High Risk Sexual Behaviour

Acceptability at Recruitment

QUALIFIED

Acceptability at CT / Work-Up

QUALIFIED - A TEMPORARY DEFERRAL MAY APPLY (SEE BELOW)

Individual at Risk

Recipient

Explanation of Condition

High-risk sexual behaviour is that which puts the donor at risk of infectious diseases which may then be transmitted to the recipient/patient. This risk occurs because the donor themselves currently participate in high-risk behaviour, or currently have sex with someone from a high-risk background. Importantly we rely on donors to assess their own individual risk.

The aim is to reduce the risk of 'window period' transmissions, where a donor is infected with (for example) HIV, but the infection is too recent to be picked up by our screening tests and the infection is passed to the patient.

Guidance at VT/WORK-UP

The following behaviours are classified as high-risk sexual activities which typically require a deferral period (unless an exception is granted by the MO and TC):

• A donor who has had sex for money or drugs --> defer for 3 months.

• A donor who has had a new sexual partner in the last 3 months and anal intercourse occurred --> defer for 3 months. A donor is eligible to donate 3 months after first sexual contact with one exclusive partner, even if anal sex occurs.

• A donor who has had multiple sexual partners in the last 3 months --> defer for 3 months if the donor has had multiple sexual partners and they have had anal intercourse with any of these partners.

• A donor who has taken oral or injectable PrEP/PEP --> See PrEP/PEP

• A donor who has participated in chemsex (including the use of stimulant drugs such as methamphetamine, mephedrone, or GHB/GBL) --> defer for 3 months.

• A donor who has been diagnosed with gonorrhoea --> defer for 3 months after completing successful treatment and follow-up. A test confirming the elimination of the infection is required. This may be a verbal report of the result from the donor.

• A donor who has had sexual contact with a high-risk sexual partner -- > defer for 3 months if the donor has had sexual contact with a partner who is known or suspected:
  • To be a hepatitis B or hepatitis C carrier.
  • To be HIV or HTLV positive.
  • To have ever received payment or drugs in exchange for sex.
  • To have ever used intravenous drugs of abuse (e.g. heroin, cocaine).

These deferral periods apply even if the donor has used a condom, though the use of a condom may factor into a TC decision on whether to defer the donation.

For the purposes of donor selection, a new partner is someone that a donor has not had sex with before, or a previous partner with whom they have restarted a sexual relationship in the last 3 months.

Deferral periods may be shortened based on individualised risk assessments if the urgency of transplantation outweighs the infectious disease risk. Such decisions should be made collaboratively by the Medical Officer and the Transplant Centre, with a concessionary release form completed if proceeding.

Justification for guidance

These guidelines are based on the FAIR III report (2022) and are designed to ensure safety while accommodating an individualised approach to donor selection. Chemsex is considered high risk as it is more likely to involve multiple sexual partners, prolonged sexual activity, and an increased likelihood of risky behaviour. Deferral periods apply with the use of PrEP as the medication can decrease the accuracy of HIV testing.

Version

Version 2

Date of Last Update

19th December 2024