Britain Lifts Ban on Gay Blood Donation…or Does It?

Hey there Guys,

This morning I awoke to an interesting headline that the British government has decided to lift its ban on gay men from donating blood. Well sort of.

To quote the British NHS blood donation website:

Men who have had anal or oral sex with another man in the past 12 months, with or without a condom, will be asked not to donate blood. Men whose last sexual contact with another man was more than 12 months ago will be able to donate, subject to meeting the other donor selection criteria.

To make sure we are all on the same page the banning of men who have sex with men from donating blood products began as a response to the HIV/AIDS crisis in the 80’s. To quote the US’s Federal and Drug Administration’s (FDA) website:

In 1983, FDA recommended donor-screening procedures to exclude individuals at increased risk for transmitting Human Immunodeficiency Virus (HIV), the virus that causes Acquired Immunodeficiency Syndrome (AIDS). These recommendations have been updated periodically since then. The exclusion of potential donors based on certain sexual histories has been discussed often, and in-depth, by FDA’s Blood Products Advisory Committee (BPAC). This panel of non-FDA independent experts continues to recommend the deferral of men who have sex with other men and their recent partners.

At the time it was the MSM (men who have sex with men) population that had a disproportionate of members infected by the HIV virus, so it made sense to not accept blood from this population from a “potential risk” perspective. Since this time the tools to screen blood for viruses such as HIV, Hepatitis B and C have enabled all donated blood to be screened for these risks.

Antibody screening of donated blood

In the early days of blood screening the only tests available were for antibodies to the viruses. Antibodies are the bodies response to infection, one of the many defences to reduce infections. Currently in Australia The Red Cross screens for 5 different antibodies for blood borne disease:

• HIV/AIDS
• hepatitis B
• hepatitis C
• Human T-cell Lymphotropic Virus- HTLV
• syphilis

Depending on the organism causing infection, there is a delay between the actual infection and the production of antibodies. This is called the “window period”.

Addressing the window period

If only antibody testing is done there is a risk that some blood that is infected with HIV, Hepatitis B or C could slip through into the blood pool as it would not be picked up during this window period. The window period for HIV is 3-6 weeks but in some cases can take up to 12 weeks to develop. The window period for Hep C is generally 2-8 weeks but can be as long as 9 months.

To help reduce the chance of blood infected with HIV or hepatitis C the Australian Red Cross also tests all blood for the presence of the actual HIV or hepatitis C DNA. This reduces the window period greatly with the potential of missed infected blood being limited to the points of early infection where the viruses have not had time to replicate creating concentrations high enough to test for. In both HIV and Hepatitis C this would be the first 1-2 weeks post infection.

Hepatitis B testing is done by checking for presence of virus surface particles and by the body’s own production of antibodies to the virus. Detection can be difficult at times and evidence reports that there can be a lapse of up to 12 months before evidence of infection is detectable. This is the reasoning behind the 12 month ban of men who have sex with men. It’s not about HIV, it’s about the risk of Hep B.

So how is hepatitis B spread?

Hepatitis B is spread via blood to blood contact. Unlike HIV, hepatitis B is able to survive outside of the body for up to 7 days. Any blood to blood contact, use of improperly cleaned tattoo or piercing equipment, sharing of injection equipment, razors or toothbrushes are ways the virus can be spread.

Sexual activity is also an effective means of hepatitis B transmission, both heterosexual and homosexual.

Who is considered a potential “high risk” of being infected with hepatitis B?

The Hepatitis B Foundation lists:

• Health care workers and emergency personnel
• Infants born to mothers who are infected at the time of delivery
• Partners or individuals living in close household contact with an infected person
• Individuals with multiple sex partners, past or present
• Individuals who have been diagnosed with a sexually transmitted disease
• Illicit drug users (injecting, inhaling, snorting, popping pills)
• Men who have sex with men
• Individuals who received a blood transfusion prior to 1992
• Individuals who get tattoos or body piercing
• Individuals who travel to countries where hepatitis B is common (Asia, Africa, South America, the Pacific Islands, Eastern Europe, and the Middle East)
• Individuals emigrating from countries where hepatitis B is common, or born to parents who emigrated from these countries (see above)
• Families adopting children from countries where hepatitis B is common (see above)
• Individuals with early kidney disease or undergoing kidney dialysis
• Individuals who use blood products for medical conditions (i.e.hemophilia)
• Residents and staff of correctional facilities and group homes

Is hepatitis B preventable?

Absolutely! Hepatitis B can be immunised against via a series of three injections. It is a very simple and straight forward procedure.

Currently this vaccination is recommended if you :

• inject drugs.
• have a sexual partner who has hepatitis B
• are a man who has sex with men.
• have many sexual partners.
• live in a house where someone has hepatitis B.
• are a health care or emergency worker, or if you come into contact with blood during your work.
• are a prisoner.
• are a kidney dialysis patient.
• have a blood clotting disorder and are treated with blood products.
• already have a liver disease such as hepatitis C.
• are a resident or staff member at a facility for people with intellectual disabilities.
• intend staying for a long time in high risk areas overseas.
• adopt children from overseas. These children should be tested for hepatitis B and if they have the virus, members of the adoptive family should be vaccinated.Vic Health Australia

Currently I highly recommend that all gay men consider having these vaccinations done.

So where does this leave gay men who wish to donate blood?

For majority of gay men, the lifting of this ban will have little effect on their ability to donate blood. Whether you are having unprotected sex with 5-6 random partners each day or in a long term monogamous relationship, as long as you are sexually active you will not be able to donate blood. No matter if you have made the decision to be vaccinated for hepatitis B or not.

Given the choice of not having sex for one year or donating blood, I know which I am going to choose. I wonder if my fellow heterosexual health care workers are going to be excluded from donating blood as well.

While I think that this change is a move in the right direction I think we have a long way to go. I think that immunisation to protect against hepatitis B may be the key to allowing more gay men to be able to donate blood. Surely if a gay man is able to show proof of immunity to hep B their blood may be acceptable? Being able to demonstrate hepatitis B immunity should be able to reduce this waiting period down to 2-4 weeks.

With regards to gay men to be able to donate blood, unless you are happy to give up sex, I would not hold my breath.

In the meanwhile, please consider vaccination against hepatitis.

Yours in good health.

Dr George

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