Michael Melia/Alamy
New rules that make it easier for gay and bisexual men in the UK to donate blood have been found to be safe, but equal rights campaigners say they don’t go far enough to eliminate discrimination.
Most rich countries, including the US and Australia, only allow men who have sex with men to donate blood if they have abstained from sex for at least 12 months, because men in these countries have a higher risk of getting HIV and hepatitis from sex. In the US, for example, two-thirds of new HIV infections result from male-to-male sexual contact.
All donated blood is tested before it is used, but it takes time for recent HIV and hepatitis infections to become detectable, which is why most countries ask that higher-risk donors avoid sex for a period of time before giving blood. However, modern screening tests can detect HIV and hepatitis within one month of a person being infected. In November 2017, England, Scotland and Wales shortened the time that men who have sex with men have to abstain from sex before donating blood to three months, on the advice of the UK’s Advisory Committee on the Safety of Blood, Tissues and Organs.
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Two years in, this policy change hasn’t compromised the safety of the UK’s donor blood supply, says Katy Davison of Public Health England, who presented the first data at a meeting of the AABB international blood bank association in San Antonio, Texas.
There was no significant rise in infected blood. Out of 2 million blood donations made in the UK in 2018, seven tested positive for HIV, compared with six in 2017. These donations were discarded and no transfusion recipients received HIV-infected blood, she told the meeting.
In addition, 89 blood donations tested positive for hepatitis in 2018, compared with 102 the previous year. Blood transfusions resulted in one person becoming infected with hepatitis B and another with hepatitis E, but this was below the required rate of no more than one infection per 1 million transfusions.
Several other countries have followed the UK’s lead. Canada moved to a three-month abstinence period in June, and France, Denmark and the Netherlands have approved four-month abstinence periods.
However, activist group Freedom to Donate says these new rules are still discriminatory because they group people together based on sexuality rather than individual behaviour. It wants governments to introduce individualised risk assessments that would allow men who have sex with men with low-risk sexual behaviour – like those in monogamous relationships or who always use protection – to donate blood without having to abstain from sex.
Illegal blood bank
To try to prove the safety of this approach, Freedom to Donate invited 26 gay and bisexual men to donate blood at an “illegal blood bank” in a secret location in London on 23 November. Before donating, participants filled out a questionnaire about their sexual behaviour. Their donations will now be tested to show that blood from “low-risk” men who have sex with men is safe to use. “The blood will not be used medically in the current system, but to prove the point,” the organisers said.
However, Mindy Goldman at Canadian Blood Services says that testing 26 men isn’t adequate to prove this point. Since HIV transmission risks are low, hundreds of thousands of men would need to be tested to confirm the safety of individualised risk assessments, she says. Statistical modelling is a better way to explore the safety of this approach, she says.
Spain and Italy have used individualised risk assessments to decide who can donate blood since 2000 and 2001, respectively. HIV is found in slightly more of their blood donations, but the risk of transmitting this to recipients of blood transfusions is very low because of screening tests. In Italy, for example, the risk of getting HIV from a blood transfusion is estimated to be 1 in 13 million.
One major question that needs to be addressed before individualised risk assessments can be introduced more widely is whether people taking pre-exposure prophylaxis (PrEP) drugs can safely donate blood, says Brian Custer at US blood research institute Vitalant. These medicines, which were approved by the US Food and Drug Administration in 2012, lower the risk of getting HIV from sex by about 99 per cent when taken properly. But HIV can still be contracted if PrEP is taken inconsistently, and the virus may not show up in screening tests because PrEP reduces the viral load in the blood, says Custer.
“PrEP is fundamental to the success in controlling the HIV epidemic, but for blood safety we have to be very cautious so as to not face the possibility of new cases of transfusion-transmitted HIV,” says Custer.
In the UK, the FAIR (For the Assessment of Individualised Risk) steering group of the UK Blood Services is exploring whether individualised blood donation risk assessments could be safely introduced. This isn’t to address blood shortages – since the UK already has enough blood donors – but to be more inclusive.
FAIR says it will report its findings to the government in late 2020. Canada is conducting its own research on individualised risk assessments and the US plans to start next year.
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