NOTES:

All donors are provided with information about keeping blood transfusions safe so that those at risk refrain from donating (Blood Safety Information). It is the responsibility of the RN to ensure that this information has been read and understood.

All potential donors must read and understand this information on donor self-exclusion.

Definitions:

Individual Risk is based on the donor’s sexual behaviour, including new partners and multiple partners

Sexual contact is defined as oral, vaginal or anal sex.

Anal sex is defined as penile-anal intercourse only. It does not apply to oro-anal sex or the use of sex toys.

Chemsex is a type of sexual activity where people take certain drugs such as methamphetamine, mephedrone, GHB/GBL or other drugs, before or during sex, for the specific purpose of enhancing sexual experience and reducing inhibitions, and letting them have sex for longer or with more people. Chemsex does not refer to sex after using alcohol, cannabis or recreational drugs for other purposes, or the use of drugs such as Viagra or other medications for erectile dysfunction.

ACTION:

• Any donor who states that they are donating just to get a test for HIV, HTLV or hepatitis must be questioned about their risk/s. Defer or permanently exclude the donor as appropriate and advise the donor to attend their GP or a Sexual Health Clinic for testing
• Defer or permanently exclude any donor who thinks they need a test for HIV, HTLV or hepatitis
• Defer or permanently exclude any donor who thinks their partner needs a test for HIV, HTLV or hepatitis
• Permanently exclude any donor who has HIV or is receiving treatment for HIV, even if they are virally suppressed and HIV is undetectable by PCR
• Permanently exclude any donor whose sexual partner has HIV or is receiving treatment for HIV, even if they are virally suppressed and HIV is undetectable by PCR
• Permanently exclude any donor who has HTLV
• Permanently exclude any donor whose sexual partner has HTLV – REFER TO HTLV risk management in additional information below
• Permanently exclude any donor who has hepatitis B or hepatitis C
• Permanently exclude any donor whose sexual partner has hepatitis B or hepatitis C*
• Permanently exclude any donor whose household contact** has hepatitis B or hepatitis C
• Permanently exclude any donor who has ever had or been treated for syphilis or gonorrhoea
• Permanently exclude any donor who has ever been given money or drugs for sex
• Permanently exclude any donor who has ever injected or been injected with non-prescribed drugs, even once or a long time ago. This includes body-building drugs, injectable tanning agents and injected chemsex drugs

* See Hepatitis B Virus, Hepatitis C Virus

** Household contacts are defined as permanent residents of the household

The risk relates to items that may contain trace amounts of blood such as toothbrushes, scissors, razors and tweezers. Permanent residents are permanently excluded, as above, even if they are not aware of any incident where they may inadvertently have shared toothbrushes or other items. Immediate family members who are not normally permanent residents of the household, and who are satisfied that they have not shared such items, can be accepted as donors. Similarly, visitors to the household are not defined as household contacts. However, all visitors should be asked if they have shared items of risk (including inadvertently) and accepted or deferred based on their response

• Defer any donor who has had oral, vaginal or anal sex with a person who has or the donor thinks may have HIV, hepatitis B or hepatitis C, for 4 months after the last sexual contact
• Defer or permanently exclude any donor who has EVER had oral, vaginal or anal sex with a person who has or the donor thinks may have HTLV. REFER TO HTLV risk management in additional information below
• Defer any donor who has had oral, vaginal or anal sex with a person who has or the donor thinks may have syphilis, gonorrhoea, or other STI, for 4 months after the last sexual contact. This excludes genital warts and secondary genital herpes
• Defer any donor who has had oral, vaginal or anal sex with a person who has ever been given money or drugs for sex, for 4 months after the last sexual contact
• Defer any donor who has had oral, vaginal or anal sex with a person who has ever injected or who has been injected with non-prescribed drugs (including body building drugs, injectable tanning agents and injected chemsex drugs) even once or a long time ago, for 4 months after the last sexual contact

NB: All the above apply even if a condom or other form of protection was used

• Defer any donor who had anal sex with a new sexual partner for 4 months after the last anal sex

A new sexual partner is someone a donor has not had sex with before or a person with whom the donor resumed/restarted a previous sexual relationship

in the past 4 months

• Defer any donor who had more than one sexual partner in the past 4 months AND who had anal sex with any (even one) of the sexual partners in the past 4 months
• Defer the donor for 4 months after the last anal sex

NB: All the above apply even if a condom or other form of protection was used

• Defer any donor who has taken part in chemsex activity for 4 months thereafter This deferral applies to oral sex, vaginal sex and anal sex
• If the donor injected or was injected with chemsex drugs, even once, or a long time ago, he/she must be permanently excluded from donating
• Defer any donor who has taken medication to prevent HIV infection (pre/post exposure prophylaxis (PrEP/PEP) for 4 months thereafter
• Defer any donor who snorted cocaine or any other non-prescribed drug for 4 months thereafter

NOTE 1:

If a donor had a once off sexual encounter and therefore does not know if any of the high risk questions apply, the donor must be deferred for 4 months after the sexual contact.

