was too low [ 20 , 22 ]. All studies were performed when a permanent deferral strategy for MSM was in place, and thus any cases would have occurred despite this deferral strategy.

There is limited evidence from one observational study, published in , about the correlation between MSM and the risk of HIV-1 infection in blood donors [ 13 ]. However, the results cannot be considered precise because of a low number of events low number of donors with MSM as a risk factor among the cases and controls [ 13 ].

For the risk of HBV infection, we found limited evidence from 2 observational studies from and , but a statistically significant correlation could not be demonstrated between MSM and HBV infection in blood donors. The reason for this is a low number of events and a large variability of the results, reflected in wide confidence intervals [ 14 , 16 ].

In one more recent study it was shown that MSM blood donors have a statistically significant increased risk of HCV, reporting a risk ratio of 8. However this risk ratio is a crude risk ratio, which represents a correlation between HCV data and MSM, not taking into account that the MSM donors could have other risk factors such as intravenous drug use or history of transfusions.

Since the latter risk factors are confounding variables and no measures were taken to control for confounding in this study, this crude risk ratio, which we calculated ourselves based on the raw data provided in the study, was not used as part of the evidence base [ 11 ].

In order to determine the final level of evidence, first of all the risk of bias was assessed at the individual study level. In all studies, risk of bias was found because of limitations in study design or execution. For several studies there was no description of possible confounders nor of the method that was used to adequately control for confounding [ 11 , 12 , 14 , 15 , 20 , 22 , 24 ], or it was unclear if measures undertaken to adequately control for confounding were sufficient [ 17 , 18 , 21 , 23 ].

For 5 of the case-control studies inappropriate eligibility criteria were used for the selection of cases and controls [ 11 , 16 , 23 , 24 ]. In 5 studies questionnaires were used [ 14 , 15 , 18 , 19 , 23 ] and in 2 studies interviews were performed [ 21 , 24 ] to obtain information about risk factors, which is prone to recall bias.

The studies by Seed et al. In addition in the study by Seed et al. It cannot be excluded that these donors may have different characteristics from men with a history of MSM since who did not donate because of the current policy, but would if it were changed [ 11 , 13 — 19 , 21 , 23 , 24 ]. In addition to the risk of bias, the level of evidence was further downgraded because of imprecision low number of events, large confidence intervals and lack of data.

There was no reason to downgrade for inconsistency or indirectness. An overview of how we obtained the level of evidence for all outcomes is shown in Table 2. We identified 14 studies: Two studies however provided statistically significant data that were not taken into account to formulate our conclusions: In addition, we found 3 studies looking at the risk of HBV infection and 7 studies looking at the risk of HCV infection, but none of these studies could demonstrate an increased risk of infection.

The latter however is based on very low level evidence from only 1 study and should therefore be interpreted with caution. This study showed that 8. In the majority of the studies there was no information available about the period between the last MSM contact and the blood donation.

The main limitations of our analysis are: Furthermore, the majority of the studies are older studies, including one study from and 7 studies from the early s, which could result in bias since test specificity and sensitivity has improved significantly since then.

This in itself could compromise the quality of further studies. A recent study from Australia confirmed high compliance to a month deferral for MSM, however compliance was calculated against the total population of male donors and not against the population of MSM donors, and no comparison between different deferral strategies was made [ 26 ].

High quality studies about the impact of different deferral strategies on non-compliance are currently lacking. Because the epidemiology of STDs which are also transfusion transmissible , sexual risk behaviour and STD prevention is different in developing countries, the results of this systematic review cannot be generalized.

Taking into account the limited evidence available, further higher quality research is necessary. There is a clear lack of studies directly comparing MSM and non-MSM donors, and studies comparing different deferral strategies.

When comparing risk factors of infected and non-infected donors, it is important to describe the studied risk factors in detail and to mention the donor selection policy used. The classic triad of evidence-based work consists of the best available evidence, complemented by expert opinion and by preference of the target population [ 28 ].

In the absence of strong evidence it is not surprising that expert opinion and preference in this case both of patients and donors play a greater role in determining policy than they would if the quality of the evidence were stronger. Donor preference MSM group is clear: Some do not contest exclusion on the basis of MSM, but rather the lifelong character of the exclusion, noting that it is applied to no other group on the basis of risk behaviour, except for, for example, intravenous drug users or commercial sex workers [ 29 ].

The preference of the patient population is also clear: Expert opinion mostly favours exclusion of MSM as the experts also take into account 1 evidence that is excluded in this systematic review because of its study type e.

The scarcity of high-quality evidence within the field of transfusion medicine together with these choices may explain existing policy differences between countries [ 27 , 34 ].

Sex for the western male

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