Time-limited deferral scenarios and blood donation intentions among men who have sex with men in China: a nationwide mixed-methods study

Abstract Background Approaches to managing blood donation eligibility for men who have sex with men (MSM) vary across countries, and time-limited deferral policies have been adopted in an increasing number of jurisdictions. Our study aimed to evaluate attitudes towards and acceptance of time-limited blood donation deferral periods among MSM in China. Methods We used an explanatory sequential mixed-methods design, consisting of a nationwide cross-sectional survey of MSM in China from April to July 2024, followed by qualitative interviews. The survey collected sociodemographic characteristics, sexual behaviors, blood donation history, and attitudes towards four hypothetical deferral scenarios (12-, 6-, 3-, and 1-month deferral after most recent same-sex sexual behavior). We assessed willingness to donate under each scenario and estimated scenario-specific behavioral eligibility based on self-reported anal sex with another man during the corresponding lookback period. Multivariable modified Poisson regression, adjusted for age, education, and income, was used to identify factors associated with support for hypothetical time-limited deferral policies. Semi-structured interviews explored perceptions of the current prohibition and hypothetical deferral approaches and were used to explain and contextualize the survey findings. Results A total of 2725 MSM participated. Overall, 48% were neutral and 32% were supportive of hypothetical time-limited deferral approaches. As the hypothetical deferral period shortened from 12 months to 1 month, willingness to donate increased among both previous donors (44%, 50%, 61%, 74%; P for trend < 0.001) and non-donors (26%, 27%, 33%, 45%; P for trend < 0.001). Among MSM willing to donate under each scenario, the proportions reporting no anal sex with another man during the corresponding periods were 37%, 42%, 45%, and 53%, respectively. In qualitative interviews ( n = 16), most participants (12/16) viewed hypothetical deferral approaches as more acceptable than the current lifelong prohibition. Conclusions Many MSM in China expressed willingness to donate blood under hypothetical time-limited deferral scenarios, with higher acceptance under shorter deferral periods. These findings provide empirical evidence for future evaluation of whether shorter time-limited deferral approaches could improve acceptability and intended compliance while maintaining blood safety within China’s existing donor screening and surveillance system.