MSM
Exclusion of Men who have Sex with Men from Blood Donation
Information last updated:7th November 2011.
The Irish Blood Transfusion Service (IBTS) has a responsibility to ensure that there is a sufficient supply of safe blood to meet the needs of patients.
This includes a duty to minimise the risk of a blood transfusion transmitting an infection to patients – the European Union directive requires that “all necessary measures have been taken to safeguard the health of individuals who are the recipients of blood and blood components.”
In order to assure the continued safety of the blood supply, we currently ask those people who may have a particularly high risk of carrying blood-borne viruses not to give blood. This includes men who have ever had sex with another man / men. The reason for this exclusion rests on specific sexual behaviour (such as anal and oral sex). There is no exclusion of gay men who have never had sex with a man nor of women who have sex with women. The decision is not based on sexuality or orientation, only specific actions.
The reasons for IBTS maintaining its current policy of permanently excluding men who have ever had sex with men from blood donation are as follows:
- Blood safety starts with the selection of donors before they give blood. By excluding persons with behaviours known to present a particularly high risk of blood-borne viruses, we are already reducing the risk of infected blood entering the blood supply.
- Every blood donation is tested for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis and human T-lymphotropic virus (HTLV). However, despite improvements in blood screening tests, a small number of infected donations may be missed because of the ‘window period’ between getting the infection and the test showing a positive result. The medical literature contains many recent examples. See further reading http://bit.ly/kD3UxQ
While safer sex, through the use of condoms, does reduce the transmission of infections, it cannot eliminate the risk altogether. Men who have sex with men are disproportionately affected by HIV according to recent Irish data.
- IBTS does not believe that performing more detailed interviews prior to donation nor other risk assessments at donation clinics is effective or feasible. For those donors who test positive for HIV or other infections, the risk behaviour that likely led to the infection may not be admitted for some time after the donor is contacted. This does not give IBTS confidence that information would be freely provided as part of a more extensive pre-donation interview.
- The issue of monogamous partners is difficult. Evidence from heterosexual partnerships suggests that ‘innocent’ partners are very often entirely unaware that their partner / spouse is unfaithful. IBTS considers therefore that individuals can only attest to their own behaviour when donating and not speak for their partner.
While there is always a need for new blood donors and for existing and previous donors to continue to provide support to the transfusion service, blood supply is not expected to increase greatly should, for example, a finite limit for deferral of 12 months since last MSM activity be introduced. The safety of blood transfusions and the supply of blood to patients in Ireland are two independent essential functions of the IBTS.
The following UK Blood Services: NHS Blood and Transplant, the Scottish Blood Transfusion Service and the Welsh Blood Transfusion Service have announced that with effect from 7th November 2011, the permanent exclusion of MSM from donating blood will change to a 12 month fixed period deferral from the most recent relevant sexual contact. This decision was made by the UK Health Ministers following advice received from the Advisory Committee on the Safety of Blood, Tissues and Organs (SABTO).
The IBTS has reviewed the report produced by SABTO, but has decided not to make a change to its current permanent exclusion of MSM. The Health Minister for Northern Ireland has recommended that no change is made to their permanent exclusion at present.
For other infections that cannot yet be tested for, or that are currently undiscovered, and may be preferentially transmitted by MSM behaviour [in the same way as HIV and hepatitis B are] it will clearly not be effective. Other countries have a permanent deferral after MSM behaviour, including the USA and the Netherlands.
Finally, while the primary requirement is to protect recipients, it is acknowledged that in order to supply blood for transfusion all decisions are based on a review of the evidence bearing in mind the desire of individuals to donate, the safety of the recipient, and the tolerance of society in general of any transfusion related infection occurring. For Ireland, the view of IBTS is that taking all of these aspects into account a permanent deferral for men with a history of MSM behaviour is justified.