Bleeding for Change: Australia Addresses Donor Discrimination

Bleeding for Change: Australia Addresses Donor Discrimination

Written by Monash University fourth year post-graduate medical student and drug design research assistant Brendan Stevenson.

They say that blood is thicker than water, and for many Australians in need of lifesaving blood products this holds true. Australia’s blood banks, namely the Australian Red Cross Blood Service (ARCBS), have initiated several blitzing campaigns over recent years to increase donor numbers to replenish our stores. Despite these efforts there remains a lingering 12-month deferral on Men who have Sex with Men (MSM), and many other high-risk groups, from donating blood in Australia. Although there is change happening in this area, the topical issue brings forward concerns about the interface between science and politics, resource scarcity and LGBTQIA+ discrimination.

All blood products received by the ARCBS undergo screening for blood born infections including Human Immunodeficiency Virus (HIV), hepatitis B (HBV) and C (HBV), syphilis and Human T-lymphotropic Virus (HTLV). Alongside this, donors complete a Donor Health Questionnaire (DHQ) which identifies ‘high risk donors’ including intravenous drug users, recent overseas travellers, MSM and sex workers. The 12-month deferral aims to reduce the risk of Transfusion Transmitted Infections (TTIs). This is due to the window, or seroconversion, periods in which infections remain undetectable. The ARCBDS Transfusion Risks Publication 2019 quotes an estimated 6-day window period for HIV, 16 days for HBV and 51 days for HTLV [1]. Based on similar evidence, the United Kingdom (UK) changed their deferral policy to a 3-month deferral period 2017 [2,3]. Within the past year both Canada and the USA reduced their deferral periods to three months [4,5].

A recent submission by Australian Red Cross Lifeblood (Lifeblood) to reduce the deferral period has been approved by the Therapeutics Goods Administration (TGA) on April 15, 2020. This proposal suggests a reduction of the deferral period to 3-months for a number of groups within the community including but not limited to: MSM, transgender donors who have had sexual contact with a male, sex workers and those who have had sexual contact with an injecting drug user [6]. Changes for individuals taking Pre-Exposure Prophylaxis (PrEP) have not been addressed. This proposal must still be approved by state and federal government but is a step in the right direction.

Beyond misalignment with current scientific evidence, the current policy reinforces a harmful stereotype that exists surrounding the MSM and LGBTQIA+ health in the community. Within the medical education system, the concepts of infectious diseases, psychiatry and the LGBTQIA+ community are often intertwined. Simulated patients for future doctors often present as MSM having recently contracted HIV from risky sexual behaviour. This reinforces a pathological basis of sexuality, an outdated concept. Much has changed over the past 20 years since the 12-month deferral was initiated and policy must now follow suit.   

Just like in the UK, a push from advocacy groups and the scientific community appears necessary to encourage change and keep our policies ethical and evidence based. Groups such as Freedom to Donate worked closely with the UK government to successfully petition for change. In Australia, ANU medical student Ky Ruprecht and his partner Connor, a nurse in the ACT, have started a petition titled ‘All Our Blood’ in 2019 with >7200 signatures. The highest priority will remain with recipient safety, however revising the 12-month deferral is a solution to addressing the issues of evidence-based practice, community inclusion and resource scarcity.

Check out the Queer Health Collective – Monash University

Sign the change.org petition: Australian Blood Donation: Review the Sexual Deferral Period #AllOurBlood

Biography

Author: Brendan Stevenson, BSc (Hons)

I am a current fourth year post-graduate medical student and drug design research assistant in Melbourne. I am passionate about LGBTQIA+ rights, evidence-based policy and promoting ethical healthcare practices.

Another great article on the same topic by a medical student and nurse here

 References

1. Residual risk estimates for transfusion-transmission infections. 2019 Retrieved from https://transfusion.com.au/adverse_events/risks/estimates (Accessed 30/04/2020).
2. Safety of Blood, Tissues and Organs. Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO): Donor Selection Criteria Report 2017. 2017. Retrieved from  https://www.gov.uk/government/publications/blood-tissue-and-cell-donor-selection-criteria-report-2017(Accessed 30/04/2020).
3. Sturrock BR, Mucklow S. What is the evidence for the change in the blood -donation deferral period for high-risk groups and does it go far enough? Clin Med (Lond). 2018;18(4):304-7.
4. Canadian Blood Services. Blood donation waiting period for meno who have sex with men reduced to three motnhs. 2019. Retrieved from https://blood.ca/en/about-us/media/newsroom/blood-donation-waiting-period-for-men-who-have-sex-with-men-reduced-to-three-months (Accessed 30/04/2020)
5. Red Cross Blood. LGBTQI+ donors. 2020. Retrieved from https://www.redcrossblood.org/donate-blood/how-to-donate/eligibility-requirements/lgbtq-donors.html (Accessed 30/04/2020)
6. Therputic Goods Administration (TGA). TGA approves reduction of the deferral period for whole blood donors with sexual activity risk factors. 2020. Retrieved from https://www.tga.gov.au/tga-approves-reduction-deferral-period-whole-blood-donors-sexual-activity-risk-factors (Accessed 30/04/2020)