Club 25... where blood donors love life!

World Health Organization

Introduction
The spread of HIV in the 1980s caused blood services across the world to seek new strategies to collect the safest blood possible. A variety of strategies have been implemented and in some cases costly and sophisticated advertising campaigns have resulted in dismal failures, while others have had limited success. Countries across the world are continually evaluating their blood donor recruitment and motivation strategies in the light of current demands for blood and blood products and in some cases a reduction in available eligible donors: this being due to the stringent criteria in place to protect blood safety. With this as a very brief backdrop to the challenges facing those tasked with the collection of the safest blood possible it is fascinating to find that often the best solutions can also be the cheapest!

Introducing Club 25 where young blood donors indeed love life and are happy to share their time, their blood, their energy and their ideas!
In 1989, Zimbabwe started targeting a previously untapped pool of low-risk donors and one such school-age blood donor at the time suggested it might be a good idea if young people pledged to give 25 blood donations by age of 25 years. Very soon many students started committing themselves to this idea and the formation of the first Pledge 25 Club took place. Now around 70% of blood collected in Zimbabwe is donated by school students and Pledge 25 Club members. The accompanying video and this leaflet provide an overview of how this initiative is now having appeal to teenagers across the world. It is interesting that the initiative has been particularly suc-

Club 25... where blood donors love life!

cessful in keeping young people protected from HIV and other infections because part of their pledge is that they will maintain healthy life-styles in order to provide the safest blood. Indeed in Zimbabwe the HIV infection rates among blood donors fell from 4.45% in 1989 to 0.61% in 2001, in a country where infection rate in the sexually active population was 33.7% at the time. Elsewhere, such as in neighboring South Africa the results are just as impressive: young people aged 16-25 years are providing about 24% of the national blood supply. This video will introduce you to various Club 25 programmes and examine their progress in three different countries, South Africa, the Philippines and Malawi. In preparation for World Blood Donor Day 14 June 2005, where we will again acknowledge the role of all voluntary blood donors, it seems appropriate to introduce an approach to blood donor motivation and HIV/AIDS education which may provide guidance to other organizations wishing to introduce similar programmes. The philosophy behind the Club 25 Programmes is to be open and honest with young people, providing clear guidelines about blood donation criteria and similarly facts about the best HIV/AIDS protection based on the evidence available, and then allowing young people to make their choices based on this evidence.

One very important consideration in setting up a Club 25 Programme is that on no account is the Blood Service used as the place to find out if one is HIV positive. This would only be counter productive and attract the wrong target population.
Club 25... where blood donors love life!

In summary it appears that Club 25 Programmes are using an evidence based approach to stimulate youth to take responsibility for their own actions. This ultimately has an impact in the community in which they live and so far the impact in maintaining blood supplies and in stopping the spread the HIV/AIDS is proving to be significant, at least in some parts of the world. Club/pledge 25worldwide activities as at November 2004 Zimbabwe Zambia India Malawi Haiti Togo
Pilot programmes are also underway elsewhere and with YOUR help this list will be extended before World Blood Donor Day 14 June 2005. Start now and establish a Club 25 programme in your country!

Botswana South Africa Indonesia Uganda Philippines

1 Stoneburner and Low-Beer, Population-Level HIV Declines and Behavioral Risk Avoidance in Uganda, Science 2004 304: 714-718 Science Journal

Club 25... where blood donors love life!

Overview with country examples:

Models of various kinds exist but generally they follow a similar structure as per this very simple example: Models of various kinds exist but generally they follow a similar structure as per this very simple example: 1. The Club elects a national and provincial administrative committee to organize activities, for example a National Youth Blood Donor Day. 2. Peer promoters are elected to assist the Blood Service in the recruitment of voluntary, non-remunerated blood donors from low-risk populations and in turn the Blood Service supervises and supports the Club.

Operationally the Club functions according to local needs but the following example from South Africa helps to illustrate the role of the Blood Service and the responsibilities of Club Members:

Adapting Pledge 25 Club to South Africa

The idea started in Zimbabwe. In the late 1990s, the blood service there revealed some interesting data and strategies in the overall context of reducing the HIV rate and retaining young donors. The service had reduced the HIV rate among Zimbabwe blood donors from about 21 per cent to 1.1 per cent including new donors (in a country where 20-26 per cent of people aged between 15-49 years were living with HIV/AIDS, and with rates climbing). They had identified young people as a low-risk group

Club 25... where blood donors love life!

but they had also observed they ceased donating after they left school. So the first Pledge 25 Club was established, for school leavers who pledged to donate 25 times in their lifetime. As part of the pledge, the young people had to remain seronegative in order to achieve their objective and within a short period there was a significant increase in both club membership and blood donor retention among school leavers. Some time afterwards the club concept was then introduced in South Africa under the title of Club 25, and in general it operates as follows: Approximate age of Club members: 18-25 years Recruitment for Club 25 is aimed at current donors who are leaving school or who have left school and already donated three or more units.. Donors (21 years or younger) who are no longer at school can also join the programme as long as they have previously given three units of blood. Club 25 members must ensure they lead a safe lifestyle in order to remain safe blood donors and meet the criteria for donor eligibility. Club 25 members must commit to donate a minimum of two units per year with the aim of donating 20 units by the end of their twenty-fifth year (ie all donations must be made before they reach 26 years.

