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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!

24 comments

Jack's picture

How can the screen test not be able to pick up aids, if that were the case how could they give the blood to another person, as there would still be a risk...so if someone got aids the day before the gave blood and then it was tested but no hiv was found because they only got infected yesterday. surely the doctors would not give blood to anyone if this was the case.

Captain Sensible's picture

And the band played on disease on the crutch of political correctness. Eventulally the virus will mutate into something really dangerous!

Luddite's picture

Let's never put bad politics and bigoted opinion, before good health. It's not stereotypical assumptions nor is it homophobic. Mr Tatchell is wrong.

Rosa's picture

I completely agree with this article.

Yes, public health has to be prioritised over political correctness, but a ten year ban is completely disproportionate.

Paul's picture

Currently, the NHS National Blood Service does not allow "men who have ever had sex with men" to give blood because, it claims, there is a greater risk of infections being passed to patients who need the blood. This is wrong.

HIV/AIDS is NOT a "gay community" disease. Yes, they were the most impacted by it in the 1980s, but the virus makes no distinction of sexual preference.

Let me repeat that: AIDS IS NOT A GAY-SPECIFIC DISEASE. Period. Your entire reasoning is based on myths and misunderstandings that were 100% debunked over 20 years ago and that even schoolchildren know by now.

By your logic, no one who is sexually active should be allowed to donate blood. This is of course unnecessary, because the blood is TESTED.

Face it, you just want to rationalise your fear of taking blood from someone you have social biases against. You're no different from those who supported separate water-fountain's and bathrooms based upon skin color just a few decades ago.

The blood transfusion service wants my blood. It sent me a leaflet, requesting that I become a donor. Why not? As the leaflet says: "your gift could save someone's life". I have also seen posters around Nottingham asking for my blood.

My first reaction was that I'd love to give blood and fulfil my civic duty. But reading the leaflet reminded me that I am not allowed to be a donor. I'm Gay.

The advice leaflet for blood donors states: "You should NEVER give blood if: you are a man who has had sex with another man, even 'safe sex' using a condom".

This means a lifetime ban on blood donations from men who've had gay sex. It is based on the assumption that all homosexual and bisexual men are 'high risk' for HIV. The transfusion service says the life ban is necessary to protect the blood supply from contamination.

The absurdity of this policy is obvious. Even a man who has had gay sex only once in his life, perhaps more than 40 years ago, is prohibited from donating blood. Men whose homosexual experience is limited to a few mutual wanks behind the school bike sheds are likewise banned as blood donors, even if their youthful escapades took place in the 1960s (more than a decade before the start of the AIDS crisis!).

Well, I'm no doctor. But this policy seems to reflect homophobic prejudices, not medical facts. I'm amazed that more people aren't kicking up a fuss about this insulting, unjustified mass exclusion of all gay donors, regardless of their individual sexual histories.

The policy of excluding every gay donor is based on crass generalisations. It lumps together all gay men, without differentiation, as if we are all the same. We're not. There is a wide diversity of gay sexual behaviours and lifestyles. Some of us are at risk of HIV, and some of us are not.

Many gay men stick rigorously to safer sex, such as jerking off and body rubbing, which involves virtually no chance of HIV infection. Others have been in monogamous relationships since long before the AIDS epidemic began. Some queers are even celibate! If men in these categories test HIV-negative, after abstaining from risky behaviour for at least six months, their blood is safe.

I realise this is a more complex policy than the simple, straightforward life ban on gay donors. But surely gay men can be trusted to understand and follow these marginally more sophisticated guidelines?

What makes me really angry is the way the blanket ban on gay blood donations stereotypes all queers as the modern-day equivalent of 'Typhoid Marys'. It brands us all as one homogenous, diseased mass. If the transfusion service made similar sweeping judgements about the black or Jewish communities, there would be an outcry. Why are we allowing the promotion of the homophobic myth that all queers are the bearers of contagion and death?

