Scottish National Blood Transfusion Service
POSITION STATEMENT: WHY WE ASK GAY
MEN NOT TO GIVE BLOOD:
Revised: 14th August 2007
Key Messages

The decision to exclude men who have had sex with men is not intended to infringe
the civil liberty of any individual

It is based on robust scientific evidence and on a sincere and honest desire to protect
the safety of the blood supply and the patients who receive it.

The UK blood services use state of the art testing systems but we cannot test for
everything. We do test all blood for HIV, Hepatitis B & C, syphilis and HTLV. However,
even the most sensitive test may miss infected donations during the ‘window period’
between getting an infection and the test being able to show a positive result.

The most recent data on the risk factors associated with these infections are reviewed
annually by a panel of experts from blood transfusion services, hospitals and
universities throughout the United Kingdom and consideration is given to changing the
donor selection criteria

We recognise that many gay men sincerely wish to help patients and may be
frustrated and angry as a result of this rule. We ask that those affected by this rule
observe it for the sake of blood safety.
Background
The primary responsibility of the Scottish National Blood Transfusion Service is to provide
safe blood for patients in Scotland requiring transfusion. We do this in two ways: by selecting
donors who are at low risk of infections and by testing every donation. Selecting safe donors
means that we have to ask some people not to donate their blood. SNBTS is legally required
to permanently exclude anyone whose sexual behaviour puts them at high risk of acquiring
severe infectious diseases that can be transmitted by blood (Blood Safety And Quality
Regulations (No 50) 2005). Acting on the advice from the Joint United Kingdom Blood
Transfusion Services and National Institute of Biological Standards and Control Professional
Advisory Committee (JPAC), the four United Kingdom Blood Transfusion Services are
currently unable to accept blood donations from men who have ever had sex with a man
because the most recent epidemiology indicates that this group is still at a significantly higher
risk of exposure to transfusion transmissible infections.
This donor selection rule is often misunderstood and perceived to be discriminatory. The
decision to ask gay men who are or have been sexually active is in no way prejudicial or
discriminatory but is based on the most up to date epidemiological information available on
the transmission of blood borne viruses such as HIV, HTLV, Hepatitis B and hepatitis C in the
UK.
How we assess the risks
The most recent data on the risk factors and behaviours associated with HIV, HTLV, Hepatitis
B and hepatitis C infections in the UK are reviewed annually by a panel of experts from blood
transfusion services, hospitals and universities throughout the United Kingdom and
Footnote: This statement has been prepared by SNBTS after reviewing the evidence available in October 2005. Since then the
annual review has continued but the format of the risk assessment has changed. The evidence still indicates that there remains a
significantly higher risk of HIV infection in men who have sex with men when compared to the heterosexual population. At this
time, SNBTS await the UK guidance resulting from the most up to date risk analysis conducted in 2006.
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Scottish National Blood Transfusion Service
POSITION STATEMENT: WHY WE ASK GAY
MEN NOT TO GIVE BLOOD:
Revised: 14th August 2007
consideration is given to changing the donor selection criteria. These data are used to identify
groups within the population who may be at higher risk of infection. Of necessity the UK blood
services need to consider risk at a population level because we cannot accurately assess the
risk posed by any one individual.
Understanding the Facts And Figures
This donor selection rule is often misunderstood and perceived to be discriminatory. This is
not the case. Recent media coverage on the increase in incidence of HIV transmission in
heterosexuals has led to the widely held misinterpretation of the data to suggest that the risk
of HIV infection is greater for heterosexuals than for homosexual men.
While the absolute number of cases of HIV in heterosexuals diagnosed annually is greater
than for men who have had sex with men, when the size of the respective populations is
taken into account it can be seen that the relative risk of exposure is very different.
In the 10 years preceding 2005 46% of HIV cases diagnosed were gay men. If we consider
that only 5-10% of the population are men who have had sex with men yet this group give
rise to just under half of all new cases diagnosed, this would indicate that a man who has
had sex with a man is still seven times more likely to contract HIV than a heterosexual.
Moreover, the situations in which heterosexuals are at risk of exposure are for the most part
