Australian Blood Donation: Screen for individual risk not sexuality

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Many people are unaware that as a man in a same-sex relationship in Australia in 2019 I cannot donate my blood. My partner of many years cannot donate his blood either. He is a nurse and I am a medical student. We are in a long term monogamous relationship and we are both negative for any bloodborne diseases. Our colleagues regularly donate blood and are often surprised to learn that we cannot. A blanket 12 month ban exists for all men who have sex with men (MSM) irrespective of circumstance. This is defined, by the Red Cross Blood Service as men who engage in oral or anal sex with or without a condom.

The most important consideration for blood donor eligibility is to maintain a secure and safe blood supply. This is achieved through screening questionaires which identify high risk behaviour and by testing blood donations for infections. Screening questionaires aim to remove individuals who engage in behaviour that places them at higher risk of bloodborne diseases leaving a pool of low risk donors. Donations are then rigorously screened for bloodborne diseases. The current exclusion of all men who have sex with men (MSM) assumes all MSM carry equally high risk of disease. While the HIV incidence and prevalence is higher in MSM populations (this is frequently cited by the Red Cross), the contact risk of exposure is not the same for every individual in this subgroup. The MSM population reflect a diverse spectrum of people. Blanket bans do little to accurately stratify individual risk. Instead screening tools that assess high risk behaviour would offer a more accurate assessment of donor eligibility.

Currently a heterosexual person can engage in unprotected sex with as many partners as they like, in whatever way they like and are eligible to donate. A monogamous gay man who can prove his negative disease status cannot. It is discriminatory to be selectively precautious for one sub population while having shorter deferrals or completely ignoring other high-risk populations.

Shortening the deferral period to 6 months, as has been suggested, does nothing to remove the barrier of MSM donation. The current policy is a remnant of historical prejudice reinforcing the belief that all MSM engage in promiscuous and irresponsible sexual practice. This blanket refusal of MSM blood casts a wide net of unnecessary exclusion. Shifting away from a categorical ban towards individual screening risk would increase the donor pool without increasing the risk of transfusion associated transmission of disease.

Would you refuse our blood if you or your family were in need?

Through sharing our story we hope to illustrate flaws that exist with the current donor eligibility criteria and urge the TGA to review their policies. We would like to acknowledge that the current policy also precludes trans and non binary folk from donating if they engage in activity with “MSM” as defined by the TGA. This ban also extends to females who have relations with MSM. In the early 2000's Australia was one of the first countries to move from a permanent ban on MSM donors to adopt a 12 month deferral in line with best evidence at that time. Almost 20 years later we are lagging behind the currently accepted best practice.