About 400 new blood donors are needed daily by the NHS to meet with demands. It’s probably not new that health service needs blood donation to keep smooth operation.
To ensure safe blood supply and protect donors, certain restrictions have been made on who can donate blood and when.
Among existing restrictions, the most controversial one is that men who have sex(with or without condoms) with men (MSM) cannot donate blood unless they have abstained from all forms of sex for at least twelve months.
The Blood Donor Ban
Gay men (Men who have ever had sex with men) were issued a lifetime ban on blood donation. This ban was introduced following a rise in HIV and hepatitis B cases that happened in the 1970s and 1980s. It was reported that a number of patients who had received blood transfusions during that time, later tested positive for HIV.
As the rates of these blood-borne infections (meaning they are transmitted via blood) were found to be highest in men who have sex with men (MSM), as a result, these men were ban from donating blood.
The lifetime ban was reviewed in 2011 and replaced with the 12-month exclusion. That is, only men who have not had sex for twelve months can be allowed to donate blood.
The rules were again updated at the end of 2017 following years of campaigning by sexual health and LGBTQ+ organizations. However, the new three-month deferral period still prevents many MSM from donating blood if they are having regular sex.
“Anyone can acquire a blood-borne virus or a sexually transmitted infection (STI), but some people have an increased risk of exposure. At a population level, men who have sex with men have a higher risk of acquiring blood-borne infections,” says a spokesperson for NHS Blood and Transplant (NHSBT).
According to the spokesperson, we have a three-month deferral because there is a small possibility the tests we carry out are not able to pick up recently acquired infections. If someone was to donate blood during this time, known as a window period, it would be possible to transmit an infection,” they explain.
Organizations who campaigned for the deferral period to be reduced argued that modern screening techniques made a lengthy period of abstinence unnecessary.
“You have to weigh up the balance between making sure that any risk to the blood supply is properly mitigated and making sure that people aren’t being unfairly prevented from giving blood should they wish to,” says Kat Smithson, director of policy at National AIDS Trust (NAT) which advocated for the change.
“We felt that most infections would be picked up after a three-month period and therefore there was no reason to have this additional nine months whereby someone couldn’t give blood. It wouldn’t make any difference to the blood supply. It meant that the rules were much fairer and more in line with the Equality Act.”
With most HIV tests that you can take at a sexual health clinic, you can have a fairly accurate result after four weeks and a definitive result after six weeks. Other blood-borne infections have different window periods.
MSM isn’t the only group affected by bans or deferrals for blood donation, (said Smithson). “Although they are one of the most significant groups affected by this, there are also other people who are affected by the rules and who may wish to give blood. For example, people who have previously worked as sex workers or people who have previously injected drugs.”
In the past, sex workers were banned for life from donating blood – as with MSM, they can now donate from three months after the last time they had sex. The same applies to people who have sex with partners in groups known to have a high risk of STIs.
Risk-based approach
The deferral period applies to MSM regardless of the kind of sex had, whether a barrier method was used to protect against STIs, those involved have tested negatively for STIs or if a person is in a monogamous relationship.
For heterosexual people and women who have not had sex with MSM, ‘risk’ is assessed through specific conditions and experiences which prevent them from donating blood, including having paid for sex or had sex with someone who has an STI.
Many organizations are now pushing for a case-by-case approach to blood donation for MSM, says Smithson. “It’s important that we continue to review and make sure that there aren’t still people who could be safely giving blood without a high risk to the blood supply who are caught by these catch-all rules.
“We’re looking at whether or not an individualized risk assessment could be the way forward. We want to work with SABTO (the advisory committee on the Safety of Blood, Tissues, and Organs), who make the recommendations, and work with people who might be affected by these rules to find out the best way of doing that.”
NHSBT is currently considering a risk-based policy, although it will take time to come into effect, explains their spokesperson.
“We’re working with key stakeholders to explore the potential for a more individualized risk assessment donor selection policy,” they said.
“We hope to report our findings towards the end of 2020. Any changes to donor selection must be based on the best available evidence to ensure that we continue to have one of the safest blood supplies in the world.
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