Blood donations and gay men: Is it all bad blood?

The lifetime blood donation ban on men who have sex with men (MSM) has been in place in various countries since the early 1980s, but this position in blood donation rules has been progressively challenged, and the wave has finally reached Malta.

But concerns and outright fears persist about the potential consequences of the removal of such a ban.

However Mark Grech, a generalist doctor with a special interest in public health, particularly for minorities, says that the safety and integrity of blood products needs to be maintained by looking at risky behaviour, rather than by a blanket ban on a generic group of people.

“It is illogical and indeed discriminatory to allow donations from heterosexual individuals who may have engaged in recent unsafe sexual practices, and simultaneously ban homosexual individuals who may be in a monogamous relationship, or who have practised safe sex,” he said, adding that many independent and medical organisations and experts maintained that the current lifetime ban on MSM is based on an “outdated practice that looks at sexual orientation rather than current sexual behaviour”.

The lifetime ban saw its dawn amid fears in the 1980s that national blood supplies could be infected by blood samples from people who either knowingly or unknowingly, were infected with HIV, but developments in medicine have made the fear somewhat null.

“Prior to the 1980s screening for HIV did not exist,” the medical director of the national blood transfusion service, Dr Alex Aquilina, said, adding that as technology develops, so does the sensitivity and specificity of the tests. 

“What is for certain is that blood has never been safer than today,” he said, stressing that although techniques weren’t completely foolproof, their ability to detect the disease earlier and to avoid false positive results had greatly increased.

“The emphasis in discussions of blood donation should be placed on safety not discrimination,” Dr Monique Abela, a specialist in transfusion medicine from the national blood transfusion service, said. Locally, no cases of infections transmitted by blood transfusion have been recorded since 1998.

“HIV was more prominently transmitted in the past from infected blood derived products (late 1970s, early 80s) due to a lack of awareness about the infection. Hence the vigilance of the national blood transfusion service to not only minimise existing infectious threats from the blood supply, but also to pre-empt as much as possible any other forms of infections which we, as yet, don’t know much about.”

Mark Grech further illustrated his argument against the ban by using examples from other countries, where the ban has been effectively removed. 

“In June 2013, the American Medical Association issued a statement calling on the American FDA to change the policy of a lifetime ban, stating that ‘the lifetime ban on blood donation by men who have sex with men is discriminatory and not based on sound science’.” 

He added that in July 2015, the US Food and Drug Administration (FDA) proposed to change the policy by replacing the indefinite deferral with a one-year deferral. 

Grech further explained that in Australia lifetime bans on blood donation by MSM were ended by the different states between 1996 and 2000. 

“This means that there has now been a substantial period to study the effect of such a change in policy, and a comparison of confirmed HIV positive blood donations before and after the change did not see a statistically significant difference.”

But HIV isn’t the only blood-related pathogen that might be dangerous to human health; indeed the national blood transfusion service routinely tests blood samples for HIV, Syphilis and Hepatitis B and C, with a weekly average of 350 units checked for these markers.

 ”These pathogens are known to be transmitted by sexual contact with infected individuals, intravenous drug abuse, blood transfusions and sometimes even from mother to child,” Monique Abela said, who adds that sexual risk behaviours account for most HIV and HCV infections in men who have sex with men and that most MSM acquire these infections through anal sex, the riskiest type of sex for getting or transmitting these infections.

The rate HIV incidence for men who have sex with men, was 27 out of 39 total HIV incidences in 2014, but this does not mean that HIV is only present in gay men.

“Much greater emphasis and subtlety needs to be introduced into screening policies that look at risky and non risky behaviour across the board, in both heterosexual behaviour and MSM behaviour. Policies should be seen to be based on fact and science, and not on an irrational discriminatory labelling of an entire population segment,” Grech said.

‘Blood has never been safer than it is today’

Grech also confirmed that modern blood testing techniques have progressed significantly over the years. 

“As regards HIV, two tests are routinely performed in checking for the virus; one is a combination test that looks for both a protein on the virus’ surface and the antibody that the body creates as a natural response to the virus,” Grech says.

Another test looks for the virus itself, targeting its nucleic acid.  “If either or both of the tests are reactive, further tests are done to confirm the result, which has made testing more accurate and specific.”

Monique Abela also explained that blood donations are tested for the presence of antibodies against HIV, Syphilis, and Hepatitis C, but that part of the virus, called the Surface Antigen, is sought in the case of Hepatitis B.

She pointed out however, that there is a period between when an infection is contracted to when even the most sensitive test cannot detect it, which is known as the ‘window period’.

“Window periods vary depending on the type of testing used and the type of infection present, but if a person donates blood during the ‘window period’, the infection may not be detected as the immune response may not yet be evident in the blood.”

She stressed that this ultimately means that the infection could be transmitted via a blood donation during this period when it isn’t detected by the test. “Testing after activities of ‘high risk of infection’ is performed at least six months after possible exposure, which covers the window period.”

Abela said that a negative test result after six months is considered reliable and indicates that there is no infection. “Should testing be carried out before this six month period, and a negative result be attained, the donor could potentially still be infective and thus pass on the infection through the blood donation.”

But would it be preferable to have a deferral period when MSM were not allowed to donate blood, to cover the so-called window period? Grech says that the important thing was an understanding that the deferral should be based on risky sexual behaviour, rather than sexual preference.

“At a time when maintaining blood supplies is a continuous challenge and headache, it is wrong and incorrect to permanently exclude a section of altruistic civic minded individuals, who wish to join their fellow citizens in safely contributing to their community.”