Ref: 57492
Dear Mr Wright,
Your comments received after the session at Grantham on the 14th December have been passed to me for further comment and explanation. I see that you consider yourself to be at no higher risk than anyone else as you have regular health checks to verify being "in the clear".
However, our donor selection rules are firmly based on epidemiology within the UK, particularly with regard to infections which can be passed on to recipients by any blood with which they get transfused. This means that we are guided by the current patterns of disease caused by such infections in the general population. Many of these diseases are also sexually transmissible, so we do take into account the latest figures from the UK Health Protection Agency. The infections we are most concerned about are HIV/AIDS, hepatitis B (HBV) and hepatitis C (HCV), but there are several others. Also we have to realise that there may be new undiscovered infections to which some people may be prone – this was the case with AIDS before 1983.
Over the last ten years 15,485 gay men and 18,349 heterosexuals were diagnosed with HIV/AIDS in the UK: 1,782 more people in whom the ‘risk factor’ has yet to be determined were also diagnosed. In 2003 – the last whole year for which figures are available – there were 1,735 diagnoses in gay men and 3801 in heterosexuals (and 802 in whom the risk factor has yet to be determined). Although these figures clearly indicate that more heterosexuals are being diagnosed these days, it must be borne in mind that no more than 10% of men are gay – most estimates put the figure at around 5%. This clearly indicates that the gay male sector of the population are individually at most risk of getting infected with HIV/AIDS.
The annual rate of new diagnoses has increased recently – in the late 1990’s it was about 1,450. In addition, there are now probably at least 300 gay men in the UK who do not know that they are infected. Apart from anything else, this is a cause of worry to health educationalists, and indicates less general awareness among gay men than is often assumed.
We also can learn a lot from the donors whose donations are confirmed to be infected, as every time we find an infected donation we follow up the donor to counsel them and find out what the risk factor – if any – was. In recent years we have found each year that about 25 donations are infected with HIV/AIDS. Up to half of these donations are given by gay men (who did not know they were infected); half of these gay men donors had given some time in the previous two years. Of the 100 or so additional donations found to be infected with hepatitis B, and the 125 or so with hepatitis C, several are also donated by gay men some of whom have donated within the past two years. So we do know that gay men continue to give blood which has to be rejected.
We do test all donations for HIV/AIDS, HBV and HCV. Although we use the best tests available to us no test is absolutely foolproof. We therefore have to assume that of the nearly 3 million donations we test each year, we may not always get the right answer. In particular, donations collected before the infection becomes detectable – during the so-called ‘window period’ – will be missed. We cannot therefore rely absolutely on the testing to exclude infected donations, and therefore have to use the double strategy of excluding people whose lifestyle puts them at risk as well as donations which test positive for infection.
Yours sincerely,
Dr F E Boulton
Consultant Haematologist and Chair, UK Standing Advisory Committee
On the Care and Selection of Blood Donors