If a donor does not know if any of the high risk questions apply to their sexual partner and they do not want to ask, the potential donor must be questioned to ascertain whether they have any doubts about their partner. In the event that he / she expresses doubt the donor must be deferred for 4 months from the last sexual contact or, in the event of an on-going sexual relationship, the donor must be permanently excluded. The donor can be advised that if they later confirm with their partner that there is no risk, they can return for another EDI and the deferral can be aged.

NOTE 2:

The Irish Blood Transfusion Service does not offer a testing service for sexual partners of potential donors, either on clinic or at the National Blood Centre or Munster Regional Transfusion Centre.

SEE IF RELEVANT:

• AIDS 
• HIV
• HIV TESTING
• HEPATITIS - RISK ACTIVITY
• HEPATITIS C VIRUS
• PRE AND POST EXPOSURE PROPHYLAXIS (PrEP / PEP)
• SYPHILIS
• GONORRHEA

ADDITIONAL INFORMATION

HTLV Management for Donors at risk due to sexual contact

Testing for HTLV commenced in the IBTS in 1996 for all donations. With effect from 19th February 2024, testing will only be carried out on donors who have no test result for HTLV on eProgesa.

Testing will be carried out routinely on the following donors:

• New Donors who are giving samples only e.g. N, C or L samples
• Donors who are donating for the first time in the IBTS (who have not already given samples that were tested for HTLV)

NB:New donors who gave N, C or L samples that tested negative for HTLV will not be tested again on their first donation

Regular donors and returning donors will not be tested again for HTLV if they have a negative HTLV result on record on eProgesa

There are 2 exceptions to the above. The following donations will be tested for HTLV as they are not leucodepleted:

• Granulocyte donations
• Serum for Tears donations

Donors who are at risk of HTLV due to sexual contact

Donors who are at risk of HTLV due to sexual contact will be identified at interview, by asking all donors, at every attendance, the following question:

‘’Have you ever had sex with anyone with HTLV?’’

NB:This risk applies to vaginal, oral and anal sex

• All donors whose current sexual partner has HTLV are permanently excluded
• All donors who are at risk of HTLV due to sexual contact will be deferred/permanently excluded until 4 months after their last sexual contact

Once the 4 months have elapsed, they will be tested for HTLV either:

• As part of the routine screening tests that are done on all donors who have no test result for HTLV on eProgesa e.g. new donors who are giving N/C/L samples and new donors who are donating for the first time (who have not already given N/C/L samples)

Or

• Organised by the Medical Virology Dept. for donors who have previously been tested and have a negative HTLV result on eProgesa e.g. regular donors and returning i.e. lapsed donors who are on eProgesa

NB: There is no facility available on eProgesa for clinic staff to request a HTLV test

NB: Lapsed donors who are not on eProgesa (as they have not donated in many years) will be tested as new donors on eProgesa and will be tested for HTLV

If a test is required on a regular or returning donor, due to sexual contact, clinic staff will permanently exclude the donor with code 9018 and refer them to Virology (FAO Virology on the HLQ) and add a comment to Medical Notes to reference the most recent date of sexual contact. Medical Virology staff will contact the donor and will arrange testing when 4 months have elapsed since the last sexual contact. If testing is negative, Virology staff will add a comment to Medical Notes, confirming that the donor tested negative for HTLV, a minimum of 4 months after the last sexual contact, and will age code 9018

The donor is then eligible to donate. It must be confirmed on clinic that the donor has not had any further sexual contact with anyone with HTLV

The following are examples of scenarios that may arise on clinic:

• New Donor had sex more than 4 months ago with a person who has HTLV (not a permanent partner). Accept. Add a comment to Medical notes to reference the date of the last sexual contact

NB:This is a new donor who has never previously been tested for HTLV by the IBTS.

All First time donors in IBTS are tested for HTLV at the time of their first donation (if they have not already been tested as sample only phlebotomies), therefore Accept.

