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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Donald Trump's cartoon nuclear rhetoric draws on a culture of American jingoism

Senior Republicans avoided condemning Trump's incendiary speech, and some endorsed it. 

From recent headlines, it seems as though Donald Trump isn't content with his Emmy-by-proxy. The US president told the United Nations General Assembly this week: “The United States has great strength and patience, but if it is forced to defend itself or its allies, we will have no choice but to totally destroy North Korea.” Trump’s speech raised eyebrows for its bellicose tone, especially when contrasted with his predecessor’s endorsement of a war-averse approach. 

A widely circulated image of Trump's chief of staff John Kelly with his head in his hand might suggest that most listeners loathed the speech. But Trump said many outrageous things on the campaign trail and voters - at least a critical number of them - agreed. So how did his words go down at home? 

My contacts in international security were unwilling to go on the record condemning it. They were mainly Americans in their twenties, hoping for a government job one day, and fearful of saying anything that could be interpreted as "un-American".

The one person who would speak to me asked for their name to withheld. A former military analyst in the US Department of Defence, they told me that “the US has the military capability and legal responsibility to address threats to itself or allies". What Trump said, they suggested, should be seen in the context of the wider US institutions. "While Trump may have advocated for isolation in the past, the political and military forces he leads are built to enforce the adherence to international law and regional security," the former analyst said. "They provide a real counterweight to the bombast in Pyongyang.”

Trump's speech may have been colourful - his nickname for the North Korean leader Kim Jong-un, "Rocket Man", is a reference to Elton John’s mid-Cold War musical hit – but the speech should be seen as yet another reassertion of US military dominance. North Korea may boast of its Inter-Continental Ballistic Missile (ICBM) development,  but its arsenal is simply not well-equipped enough to present the same existential threat to the US that the USSR did at its peak. 

Rather than lacking comprehension, the analyst said of the speech: “Trump's rhetoric is intended to galvanise recognition that the current rules based order is threatened by North Korea's actions”.

Trump’s jingoism is not unique amongst the current American elite. Back in 1983, in his book, The Wizards of Armageddon, the liberal journalist Fred Kaplan characterised the hawkish US military strategy as simply ejaculating combative statements without a long-term plan. Kaplan quoted Herman Kahn, one of the early nuclear strategists, who called one proposal targeting the USSR a “war orgasm”. 

The US Senate recently passed a defence policy bill to increase military spending to $700bn, which includes $8.5bn for missile defence purposes. Overtly catastrophic language, meanwhile, has long been a staple of US foreign policy debates. In 2015, Trump's rival for the Republican presidential nomination, Ted Cruz, made headlines when he vowed to carpet-bomb Isis until he found out "if sand can glow in the dark". While most leading Republicans chose to stay silent after Trump's speech, a few, such as Paul Ryan and Rand Paul, publicly endorsed the message. Cruz, despite the rivalry, was among them. 

On social media, the American public are vocally divided. Some called for Trump to be denounced for his inflammatory speech, but others tweeted #MakeAmericaGreatAgain. Even some Trump sceptics agreed that the North Korea “nuclear summer” needed to be kept in check.

By contrast, overseas listeners have perceived the speech, and this administration’s foreign policy, as unnecessarily incendiary. Matt Korda, a Canadian research assistant on strategic stability at the UK-based Centre for Science and Security Studies,  told me: “Kim Jong-un perceives his nuclear weapons to be the only thing guaranteeing his regime's survival”.

“He will never give them up, no matter how much Trump threatens him," Korda added. “On the contrary: Trump's threat to ‘totally destroy’ the entire country (including millions of innocent and oppressed civilians) will only tighten Kim's grip on his nuclear weapons”.

The effects of Trump’s speech are yet to fully play out, but it is clear that his words have rallied at least a section of American society, and rankled everyone else. The Donald may seem to be mirroring the culture of nuclear recklessness his North Korean opponent helped to create, but this is also the kind of hostile and hyperbolic rhetoric which fuelled his rise to power. In reality, once Trump’s unpleasant vernacular is decoded, he can be seen to be echoing the same global view that has long pervaded the collective American consciousness. Trump's speech was not addressed at his UN doubters, but rather at his domestic fan base and his allies in the South Pacific. This is not a shift in US foreign policy - it is tradition with a spray-tan.

 

 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman