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This document is one component of the full-length and abbreviated PPTA donor history questionnaire documents for source plasma organizations that do not 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.
Do NOT donate PLASMA, whole blood or platelets if you…
Were born in, lived in, or travelled to any of the following African countries or had sexual contact with anyone who was born or lived in:
Cameroon, Central African Republic, Chad, Congo, Equatorial Guinea, Gabon, Niger, Nigeria, Senegal, Togo, Zambia, Benin or Kenya
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 anothermale, 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 (For more than 72 hours)
juvenile detention
lock up
jail
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
