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Bad blood
The National Blood
Service claims it wants to protect patients
from HIV, but its indiscriminate ban on gay
donors is flawed, says
Peter
Tatchell. (This article first
appeared in the Guardian’s “Comment
Is Free” section on 1 December 2008,
World AIDS Day.)
It is
World
AIDS Day and many gay people overseas
are donating blood. Encouraged to donate by
their national blood services, they are
doing their civic duty, alongside their
heterosexual families and friends, to help
ensure that there are plentiful blood
supplies for patients and accident victims
who need emergency transfusions.
But this is not happening
in the UK. Gay blood has been officially
declared queer, tainted and a menace to the
health of the nation. Gay and bisexual men
are banned as blood donors by the National
Blood Service (NBS).
We all now carry the mark
of the HIV “Anti-Christ”. Every single same-sexer
in Britain is categorised by the NBS as a
potential purveyor of death and destruction.
We are all reckless liars, who can never be
trusted to behave with sexual responsibility
or to tell the truth about our sexual
history and HIV risk factors. Every last one
of us – including gay doctors, priests and
HIV educators – are prohibited from giving
blood, now and forever.
This NBS ban applies to
all men who have had oral or anal sex with
another man, at any point in their life –
even just once with a condom. It has
introduced this catch-all ban in the name of
protecting the blood supply from
contamination with HIV. This is a laudable
aim but the indiscriminate gay ban is an
unjustified and flawed way of achieving it.
Five to ten
per cent
On the basis that roughly
5% to 10% of the male population is gay or
bisexual for all or part of their lives,
this policy excludes around one to two
million potential blood donors. This is
madness at a time when the NBS is crying out
for donors to “do something amazing”.
If the NBS is seriously
concerned about screening out HIV
contaminated blood donations, why is it
refusing to test donated blood for the HIV
virus? What is its excuse for adopting the
cheaper, less safe option of testing for HIV
antibodies?
In an infected person,
the virus shows up in the blood with a few
days, whereas the antibodies can take up to
three months to become identifiable. Within
this three-month period, the antibodies may
be present but not detectable. This means
that a recently infected person might not be
aware of their HIV status. When they donate
blood, their blood will be passed as safe by
the NBS and be offered for use in
transfusions and blood products –
potentially infecting dozens of people. This
short-sighted policy of only testing for
antibodies increases the likelihood of the
blood supply becoming infected with HIV.
If the NBS switched to
testing directly for the virus this would
not only make the blood supply safer, it
would also enable an easing of the ban on
gay blood, which would boost blood stocks.
Because the HIV virus is
manifest in the blood with a few days of
infection, it would be feasible for the NBS
to introduce a new policy whereby only men
who’ve had sex with men in the preceding
seven days would be excluded from donating
blood. This would significantly increase the
pool of available donors.
Gay
Blood Donation
Already, several
countries have ditched or qualified their
ban on gay and bisexual blood donors. See
the global movement for reform at
Gay Blood Donation.
Spain and Italy only rule
out donations from men who have engaged in
risky sexual behaviour. Since these two
countries relaxed their policies and allowed
more gay men to become donors, the number of
people who have become infected via blood
donations has more than halved. Experts
suggest that this is partly to do with the
new emphasis on excluding donations from
people who engage in risky sexual behaviour,
as opposed to the previous blanket exclusion
of entire high-risk groups.
An easing of the gay ban
has also taken place in Argentina,
Australia, Japan and Hungary, where gay and
bisexual men are only prohibited from
donating blood if they’ve had sex in the
last year. A five-year deferral on gay
donors operates in New Zealand and South
Africa. In the UK, the NBS still insists on
a lifetime ban.
Oddly, this unscientific,
irrational policy is backed by gay-led HIV
charities in the UK, such as the Terrence
Higgins Trust [see THT’s
Blood donations by people at higher risk of
HIV – our policy]
and Gay Men Fighting Aids [see
Should G*y Men Give Blood?.
