Photo by Marja Helander
ANAHEIM—A survey of UK blood donors suggests that as many as 30% of donors who are men who have sex with men (MSM) may not be compliant with the MSM blood donor policy.
The UK’s policy requires that MSMs do not donate blood if they have engaged in sexual activity with another male in the last 12 months.
But the survey indicates that as many as 3 in 10 MSMs are disregarding this policy.
The research also suggests that MSMs who do not comply with the policy engage in riskier sexual behavior than non-MSM male blood donors.
However, the researchers found no increase in the number of sexually transmitted infections present in the blood supply since the donation policy for MSMs changed from a lifetime ban to a 12-month deferral period.
The infections evaluated include human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV), and syphilis.
The researchers also emphasized that the prevalence of HIV-positive blood donations in the UK remains low.
She noted that, in 2011, the blood services of England, Wales, and Scotland changed the blood donor policy for MSMs from a lifetime ban to a 12-month deferral since last male-to-male sex.
Before this policy change took effect, the blood services estimated that the change would mean 2679 MSMs would be newly eligible to donate blood (0.7% of male donors), and 8 of these donors would have HIV. So there would be a 0.5% increase in HIV risk.
“But what was clear was that these predictions in terms of HIV risk would be very dependent upon compliance,” Davidson said. “And what we mean by compliance is that a donor understands the rule, applies it correctly, and discloses any relevant information when they’re asked.”
To investigate donor behavior and compliance, Davidson and her colleagues conducted a large-scale, anonymous, web-based survey of blood donors.
Each month for 1 year (2013), all eligible new blood donors and at least an equal number of repeat blood donors in the UK were invited, via email, to complete an online questionnaire asking about their sexual history and compliance with the 12-month deferral policy for MSM (if applicable).
The researchers also looked at UK surveillance data on infections (HIV, HBV, HCV, and syphilis) in new and repeat blood donors over 6 years, comparing the incidence of infections before and after the policy change took effect (3 years pre- and post-change).
Donation and compliance
Among 65,439 survey respondents, 22,776 (35%) were male, and 242 (1%) were MSMs. Among the MSMs, 73 reported male-to-male sex within the last 12 months (non-compliance), and 181 said it had been more than 12 months since their last male-to-male sexual encounter.
The researchers adjusted these proportions for differences among the respondents and the donor population and extrapolated the data to the whole UK donor population.
The team estimated that, among 488,523 UK donors, there would be 5471 MSMs. Of the MSM donors, 3713 would be eligible under the new policy, and 1759 would be non-compliant.
So MSM compliance with the 12-month deferral policy would be 99.7% among all male donors but 70.4% of the MSM population.
“So 3 in every 10 MSMs donating blood in the UK shouldn’t be, [according to the estimates],” Davidson said.
The survey asked non-compliant MSM donors to provide their reasons for non-compliance, and many gave more than 1 reason.
“The reasons seemed to be associated, mostly, with self-assessment of their own risk [of transmitting infection] to be low,” Davidson said. “So that was based on the fact that they were in a monogamous relationship, they used condoms, practiced safe sex, or had regular [sexual health] screenings.”
However, there were some donors who regarded the policy as unimportant or said they didn’t agree with it. And there were some donors who didn’t declare their sexual behavior because they knew they wouldn’t be allowed to donate if they did.
Among all male respondents who reported having sex within the last 12 months, MSMs were more likely than men who had only female sexual partners to report having sex with more than 1 partner. Fifty percent of MSMs had more than 1 sexual partner in the last 12 months, as did 9.1% of male donors with only female sexual partners.
Ten percent of MSMs reported paying for sex, as did 0.3% of non-MSMs. None of the MSMs reported having a partner who was HIV-positive, and less than 0.1% of non-MSMs said they had an HIV-positive partner.
Eleven percent of MSMs said they had a history of sexually transmitted infection, as did less than 0.1% of non-MSMs.
“So among the responders, there was very low numbers who reported a high-risk partner in the last 12 months,” Davidson noted. “But there was some suggestion, among these low numbers, that this was more common in the MSMs than the non-MSMs.”
She also acknowledged that some donors were unsure about whether they had a high-risk partner in the last 12 months.
The UK surveillance data on infections encompassed HIV, HBV, HCV, and syphilis.
In all, 3,667,408 blood donations from males were tested for infection in the 3 years prior to the MSM donor policy change, and 3,066,076 donations were tested in the 3 years after the change was implemented.
There were 428 donors who reported having an infection risk before the change and 268 who did so after. There were 577 donors who actually had an infection before the change and 434 who did after. And there were 32 infected MSM donors before the change and 34 after.
“So the number of male donors fell post-change by approximately 20%, [and] the total number of infected donors . . . fell by almost 30%,” Davidson noted.
“However, the number of MSM infected donors marginally increased, [and] the proportion of male infected donors who were MSMs, among all of those who reported a risk, increased from 7% [32/428] to 13% [34/268]. So there seems to be some impact [on infection] from MSMs, but the numbers are very small, and these differences are not significant.”
Predictions and HIV infection
Finally, the researchers compared their predictions from before the MSM blood donor policy change to the actual data after the change. This comparison assumed that the absolute number of compliant MSMs did not change after the policy changed.
In 2007, the group predicted there would be about 2 million blood donations, including 2679 from MSMs. In reality, in 2014, there were 1.9 million blood donations, including 3126 from MSMs.
The researchers predicted the number of HIV-positive donations would be 30, including 8 from MSMs. In reality, in 2014, there were 13 HIV-positive donations, including 1 from an MSM.
So the predicted HIV prevalence per 100,000 donations was 1.4, and the actual HIV prevalence was 0.7. The predicted HIV incidence per 100,000 person-years was 0.9, and the actual HIV incidence was 0.7.
The predicted HIV risk was 0.022 per 100,000, and the actual HIV risk was 0.016 per 100,000.
“So the estimated risk of HIV post-change remains very low,” Davidson noted, adding that she and her colleagues will continue to monitor the impact of the policy change.
*Data in the abstract differ from data presented at the meeting.