Press Release December 2020

Recommendations from the FAIR (For the Assessment of Individualised Risk) steering group, to enable a more individualised way of assessing safe blood donations, have today been accepted in full by the Department of Health and Social Care. This move will mean men who have sex with men in a long-term relationship will be able to give blood from summer 2021.

FAIR – a collaboration of UK blood services, Public Health England, University of Nottingham and LGBT+ charities, led by NHSBT – came together last year with a shared determination to lead the change towards a more individualised risk assessment for donation. The group’s analysis of the latest evidence about sexual behaviours and blood donation concluded that changes can be made to the donor health check questionnaire to allow the introduction of new behaviour-based deferrals – a fairer way to maintain blood safety. People are asked to complete the health check questionnaire before they donate to assess eligibility and ensure both the safety of donor and patient.

FAIR was asked by the government two years ago to conduct an evidence-based review to assess if sexual behaviours could be an effective measure of assessing individual risk of sexually transmitted infection, which could be passed on through blood transfusions. The main findings from FAIR’s evidence review found that people with multiple partners or who have chemsex are the most likely to have blood-borne sexual infections; a strong link between HIV and a history of syphilis or gonorrhoea; and receiving anal sex was identified as the easiest way to acquire a sexual infection from a partner.

When the changes come into effect in Summer 2021 any individual who attends to give blood – regardless of gender or sexuality – will be assessed for eligibility against these sexual behaviour risks and deferred if found to be at a higher risk of infection. The biggest change will mean anyone who has the same sexual partner for more than three months will be eligible to donate if there is no known exposure to an STI or use of PreP or PEP.

Donors will no longer be asked to declare if they have had sex with another man, making the criteria for blood donation gender neutral and more inclusive. A set of other deferrals will also be introduced for the other higher risk sexual behaviours identified, such as if a person recently had chemsex, and updated for anyone who has had syphilis. FAIR concluded that this new deferral system will maintain the world-leading safe supply of blood in the UK, where there’s less than one in a million chance of not-detecting a hepatitis B, C and HIV infection in a donation.

Su Brailsford, Associate Medical Director at NHS Blood and Transplant and Chair of FAIR said:

“Patients rely on the generosity and altruism of donors for their lifesaving blood. We are proud to have the safest blood supply in the world and I’m pleased to have concluded that these new changes to donor selection will keep blood just as safe."

“We welcome this decision by government to accept the recommendations made by FAIR in full. We will keep collaborating with and listening to LGBT representatives, patients and current donors to make sure by Summer 2021, when we bring about these changes, that our process for getting accurate information from donors about their sexual behaviours is inclusive and done well."

“This is just the beginning of a more individualised way of assessing blood donation eligibility and we recognise that more work needs to be done, which is why FAIR has also made a recommendation to government that further evidence-based reviews are needed for other deferrals such as how we determine risk based on travel.”

FAIR carried out an epidemiology review of the latest data on general population and donor blood borne infections to understand the highest risk sexual behaviours for acquiring blood borne STIs. The group then tested behavioural and psychosocial theories to find the best way of phrasing questions of donors about their sexual behaviours within the current limitations of the blood donation process.

The research was supported by a large-scale survey, focus groups and interviews of current and non-donors to assess their sexual behaviours and whether being asked questions about the five highest risk behaviours would affect their willingness to donate and answer accurately.

Most evidence focuses on high risk behaviours – FAIR wants to improve the evidence for allowing potential gay and bisexual donors who are at lower risk to donate. FAIR has made a recommendation to government that more evidence-based reviews can be done to continue to shift blood donation towards more individual assessments of risk.

You can read the full report here: