Red Cross HIV policy questioned

By Renata Arianingtyas

JAKARTA (JP): Jaka (not his real name) donated blood 32 times between 1987 and July 1996 before he found out he had the Human Immunodeficiency Virus (HIV).

His first concern was whether he had, through blood donations, infected other people. An official at the Red Cross said airily that he had not -- the sample of his blood was taken, tested and found HIV positive, and so was not given to anyone.

As Support, the magazine for people with HIV or Acquired Immune Deficiency Syndrome (AIDS), said, Jaka became very upset. "Why couldn't they tell me outright, so that I didn't give blood for nothing," he said.

The Red Cross official, however, said the organization was only adhering to the policy of "unlinked, anonymous and mandatory HIV-antibody testing", as stipulated by the 1992 Health Law.

The policy states that the object of HIV/AIDS screening is the blood, not the donors. The argument was that the identity of donors with HIV/AIDS would be protected.

The problem was, as Jaka pointed out, HIV screening of blood samples was not mandatory before 1992, while the first HIV- positive person was found in 1987. There was a possibility that HIV transmission through blood donations occurred before the law was enacted in 1992.

Jaka was not the only one.

As of June this year, the official figure for people with HIV/AIDS was 550, although officials admitted the actual number could be 100 times higher. About 50 people in the official record had at one time or another donated blood; in fact, one of them donated blood 56 times.

AIDS activist Nafsiah Mboi, who is also a legislator of the Golkar faction, brought this case up in a recent hearing with Minister of Health Sujudi. She questioned blood donors' right to be informed of an illness.

As a health expert, Mboi argued that the World Health Organization applied the principle of "voluntary testing and confidential counseling", which means that bodies such as the Red Cross should tell a blood donor, in strict confidentiality, if he/she was infected by HIV. The organizations should also offer counseling prior to and after testing.

The same principle, she argued, was also stated in the national strategy for the campaign against AIDS drafted in 1994 by the office of the Coordinating Minister for People's Welfare.

Sujudi, however, believed the principle of "unlinked, anonymous and mandatory HIV-antibody testing" was more beneficial. Although HIV-infected blood cannot be given away for transfusion, it can still be used for research purposes.

He also pointed out that the government would not have to pay for counseling before and after testing.

"If we tell people (about whether a blood donor is HIV positive), they may think blood donations are actually part of an HIV-screening process. Remember, we are still in short supply of blood donors," he said.

Policies

Chief of Blood Transfusion at the Indonesian Red Cross, Melanie Wikanta, said that both policies were actually in effect and for different reasons.

The first principle, she said, was used for blood transfusions and survey purposes. The second was only used for diagnostic purposes, where patients voluntarily ask for screening and are prepared to face further developments related to their health.

In order to meet criteria of unlinked and anonymous screening, blood donors have to reveal details about health and sexual practices.

The Red Cross, for instance, is also obligated to keep donors anonymous. In practice, however, "we still keep donor files for emergency cases, such as when we need a certain type of blood," she said.

"In addition, there's a decree that screening results of people with HIV have to be reported to the Ministry of Health. So it's not really unlinked and anonymous," Melanie admitted.

Melanie pointed out that the policy of unlinked and anonymous was against a doctor's obligation to inform patients of illnesses. Samsuridjal, a health expert and activist at the Pelita Ilmu Foundation for AIDS, agreed, adding that an uninformed person with AIDS may unknowingly infect others through means other than blood transfusion.

If informed, a blood donor would be able to take necessary precautions to avoid infecting others, he said.

Melanie said many countries choose to inform donors if they have HIV and offer them counseling. "Even some African countries whose welfare levels are lower than Indonesia's," Melanie said.

In fairness, the Red Cross carried out an experiment in Jakarta in which donors were given counseling before and after screening. The medical workers informed donors who were screened whether or not they had HIV, hepatitis or syphilis.

Only after donors filled in an informed/consent form were blood samples taken. Those who were found to be HIV-positive were offered counseling.

Results of the German-funded experiment were promising. "There was no drastic decline in donors, so the government's concern about this particular problem was not proven," Melanie said.