Teamwork
In South Africa Club 25 is very much a team exercise, involving various elements within the blood service. In involves the donor staff in recruiting new members, the Corporate Public Relations/Donor Marketing Department in special efforts to retain members as donors and to educate them to commit to healthy lifestyles and a Club 25 newsletter to reinforce education

Club 25... where blood donors love life!

and to remind donors of their commitment. Finally, telerecruiters also play a key role by contacting the young donors and reminding them about their first donation during the January-March period and again for subsequent donations later in the year.

The process
After blood donors leave school they sign up as Club 25 members and give their first donation as part of the club. They receive a bag from the Blood Banks of South Africa as token of their appreciation for their support and commitment. On their 20th donation, a Club 25 member receives a nationally recognised Club 25 medal and there is also a quarterly Club 25 newsletter to keep all members informed about blood donation drives and activities. One of the primary functions of this newsletter is to remind these donors of their commitment and to continually provide them with information on risk behaviour: the focus is on the importance of donating blood regularly and living a safe lifestyle.

Results
The launching of Club 25, conducted on National Youth Blood Donor Day, 4 December 1999, involved twenty branches of SANBS and all centres reported that Club 25 was well received. Despite the cultural diversity of South Africa the National Blood Service (SANBS) has been successful in creating a concept that appeals to a target age group across all ethnic boundaries. SANBS has had some years to develop the concept and watch the programme grow. Latest statistics indicate that Club 25 is certainly making an impact on the quality and quantity of the countrys blood supply. Moreover, it is also clear that the Blood Centre is playing a significant role in educating young people about risk behaviour and ensure they remain free of the HIV/AIDS scourge that has taken hold of the continent.

Club 25... where blood donors love life!

Latest data
In 4 years: 35,193 active donors on Club 25 donor panel. 177,426 donations from Club 25 members. Increase in 18-25 year old donors on SANBS donor panel from 6% to 15%. Decrease in HIV prevalence of Club 25 panel to 0.04%: SANBS donor panel to 0.07%: South Africa country 26 28%.

A similar model in the Philippines

Pledge 25 has recently become a project of the Philippine National Red Cross (PNRC)-Red Cross Youth Department (RCY) in support of the drive on voluntary blood donation. It consists of a group of young blood donors who pledge to regularly donate blood 3 to 4 times a year starting the age of 18 until they reach 25 years old. After this period, they will be joining other blood donor groups for their regular blood donations.

Objectives
To organize a youth group as a link with Red Cross to tap the youth sector as regular donors of the PNRC. To create a group of young blood donor recruiters. To interface the youth program with the NBS. To promote the participation of women in voluntary blood donation. To instill into both young and old alike, the value of saving others lives by voluntary blood donation.

Club 25... where blood donors love life!

Representation
Members mostly represent various youth groups, either government or non-government. But also accepted are young people who do not belong to any youth organization. There are thousands of active members nationwide, and these young people are also actively participating in other various worthwhile Red Cross Youth activities. Each member receives an attractive ID card after their second donation, and a pin is given after the third donation. A regular Pledge 25 blood donor will receive a different design of pin every year after the third donation.

Results
Pledge 25 memberships for year 1999, 2000, 2001, 2002: Nationwide membership Luzon Visayas Mindanao Total 1,038 353 960 2,351 1,249 624 555 2,428 815 913 271 1,999 1525 605 820 2,950 266 386 120 772 4,893 2,881 2,726 10,500

Year 1999 2000 2001 2002 January-June 2003 Over All total

Club 25... where blood donors love life!

HIV/AIDS prevention: it is your choice!

Based on current evidence available there are three broad categories of risk concerning HIV/AIDS (No Risk, Low Risk and High Risk) and the chart opposite tries to identify these categories to enable young people especially make their choice in terms of appropriate protection where sexual relationships are concerned. Generally Club 25 Programmes include guidelines for young people to ensure they remain eligible as blood donors by leading healthy life-styles and the Blood Service can play an important role in providing HIV/AIDS education materials. In this way young people themselves become HIV/AIDS peer educators and their role in the community is even more significant than saving lives by blood donation... they now also play a vital role in health promotion as well! The Club 25 Programme, though only just beginning in some cases, appears to be a most economical model in terms of public health care. With young people playing such valuable roles in helping to secure a safe and adequate blood supply, and in creating a culture of healthy lifestyles among their peers, World Blood Donor Day, 14 June 2005 seems be a good opportunity for governments, policymakers and blood programmes to include them in their message of thanks to all blood donors.

Thank you to all Pledge/Club 25 members!

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Club 25... where blood donors love life!

Club 25... where blood donors love life!

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Further information, see World Blood Donor Day website

www.wbdd.org