Australia’s blood donors and the wider public largely favour replacing the country’s current sexual behaviour screening questions with gender-neutral alternatives, even though most of them admit they do not fully understand what such a change would mean for the safety of the blood supply. That is the central finding of a new qualitative study published in BMC Public Health, which offers an unusually candid window into how ordinary people weigh two values that are often framed as being in tension: the imperative of a safe blood supply and the demand that health screening policies treat all population groups fairly. The research, led by Rachel Thorpe of Australian Red Cross Lifeblood and the University of Melbourne, together with colleagues at Lifeblood, the University of Queensland and Pathology West in Perth, suggests that public acceptance of screening policy rests less on technical comprehension than on something harder to measure: trust in the institution asking the questions.
The study comes at a moment when blood services around the world are rethinking one of the most contested eligibility criteria in modern medicine. For decades, blood collection agencies screened donors using questions that targeted specific populations, most notably gay and bisexual men who have sex with men, a group disproportionately affected by HIV in the early years of the epidemic. As testing technology improved and epidemiological evidence evolved, several countries moved away from population-based rules and toward gender-neutral questions that assess individual sexual behaviour, such as the number of recent partners or particular higher-risk practices, regardless of the donor’s gender or the gender of their partners. Any such change, however, must be grounded in local evidence and must be acceptable to the donors and the public whose donations sustain the system. It was that acceptability question that the Australian team set out to answer.
The researchers conducted structured interviews with 43 people: 23 current blood donors and 20 non-donors. Participants were purposively sampled, meaning the team deliberately recruited to maximise diversity across age, gender, sexuality and ethnicity rather than simply taking whoever volunteered. Each participant was presented with three different approaches to sexual behaviour screening: the current Australian approach and two non-gender-neutral alternatives, alongside a gender-neutral option. The interview transcripts were then analysed using both inductive and deductive thematic analysis, a qualitative method that allows patterns to emerge from the data while also testing them against existing theoretical frameworks. In this case, the authors drew on scholarship that frames blood donation as an act of citizenship and on theories of institutional trust, asking not just what people preferred but why.
The headline result is straightforward: more than half of the participants indicated a preference for gender-neutral questions over both the current approach and the two alternatives they were shown. But the reasoning behind that preference proved to be more complicated, and more revealing, than a simple vote for inclusivity. Through their analysis, the researchers constructed four themes that underpinned participants’ views: the principle of blood safety; understanding the impact of change and perceptions of safety; operational simplicity; and the importance of inclusivity. Together, these themes map the terrain on which lay people negotiate a policy question that even specialists find technically demanding.
The first and most striking pattern was a widespread assumption that more screening questions would automatically yield greater safety. Participants broadly reasoned that if you ask donors more things about their sexual behaviour, you catch more potential risks, a kind of intuitive risk arithmetic that feels self-evident even though the epidemiological reality is more nuanced. Question design in donor screening is not simply additive; poorly framed or excessive questions can produce donor fatigue, inaccurate answers and deferral of people at negligible risk, all of which carry their own costs for supply and safety. Yet the lay intuition that quantity equals protection shaped how participants evaluated each option, and it meant that alternatives involving additional questions were often credited with a safety benefit that participants could not actually specify.
Against that backdrop, gender-neutral questions won support on two grounds that had little to do with risk calculations. The first was operational simplicity: participants valued a single set of questions asked of everyone over a system that routed donors through different screening pathways depending on their gender or the gender of their partners. Simpler questions are easier to understand, easier to answer honestly and easier to administer consistently, and participants appeared to sense that this consistency itself serves the system. The second ground was inclusivity. Participants recognised that population-based questions single out specific groups, and many saw gender-neutral screening as a fairer way to assess risk that does not define donors by who they are rather than by what they do.
What makes the study genuinely provocative, however, is what participants did not know. Most of them were unsure what each screening approach would actually mean for blood safety or for donor eligibility. They could not articulate how the different question sets would perform against transfusion-transmissible infections, or how many donors might be deferred under each option. And crucially, this uncertainty did not undermine their support. People were comfortable endorsing a major change to a safety-critical screening system without understanding its technical implications, because they trusted the blood collection agency to have done that work for them. Acceptability, the authors conclude, was grounded in trust in the blood collection agency as a competent and legitimate institution capable of balancing competing priorities.
This finding resonates with a substantial body of social science on how the public relates to technical risk governance. Scholars have long observed that lay people rarely engage directly with epidemiological evidence when forming views on health policy; instead, they delegate authority to institutions they regard as competent, honest and accountable. Blood donation is a particularly vivid case because it is built on an act of bodily generosity that depends on volunteers believing the system is well run. The study’s framing of donation as citizenship captures this: giving blood is a civic act, and the rules governing who may give are read as statements about who counts as a full participant in that civic community. Screening questions that appear to exclude groups on the basis of identity, rather than behaviour, can therefore erode the sense of shared citizenship that donation depends on, even among people who are not themselves affected.
The implications for blood services are practical as well as theoretical. If public support for gender-neutral screening is conditional on institutional trustworthiness rather than policy comprehension, then how agencies communicate change matters enormously. Explaining the evidence base for new questions is important, but the study suggests it is not sufficient, and perhaps not even primary. What sustains acceptance is the public’s confidence that the agency is competent, transparent and acting in good faith. A blood service that has built credibility over years of reliable operation can implement a screening change that most of its supporters do not technically understand; one that has squandered that credibility cannot, however sound its science. For agencies contemplating a shift to gender-neutral questions, the message is that trust is the asset to protect, and communication should be designed to reinforce it rather than assuming the public will follow the epidemiology.
Beyond the blood bank, the study speaks to a broader and increasingly heated debate about inclusion, risk governance and citizenship in health systems. Screening policies sit at the intersection of individual risk assessment and population-level fairness, and they are among the most visible places where a health system declares which differences matter and which do not. The Australian findings show that the public is capable of holding both commitments at once, valuing safety and inclusivity without treating them as opposites, and that the apparent tension between them is mediated not by technical argument but by institutional character. As more countries consider following the path already taken by several of their peers, the lesson from Australia is that the decisive question may not be whether gender-neutral screening is defensible on the evidence, but whether the institution proposing it has earned the public’s confidence to carry it through. The study, which received ethics approval from Australian Red Cross Lifeblood’s Human Research Ethics Committee and was funded through the Australian Government support of Lifeblood, was published open access, allowing blood services and policymakers elsewhere to examine the full detail of how 43 Australians reasoned their way through one of modern medicine’s most persistent dilemmas.
Subject of Research: Public acceptability of gender-neutral sexual behaviour screening questions for blood donor eligibility in Australia
Article Title: Negotiating safety and inclusivity: a qualitative analysis examining public priorities for sexual behaviour screening in blood donation in Australia
Article References: Negotiating safety and inclusivity: a qualitative analysis examining public priorities for sexual behaviour screening in blood donation in Australia. (n.d.). https://doi.org/10.1186/s12889-026-29847-z
Image Credits: AI Generated
DOI: 10.1186/s12889-026-29847-z
Keywords: blood donation, donor eligibility, gender-neutral screening, sexual behaviour, institutional trust, inclusivity, blood safety, qualitative research, health policy, risk governance, Australia, public health
News Source: Ophelia Keating. (October 13, 2026). Trust, Not Technical Detail, Drives Public Support for Gender-Neutral Blood Donor Screening. Scienmag.
