The NHS needs nearly 400 new blood donors a day to meet demand. Yet a blanket rule for men who have sex with men means they cannot donate blood without abstaining from sex.
Blood donation is crucial to keep the health service running. To maintain a safe blood supply and protect donors, there are restrictions on who can donate blood and when. For example, you can't give blood if you are unwell or have had a new piercing in the preceding four months.
One of the most controversial restrictions is that men who have sex with men (MSM) cannot donate blood unless they have abstained from all sex for at least three months.
A lifetime blanket ban on blood donation for any man who had ever had sex with a man was introduced following a rise in HIV and hepatitis B cases in the 1970s and 1980s. Once it was realised that these conditions could be passed on through blood, it was crucial that those who were most at risk of contracting the viruses, including gay and bisexual men, were not able to pass them on through blood donation since effective screening was not yet available.
In 2011, the ban was lifted and replaced by a twelve-month deferral period in which MSM had to abstain from sex to be allowed to donate blood.
The rules were again updated at the end of 2017 following years of campaigning by sexual health and LGBTQ+ organisations. However, the new three-month deferral period still prevents many MSM from donating blood if they are having regular sex.
"Anyone can acquire a blood-borne virus or a sexually transmitted infection (STI), but some people have an increased risk of exposure. At a population level, men who have sex with men have a higher risk of acquiring blood-borne infections," says a spokesperson for NHS Blood and Transplant (NHSBT).
"We have a three-month deferral because there is a small possibility the tests we carry out are not able to pick up recently acquired infections. If someone was to donate blood during this time, known as a window period, it would be possible to transmit an infection," they explain.
Organisations who campaigned for the deferral period to be reduced argued that modern screening techniques made a lengthy period of abstinence unnecessary.
"You have to weigh up the balance between making sure that any risk to the blood supply is properly mitigated and making sure that people aren't being unfairly prevented from giving blood should they wish to," says Kat Smithson, director of policy at National AIDS Trust (NAT) which advocated for the change.
"We felt that most infections would be picked up after a three-month period and therefore there was no reason to have this additional nine months whereby someone couldn't give blood. It wouldn't make any difference to the blood supply. It meant that the rules were much fairer and more in line with the Equality Act."
With most HIV tests that you can take at a sexual health clinic, you can have a fairly accurate result after four weeks and a definitive result after six weeks. Other blood-borne infections have different window periods.
MSM aren't the only group affected by bans or deferrals for blood donation, explains Smithson. "Although they are one of the most significant groups affected by this, there are also other people who are affected by the rules and who may wish to give blood. For example, people who have previously worked as sex workers or people who have previously injected drugs."
In the past, sex workers were banned for life from donating blood - as with MSM, they can now donate from three months after the last time they had sex. The same applies to people who have sex with partners in groups known to have a high risk of STIs.
When anyone donates blood in the UK, they must fill out a questionnaire to establish any behaviours which may put their blood at risk of infection, including recent piercings and travel. The blood is then screened to make sure that it is safe to be used in transfusions and transplants.
"All donations are routinely tested for hepatitis B, hepatitis C, hepatitis E, human immunodeficiency virus, syphilis and, for first-time donors, human T-lymphotropic virus. There are other tests that are used for specific risks - for example, West Nile Virus for those who have travelled to areas where West Nile virus is common," explains the NHSBT spokesperson.
"If any blood donation tests positive for infection, it is not released into the blood supply chain and therefore cannot be issued to a patient."
The priority of the blood donation service is to maintain a safe and continuous blood supply which can save lives in hospitals across the country.
"We can reassure the wider public that modern safety standards are rigorous, and our blood supply is one of the safest in the world," the spokesperson says.
"The blood donor selection criteria and a wide range of other blood safety measures, including stringent testing, mean that in the last 10 years of the Serious Hazards of Transfusion (SHOT) Report just two cases of confirmed transfusion-transmitted hepatitis B infection were shown and no incidences of transfusion-transmitted hepatitis C or HIV infections in the UK.”
The deferral period applies to MSM regardless of the kind of sex had, whether a barrier method was used to protect against STIs, those involved have tested negatively for STIs or if a person is in a monogamous relationship.
For heterosexual people and women who have not had sex with MSM, 'risk' is assessed through specific conditions and experiences which prevent them from donating blood, including having paid for sex or had sex with someone who has an STI.
Many organisations are now pushing for a case-by-case approach to blood donation for MSM, says Smithson. "It's important that we continue to review and make sure that there aren't still people who could be safely giving blood without a high risk to the blood supply who are caught by these catch-all rules.
"We're looking at whether or not an individualised risk assessment could be the way forward. We want to work with SABTO (the advisory committee on the Safety of Blood, Tissues and Organs), who make the recommendations, and work with people who might be affected by these rules to find out the best way of doing that."
NHSBT is currently considering a risk-based policy, although it will take time to come into effect, explains their spokesperson.
"We're working with key stakeholders to explore the potential for a more individualised risk assessment donor selection policy," they said.
"We hope to report our findings towards the end of 2020. Any changes to donor selection must be based on the best available evidence to ensure that we continue to have one of the safest blood supplies in the world."
Asking the right questions
Part of the difficulty of introducing an individual risk assessment is making sure that the public are comfortable with personal questions they will have to answer and finding a setting, face to face or online, where those questions will be appropriate, explains Smithson.
"The questions have got to properly assess risk and be acceptable to people at the point where they're going to donate blood. They might look at, for example, levels of risk between oral sex, anal sex and vaginal sex. It's really important that you get these questions right, as more detailed questions about sexual behaviours could deter some donors," she says.
"There is a lot of value, potentially, in moving toward this individualised case-by-case risk assessment system but it has to be got right."