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A shift in the UK on blood donations from sexually active gay men

AIDS

By Adam Bink

Via Towleroad, the United Kingdom is set to lift the ban on blood donations from men who have sex with men, with an important caveat:

However, gay men will only be permitted to donate if they have not had sexual intercourse for a decade. Homosexuals who are or have recently been sexually active will continue to be barred from giving blood.

Anne Milton, the public health minister, is expected to announce the changes within weeks and she is understood to be backed by Andrew Lansley, the Health Secretary, and Lynne Featherstone, the Equalities Minister.

***

The changes were instigated by Sabto, the advisory committee on the safety of blood, tissues and organs, which had concluded that if the ban were replaced by a new rule preventing gay men from giving blood for five years after having sex with another man, the risk of HIV reaching the blood supply would go up by less than 5%.

It is estimated that this figure would halve if the “deferral” period were increased to 10 years, so ministers backed this option. The 10-year delay also ensures that people who are not aware they have contracted HIV do not pass it on accidentally.

Last year, I worked with Gay Men’s Health Crisis and colleagues in the blogosphere on revising the unfair and discriminatory ban here in the United States. Ultimately, because HIV refuses to show itself in newly infected individual for a window period, any potential donor — heterosexual or homosexual — risks the blood supply. It comes down to a question of how much risk. What is the most important thing is that the rules apply fairly to everyone. For example, here in the US, if a heterosexual man has sex with an HIV-positive woman, he is banned from giving blood for a year afterwards (which by itself makes little sense because of window period). But if I have sex with my boyfriend, even once, I’m banned for life. The other thing is to change to a risk-based deferral based on behavior, not arbitrary time periods like 10 years or one year. If you engage in frequent unprotected sex with multiple partners, your risk is much different than that of an HIV-negative, longtime monogamous couple, which makes this 10-year period so arbitrary. Ultimately, perhaps a small step forward.

Currently, HHS is studying a potential change in the policy as a result of last summer’s committee vote that found the current policy is ”suboptimal in permitting some high risk donations [from populations other than MSM] while preventing some low risk donations [from the MSM population].” The ultimate decision is up to the FDA. A change in the policy is also supported by the Red Cross, America’s Blood Centers and AABB. For more, some work on this I did with colleagues can be found here.

25 Comments

  • 1. Michelle Evans  |  April 10, 2011 at 7:19 am

    Too many homophobes out there to change the US policy. Can't see it happening anytime in the near future, although I would hope to be proven wrong.

  • 2. Straight for Equalit  |  April 10, 2011 at 7:23 am

  • 3. Sagesse  |  April 10, 2011 at 7:35 am

    Tough one. The science of screening is not there yet (because of the latency period).

  • 4. bJason  |  April 10, 2011 at 7:40 am

    If all blood is screened (if I am correct in remembering that it is) then WHY ON EARTH does it matter who gives the blood? This pisses me off. I would love to donate blood. But, I refuse to donate as they don't want it.

    THIS ISSUE PISSES ME OFF!!!

  • 5. John  |  April 10, 2011 at 8:07 am

    Screening is not 100% effective. There's both a false positive risk (no big deal with blood donation – it's better to throw out falsely-positive blood than to risk infection) and, much more significantly, false negatives.

    In other words, some amount of blood tested for HIV (or other things) that *actually contains HIV* will test as if it doesn't contain HIV. That's why screening based on risky behavior (not sexual identity, as is currently done) is important.

    Note: I'm not defending the current standards, which are prejudiced and not based on science.

  • 6. Rhie  |  April 10, 2011 at 8:09 am

    Cool…

  • 7. John  |  April 10, 2011 at 8:17 am

    As I've posted on another forum:

    As a heterosexual man, I could sleep with 20 prostitutes, wait 12 months, and then donate blood. But if I and a male partner were both virgins and then had sex, only once and never again with anyone in the remainder of our lives, we couldn't donate blood ever in the US – not even 50 years from now. How does this make blood safer? It's absurd and has no relationship to risk. It's become political. If a guy slept with another guy in 1977, and never had sex since, I don't see how his blood is more dangerous than mine or anyone else's. It is purely politically motivated, or the rules would be concerned with risky behavior, not, essentially, sexual identity.