well defined, and result in deferral of those affected, and their partners, from blood donation
for one year after potential exposure.
With respect to current (most recent) data on HIV prevalence in the UK (i.e. new cases),
from unlinked anonymous HIV testing surveys undertaken throughout the UK in 2003, it is
evident that the prevalence of HIV among men who have sex with men is between 5 and 10
times the prevalence of HIV among heterosexual men and women: these observations
apply to individuals attending genitourinary medicine clinics and exclude persons already
known to be HIV infected. For MSM throughout the UK, the prevalence ranged from 1.8 to
5.2% and for heterosexual men and women between 0.1 to 0.7%.
Risk Factors in Heterosexual Men and Women
The increase in incidence of HIV in heterosexual men and women is a cause for concern,
but review of the risk factors indicates that 76% of all heterosexual cases are associated
with sex while abroad or with a partner from overseas. The most common geographical link
is with partners in or from sub-Saharan Africa. This risk factor has been known since the
mid 1980s and the UK services have questioned donors on this risk factor and excluded
donors for this risk since that time.
The UK Blood Services are often asked why we do not exclude women who have oral or
anal sex with men while we exclude men who practice the same sexual acts. The risk of
infection does not relate to any individual sexual practice but to the sexual partner.
Therefore the UK services do exclude women who have had sex (oral, anal or vaginal) with
a man who has had sex with a man, an iv drug user or someone who has been sexually
active in sub-Saharan Africa.
Footnote: This statement has been prepared by SNBTS after reviewing the evidence available in October 2005. Since then the
annual review has continued but the format of the risk assessment has changed. The evidence still indicates that there remains a
significantly higher risk of HIV infection in men who have sex with men when compared to the heterosexual population. At this
time, SNBTS await the UK guidance resulting from the most up to date risk analysis conducted in 2006.
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Scottish National Blood Transfusion Service
POSITION STATEMENT: WHY WE ASK GAY
MEN NOT TO GIVE BLOOD:
Revised: 14th August 2007
Recent Blood Service Experience
In the 5 years preceding 2005 over 100 new cases of HIV were detected by the UK
transfusion services. 45% of these cases were from heterosexual men and women who had
sex while abroad, sex with someone from overseas or a partner from another high-risk group.
28% of these cases were men who had sex with men. This is extremely worrying. Most gay
men do not give blood and it is estimated that up to 97% comply with our rules. It is also
estimated that less than 10% of the population are men who have had sex with men. This
means that less than 1% of the population give rise to 28% of the cases of HIV that we detect
in the donor population.
Approximately half were new donors but more worryingly, the other half of these cases were
gay men who had become infected between donations and who had not previously declared
their lifestyle. We recognise that gay men may well not perceive themselves to be at risk
because they practice ’safe sex’ or are in a monogamous relationship or always know the HIV
status of their partner. If these men did not consider themselves to be at risk of infection, how
could we as a service accurately assess individual risk? The fact that we consistently
diagnose infection in men, who did not consider that they were at risk, and therefore did not
declare it to us, clearly indicates that these risks are very real.
How safe is ‘Safe Sex’?
Although condoms can reduce the risk of transmitting infections, they cannot reduce the risk to
such low levels as to make sexual activity risk free. The term preferred by the Terence
Higgins Trust is ‘safer sex’. Safer sex will keep most gay men free from infection, however
recent research (Hart & Williamson 2005) indicates that in Scotland there has been a
significant rise in sexual behaviours which would increase the risk of HIV infection, while at the
same time there is a decreased awareness and perception of risk of infection. Additionally
research shows that allowing gay men, as a group, to donate would increase the risk of HIV
infected blood entering the blood supply. Abolishing the rule for gay men would increase the
risk of an HIV infected donation entering the blood supply by about five times and changing
the rule to allow gay men to donate one year after they last had sex with a man would
increase the risk by 60% (Soldan & Sinka 2003).
How effective is testing?
There is a misconception that the need to exclude gay men is unnecessary because we test
for everything. This is not true. The UK blood services use state of the art testing systems but
