Is blood donor selection appropriate and non-discriminatory? During a debate at the recent Blood Transfusion Forum conference, COLIN ROBERTS from the Sexual Health Forum was given the role of defending why men who have sex with men (MSM) should be able to donate blood. His formidable opponent was Professor Ian Franklin, National Medical and Scientific Director, Scottish National Blood Transfusion Service. Colin performed admirably and got the audience on his side - well done, Colin! Here's his evidence to the debate.
The case for allowing MSM to donate blood
Looking at what the blood service does, a donor is one who gives or bestows; one who confers anything gratuitously; a benefactor. No one would wish to alter the fundamental tenant of the National Blood Service (NBS) in the UK by altering the service to one where the donor is profiting from a biological process and the consumer pays for the privilege of being kept alive through purchasing blood or its products. All nurses are aware of the historical outcomes of a fee for donation - just think of HIV and haemophilia!
The current NBS criterion is an artificially contrived selection process that has had its historical roots in the recent past where technology lagged seriously behind the HIV health crisis. Subsequent to the emergence of HIV, testing modalities have improved dramatically, thus reducing the traditional window period of 12 weeks when using fourth generation HIV tests.
Prior to the emergence of HIV in many areas of the world, the gay community fully participated in providing blood as part of a wider duty to the community. The less altruistic members of the general public did as they do now: assume that "everything is all right."
Provoking a crisis
The generally altruistic behaviour of the MSM community was demonised in a broad brush approach when it was asked that all MSM must stop donating. So those who acknowledged their innate sexuality stopped donating - resulting in a variable crisis for many NBSs, which would appear to be an ongoing issue.
Who has decided that this stance of banning MSM from donating blood through self-selection was appropriate? A body of scholarly and scientific persons - those who have the skills, knowledge and abilities to make informed decisions based on facts.
Indeed that was the case. The decision was made based on the available knowledge at that time - on the assertion that there was no reliable method of testing for GRID (Gay Related Immuno Deficiency), which became known as AIDS Acquired Immune Deficiency Syndrome in 1982.
Within a couple of years it was appropriately described as Human Immuno Deficiency Virus - a reflection on what it was and did. The rules, however, have not kept pace with scientific knowledge and empirical research.
It's what you do, not who you are
The ban is an anachronism from the early 1980s when the transmission of HIV was still not properly understood. It is mistaken because it restricts blood donations based on sexual orientation rather than sexual behaviour.
That was an understandable approach in those early days, but our grasp of HIV and AIDS has moved on a long way since then. For many years now it has been clear that what matters is not who you are having sex with, but how you are having sex or if indeed you are having sex at all.
"Discriminatory": Treatment or consideration of, or making a distinction in favour of or against, a person or thing based on the group, class or category to which that person or thing belongs rather than on individual merit.
This definition makes it very clear in that the NBS is discriminatory. It's ongoing collective exclusion of men who have sex with men (MSM) from donating blood is based on a flawed categorisation of a subset of the community who by and large have heeded the now archaic request to never donate. The decision is not based on individual merit or individualised risk assessment, but ignorance, fear, fiscal imperatives and a display of blatant homophobic prejudice.
Is it not a case of stereotyping?
This is by definition a generalisation, usually exaggerated or oversimplified, too simple and therefore a distorted image of and offensive to the group in question.
According to www.bloodban.co.uk , who quote the NBS: "It is (the) cost, as gay people will have more infections than a heterosexual person so it is not justified to spend this money on screening." While the arguments on this website could be seen by some as overly simplistic, there is a case in point.
The ban is sustained, based on superseded scientific evidence and the homophobic presumption that all gay and bisexual men are "high risk" for HIV, regardless of their individual sexual behaviour.
Interpreting the NBS website pre-selection quiz, a man who has had oral or anal sex with another man only once in his life, perhaps more than 40 years ago (long before the beginning of the HIV pandemic), is prohibited from donating blood. The ban also applies to men who have had sex with other men, but never had unprotected oral or anal sex, having always used a condom.
