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U.S. Department of Health and Human Services

Vaccines, Blood & Biologics

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PPTA Risk Poster I v1.2

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This document is one component of the full-length and abbreviated PPTA donor history questionnaire documents for collection facilities that use an approved test for antibodies to HIV that detect HIV-1 Group O. The full-length and abbreviated PPTA donor history questionnaire documents must be used collectively.

 

Source Plasma Industry Risk Poster I

Sexual contact means any of the following (whether or not a condom or barrier device was used):

  • Vaginal intercourse (contact between penis and vagina) 
  • Oral sex (mouth or tongue on someone’s vagina, penis, or anus)
  • Anal intercourse (contact between penis and anus).

Do NOT donate PLASMA, whole blood or platelets if you…

Ever

  • Had HIV/AIDS (see list of symptoms below)
  • Had a positive test for HIV (AIDS virus)
  • Had a positive test for hepatitis
  • Had hepatitis (after your 11th birthday)
  • Used needles to take drugs, steroids or anything not prescribed by your doctor
  • Used clotting factor concentrates for a bleeding disorder
  • Had a transplant such as organ or bone marrow 

Since 1977

  • Received money, drugs or other payment for sex
  • (Male donors ) Had sexual contact with another male, even once

In the last 12 months

  • Have given money, drugs or other payment for sex
  • Have been treated for
    • syphilis
    • gonorrhea
  •  “Lived with” a person who has hepatitis (lived at same residence and shared kitchen and bathroom)
  • Had a blood transfusion or received other blood products
  • Received during surgery bone, tissue or skin
  • Had an accidental needle-stick involving exposure to blood
  • Had contact with someone else’s blood
  • Had a tattoo applied
  • Had ear or body piercing
  • Have been in                     
    • juvenile detention        |
    • lock up                          | For more than 
    • jail                                |   72 hours
    • prison                           |

Had sexual contact with anyone who:

  • Has HIV/AIDS (see list of symptoms below)
  • Has a positive test for HIV (AIDS virus)
  • Has hepatitis
  • Used needles to take drugs, steroids or anything not prescribed by their doctor
  • Has hemophilia or has used clotting factor concentrates
  • (Female donors) Had sexual contact with a male who has had sexual contact with another male, even once

Signs or symptoms of HIV/AIDS:

  • Unexplained weight loss
  • Night sweats
  • Blue or purple spots in your mouth or skin
  • White spots or unusual sores in your mouth
  • Swollen lymph nodes for more than one month
  • Fever of more than100.5 oF for more than 10 days
  • Cough that won’t go away
  • Shortness of breath
  • Diarrhea that won’t go away

September 2012, v1.2