LGBTQ+ Donations

In the 1980s restrictions were put in place which meant that MSM were never allowed to donate blood due to the fear of HIV contamination. In November 2011, this lifetime ban was reduced to a 12 month deferral period due to questioning over the merit of the permanent ban and advances in testing of blood donations. However, it wasn’t until 2016 that the Irish Blood Transfusion service followed suit. 

In 2017, the deferral period in Great Britain was further reduced to 3 months since MSM donors’ last sexual contact. Yet, in Northern and the Republic of Ireland this still remains at 12 months. 

We fully support these steps towards equality and reducing stigma that surrounds HIV and gay men. However, it can be argued that this has not gone far enough and believe that blood donation should be assessed on individual risk-behaviour rather than sexuality. The current system does not take into account whether MSM donors practice safe sex or are in monogamous relationships. It also doesn’t account for heterosexual donors’ sexual activity as they are not considered a high risk group for blood borne viruses. 

The top priority is undoubtedly the safety of blood transfusions for the donor and recipient. However, with improvements in blood screening technology it could be possible to go further than the current deferral system in regards to equality, following countries such as Spain and Italy who both assess the ability to donate on individualised risk-assessment instead of sexuality.

A study carried out by the Royal College of Physicians in 2018 assessed the merit in the current system and details the reasoning behind the 3 month deferral system which currently stands for MSM, commercial sex workers (CSW), those with MSM partners and those who have been sexually active in regions where HIV is highly prevalent. They concluded that the 3 month deferral for these groups can be justified but this restriction is conservative and if more high quality evidence is obtained this deferral period could be reduced.

The current deferral period is operated across Britain due to the recommendations of the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO). Every blood donation in the UK is required to be tested for HIV, hepatitis B (HBV), hepatitis C (HCV) and syphilis. Even though all donations are screened, there is an initial time period from infection where tests may produce a false positive. In other words, there is a time frame where viruses are potentially not detected known as the “window period”.

In the UK, the incidence rate of HIV across the population is 1.6 per 1,000 compared to 58.7 per 1,000 for MSM. However, in 2018 MSM accounted for 51% of new HIV cases and there has been a steep decline in new cases amongst MSM since 2015. Therefore, it is important to understand that HIV and other blood borne cases are not solely restricted to these groups. 

There are currently two types of screening used called nucleic acid amplification testing (NAT) and serological testing. The window period for these tests are as follows:

• HIV: 5 days for NAT, 15 days for serological testing

• HBV: 21 days for NAT, 36 days for serological testing

• HCV: 3-5 days for NAT, 65 days for serological testing

In England, NAT testing is required for HCV and syphilis. Testing for HIV, HBV and HCV are performed in a group of up to 48 samples when using NAT testing, which reduces the sensitivity of the test. However, NAT testing is expensive and highly technically demanding which means it is not always possible to be used. Despite this, it is

possible to detect all of the viruses discussed within the first month of infection. The SaBTO advises that the international standard is for the deferral time to be double that of the window period. Therefore, three months could be viewed as over cautious for a deferral period but as the welfare of patients is at stake this is justifiable. 

One of the suggested alternatives to the deferral process is to change to a system which assesses the individual risk-behaviour of blood donors. This process would involve the current questionnaire and confidential face-to-face interview including a section on the donors sexual behavior regardless of their orientation. Eligibility to donate would be based on risk of acquiring a blood borne virus. The ‘no risk’ group could include those in monogamous relationships or with no new sexual partners. A ‘low risk’ group could account for donors that have had sex with a new partner with unknown sexual behaviour, and people who have had sex with several partners with an unknown sexual history could be classed as ‘high risk’. Those who have no risk would be free to donate, low risk would be given a deferral period and high risk could be permanently deferred. However, a possible problem with this system is that donors have the potential to underestimate the risk of their sexual behaviour.

A study was carried out in Italy comparing the difference in HIV incidence and prevalence between the permanent deferral of MSM donors compared to the individualised-risk assessment that was introduced in 2001. They found that of those who tested as being HIV positive in 2009-2010, 28.5% had reported that they were in the ‘no risk’ category. Despite this, the overall findings of this study showed there was no substantial difference in incidence rate between 2009 and 2010 compared to 1999, when there was a permanent deferral in place. Additionally, the prevalence of HIV among first time donors decreased over time. 

The safety of blood is the top priority for both blood donations and transfusions. However, with advances in HIV testing and individualised risk assessments it could be possible to promote equality in blood donation and ultimately increase donor numbers. There is evidence that the three month deferral period is overly cautious and could be reduced within the current system. On the other hand, changing this system to an individualised risk assessment has the potential to promote equality but would rely on all donors fully understanding the risk of their sexual behaviours and how this could impact the safety of blood. At Give Blood 4 Good, we feel it essential to ensure that all blood donations are as safe as possible for the people who will be receiving them. In saying that, we feel hopeful that with advances in HIV testing and donor screening, equality could be promoted in blood donation.