HIV infections

HIV transmission: Why is blood transfusion in India not yet safe?

Voluntary blood donation, careful screening of patients, use of better technology, and rational use of blood needs to be promoted.

Nowhere in the world is transfused blood considered 100% safe. This, despite the fact that each unit of blood is mandatorily tested for infection, among other things, before transfusion.

This happens because several infections, such as Hepatitis A, B, C and Human Immunodeficiency Virus, have a window period during which the virus doesn’t show up in a blood test.

So, if a person contracts the HIV today and decides to donate blood the next day, the laboratory that tests the blood will not detect the virus in it. The window period for HIV is usually between three weeks and three months, depending on the technology used at the laboratory.

Even the best-available technology in the market right now – the Nucleic Acid Amplification Test – only reduces the window period to seven days. It does not entirely eliminate the risk.

But India fares poorly

Despite this limitation, many countries have not reported a case of HIV transmission through blood transfusion for years now. Canada has had no transfusion-transmitted HIV cases since 1985. In the US, the last known case of HIV transmission was in 2008 and the risk of disease spreading through transfusion is one in two million donations. In the UK, the last known case of a viral infection, including HIV, transmitted through blood transfusion was in 2005.

In India, on the other hand, at least 2,234 people are reported to have been infected with HIV while getting blood transfusions in the last 17 months. The National Aids Control Organisation had on Wednesday revealed this in response to a Right to Information plea filed by activist Chetan Kothari.

The organisation, however, has maintained that it has not been scientifically corroborated that the infection was indeed transmitted through transfusion. “The data shows the number of self-reported cases of HIV through blood transfusion during post-test counselling of positive clients,” said Dr Shobini Rajan, Assistant Director-General, National Aids Control Organisation. “This is a socially acceptable way of contracting the disease, as opposed to, say, sexual transmission. These are not proven cases of the virus being transmitted through blood transfusion.”

In India, approximately 0.2% of the donated blood units are detected with HIV. These are then removed from the supply. So, any infected blood that remains was ostensibly within the window period at the time of testing and could go on and infect healthy people.

The National Consumer Disputes Redressal Commission recently ordered a hospital in the outskirts of Mumbai to pay Rs 12,000 to a patient who had contracted HIV 20 years ago after blood transfusion. The court held that the blood was transfused without the woman’s “informed consent”, enlisting the risks of blood transfusion.

Blame it on the technology?

At present, most blood banks in the country use the enzyme-linked immunosorbent assay or ELISA to test for HIV and Hepatitis B and C, among other infections. This is the technology mandated by the Central Drug Standards Control Organisation.

How up-to-date the kits are impacts the window period of the infection. “The new kits that are third- or fourth-generation ELISA kits reduce the window period to about three weeks. But not everyone has this technology,” said Vinay Shetty from Think Foundation, which promotes and organises blood donation camps all over Maharashtra. The organisation works with Thalassaemia patients who need to undergo blood transfusions at least once a month.

The Nucleic Acid Amplification Test, in comparison, reduces the window period to about seven days, but it also increases the cost of the blood unit to Rs 2000 to Rs 2500 per unit, Shetty said.

The current policy of the National Aids Control Organisation caps the price at Rs 1,050 per unit of whole blood in a government institution and Rs 1,450 in a private institution.

“Can patients really afford this technology?” asked Shetty. “We need to do a cost-effect analysis and see if it works out for our patients. Blood is not free in our country.” Government hospitals only provide blood free of cost to Thalassaemia, Haemophilia and sickle-cell disease patients who require repeated transfusions.

Still, states such as Karnataka have implemented the Nucleic Acid Amplification Test technology for all their government hospitals. Some others, including Maharashtra, want to follow suit.

Voluntary blood donation

The World Health Organisation defines a voluntary blood donor as someone who donates blood or any of its components on free will and receives no payment, either in cash or in kind. It is widely accepted the world over that the safest blood donors are voluntary, non-remunerated ones from low-risk populations.

The Supreme Court of India, in 1998, banned the system of using professional donors who were remunerated for donating blood.

Till September 2014, 30 lakh units of blood had been collected through National Aids Control Organisation-supported blood banks. The organisation's website states that voluntary blood donation increased from about 54.4% in 2006 to 84% in 2013-14.

This figure, activists believe, is misleading.

Hospitals, even private ones, regularly ask patients in need of blood transfusions to get donors so that they can replenish the stock of blood units. This system, called replacement donation, is not voluntary. This is against the National Blood Policy of the country.

“Every day I get requests of patients’ relatives not for blood, but for donors. I tell them I can arrange for blood from a bank, but they insist on donors. These are patients in big private hospitals,” said Shetty.

The National Aids Control Organisation, in recent years, has started counting family donations as voluntary.

“This goes against the WHO definition completely,” said Rajat Agarwal, from Sankalp India Foundation, which works in the field of voluntary blood donation and with thalassaemia patients in Karnataka and Maharashtra. “No wonder the figures of blood units from voluntary donations have shown a rise.”

There are no penal provisions for blood banks not following the rule of voluntary non-remunerative donations, as yet.

“Unless it is a gross violation, we do not have any punitive provisions yet for banks that do replacement donations,” said Dr Rajan.

No thorough screening process

Often, patients are not screened well before they donate blood. They do not even fill their forms, which ask questions related to recent illness and unsafe sexual activity, among other things, said Shetty.

“In Canada, for instance, patients have to fill their forms themselves and go through lengthy counselling, where they are asked about sexual partners and other parameters, to rule out any infection in the blood. Till recently, homosexual men were not allowed to donate blood,” said Shetty.

In India, there is no counselling for the patient before the test.

Rational use of blood

One of the best ways to reduce the infection is to rationalise blood transfusions, to ensure that it is only done when necessary.

“There are a number of instances when transfusions may not be warranted,” said Dr Rajan. “One needs to follow our guidelines before blood transfusion.”

In dengue cases, particularly, it has been observed that blood plasma is transfused to patients who do not need it.

In the US, the requirement of blood is going down every year. “This is not because they are getting healthier,” said Agarwal. “It is because people are not using blood irrationally. These guidelines are not being implemented. It is well known that using blood increases the number of days a patient is hospitalised and the potential complications.”

A thorough investigation

As the National Aids Control Organisation has said, it has not been proven that the HIV virus was in fact transmitted by blood transfusion in all the more than 2,000 cases.

Therefore, even as there is room for improvement in the blood transfusion policy and its implementation, we also need to ascertain the cause of infection in patients claiming to have contracted HIV via transfusion.

For this, each case should be scientifically investigated. “These cases should be mapped right back to the individual,” said Agarwal. “How can we decide a change in the policy unless we know what the problem is?”

Based on the findings of such an investigation, Agarwal said, the government and other stakeholders should work on a revised policy.

We welcome your comments at letters@scroll.in.
Sponsored Content  BY 

How technology is changing the way Indians work

An extensive survey reveals the forces that are shaping our new workforce 

Shreya Srivastav, 28, a sales professional, logs in from a cafe. After catching up on email, she connects with her colleagues to discuss, exchange notes and crunch numbers coming in from across India and the world. Shreya who works out of the café most of the time, is employed with an MNC and is a ‘remote worker’. At her company headquarters, there are many who defy the stereotype of a big company workforce - the marketing professional who by necessity is a ‘meeting-hopper’ on the office campus or those who have no fixed desks and are often found hobnobbing with their colleagues in the corridors for work. There are also the typical deskbound knowledge workers.

These represent a new breed of professionals in India. Gone are the days when an employee was bound to a desk and the timings of the workplace – the new set of professionals thrive on flexibility which leads to better creativity and productivity as well as work-life balance. There is one common thread to all of them – technology, tailored to their work styles, which delivers on speed and ease of interactions. Several influential industry studies and economists have predicted that digital technologies have been as impactful as the Industrial Revolution in shaping the way people work. India is at the forefront of this change because of the lack of legacy barriers, a fast-growing economy and young workers. Five factors are enabling the birth of this new workforce:

Smart is the way forward

According to the Future Workforce Study conducted by Dell, three in five working Indians surveyed said that they were likely to quit their job if their work technology did not meet their standards. Everyone knows the frustration caused by slow or broken technology – in fact 41% of the working Indians surveyed identified this as the biggest waste of time at work. A ‘Smart workplace’ translates into fast, efficient and anytime-anywhere access to data, applications and other resources. Technology adoption is thus a major factor in an employee’s choice of place of work.

Openness to new technologies

While young professionals want their companies to get the basics right, they are also open to new technologies like Augmented Reality, Virtual Reality and Artificial Intelligence. The Dell study clearly reflects this trend — 93% of Indians surveyed are willing to use Augmented/Virtual Reality at work and 90% say Artificial Intelligence would make their jobs easier. The use of these technologies is no longer just a novelty project at firms. For example, ThysenKrupp, the elevator manufacturer uses VR to help its maintenance technician visualize an elevator repair job before he reaches the site. In India, startups such as vPhrase and Fluid AI are evolving AI solutions in the field of data processing and predictive analysis.

Desire for flexibility 

A majority of Indians surveyed rate freedom to bring their own devices (laptops, tablets, smartphones etc.) to work very highly. This should not be surprising, personal devices are usually highly customized to an individual’s requirements and help increase their productivity. For example, some may prefer a high-performance system while others may prioritize portability over anything else. Half the working Indians surveyed also feel that the flexibility of work location enhances productivity and enables better work-life balance. Work-life balance is fast emerging as one of the top drivers of workplace happiness for employees and initiatives aimed at it are finding their way to the priority list of business leaders.

Maintaining close collaboration 

While flexible working is here to stay, there is great value in collaborating in person in the office. When people work face to face, they can pick up verbal and body language cues, respond to each other better and build connections. Thus, companies are trying to implement technology that boosts seamless collaboration, even when teams are working remotely. Work place collaboration tools like Slack and Trello help employees keep in touch and manage projects from different locations. The usage of Skype has also become common. Companies like Dell are also working on hi-tech tools such as devices which boost connectivity in the most remote locations and responsive videos screens which make people across geographies feel like they are interacting face to face.

Rise of Data Security 

All these trends involve a massive amount of data being stored and exchanged online. With this comes the inevitable anxiety around data security. Apart from more data being online, security threats have also evolved to become sophisticated cyber-attacks which traditional security systems cannot handle. The Dell study shows that about 74% of those surveyed ranked data security measures as their number one priority. This level of concern about data security has made the new Indian workforce very willing to consider new solutions such as biometric authentication and advanced encryption in work systems.

Technology is at the core of change, whether in the context of an enterprise as a whole, the workforce or the individual employee. Dell, in their study of working professionals, identified five distinct personas — the Remote Workers, the On-The-Go Workers, the Desk-centric Workers, the Corridor Warriors and the Specialized Workers.

Dell has developed a range of laptops in the Dell Latitude series to suit each of these personas and match their requirements in terms of ease, speed and power. To know more about the ‘types of professionals’ and how the Dell Latitude laptops serve each, see here.

This article was produced by the Scroll marketing team on behalf of Dell and not by the Scroll editorial team.