Although quick to reject blood from risk-free gay men, the transfusion service happily accepts donations from promiscuous heterosexuals who have lots of unprotected sex with many different partners.

A straight businessman who regularly travels abroad, and who has unsafe sex with large numbers of women in a city like New York (where there is a massive AIDS epidemic), is highly vulnerable to HIV. In contrast, a gay man on the isolated Shetland Islands who has had only a few homosexual encounters in his life - all limited to very low-risk mutual masturbation - has almost no chance of getting HIV. Under the policy of the transfusion service, the high-risk straight businessman can donate blood, but the low-risk gay man cannot.

Most bizarrely of all, the transfusion service insists that even those who always practice safer sex are banned from giving blood. This begs the question: if safer sex cannot safeguard the blood supply, why have AIDS organisations been telling us that safer sex can stop the spread of HIV and save the lives of gay men? Either safer sex works or it doesn't.

Amazingly, the ban on gay donors and the disparagement of safer sex is endorsed by otherwise homo-friendly AIDS organisations like the Terrence Higgins Trust. For over a decade, these organisations have claimed correctly that the risk from sucking and wanking is miniscule. Now, however, they argue that even if gay men always stick to these low-risk activities, their blood donations are still a danger to the blood supply.

The fact is that 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 of us who have long and rigorously practised safe sex, and who have since tested HIV-negative, should be banned automatically from giving blood.

There are also restrictions on intravenous drug users, or heterosexuals who admit "risky" sexual practices involving prostitutes.

This is wrong....

isavutha's picture

The virus test has increased in sensitivity in the last few years but it is not able to detect very very low viral load - the best available result is 'undetectable. I have HIV+ antibodies but am not on treatment because viral load is 'undetectable' - a 'non-progressor'. Still I would prefer not to donate while that risk remains. Nor receive, not even yours, Dan!

Alyssa's picture

as do so as do not abot you is just ok

Seaman T's picture

Look at it this way. If you were dying for a transfusion, whose blood would you choose? I am also in a rare group. Good for the ego but not so good if you bleed a lot. I once got thirteen pounds for a pint in Kuwait, but since I reached sixty I can't give the stuff away in England. My best advice is try to stay young and healthy and try to hang on to whatever you've been issued with, sex, race and blood can caused more bother than they're worth.

Sami's picture

Yes, I would understand it if they tested positive. But even if you test negative you can't? THIS is why the word is so horrible. Because stupid people make other people feel like they can't do what everyone else does. This pisses me off.
If you could stop making gay/les/bi people feel like they don't belong because they don't love who they "should" love, then I think the world would be much better. You people are ridiculous.!

davlat's picture

The Gay lobby in the US put pressure on Blood Products industry back in the 80s with exactly the same homophobic smear. Haemophiliacs using these blood products then went on to contract HIV. The UK deaths from HIV & Hepatitis C among haemophiliacs is around 2,000 people. Safety first and last.

James's picture

Paul: HIV is not a gay specific disease, but it is more prevalent in certain groups of people.

Of all new HIV infections in 2009, 42% resulted from homosexual sex. Amongst heterosexual infections, 68% acquired their infection abroad, mainly in sub-Saharan Africa.
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287145367237

In the absence of being able to perform full diagnostic tests on donated blood, one of the ways in which risk is reduced is by eliminating certain risk groups from donating, including homosexual men, and those who've recently visited at risk countries. This isn't a racist, or homophobic policy, it's based on the best possible scientific evidence and risk analysis.

fra's picture

The assumption is that blood borne diseases such as HIV are exclusive to homosexual men. This is untrue, so where are the safeguards preventing infected blood from heterosexual men or women getting into the system?

James's picture

"Research shows that completely removing the current exclusion on blood donation from men who have sex with men would result in a fivefold increase in the risk of HIV-infected blood entering the blood supply. While changing deferral to one year from the last sexual contact would have a lesser effect, it would still increase this risk by 60%.