    Certainly for AIDS, and likely other conditions, I disagree because the thing that makes AIDS common is unprotected sex with partners of unknown status – not sexual orientation. That's what they should be asking about, as *that* is the risk. It's one of the things we've learned since the early 80s. But revising the blood donation standards to match our scientific knowledge is a political hot-potato now, so it's easier to just leave things as they are.

    They could have easily eliminated donations from those who are originally from Swaziland – a country where 1 of 4 living people have AIDS. They didn't – there is no rule against someone from Swaziland donating.

    Yes, the prejudice had the side-effect of reducing positives. But it would reduce it even more if it was focused on the right category: unsafe sex rather than gay sex.

    Right now, if I was a female and had sex thousands of times with a man who was HIV positive, as long as I waited one year, I could donate. That isn't something that is scientifically based, it's just plain dumb.

    Even the countries that are excluded on the basis of AIDS are wrong. For instance, Swaziland citizens – where there is the highest AIDS prevalence in the world is not excluded from donation, yet other countries with lower AIDS prevalence are excluded from donation (due specifically to AIDS, not other things such as Malaria or "mad cow"). That's also dumb and unscientific. We actually don't ask about having sex with AIDS-positive people, but we ask about gay sex from the 1970s. But we can't revise the standards to make them consistent (if you are going to ban donations from people who lived in some countries on the basis of AIDS, you should DEFINITELY ban donations from the country with the highest AIDS rate – but we don't)

    The current rules – because they focus on sexual orientation – also create a condition where the closeted gay man is encouraged to lie, for fear (reasonable or not) of being "outed". That's not good either – asking questions that are less threatening and which allow them to stay in the closet are more likely to get accurate answers ("Have you had sex with new partners, male or female, in the last X amount of time?" as well as "Have you ever had sex with someone who tested positive for AIDS either before you had sex or within X amount of time since you last had sex?" Neither of these is currently asked).

    Yes, there's overlap between the groups that are excluded and the groups *really* that are more likely to have AIDS. But it would be best if they focused on the risk factor (promiscuous sex), not some coincidence or prejudice.

    I do agree that depending on blood testing to detect disease is not wise – tests sometimes have false negatives. We need to do more than just rely on tests (and too many people see blood donation as a free AIDS test – another problem that we have today). Yet the best way to stop AIDS always has been education – so we have Republicans trying to defund one group that does a ton for education (Planned Parenthood). If they cared about stopping AIDS rather than making political points…(as an aside, abstinence-only sex-ed is nearly the worst way to prevent AIDS)

    (As an aside: have you had a new sexual partner in the last few years? If so, GET TESTED – whether you are straight or gay doesn't matter, as AIDS, unlike the CDC/FDA, doesn't discriminate – your life depends upon it; Us straight people need this too, as the more people who routinely get tested, the less stigma there is upon others to get tested – and a blood donation is NOT acceptable as a way to get an AIDS test!)

  • 8. John  |  April 10, 2011 at 8:19 am

    (a minor note about the last paragraph)

    I don't mean to say that straight people have less chance of getting AIDS, either. We don't. If we sleep with partners and don't know their history, we are at risk. The same for people who aren't straight.

  • 9. Rhie  |  April 10, 2011 at 8:26 am

    That brings up a nasty part of that law that I hadn't considered. The law is basically saying "Hey, we the US, government think that gay men are liars, cheaters, and reckless. More so than a sociopathic heterosexual man who cheats on his wife constantly." That's just disgusting coming from the government but not surprising.

  • 10. Rich  |  April 10, 2011 at 8:35 am

    Check out the NOM website. They're in a tizzy because Canadian schools require Catholic Schools to be open and accepting of gay students who wish to establish Gay-Straight Alliances in their schools…because Catholic Schools in Canada receive plenty of Canadian federal dollars in order to operate. Why is this concept so difficult for some NOM people to understand? I suggested a simple solution: Don't like the federal mandate? Don't take the dollars. I was promptly cut off from posting. I guess I hit a nerve.

