Ten-year gay blood ban is unjustified

A change of policy to include the HIV virus test alongside the antibody test would be safer, smarter

According to the Sunday Times (£), the government is planning to lift the blanket, lifetime ban on blood donations from men who have had oral or anal sex with men. This ban was introduced at the height of the Aids panic in the 1980s, on the grounds that gay and bisexual men are at greater risk of HIV.

The public health minister Anne Milton is reportedly planning to modify the ban. Men who have had sex with men will be no longer be barred for life, but only for ten years after the last time they had oral or anal sex. This ban will apply even if they always use a condom and even if they test HIV-negative.

A ten-year ban is too long. So is five years or even one year. These are needlessly cautious exclusion periods. Protecting the blood supply is the number-one priority but ensuring blood safety does not require such lengthy time spans during which gay and bisexual men should not donate blood.

The blood service could replace the blanket lifetime ban on blood donations from gay and bisexual men with a much shorter exclusion period. It should focus on excluding donors who have engaged in risky behaviour and those whose HIV status cannot be accurately determined because of the delay between the date of infection and the date when the HIV virus and HIV antibodies manifest and become detectable in an infected person's blood.

HIV antibodies normally take a maximum of one to three months to become identifiable in lab tests. The HIV virus can take two weeks to be detected. The blood service currently tests all donated blood for HIV antibodies but not for the HIV virus. To be safe, perhaps it should do both tests on potentially risky blood donations?

Reducing the exclusion period for blood donations from gay and bisexual men should go hand-in-hand with a "Safe Blood" education campaign, targeted at the gay community, to ensure that no one donates blood if they are at risk of HIV and other blood-borne infections due to unsafe sexual behaviour.

Moreover, the questionnaire that would-be blood donors have to answer should be made more detailed for men who have had sex with men, in order to identify more accurately the degree of risk – if any – that their blood may pose.

There is, in addition, a strong case for excluding only men who have had risky sex without a condom. At the moment the blood service makes no distinction between sex with a condom and sex without one. All oral or anal sex between men – even with a rubber – is grounds for refusing a donor under the current rules. This strikes me as odd. If a condom is used correctly, it is absolute protection against the transmission and contraction of HIV. Those who use condoms every time and without breakages should not be barred from donating blood.

In contrast to the suggested ten-year ban for gay and bisexual blood donors, a six-month exclusion period would be sufficient. This would exclude male donors who have had oral or anal sex with a man without a condom in the previous six months. All men who last had unprotected sex with men more than six months ago would have their blood tested for HIV antibodies, as is the current practice.

Although the six-month exclusion period is more than twice as long as it takes HIV antibodies to appear in the blood of an infected person, this is may be justified, to err on the side of caution and to reassure the public.

The exclusion period could, however, be much shorter than six months, with certain provisos. The blood service could decide to ban only donations from men who have had unsafe, condomless oral or anal sex with a man in the past month. For men who have had unprotected oral or anal sex with a man in the preceding one to six months, the blood service could be extra-safe and do both a HIV antibody test and a HIV virus test on their blood.

Since the HIV virus shows up in blood tests within two weeks of the date of infection, the one-month total exclusion period offers a double-length margin of safety. This would guarantee that the donated blood posed no risk to recipients.

A change of policy along either of the aforementioned lines would not endanger the blood supply. With the specified safeguards, the blood donated would be safe.

The call for change is growing worldwide. The American Red Cross, the American Association of Blood Banks and America's blood centres favour ending the lifetime ban on gay and bisexual men donating blood.

According to Dr Arthur Caplan, former chair of the US government advisory panel on blood donation: "Letting gay men give blood could help bolster the supply. At one time, long ago, the gay-blood ban may have made sense. But it no longer does."

The truth is that most gay and bisexual men do not have HIV and will never have HIV. Both the lifetime and ten-year bans are driven by homophobic, stereotypical assumptions, not by scientific facts and medical evidence. For the vast majority of men who have sex with men, their blood is safe to donate. Far from threatening patients' lives, they can and should help save lives by becoming donors.

