Steering group concludes on a safe way for more men who have sex with men to give blood
Recommendations from the FAIR (For the Assessment of Individualised Risk) steering group, to enable a more individualised way of assessing safe blood donations, have today been accepted in full by the Department of Health and Social Care. This move will mean men who have sex with men and had the same partner for three months or more will be able to give blood from summer 2021.
FAIR – a collaboration of UK blood services, Public Health England, University of Nottingham and LGBT+ charities, led by NHSBT – came together last year with a shared determination to lead the change towards a more individualised risk assessment for donation.
The group’s analysis of the latest evidence about sexual behaviours and blood donation concluded that changes can be made to the donor health check questionnaire to allow the introduction of new behaviour-based deferrals – a fairer way to maintain blood safety. People are asked to complete the health check questionnaire before they donate to assess eligibility and ensure both the safety of donor and patient.
FAIR was asked by the government two years ago to conduct an evidence-based review to assess if sexual behaviours could be an effective measure of assessing individual risk of sexually transmitted infection, which could be passed on through blood transfusions.
The main findings from FAIR’s evidence review found that people with multiple partners or who have chemsex are the most likely to have blood-borne sexual infections; a strong link between HIV and a history of syphilis or gonorrhoea; and receiving anal sex was identified as the easiest way to acquire a sexual infection from a partner.
When the changes come into effect in Summer 2021 any individual who attends to give blood – regardless of gender or sexuality – will be assessed for eligibility against these sexual behaviour risks and deferred if found to be at a higher risk of infection.
The biggest change will mean anyone who has the same sexual partner for more than three months will be eligible to donate if there is no known exposure to an STI or use of PreP or PEP. Donors will no longer be asked to declare if they have had sex with another man, making the criteria for blood donation gender neutral and more inclusive. A set of other deferrals will also be introduced for the other higher risk sexual behaviours identified, such as if a person recently had chemsex, and updated for anyone who has had syphilis.
FAIR concluded that this new deferral system will maintain the world-leading safe supply of blood in the UK, where there’s less than one in a million chance of not-detecting a hepatitis B, C and HIV infection in a donation.
Su Brailsford, Associate Medical Director at NHS Blood and Transplant and Chair of FAIR said: “Patients rely on the generosity and altruism of donors for their lifesaving blood. We are proud to have the safest blood supply in the world and I’m pleased to have concluded that these new changes to donor selection will keep blood just as safe.
“We welcome this decision by government to accept the recommendations made by FAIR in full. We will keep collaborating with and listening to LGBT representatives, patients and current donors to make sure by Summer 2021, when we bring about these changes, that our process for getting accurate information from donors about their sexual behaviours is inclusive and done well.
“This is just the beginning of a more individualised way of assessing blood donation eligibility and we recognise that more work needs to be done, which is why FAIR has also made a recommendation to government that further evidence-based reviews are needed for other deferrals such as how we determine risk based on travel.”
FAIR carried out an epidemiology review of the latest data on general population and donor blood borne infections to understand the highest risk sexual behaviours for acquiring blood borne STIs. The group then tested behavioural and psychosocial theories to find the best way of phrasing questions of donors about their sexual behaviours within the current limitations of the blood donation process.
The research was supported by a large-scale survey, focus groups and interviews of current and non-donors to assess their sexual behaviours and whether being asked questions about the five highest risk behaviours would affect their willingness to donate and answer accurately.
Most evidence focuses on high risk behaviours – FAIR wants to improve the evidence for allowing potential gay and bisexual donors who are at lower risk to donate. FAIR has made a recommendation to government that more evidence-based reviews can be done to continue to shift blood donation towards more individual assessments of risk.
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FAIR steering group quotes
Eamonn Ferguson, Professor of Health Psychology at University of Nottingham said: “The FAIR project was novel in that it triangulated epidemiological and behavioural science research to identify the best combination of a question to use for the policy change. The behavioural research contributed by exploring the appropriateness, perceived recall accuracy, reliability and potential for self-deferral of these questions, as well as identifying a subset of questions that reliably predicted self-report sexual risk taking. This was achieved using a variety of psychometric analyses of donor and non-donor surveys, and interview with donor staff, donors, non-donors, MSM and patients. The results from these analyses triangulated with the epidemiological evidence and provided additional insights into ways to implement the policy changes.”
Dr Michael Brady, Medical Director at Terrence Higgins Trust, said: ‘Our first priority must be to ensure the safety of the blood supply in the UK. We welcome the move to a more individualised risk assessment approach to blood donation. The UK is leading the way in ensuring that blood donation is more inclusive and now will allow many more gay, bisexual and other men who have sex with men to donate blood.
‘There is certainly more work to do and we will continue to work to ensure that our blood donation service is inclusive, evidence based and both maximises the numbers who can donate while ensuring our blood supply is safe.’
Ethan Spibey, founder of FreedomToDonate, said: “We have campaigned for over 6 years for the restrictions on men who have sex with men (MSM) donating blood to be updated and warmly welcome this announcement.
“This means the UK has one of the world’s most progressive blood donation policies and more people than ever will be able to safely donate for those who need it. The work of the FAIR steering group shows that simply being a MSM is not a good enough reason to exclude someone from donating blood.
“We’ve made great progress and look forward to continuing to work with the Government and others to ensure as many people who could safely donate blood can do so.”
Nancy Kelley (she/her), Chief Executive, Stonewall said: ‘We want to see a blood donation system that allows the greatest number of people to donate safely. This change will help ensure more gay and bi men can donate blood, and represents an important first step towards a donation selection policy entirely based on an individualised assessment of risk. We will continue to work with Government to build on this progress and ensure that more people, including LGBT+ people, can donate blood safely in the future.
‘While we welcome today’s news, we know much more still needs to be done to tackle the challenges that lead to gay and bi men, along with other groups of people including Black African communities, sex workers, and trans communities, being at higher risk of acquiring HIV and other STIs. The recommendations of the HIV Commission set out a clear roadmap for achieving the UK Government’s commitment to ending new HIV infections by 2030, and we will continue to work with the Government and other charities to make this a reality.’
Deborah Gold, Chief Executive at National AIDS Trust, said: “We welcome this step towards a fairer system of individualised, evidence-based assessment of risk for people who choose to donate blood. It’s important that the Government now builds on this to address the remaining inequalities in blood donation policies, such as restrictions for people who have ever injected drugs. In doing so it should prioritise protecting the safety of the blood supply while maximising the potential for people to give blood.
“We now need to see action on the endemic health inequalities that lead to the disproportionate impact of HIV on some groups including gay and bisexual men and people from black African communities. This includes the Government meeting its commitment to end new HIV transmissions by 2030 and implementing the findings of the HIV Commission, which set out how this can be achieved.”
Notes to editor
Read the full recommendations set out by FAIR.
The Government sets blood donor selection criteria based on expert advice from the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO). In 2017, the UK introduced a world-leading blood donation policy reducing the deferral to three months since last sexual contact for MSM. In many parts of the world the deferral is 12 months or longer and in some areas men who have sex with men are asked not to donate at all.
FAIR membership includes NHS Blood and Transplant, Scottish National Blood Transfusion Service, the Welsh Blood Service, the Northern Ireland Blood Transfusion Service, Public Health England, the University of Nottingham, the National Aids Trust (NAT), Stonewall, Freedom to Donate, Terrence Higgins Trust (THT), patient and donor representatives, and experts in epidemiology, virology and psychology.
FAIR was set up at the beginning of 2019 at the request of the Department of Health and Social Care.