  • 11. John  |  April 10, 2011 at 8:35 am

    And one more note: "last few years" looks like it should be 10 years or more. I guess I didn't realize that it often takes 6-10 years after infection for symptoms to develop in men. Why isn't this kind of information something that the President, our doctors, TV personalities, etc, making sure we know? (it makes me both angry and sad)

  • 12. Michelle Evans  |  April 10, 2011 at 8:41 am

    Yes, that is exactly what the law is saying, and shows the homophobia behind that law.

    The other thing that has been mentioned here is that the blood donation laws are not based in science, which is a very unfortunate truth more and more in this country. This has been the most troubling thing for myself and Cherie to witness as we try to survive in this society.

    It is also the basis for the reasoning for keeping LGBT from marrying. There is scientific evidence that shows conclusively that being LGBT is an immutable characteristic. With that evidence in hand, any laws discriminating against us must disappear. The fact that the debate continues, as well as the attacks against LGBT people because if their "choice" in being so shows the fantasyland our country still lives in.

    When it comes to law and medicine, science must prevail. When actual evidence and proofs are dismissed in favor of rhetoric and fantasy, then this country is truly in great trouble. Which is exactly where we find ourselves today.

  • 13. Straight for Equalit  |  April 10, 2011 at 8:45 am

    It used to be the case that blood donations were taken at prisons. They knew that many inmates had taken part in risky behavior so they used the blood to make components rather than use it as raw blood. They could use the platelets, gamma globulin, etc. (not sure if I have the components right). I don't know if that is still the practice. But I would think they are passing up lots of valuable donors.

  • 14. Martin the Brit  |  April 10, 2011 at 9:55 am

    I’m no expert but I think there is more to HIV risk in gay and bisexual men than just behaviour. I may be in danger of taking an unpopular position but I think gay and bisexual men will always be at greater risk due to epidemiological factors.

    Even if MSM (men who have sex with men) take more stringent measures to prevent HIV transmission, we are still at greater risk than the wider population for the simple reason that we are a small group who select sexual partners from mostly within our group. The fact that heterosexuals have a much greater selection of sexual partners to choose from means that HIV transmission is, in effect, diluted by their numbers.

    This effect has been studied and documented in African American MSM, who are a very high risk group because they face the added disadvantage of being undesirable sexual partners to non-African Americans. This means they are forced to select partners from a very limited pool within their own group, amplifying the transmission risk:
    http://www.springerlink.com/content/a558641m7486r

    There is also the additional factor that transmission is likely to be limited in the heterosexual population by sex segregation. In other words, in an exclusively heterosexual population transmission of infection should largely be male to female or female to male. There is no such barrier to transmission in MSM.

  • 15. Kathleen  |  April 10, 2011 at 10:07 am

  • 16. Sagesse  |  April 10, 2011 at 10:12 am

    Change.org has a petition, if people are interested in showing support.

    Premier of Ontario Weighs In On Debate Over GSAs in Catholic Schools
    http://news.change.org/stories/premier-of-ontario

  • 17. John  |  April 10, 2011 at 10:37 am

    I certainly think one factor is a smaller group. But I can't accept anything that rates a heterosexual who has sex with known HIV infected partners as "safer" than a gay man who has safe sexual behavior.

    Is the person who had sex with another man in 1977 once, and has abstained from any since 1977, and who has an annual HIV test, *really* more at risk of contaminating the blood supply than a woman who slept, last year, with a man who is known to have AIDS? It's sadly still risky behavior which has the greatest risk of AIDS transmission – straight or gay. The policies need to reflect true risk.

    Now if someone is sleeping with lots of partners, has no good way to know the HIV status of their partners, and doesn't use a condom, then, yes, I'd say I probably would prefer they don't donate me any blood. But I'd say that to a straight person or a gay person. I think us straight people have a false sense of safety right now precisely because of stuff like this policy.

