Is it time to lift restrictions on sexually active gay men giving blood?

Ireland is importing blood from the UK, where rules for gay donors are different


The importation of blood from the UK by the Irish Blood Transfusion Service (IBTS) this summer drew attention to the rules that forbid sexually active gay men from donating blood in Ireland, compared to more nuanced criteria for gay blood donors in the UK and many other countries.

In fact, some would argue that importing the blood made the Irish rules – whereby gay men are only allowed to donate blood if they have been sexually inactive for a year or more – seem absurd. Blood donated in the UK, which includes blood donated by gay or bisexual men if they have had the same partner for three months or more, is deemed safe to import into Ireland. In Ireland, a man who has had oral or anal sex with another man in the past 12 months is banned from donating blood, even if he uses a condom.

This current one-year deferral was introduced in 2016 and replaced a lifelong ban on men who have sex with men from donating blood. The UK blood donation rules for men who have sex with men were changed from 12 months to a three-month deferral in 2017. Northern Ireland made this change in 2020.

Discriminates

Health researcher James Larkin says it is not acceptable to have a blood donation policy in Ireland that still unnecessarily discriminates against gay men, albeit to a lesser extent. "It's hard not to ascribe this to homophobia," says Larkin, who is studying for a PhD in health economics at the Royal College of Surgeons of Ireland.

READ MORE

He acknowledges that there is a higher rate of HIV amongst the male homosexual population than most other populations. But, he argues that people engaging in risky sexual behaviour, be they heterosexual or homosexual, have an even higher rate of HIV.

Larkin suggests it would be fairer if the IBTS focused on risky sexual behaviour instead of sexual orientation. “It’s unlikely that the risk [of transfusion-transmissible infections] is lower in a heterosexual person having anal sex with multiple partners than a homosexual person having oral sex once in the last year,” says Larkin.

In the UK, anyone who has had anal sex with a new partner or multiple partners in the last three months – regardless of their gender or their partner’s gender – must wait three months before donating blood.

Italy currently has no deferral period for men who have sex with men. Instead, an individual risk assessment is carried out which asks questions unrelated to sexual orientation. "There is no evidence that this has had an effect on transfusion-transmission rates of HIV in Italy," adds Larkin.

Lifelong ban

In 2015, University of Limerick student Tomás Heneghan took a High Court case against the state for the lifelong ban on gay men in Ireland donating blood in place since the 1980s. Heneghan subsequently dropped the case when then minister for health Simon Harris announced a change in policy at the IBTS. And, from 2016, the IBTS replaced the lifelong ban on men who have sex with men from donating blood to a one-year deferral.

The IBTS said at the time that it changed its policy based on changed policies in other countries which didn't result in an increase in the number of HIV-positive blood donations. On its website, the IBTS states that "international experience had shown that a one-year deferral is as effective as a lifetime deferral from the point of view of protecting blood supply against the risk of HIV transmission".

In recent weeks, the IBTS has acknowledged the anomaly in importing blood from a country which has a different approach to risk assessment. “The IBTS is aware of the different approaches to assessing the risk of transfusion-transmissible diseases associated with various social behaviours,” said a spokesperson from the Irish Blood Transfusion Service.

The IBTS has commissioned an independent group to carry out a review of the risks associated with transfusion-transmitted infections. This review will examine the scientific and epidemiological evidence relating to the risks of transfusion-transmissible infections, including the individual risk-assessment process that has been introduced in the UK. The recommendations of this group are expected this autumn.

Sexual activity and blood donation: some of the rules in Ireland

You cannot donate blood in Ireland if:
– You think you need a test for HIV or hepatitis.
– You or your partner have HIV or HTLV.
– You, your partner or close household contacts have hepatitis B or hepatitis C.
– You have ever received money or drugs for sex.
– You have ever injected, or have been injected with, non-prescribed drugs; even once or a long time ago. This includes body-building drugs and injectable tanning agents.

You must not give blood for at least 12 months after you last had:
– Sex with anyone who has HIV, hepatitis B or C or HTLV.
– Sex with anyone who has syphilis or any other sexually transmitted infection.
– Sex with anyone who had ever been given money or drugs for sex.
– Sex with anyone who has ever injected or who has been injected with non-prescribed drugs, even once or a long time ago. This includes body-building drugs and injectable tanning agents.
– Sex with anyone (including your current partner) who may ever have had sex in parts of the world where HIV is very common. This includes Africa and Southeast Asia.
– If you are female: Sex with a male who has ever had oral or anal sex with another male with or without a condom or other form of protection.
– If you are male: Sex with another male, even "safer sex" using a condom or pre-exposure prophylaxis.
(All of the above apply even if a condom or other form of protection was used.)

Read: UK’s new rules mean I can give blood