we cannot test for everything. We do test all blood for HIV, Hepatitis B & C, syphilis and
HTLV. However, even the most sensitive test may miss infected donations during the ‘window
period’ between getting an infection and the test being able to show a positive result. Such
donations can be highly infectious, and it is for this reason that transfusion services throughout
the world regard donor selection based on risk behaviour as vitally important even when the
most sophisticated testing strategies are in place. That’s why it is so important that donors
read the health check carefully every time and answer the questions honestly.
Many men who contact us tell us that they are regularly tested and that they therefore
consider themselves safe to give blood, The results of regular testing, while reassuring to the
individual, do not help us to assess the risk of a window period donation, since this can only
occur in an individual who has been uninfected until a recent exposure has occurred.
Footnote: This statement has been prepared by SNBTS after reviewing the evidence available in October 2005. Since then the
annual review has continued but the format of the risk assessment has changed. The evidence still indicates that there remains a
significantly higher risk of HIV infection in men who have sex with men when compared to the heterosexual population. At this
time, SNBTS await the UK guidance resulting from the most up to date risk analysis conducted in 2006.
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Scottish National Blood Transfusion Service
POSITION STATEMENT: WHY WE ASK GAY
MEN NOT TO GIVE BLOOD:
Revised: 14th August 2007
How important is it to answer truthfully?
Evidence of how important this type of donor selection is can be seen in the data which
show that 76% of new heterosexual HIV infections in the general UK population result from
sexual activity with a partner from an area outside the UK with a high prevalence of
infection, while only 55% of the heterosexual cases detected in the blood donor population
can be ascribed to this risk behaviour. This shows that the risk is significantly reduced by
selecting safe donors and deferring affected donors until there is no risk of a ‘window period’
donation.
Why are all MSM permanently excluded?
We recognise that within the gay male community there is a variety of lifestyles and
acknowledge that many gay men are monogamous, use condoms and seek regular testing.
While it would seem logical to assume that this would significantly reduce the risk of
contracting HIV or Hepatitis, the available data does not have sufficient detail to allow us to
assess the remaining risk in order to consider changing the donor selection criteria. No
alternative set of donor eligibility criteria (even including practice of safe sex or a low number
of lifetime partners) has yet been found to reliably identify MSM who are not at increased risk
for HIV or certain other transfusion transmissible infections.
Legal Requirements
In the UK (and the European Union) the Consumer Protection Act (CPA) requires the blood
services to provide safe transfusions. This status of blood as a product required to be safe
was defined in the 2001 judgement of Mr Justice Burton. It is conceivable that additional HIV
transmissions by blood that occurred after a relaxation of the donor guidelines would not only
represent a “non-standard” product under the CPA but could be interpreted as negligence,
given that the ways and means of maintaining blood safety were known to the UK blood
services but were wilfully relaxed.
Civil Rights
Every individual has the right to be considered to be a blood donor. Every donor who is not
accepted to give blood has a right to receive a clear explanation as to why they cannot
donate. The patients who receive blood are vulnerable and require the very best care that we
can provide. They have the right to expect that the blood they receive is as safe as possible.
We realise that many gay men sincerely wish to help patients and may be frustrated and
angry as a result of this rule. The decision to exclude men who have had sex with men is not
intended to infringe the civil liberty of any individual but is based on robust scientific evidence
and on a sincere and honest desire to protect the safety of the blood supply and the patients
who receive it. We ask that those affected by this rule observe it for the sake of blood safety.
Footnote: This statement has been prepared by SNBTS after reviewing the evidence available in October 2005. Since then the
annual review has continued but the format of the risk assessment has changed. The evidence still indicates that there remains a
significantly higher risk of HIV infection in men who have sex with men when compared to the heterosexual population. At this
time, SNBTS await the UK guidance resulting from the most up to date risk analysis conducted in 2006.
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