Soldan K & Sinka K – Vox Sanguinis (2003) 84, p265-273"

This isn't a discrimination issue. Health policy shouldn't be made into a political issue, and neither should it pander to rights groups, it should be led by the best scientific evidence available.

Diagnostic tests for HIV are prohibitively expensive in terms of testing all blood donations. As such, the most safe and affordable way is to eliminate certain groups which are statistically higher risk. This includes, but is not limited to, homosexual males.

Travis's picture

I have a very simple idea.

If you're not HIV positive, you can donate blood.

Simple as that.

Lyn's picture

A 10 year ban is ridiculous and completely discounts monogamy and personal care. It assumes that gay men are all off picking up random other men. Sure, some gay men do that. Some straight men do it, some straight women do it. This ban perpetuates the myth that gay men behave in sexually permissive and unsafe ways.

Alyssa's picture

I like you at the we as are is ok just

Alyssa's picture

as do you just

Alyssa's picture

you is just we of go is you just we are of at you just as of

Zoe Brain's picture

By those figures, we should also ban donations by all women born in Africa.

The problem is that "MSM" is too coarse a metric to be useful.

Someone - male or female - who engages in unprotected sex with a variety of partners is at risk.

Someone - male or female - who engages in unprotected sex in an exclusively monogamous relationship is not.

The usual case is someone, male or female, who engages in protected or unprotected sex not in an exclusively monogamous relationship (though they may think it is), and there the risk is much higher if at least one partner is male and the sex is unprotected. If both are male, the risk is higher still.

The questions should be: "have you had unprotected sex with a man in the last 6 months?" and "have you ever had unprotected sex with a man and not had a negative HiV test at least 6 months later?"

The rest is just homophobia.

Paddy's picture

Let's run the numbers on this.

People currently excluded from giving blood in the UK: Men who've had sex with men in the past ten years, anyone who's ever been an injecting drug user, anyone who's received blood anywhere in the world since 1980, anyone who's ever been a prostitute, anyone who's had sex in Africa in the past year. Plus various other categories. (https://secure.blood.co.uk/c11_cant.asp)

Estimated UK prevalence of HIV among MSM aged 15-44: 5.3% in 2007, according to the HPA, and rising (http://www.hpa.org.uk/web/HPAweb&HPAwebStandard/HPAweb_C/1227515299279)

Estimated UK prevalence of HIV among non-IDU heterosexuals aged 15-59: 0.1% (based on a back-of-envelope calculation from figures here http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287145367237; apologies for not finding a directly comparable age group etc.).

Without meaning to offend, since the balance of harms either way is unequal (accidentally giving patients HIV, versus vaguely offending, but in no way actually harming, some people by refusing to take their blood), being cautious is worthwhile here. We've nearly 100,000 people with HIV in the UK already; let's not give this to anyone else if we can avoid it.

As for the "why not ban African blood as well" question - the fact is that they can't. There are certain rare blood groups that are only found among black Africans, and they'd be doing a major disservice to patients of this ethnicity if they refused to collect them. However, where groups pose a specific risk but no specific benefit, they can be banned. Sensitivity is important, but patient safety trumps it.

Paddy's picture

Incidentally, for more on this debate, I'd quite recommend these two contrasting views, from a head-to-head in the BMJ a couple of years back.

The case for the ban: http://www.bmj.com/content/338/bmj.b318.long

The case against: http://www.bmj.com/content/338/bmj.b311.long

Freddy's picture

It’s been 30 years! We are long overdue for a cure! Please support re:solve AIDS and the Chronic Disease Fund. resolvefromcdf.org

Dan Filson's picture

I was a donor regularly from 1967 to 1983. From the 1980s I have been banned. That's 28 years of lost donations just from one person. To say that I have been careful over the last 28 years is an understatement. Meanwhile, no ban on those who have travelled abroad, no ban on those with risky practices.

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