• New Donor had sex in the last 4 months with a person who has HTLV (not a permanent partner). Defer the donor for 4 months after the most recent sexual contact.  Add a comment to Medical notes to reference the date of the last sexual contact. The donor can return once the 4 month deferral ends – if eligible to donate the HTLV test will be automatically applied
• Since the last donation the Returning i.e. Lapsed Donor had sex in the last 4 months with a person who has HTLV– not a permanent partner Defer the donor. Write FAO Virology on HLQ. Add a comment to Med Notes to reference the most recent sexual contact date
• Since the last donation the Returning i.e. Lapsed Donor had sex more than 4 months ago with a person who has HTLV (not a permanent partner). Defer the donor with code 9018. Write FAO Virology on HLQ. Add a comment to Med Notes to reference the most recent sexual contact date
• Before the last donation (i.e. more than 5 years ago) the Returning i.e. Lapsed Donor had sex with a person who had HTLV (not a permanent partner). Defer the donor. Write FAO Virology on HLQ. Add a comment to Med Notes to reference the most recent sexual contact date. Virology will check (the routine testing done prior to 19 Feb 2024) if the donor was tested for HTLV at least 4 months after the last sexual contact and tested negative, and will update the donor’s eProgesa record. If testing was not done, Virology will arrange testing
• If a regular donor answers ‘Yes’ to ever having had sex with a person (not a permanent partner) who has HTLV establish if the contact was before or since the last donation
• Where the contact was since the last donation and in the last 4 months with a person who has HTLV– but not a permanent partner. Defer the donor. Write FAO Virology on HLQ. Add a comment to Med Notes to reference the most recent sexual contact date
• Where the contact was before or since the last donation and over 4 months ago with a person who has HTLV– but not a permanent partner. Check medical notes for a comment from the Virology Department confirming a HTLV test was carried out by IBTS with a Negative result at least 4 months after the last sexual contact. Once comment in place to confirm the above Accept the donor. Where no comment in place Defer. FAO Virology and add a comment to Med Notes to reference the most recent sexual contact date.

NB:that a donor, who is a current or former household contact with a person with HTLV, can donate, as HTLV is not contagious and is not spread by the fecal-oral route.

Individual Donor Risk Assessment (IDRA)

The Social Behaviour’s Review Group (SBRG) considered changes to the donor selection guidelines to allow a more individualised risk-based approach to donor selection policy. They specifically looked at the guidelines which applied to men who have sex with men (MSM) and recommended an approach based on assessment of a donor’s recent sexual behaviour. Changes to donor selection criteria mean that donors who were previously excluded because of their sexual behaviour can now be accepted, if they meet the individual risk criteria outlined above. These eligibility criteria apply to all donors regardless of their sexual orientation or gender or those of their sexual partners. Several factors were identified that were associated with a higher risk of blood borne infections. These include the recent diagnosis of a bacterial sexually transmitted disease and the following sexual behaviours:

• new or multiple sexual partners
• anal sex
• participation in chemsex activity

Drugs used for chemsex include methamphetamine, mephedrone and GHB/GBL, but other drugs may be used (e.g. ketamine, poppers, cocaine). Chemsex is a high risk activity because it usually (though not always) involves multiple sexual partners, sometimes for extended periods of time. The drugs involved also reduce inhibition leading to riskier sexual activity. Methamphetamine is also known as Crystal, Crystal Meth, Tina and Meth. Mephedrone is also known as meph, drone, M-Cat, Meow-Meow. GHB/GBL are also known as G, Gina, Liquid E and Liquid Ecstasy. Infection with some sexually transmitted diseases, particularly gonorrhoea or syphilis, is associated with a higher risk of acquiring blood borne infections. Donors who have ever had or been treated for syphilis or gonorrhoea are permanently excluded from donating. In the case of syphilis donors’ blood would test positive in screening tests, even if they have been successfully treated many years previously.

Some partner risk criteria still apply to donors who have a partner in a population group at higher risk of infection. For affected donors, these risk criteria should be applied even if the donor is eligible under individual risk criteria. For example, if a donor’s current sexual partner is HIV positive; the donor will not be eligible to donate, even if they have been sexual partners for longer than 4 months. The drugs used in both Pre- and Post-Exposure Prophylaxis for HIV (PrEP and PEP) may interfere with the routine HIV screening tests carried out on all blood donations. For this reason, donors who have taken PrEP or PEP should not donate for four months thereafter, even if they are otherwise eligible under individual risk criteria. The defer donors whose sexual partners have been sexually active in Sub-Saharan Africa or South-East Asia.