  • 18. Ronnie  |  April 10, 2011 at 10:45 am

    Subscribing….<3…Ronnie

  • 19. Martin the Brit  |  April 10, 2011 at 10:50 am

    John, I’m sorry, I should have been more articulate in my point. I’m not implying at all that heterosexuals who engage in risky behaviour are at less risk than gay men who don’t. I’m just pointing out that the risks will always unfortunately be amplified for us because of the group we belong to. I don’t think the previous life time ban policies on blood donation or even the revised policy make a lot of sense. I think they should definitely take risk behaviours into consideration more. However, when such an astoundingly high number of new HIV cases are amongst MSM I definitely think there’s a need to tread carefully.

  • 20. Joe  |  April 10, 2011 at 5:20 pm

    Someone who had one incident (even safe sex!) with a man 20 years ago can't donate blood from a heterosexual who had unprotected sex with a prostitute just 12 months ago can. That's crazy.

  • 21. Sagesse  |  April 10, 2011 at 10:07 pm

    To put the debate in context, Canada's Charter of Rights and Freedoms protects against discrimination based on sexual orientation… including high school students.

    In Ontario, municipal property taxpayers can direct their school tax dollars to either the public or the Catholic school board. Catholic school supporters elect the Catholic school board. The province has jurisdiction over education, and also funds the schools.

    An LGBT high school student has the right to belong to a GSA where sexual orientation is treated with tolerance and understanding. More to the point, that student should not have to seek that tolerance and understanding elsewhere while being subjected at school to a publicly funded program that treats his/her sexuality as something sinful, to be denied or corrected.

    Because there are two levels of government involved, it will take time to resolve, but I believe that ultimately the student's civil rights trump the rights of the Catholic schools, and for high school age children, the rights of their parents. Catholics and the Church can maintain their beliefs on homosexuality, but in Canada, there are limits.

  • 22. Ann S.  |  April 11, 2011 at 1:29 am

    §

  • 23. Elf  |  April 11, 2011 at 2:41 am

    I'd like to donate blood. Currently I can't, unless I lie on the forms–my husband's not straight. He's had sex with men since 1977. Not since 1995 and probably not since 1985, but hey, we wouldn't want to limit these things to reasonable risks. I've had sex with a man who's had sex with men, and therefore am ineligible to donate.

    If I refrain from sex with my husband for a year, I can donate blood. Because that, of course, will make me less risky.

    Hm. Sex with husband, vs donating blood … anyone want to guess which one I choose?

  • 24. Bob  |  April 11, 2011 at 2:56 am

    guess they have some guidelines around threatening their funding source and access to their share of tax dollars, or something like that,,,,,,
    Nom has always been quick to ban people who don't agree with their view…

    but this is an important point, and one they will eventually have to come to grips with,,,, i.e. putting them back in their church,,, like Louis they are challenged to understand the difference between Holy Matrimony which they enforce in the church, and civil marriage, which is in the domain of the government, they've morphed to far out into main stream politics, and have become used to imposing their beliefs on the general public,,,,,,,

    the context Sagesse brings to the issue of the gsa in schools is an interesting one which clarifies the difference, in Canada there has been an amazing advance in the rights of LGBT people, and following protections,,,

    it seems that pesently in the U.S. those favoured with protection are the ones who misuse religious status, drawing limiits which exclude LGBT's
    a huge part of advancing equality is to reverse that situation, and of course NOM would be very alrarmed at that, pointing to Canada as an example of what is happening,,, they use that to play on peoples minds,,, and misinterpret it to say what they want, about gov't interference,,,, it's difficult to take back the ground they've been allowed to feel they own in the secular rhelm..

    the notion of protecting religious freedoms must at some point be seen as the same as or equal to the protection of peoples sexual orientation, so that people are free to expess their orientation in a religion of their choosing,,,,,

  • 25. Rhie  |  April 11, 2011 at 8:12 am

    Laws like this aren't telling Catholics what they can personally believe. They are defining the terms under which
    Catholics can enforce that belief on a secular society.

    That's the distinction which a lot of American Tea Party types have trouble understanding. No one is arresting people for believing whatever they want. They can go to church and talk amongst fellow-minded followers about their viewpoint. They can even do that in private conversations at schools, parks, and other public areas.

    They CANNOT enforce that belief through bullying, taunting or even well-meaning but basically bigoted speeches as a professional mentor of children.

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