Peter Tatchell is a human rights campaigner and the founder of the gay rights group OutRage!

Peter Tatchell is Director of the Peter Tatchell Foundation, which campaigns for human rights the UK and worldwide: www.PeterTatchellFoundation.org His personal biography can be viewed here: www.petertatchell.net/biography.htm

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A swimming pool and a bleeding toe put my medical competency in doubt

Doctors are used to contending with Google. Sometimes the search engine wins. 

The brutal heatwave affecting southern Europe this summer has become known among locals as “Lucifer”. Having just returned from Italy, I fully understand the nickname. An early excursion caused the beginnings of sunstroke, so we abandoned plans to explore the cultural heritage of the Amalfi region and strayed no further than five metres from the hotel pool for the rest of the week.

The children were delighted, particularly my 12-year-old stepdaughter, Gracie, who proceeded to spend hours at a time playing in the water. Towelling herself after one long session, she noticed something odd.

“What’s happened there?” she asked, holding her foot aloft in front of my face.

I inspected the proffered appendage: on the underside of her big toe was an oblong area of glistening red flesh that looked like a chunk of raw steak.

“Did you injure it?”

She shook her head. “It doesn’t hurt at all.”

I shrugged and said she must have grazed it. She wasn’t convinced, pointing out that she would remember if she had done that. She has great faith in plasters, though, and once it was dressed she forgot all about it. I dismissed it, too, assuming it was one of those things.

By the end of the next day, the pulp on the underside of all of her toes looked the same. As the doctor in the family, I felt under some pressure to come up with an explanation. I made up something about burns from the hot paving slabs around the pool. Gracie didn’t say as much, but her look suggested a dawning scepticism over my claims to hold a medical degree.

The next day, Gracie and her new-found holiday playmate, Eve, abruptly terminated a marathon piggy-in-the-middle session in the pool with Eve’s dad. “Our feet are bleeding,” they announced, somewhat incredulously. Sure enough, bright-red blood was flowing, apparently painlessly, from the bottoms of their big toes.

Doctors are used to contending with Google. Often, what patients discover on the internet causes them undue alarm, and our role is to provide context and reassurance. But not infrequently, people come across information that outstrips our knowledge. On my return from our room with fresh supplies of plasters, my wife looked up from her sun lounger with an air of quiet amusement.

“It’s called ‘pool toe’,” she said, handing me her iPhone. The page she had tracked down described the girls’ situation exactly: friction burns, most commonly seen in children, caused by repetitive hopping about on the abrasive floors of swimming pools. Doctors practising in hot countries must see it all the time. I doubt it presents often to British GPs.

I remained puzzled about the lack of pain. The injuries looked bad, but neither Gracie nor Eve was particularly bothered. Here the internet drew a blank, but I suspect it has to do with the “pruning” of our skin that we’re all familiar with after a soak in the bath. This only occurs over the pulps of our fingers and toes. It was once thought to be caused by water diffusing into skin cells, making them swell, but the truth is far more fascinating.

The wrinkling is an active process, triggered by immersion, in which the blood supply to the pulp regions is switched off, causing the skin there to shrink and pucker. This creates the biological equivalent of tyre treads on our fingers and toes and markedly improves our grip – of great evolutionary advantage when grasping slippery fish in a river, or if trying to maintain balance on slick wet rocks.

The flip side of this is much greater friction, leading to abrasion of the skin through repeated micro-trauma. And the lack of blood flow causes nerves to shut down, depriving us of the pain that would otherwise alert us to the ongoing tissue damage. An adaptation that helped our ancestors hunt in rivers proves considerably less use on a modern summer holiday.

I may not have seen much of the local heritage, but the trip to Italy taught me something new all the same. 

This article first appeared in the 17 August 2017 issue of the New Statesman, Trump goes nuclear