Gay men and blood donation
On September 8th 2011, Health Ministers announced that the rule regarding the eligibility of gay and bisexual men to donate blood have changed. The new policy allows gay and bisexual men to donate blood if they have not had oral or anal sex with a man in the last year. Previously all men who had ever had sex with another man (including men who are gay, bisexual or had a one off sexual encounter with another man) could not donate blood.
The reason for the original lifetime ban
The ban on gay men donating blood was introduced as a response to the HIV epidemic, which in the UK mostly affected gay men. While the proportion of gay men with HIV was, at that time, small, the technology to accurately test all blood for HIV did not exist. Therefore it was considered that this group presented a significant risk of blood containing HIV entering the blood transfusion service. Consequently the UK Blood Service chose to impose a lifetime ban on all men who had ever had sex with another man
The reason for the change in the policy
The criteria for accepting blood donors are recommended to the UK Government by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO). These criteria are regularly reviewed to ensure they are appropriate and based on the most up to date scientific evidence.
The review that prompted the change, carried out by SaBTO and completed in May 2011, found that:
- Improvements in blood donation testing have been implemented since the last review
- All UK Blood Services now use Nucleic Acid Testing for HIV and hepatitis B and C viruses, which has greatly reduced the window period for detection of these viruses
- All tests are fully automated and are monitored by advanced IT systems, reducing the risk of any error in the testing process
- The introduction of a 12 month deferral would maintain the safety of the blood supply and bring the criteria for MSM in line with those for other groups that are at an increased risk of carrying blood-borne infections
- A 12 month deferral would not adversely affect the safety of the blood supply, however compliance with the policy (and all donor selection criteria) is crucial
- If donors do not comply with donor selection criteria and donate blood shortly after any behaviour that places them at risk of acquiring a blood-borne infection, there is a possibility that they might donate blood during the window period where infection will not be detected by available screening tests, but could be transmitted via a blood donation.
The reason for a one year deferral period
Given that gay and bisexual men are now allowed to donate blood, it may be difficult for some people to accept and understand why there is still a one year deferral period after sex for these men. Even though the vast majority of gay and bisexual men do not have HIV or Hepatitis B , Gay and bisexual men, as a group, are at higher risk of acquiring some these blood borne infections than the majority of the UK population. In recent years there have been great advances in testing technologies, leading to shorter window periods, when infections may not be detected in tests. However, these window periods cannot be eliminated and if a person donates blood during the window period, the infection could then be transmitted via a blood donation.
The window period for modern HIV testing is now quite short (between 9 and 15 days after acquiring HIV). As soon as a person is past this stage of infection, HIV will always be detected in their blood when tested with a combined P24 antigen / antibody test.
The initial window period for Hepatitis B is between 39 and 67 days after infection. However, unlike HIV, Hepatitis B infection can be gradually cleared from a person’s body. This can occur without any medical intervention and without a person knowing that they had Hepatitis B. As Hepatitis B infection clears from a person’s body there is a second window period towards the end of the infection when the levels of Hepatitis B may not be detected by tests, but infection could still be passed on via a blood donation.
The deferral period has been set so that it is long enough for a donor to have recovered from any Hepatitis B infection before allowing a subsequent blood donation. A deferral period of 12 months since oral or anal sex is considered sufficient to allow for the complete clearance of Hepatitis B in an individual who clears the virus naturally. Not all people will recover from Hepatitis B infection without treatment. Hepatitis B infection amongst those individuals who do not naturally clear the virus will be detected by the screening tests.
The reason why the policy covers all sex between men
The majority of sex between men does not carry a risk of transmitting blood borne virus. However it is not always possible for everyone to know when a virus has been transmitted through oral or anal sex even when precautions are taken. For example, even though condoms are usually effective at stopping HIV and other infections, enough people have problems with condoms breaking or slipping off that some people have become infected even though they use condoms consistently. Most gay men have oral sex without using condoms. While the risk of HIV infection through oral sex isn’t high, it is estimated that around 2% of gay men with HIV have become infected in this way.
Even people who believe they are in a monogamous relationship can get an STI. GMFA’s research found that 13% of gay men stated that they had been infected with an STI during the period that they were supposedly having a monogamous relationship . Many gay men are in genuinely monogamous relationships however some people, regardless of gender or sexuality, do not always stick to the rules of their relationship. There is no evidence to suggest that gay men are more likely to be dishonest in their relationships, but if a gay man has sex with another man outside of his relationship he is far more likely than a heterosexual, to be having sex with someone with a blood borne virus.
For these reasons, the new policy applies to all oral and anal sexual activity between men, not just ‘risky’ sexual activity.
What gay men can do
The campaign slogan for the Blood Donation Service is, “Do something amazing …”. Many gay men want to do just that but have been unable to do so because of the blanket ban on all men who have had any gay sex. The new policy, which removes the total ban but still requires that no gay man who has had sex in the last year donates blood, means that around 90% of gay men will still not be able to give blood. This new deferral period is as a result of the risks of transmitting Hepatitis B through blood products, which is far more infectious than HIV, and the complications in testing blood for Hepatitis B. It may feel to some gay men that they can’t “do something amazing”. But we can.
Gay men can play a vital role in supporting the blood transfusion service by helping to ensure that the donated blood is safe for all people. The specific complications in testing blood for Hepatitis B requires a longer deferral than HIV would on its own. The higher prevalence of blood-borne viruses, including HIV and Hepatitis B, amongst gay men requires greater caution when it comes to the risks of condom failure or relationship agreements not being kept. Any one of us may need a blood transfusion at some point, as may our friends, family and other gay men. We all want the blood supply to be as safe as it can be, and so we should feel proud that we can help keep the blood transfusion service free of blood borne virus by observing the one year deferral.
Gay men can also change the situation by working to reduce the level of blood borne virus within the gay community. We can do this by getting a Hepatitis B vaccination. If enough gay men get vaccinated then this will help prevent the spread of Hepatitis B within the gay community and reduce the percentage of us with Hepatitis B, so that we are no longer a higher risk to the blood transfusion service. Similarly, by doing all that we can to prevent the transmission of HIV, by taking responsibility for safer sex, testing and consistent condom use, there would be fewer gay men with HIV.
And, even if most gay men are not eligible to donate blood, most of us can donate our organs when we die. More than 10,000 people in the UK currently need an organ transplant. Of these, 1,000 each year, that's almost three each day, will die waiting as there are not enough organs available. There is no restriction that prevents HIV negative gay men (and that’s about 93% of us) from donating their organs when they die.
To join the NHS Organ Donor Register go to www.organdonation.nhs.uk._________________
1 - GMFA survey of 3,000 gay men, published in the Journal of HIV Medicine supplement ‘Abstracts of the 17th Annual Conference of the British HIV Association’.