Key Points
- Australia has restrictions on blood donations from gay and bisexual men, introduced in the 1980s
- Rights advocates want Australia to adopt the same individual risk assessment policy as the US, Canada and UK.
- Changing Australia's blood donation rules involves a "quite complex" process.
The United States' Food and Drug Administration (FDA) announced last week it would ease its restrictions on blood donations for men who have sex with men (MSM) after previous screening rules were labelled "homophobic".
Under the changes, all prospective donors, regardless of their sex, gender or sexual orientation, will be asked a series of questions about their lifestyle to determine their eligibility — a practice known as an individual risk assessment.
If they've had anal sex with new or multiple partners in the past three months, they won't be allowed to give blood.
Those who have taken pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) — medications used to prevent HIV infection — must also defer donating blood.
campaign spokesperson Rodney Croome said it also highlighted how Australia was "slipping further and further behind best practice".
"It sends a message that gay and bisexual men are a threat to public health, and our contribution to saving the lives of others isn't welcome. That's a very stigmatising message — it's basically that we're still second class citizens.
"The other impact of the current policy is that it means there's less safe blood available to save the lives of those in need."
Mr Croome said he'd like to see Australia adopt the same individual risk assessment policy as the US, Canada and UK.
What are Australia's blood donation rules around sexual activity?
More than 1.7 million blood donations are needed every year to meet demand, according to the Australian Red Cross' Lifeblood organisation.
But there are certain rules in place determining who can and can't give blood, in order to maintain the safety of the supply.
Restrictions for gay and bisexual men were introduced in the 1980s at the height of the HIV/AIDS epidemic over concerns of transmission through transfusion.
While the rules have somewhat eased since then, most MSMs and people who have sex with MSMs are still ineligible to give blood, as the tests performed on their donations are unable to detect early HIV infections.
Currently, anyone who answers 'yes' to any of these questions will have to wait three months before they're allowed to donate:
- had oral or anal sex with another man?
- had sex with a male who you think may have had oral or anal sex with another man?
- been a male or female sex worker or had sex with one?
- engaged in sexual activity with someone who ever injected drugs not prescribed by a doctor or dentist?
- engaged in sexual activity with someone who was found to have HIV, hepatitis B, hepatitis C or human T-lymphotropic virus (HTLV) infection?
You may also need to wait to donate if you’ve had sex with a new partner who lives or lived overseas, depending on the level of HIV risk in that country.
How are Australia's blood donation rules changed?
Lifeblood chief medical officer Dr Joanne Pink said Australia's approval process for changes to blood safety rules was "quite complex".
The first step involves Lifeblood making a submission to the Therapeutic Goods Administration, advocating for a change to take place.
If the TGA approves the submission, agreement then needs to be sought from state and territory governments, as well as global biotech company CSL Behring, before it is implemented.
Earlier this year, Lifeblood made a submission to the TGA proposing all sexual activity rules be removed for plasma donation, including for those taking PrEP.
"What's really exciting about plasma is that it's got an additional safety plant called pathogen inactivation, and what that means is that they use a process which can kill off or remove viruses and bacteria," Dr Pink told SBS News.
"That particular process is not currently available for red cells, so we've got more options with plasma.
"To be able to offer this approach without impacting on patient safety is a powerful and inclusive way to potentially allow more people in Australia to help others."
A TGA spokesperson confirmed the application was currently being assessed.
"A decision by TGA is expected in the near future," they told SBS News in a statement.
Mr Croome said while any increase in Australia's blood product supply would be welcome, other countries' experiences showed removing rules for plasma donation didn't address the main problem.
"The issue is continued discrimination in the supply of whole blood, and the fact that whole blood is what is regularly in short supply," he said.
"In Canada and Israel in the last few years, they allowed gay men to give plasma, but not whole blood, and in both of those countries, they found that that wasn't the solution.
"Plasma donation is a much more time consuming and difficult process than donating whole blood … so the amount of plasma given didn't increase very much, and of course, there still continued to be a shortage of whole blood and discrimination in the collection of whole blood.
"Israel and Canada abandoned that pathway very quickly, and both countries moved on to allowing gay men to donate whole blood."
Will Lifeblood recommend changes for MSM whole blood donation?
Lifeblood recently established a research advisory panel to decide whether to recommend individual risk assessment for blood donations, and if so, how it could be best adapted to suit Australia.
Dr Pink said she expected it would take one to two years for Lifeblood to complete the research needed to reach its decision, before a submission to the TGA was even considered.
"We know people want change on this rule, and we do, too," she said.
But Australia couldn't simply introduce new blood safety rules because other countries had, Dr Pink said.
"It is important to consider local health data, such as, for example, how common HIV is across the population, and whether there are particular groups of individuals who may have a higher chance of carrying the infection," she said.
"Within Australia, there are two main groups who have a higher risk of HIV, that's gay and bisexual men, but also, there is a higher risk in heterosexuals who have a sexual partner from a country with a higher risk of HIV.
"The countries that typically have implemented individual risk assessment have a more even distribution of HIV across the population."
Mr Croome said Lifeblood was being "overly cautious" on the issue and needed to act "much more quickly".
"There is almost no difference between the demographics of HIV infection in Canada and Australia. Amongst men, it's almost exactly the same," he said.
The real safety risk came from those who were newly infected with HIV, regardless of their sexual orientation, Mr Croome said.
"The new infection rate amongst gay men is going down to to point where the risk of HIV transmission through blood donation is statistically negligible," he said.
