Patients who depend on donated blood rightly expect the blood to be safe. The Blood Service uses a range of measures which aim to make the blood as safe as possible.
One area of great potential risk is viral infection, particularly, HIV (the virus causing AIDS).
The Blood Service has been deferring donors who declare a history of male to male sex since the mid 1980’s. The current 12 month deferral period was implemented nationally in 2000 and is relatively liberal in comparison to other countries.
The current deferral policy is based on previous reviews of Australian scientific data that indicates that donors who have engaged in male to male sex pose the greatest risk of HIV transmission to blood recipients.
The policy has been tested in a number of legal forums - In the most recent, the Tasmanian Anti-discrimination Tribunal stated in May 2009 :
"It seems to the Tribunal that ongoing scrutiny of the current deferral is a positive feature of our blood banking system in Australia. Ongoing critical review of the policy will ensure that our blood supply is and will continue to be as safe as it can be and ensure that if other viable options are indicated then they will be assessed. New data, enhanced research and refined methods can be considered and the policy reviewed in the light of those developments. It cannot be overlooked that this review and critical analysis will assist in maintaining public confidence in the blood supply". (clause 560)
In order to ensure any revision to the policy relating to men who have had sex with men (MSM) aligns with all other deferral policies relating to sexual activity, the scope of the proposed review has been widened to include all deferrals based on sexual activity but with a particular focus on MSM.
Blood collection agencies worldwide use a number of processes to minimise the risk of infections being spread by blood transfusions. Importantly, no single process can completely eliminate the risk.
The Australian Red Cross Blood Service uses a combination approach, which has four elements:-.
- Public promotion of the eligibility criteria. These are explained on the Blood Service website, in brochures, in the media, and via the National Contact Centre. The purpose is to inform donors of any reasons they might be deferred from donating blood.
- Donor assessment. All potential donors fill out a questionnaire, and take part in an interview, to determine if they meet the eligibility criteria.
- State-of-the-art tests are conducted on donated blood to identify pre-existing infections and any new infections.
- Where available, physical and/or chemical measures are used during the processing of blood to inactivate or remove viruses and other infections
Since infection and viruses are often sexually transmitted, a number of questions are asked about sexual practices.
The current Eligibility Criteria relating to sexual activity state that a potential donor is deferred for 12 months, if they:
- Are a man who has had sex with another man: that is, oral or anal sex with or without a condom.
- Had sex (with or without a condom) with a man who the donor thinks may have had oral or anal sex with another man.
- Had sex with someone who has ever “used drugs” by injection or been injected, even once, with drugs not prescribed by a doctor or dentist.
- Had sex with someone who, in the last 12 months, has had an illness with swollen glands and a rash, with or without a fever.
- Had sex with someone with HIV/Aids, human T-lymphotropic virus (HTLV) or hepatitis C.
- Had sex with someone with hepatitis B, unless the donor has a high level of immunity.
- Had sex with someone who has ever had treatment with clotting factors such as Factor VIII or factor IX.
- Had sex with a new partner who currently lives or has previously lived overseas in an HIV risk area.
- Had sex with a sex worker.
- Worked as a sex worker: i.e. received payment for sex in money, gifts or drugs.
It should be noted that these questions apply even where ‘safer sex’ practises (including condoms) are used.
The Australian Red Cross Blood Service internally reviews these Eligibility Criteria from time to time. This Review Committee is part of that ongoing policy review, however it is being established as body to provide independent advice to the Blood Service in this instance.