Blood Restrictions on Blood Donations for Gay and Bisexual Men

Written by Zachary Carter

Since the HIV epidemic in the 1980s, blood donation policies are deeply rooted in discrimination towards men who have sex with men (MSM). Australia imposes strict regulations on the ability of gay and bisexual men to donate blood. A deferral period limits donations by MSM if they have engaged in sexual activity within a specified period of time and acts as a precautionary measure to prevent transfusion-transmitted infections to ensure the safety of the blood supply. Recently, upon an application from the Australian Red Cross, The Therapeutic Goods Administration reduced the deferral period for MSM from twelve months to three months. Restrictions on blood donations in Australia should not cause harm to particular social groups or increase the stigma against them in the absence of a legitimate public health concern. 

Stigma/Science

In Australia, gay and bisexual men have a higher risk of transmitting human immunodeficiency virus (HIV) and other blood-borne viruses (BBVs) compared to other populations. The testing of donations is more robust following the introduction of nucleic acid testing (NAT) as the window for blood-borne infections (the period in which infections can go undetectable) are now extremely short. 

There is little justification for excluding MSM who engage in low-risk sexual activity. Lifeblood imposes the three-month deferral period on MSM and anyone who engages in sexual activity with MSM. What is described as sexual activity, however, includes activity that does not pose a risk of transmitting a disease. Oral sex precludes MSM from donating, however, the best available evidence has consistently indicated that the per-act risk of HIV transmission via oral sex is too low to quantify. Furthermore, MSM who practice safe sex through the use of condoms are not permitted to donate blood, despite the best available science finding a considerable reduction – and possibly elimination – of HIV acquisition. The three-month deferral period also does not apply to MSM taking pre-exposure prophylaxis (PrEP). Men who take PrEP must undergo a twelve-month deferral period from their last dose, despite PrEP significantly reducing their risk of transfusion-transmitted infection. Lifeblood’s basis for amending the deferral period in these instances is drawn upon insufficient evidence of whether PrEP may impede the ability to detect viral infections. The policy can be criticized for not supporting practices (such as PrEP), which can eliminate the risk of HIV transmission, and instead, extending the deferral period without a sound scientific basis. Furthermore, there is little justification for the exclusion of MSM who have had the same sexual partner for the past three months, and who are unlikely to contract the virus if practicing safe sex in monogamous relationships.  

The policy seemingly discourages homosexual activity and perpetuates the stigma of associating gay men with HIV.  The change in deferral period from twelve to three months, while a step in the right direction, fails to provide a semblance of actual improvement for the LGBT community. Monogamy, safe sex, low-risk sexual activity (oral sex), and having low partner numbers are not considered under the policy, and unfairly exclude MSM who pose no risk at all from donating blood.

Policy Reform

In a 2018 survey of MSM, over three-quarters of participants(77.7%) said that if the policy changed, they would likely donate blood. Recently, the UK has decided to replace the deferral period for MSM with an individual risk assessment for anyone wishing to donate blood. Under the policy, individuals have their level of risk assessed, not based on questions relating to gender or sexuality. This allows members of a particular social groups, who have a higher risk of infection by virtue of their prevalence within that social group, assessed on their actual risk rather than the risk of the group as a whole. The US, Canada, and New Zealand is considering a similar shift in policy. The willingness of the community to contribute to the cause, demonstrates the ability to increase blood supply and reinforces the demand for policy reform.  Australia should enact a new policy, representative of the UK, to eliminate the discriminatory practices of current blood donations and ensure better health practices. 

Summary 

The current policy regarding blood donations for MSM fails to consider the best available science. Gay and bisexual men who pose no threat to the safety of blood donations are denied the opportunity to give back to the community, further reinforcing their exclusion from society. While there is scientific justification for excluding certain high-risk MSM from donating blood, the exclusion of the entire community is unjust. It is imperative to maintain blood safety, however, the current policy is causing social harm without providing any additional or necessary protections. A behavior and individual risk assessment for MSM is recommended under a new policy, assessing the individual’s actual risk rather than the risk of the population as a whole. Policy reform in Australia is crucial in reducing the discrimination faced by gay and bisexual men, increasing the inclusiveness of the LGBT+ community, and increasing donations.