Even a man whose same-sex experience was limited to a bit of oral sex when a schoolboy, which is not as rare as you may think, would be theoretically banned as a blood donor.
Diversity within MSM
Peter Tatchell, gay activist, is quoted in The Guardian on this issue: "It lumps together all gay and bi men, without differentiation, as if we are all the same. We're not. There is a wide diversity of same-sex behaviours and lifestyles. Some of us are at risk of HIV and some of us are not."
Many gay and bisexual men stick rigorously to safer sex, always using a condom. Others have been in long-term monogamous relationships (since before the HIV epidemic began). If men in these categories test HIV-negative after having abstained from at risk sexual practices for at least six months - have been screened through the national GUM clinic network, for example - their blood is safe. Indeed, their blood is likely to be safer than the voracious heterosexual who has multiple sexual partners and rarely uses condoms but, by virtue of the online quiz, may still donate blood.
Peter Tatchell goes on to say: "The blanket ban on gay and bisexual blood donors stereotypes all queers as modern-day "Typhoid Marys". It brands us all as one homogenous, diseased mass. If the transfusion service made similar sweeping stereotypical judgements about the Jewish community, there would rightly be an outcry. The NBS is promoting the homophobic myth that all queers are the bearers of contagion and death."
From a health promotion perspective ...
If you continue to promulgate "no sex is safe sex for MSM", how do we then convince a young gay person starting out on his sexual career that using condoms is worthwhile - if the blood transfusion service pushes nothing is safer sex?
The NBS continues to insist that even same-sex male partners who always use a condom are banned. If safer sex cannot safeguard the blood supply, then why has the World Health Organization, UK Departments of Health, fpa and every international HIV/AIDS organisation been telling us that safer sex can stop the spread of HIV and preserve lives?
More than a hint of inconsistency
Quite simply, either safer sex works or it doesn't. When the lives of gay men are threatened by a deadly virus, HIV organisations urge gay men to practise safer sex - that is, consistent use of condoms. Yet when it comes to the protection of the blood supply, some sexual health agencies endorse the transfusion service argument that safer sex is inadequate.
The NBS says via its website: "We ask gay men not to give blood because gay men, as a group, are known to be at an increased risk of acquiring HIV and a number of other sexually transmitted infections, many of which are carried in the blood."
The NBS has stated that the ban on gay and bisexual men giving blood is "justified" despite the fact that lifting the order would dramatically increase depleted stocks.
Guidelines from the UK blood safety leaflet specify that any individual donating: "... must wait 12 months after sex with a partner who has, or you think may have been, sexually active in parts of the world where HIV/AIDS is very common, including most countries in Africa."
The 12-month wait is not an option for gay or bisexual men, even one who has been celibate for most of his life.
And in other countries?
Australia formerly had a similar ban, but now only prohibits donating blood within one year after male-male sex (which is far longer than the typical window period for HIV blood screening tests performed on donated blood). In Finland the Parliamentary Ombudsman launched an investigation on the possible unconstitutionality of the lifetime ban in January 2006.
The Red Cross, the international blood association AABB and America's Blood Centers proposed replacing the lifetime ban with a one-year deferral following male-to-male sexual contact. They stated that with new and improved tests which can detect HIV-positive donors within just 10-to-21 days of infection, the lifetime ban is unnecessary.
France, Russia and South Africa have also recently lifted the blanket ban on blood donations from gay and bisexual men. Belgium and parts of Spain don't discriminate on the basis of sexuality. The Dutch are reviewing their blanket exclusion of gay men and the Swiss government has already recommended that blood donor policy should be based on differentiating between risky and non-risky behaviour, regardless of sexual orientation.
The vast majority of gay and bisexual men in Britain do not have HIV and will never have HIV. There is no medical or ethical reason why those who rigorously practise safe sex and who have tested HIV-negative should be banned automatically from giving blood.
And the winner was ...
The audience narrowly found in favour of "yes, the ban is discriminatory". Time will tell if the UK guidance is altered to reflect the rest of the blood transfusion service internationally.