Background

Patients who depend on donated blood rightly expect the blood to be safe. The Lifeblood 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 Lifeblood has been deferring donors who declare a history of male to male sex since the mid-1980s. The current 12 month deferral period was introduced in 2000 and was considered liberal. The recent international trend is for countries to move from indefinite to time-based deferrals and there are now many with 12 month deferrals. 

In November 2017, UK Lifeblood began incrementally moving from 12 to three months for deferrals for all sexual activity-based risks including male-to-male sex.

The current deferral policy was based on Australian scientific data that indicated men who have sex with men (MSM) pose the greatest risk of HIV transmission.

The policy has been discussed in a number of legal forums. In May 2009, the Tasmanian Anti-discrimination Tribunal stated:

"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)

To ensure any revision to the policy relating to MSM aligns with all other deferral policies relating to sexual activity and is consistent with the 2012 review, the scope of the current review includes 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. No single process can completely eliminate the risk, which is why the Australian Red Cross Lifeblood uses a combination approach:

1. Public promotion of the eligibility criteria. These are explained on the Lifeblood website, in brochures, in the media, and via the National Contact Centre. These inform donors of any reasons they might be deferred from donating blood.

2. Donor assessment. All potential donors fill out a questionnaire and take part in an interview to determine if they meet the eligibility criteria.

3. State-of-the-art tests. All donated blood undergoes thorough testing to identify pre-existing infections and any new infections.

4. Additional processing. Where available, physical and/or chemical measures are used during the processing of blood to inactivate or remove viruses and other infections

5. Since infections and viruses are often sexually transmitted, a number of questions are asked about sexual practices.

6. The eligibility criteria applicable in 2017 relating to sexual activity stated that a potential donor is deferred for 12 months, if they:

  1. are a man who has had sex with another man (i.e. oral or anal sex with or without a condom).
  2. have had sex with a man who they think may have had oral or anal sex with another man,
  3. have had sex with someone who has ever been injected with drugs not prescribed by a doctor or dentist,
  4. have had sex with someone with HIV/AIDS, human T-lymphotropic virus (HTLV) or hepatitis C,
  5. have had sex with someone with hepatitis B (depending on the donor’s level of immunity),
  6. have had sex with a new partner who currently lives or has previously lived overseas in an HIV risk area,
  7. have had sex with a sex worker, or
  8. have 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 or HIV pre-exposure prophylaxis-PrEP) are used.

The Lifeblood internally reviews these eligibility criteria regularly. This Review Committee is part of these ongoing policy reviews, and like the original 2012 Review Committee, was established to provide advice to the Lifeblood on specific questions relating to the risk of sexual activity and blood donation.

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