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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Air pollution: 5 steps to vanquishing an invisible killer

A new report looks at the economics of air pollution. 

110, 150, 520... These chilling statistics are the number of deaths attributable to particulate air pollution for the cities of Southampton, Nottingham and Birmingham in 2010 respectively. Or how about 40,000 - that is the total number of UK deaths per year that are attributable the combined effects of particulate matter (PM2.5) and Nitrogen Oxides (NOx).

This situation sucks, to say the very least. But while there are no dramatic images to stir up action, these deaths are preventable and we know their cause. Road traffic is the worst culprit. Traffic is responsible for 80 per cent of NOx on high pollution roads, with diesel engines contributing the bulk of the problem.

Now a new report by ResPublica has compiled a list of ways that city councils around the UK can help. The report argues that: “The onus is on cities to create plans that can meet the health and economic challenge within a short time-frame, and identify what they need from national government to do so.”

This is a diplomatic way of saying that current government action on the subject does not go far enough – and that cities must help prod them into gear. That includes poking holes in the government’s proposed plans for new “Clean Air Zones”.

Here are just five of the ways the report suggests letting the light in and the pollution out:

1. Clean up the draft Clean Air Zones framework

Last October, the government set out its draft plans for new Clean Air Zones in the UK’s five most polluted cities, Birmingham, Derby, Leeds, Nottingham and Southampton (excluding London - where other plans are afoot). These zones will charge “polluting” vehicles to enter and can be implemented with varying levels of intensity, with three options that include cars and one that does not.

But the report argues that there is still too much potential for polluters to play dirty with the rules. Car-charging zones must be mandatory for all cities that breach the current EU standards, the report argues (not just the suggested five). Otherwise national operators who own fleets of vehicles could simply relocate outdated buses or taxis to places where they don’t have to pay.  

Different vehicles should fall under the same rules, the report added. Otherwise, taking your car rather than the bus could suddenly seem like the cost-saving option.

2. Vouchers to vouch-safe the project’s success

The government is exploring a scrappage scheme for diesel cars, to help get the worst and oldest polluting vehicles off the road. But as the report points out, blanket scrappage could simply put a whole load of new fossil-fuel cars on the road.

Instead, ResPublica suggests using the revenue from the Clean Air Zone charges, plus hiked vehicle registration fees, to create “Pollution Reduction Vouchers”.

Low-income households with older cars, that would be liable to charging, could then use the vouchers to help secure alternative transport, buy a new and compliant car, or retrofit their existing vehicle with new technology.

3. Extend Vehicle Excise Duty

Vehicle Excise Duty is currently only tiered by how much CO2 pollution a car creates for the first year. After that it becomes a flat rate for all cars under £40,000. The report suggests changing this so that the most polluting vehicles for CO2, NOx and PM2.5 continue to pay higher rates throughout their life span.

For ClientEarth CEO James Thornton, changes to vehicle excise duty are key to moving people onto cleaner modes of transport: “We need a network of clean air zones to keep the most polluting diesel vehicles from the most polluted parts of our towns and cities and incentives such as a targeted scrappage scheme and changes to vehicle excise duty to move people onto cleaner modes of transport.”

4. Repurposed car parks

You would think city bosses would want less cars in the centre of town. But while less cars is good news for oxygen-breathers, it is bad news for city budgets reliant on parking charges. But using car parks to tap into new revenue from property development and joint ventures could help cities reverse this thinking.

5. Prioritise public awareness

Charge zones can be understandably unpopular. In 2008, a referendum in Manchester defeated the idea of congestion charging. So a big effort is needed to raise public awareness of the health crisis our roads have caused. Metro mayors should outline pollution plans in their manifestos, the report suggests. And cities can take advantage of their existing assets. For example in London there are plans to use electronics in the Underground to update travellers on the air pollution levels.

***

Change is already in the air. Southampton has used money from the Local Sustainable Travel Fund to run a successful messaging campaign. And in 2011 Nottingham City Council became the first city to implement a Workplace Parking levy – a scheme which has raised £35.3m to help extend its tram system, upgrade the station and purchase electric buses.

But many more “air necessities” are needed before we can forget about pollution’s worry and its strife.  

 

India Bourke is an environment writer and editorial assistant at the New Statesman.