Earlier this month I saw 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 1980s.

The US’s Food and Drug Administration’s (FDA) website says:

“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 number of members infected by the HIV virus, so it made sense to not accept blood from this population from a ‘potential risk’ perspective. Since then, 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.

In the early days of blood screening, the only tests available were for antibodies to the viruses. Antibodies are the body’s response to infection, one of the many defences to reduce infections.

Currently in Australia, the Red Cross screens for five 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’.

If only antibody testing is done, there is a risk that blood infected with HIV, hepatitis B or C could slip through to the blood pool as it would not be picked up during this window period. The window period for HIV is three to six weeks but in some cases it can take up to 12 weeks to develop. The window period for hep C is generally two to eight weeks but can be as long as nine 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 one to two weeks post-infection.

Hepatitis B testing is done by checking for the 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 where does this leave gay men who wish to donate blood?

For most gay men, the lifting of this ban will have little effect on their ability to donate blood. Whether you are having unprotected sex with five to six random partners a day or are in a long-term monogamous relationship, as long as you are sexually active you will not be able to donate blood. It doesn’t 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 this change is a move in the right direction, we have a long way to go. Immunisation to protect against hepatitis B may be the key to allowing more gay men to donate blood. Surely if a gay man is able to show proof of immunity to hep B his blood may be acceptable? Being able to demonstrate hepatitis B immunity should be able to reduce this waiting period to two to four weeks.

Regarding gay men being 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.

By Dr George Forgan-Smith
INFO: An excerpt from Dr George’s blog at http://thehealthybear.com.au

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