Recommendations from the FAIR (For the Assessment of Individualised Risk) steering group, to enable a more individualised way of assessing safe blood donations, have been accepted in full by the Department of Health and Social Care, which means men who have sex with men (MSM) in a long-term relationship will be able to give blood from summer 2021.
Led by NHS Blood and Transplant (NHSBT), FAIR – a collaboration of UK blood services, Public Health England, University of Nottingham and LGBTQ+ / sexual health charities, including Terrence Higgins Trust (THT) and Stonewall – 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, which ther group says is 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 NHSBT and Chair of FAIR, said: “We welcome this decision by government to accept the recommendations made by FAIR in full. We will keep collaborating with and listening to LGBTQ+ 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.”
Dr Michael Brady, Medical Director at THT, added: “Our first priority must always be to ensure the safety of the blood supply in the UK. We welcome this move to a more individualised risk assessment approach for any potential donor, which both maximises the number of people who can donate while ensuring the blood supply is safe.
“Eligibility to donate blood will now be based on the behaviours identified as being at highest risk of infection, rather than gender or sexuality. This means the removal of the three month deferral period for gay, bisexual and other men who have sex with men. Welcome changes include the differentiation between oral and anal sex, and for those whose partner is HIV positive and virally supressed due to six months or more of adherence to treatment.
“There is certainly more work to do and we will continue to work to ensure that our blood donation service is inclusive and evidence based. The scope of this review was to consider the three month deferral period for men who have sex with men, which has been addressed. We now need to look at the restrictions in place for other groups, including former injecting drug users, to see if we can safely make the blood donation eligibility even more inclusive.”
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