Now dependent on funding
and goodwill from establishment bodies, they
have joined the establishment. Unwilling to
challenge a blanket ban that is irrational
and ignorant, they collude with the NBS’s
stereotyped and prejudiced assumptions about
gay and bisexual men.
Scientists, doctors, HIV
organisations and gay rights campaigners in
many other countries take a different view.
They say that a total ban on all blood
donations from men who have sex with men
lacks scientific credibility and medical
justification. They are right.
The NBS gay blood ban is
based on the ill-informed, homophobic
presumption that all gay and bisexual men
are “high risk” for HIV, regardless of their
individual sexual behaviour. This is
nonsense. Most gay men do not have HIV and
will never have HIV.
Based on crass
generalisations, the NBS policy lumps
together all gay and bisexual men, without
differentiation, as if we are all the same.
We’re not. There is a wide diversity of
same-sex behaviours and lifestyles. Some of
us are at risk of HIV, and some of us are
not. Those who are not at risk should not be
excluded from doing “something amazing”.
~~~
Experts
oppose gay blood ban
After this article
appeared in “Comment Is Free”, Peter
Tatchell issued this statement citing
several references to support an end to the
ban on gay blood.
A growing number of
scientific and medical experts oppose the
blanket, lifetime ban on gay and bisexual
men donating blood.
Below is a selection of
this expert opinion, which supports the
opposition to the total ban expressed by the
National
AIDS Trust and
contradicts the support for the gay
blood ban expressed by the Terrence Higgins
Trust and Gay Men Fighting Aids.
“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. Fear and
prejudice are terrible reasons to let you or
someone you love die.”
– Dr Arthur Caplan,
former chair, US Government Advisory Panel
on Blood Donation, 4 November 2005
The American Red Cross
(ARC), The American Association of Blood
Banks (AABB), and Americas Blood
Centers (ABC) are
all in favour of changing the lifetime ban
on gay men donating blood. These are highly
responsible, professional bodies with
expertise in the field. If the lifetime ban
endorsed by the UK blood service was
medically or scientifically justified, these
bodies would not oppose it.
According to Johann Hari,
writing in the Independent, the US
epidemiologist and bioethicist Dr Scott
Halpern has calculated that, if the gay
blood ban is lifted and gay men who practise
safe sex are allowed to donate, a single
HIV-positive blood donation will slip
through clinical screening once every 5,769
years. That’s once between now and the year
7777 – the equivalent to its happening once
since 3761
bce,
when cities had not yet been invented.
See Hari’s full article
here.
Let’s put the risks in
perspective:
The use of old blood
(more than 15 days old) is thousands of
times more risky than accepting donations
from gay men who practice safe sex.
Dr Scott Halpern and Dr
Leslie Cannold gave evidence against the
blanket gay blood ban in Tasmania,
Australia, in late 2008. Dr Halpern, who is
a bioethicist and epidemiologist at the
University of Pennsylvania and a consultant
to the US Centre for Disease Control and the
US Food and Drug Administration, put the
claims of the “increased risk” from blood
donation from gay men in perspective.
He noted that blood older
than 15 days (which comprises at least 13
per cent of the Australian supply) poses a
risk of mortality “thousands of times
greater” than the very worst predictions of
HIV infection stemming from unsafe
male-to-male sex.
Dr Halpern said, “I think
we’re talking about one in one hundred risk
of death on the one hand with using old
blood, and about a one in a million risk of
HIV on the other – much rarer than getting
struck by lightning.”
Here is more expert
opinion in the UK that opposes the blanket,
lifetime ban on gay blood donors:
NAT (National AIDS Trust)
is Britain’s leading HIV charity. It is
questioning the lifetime ban on gay donors.
NAT met with the National Blood Service
recently and says it was unconvinced by the
justifications the NBS put forward for the
ban.
NAT has publicly spoken
out on the ban and last month wrote to the
to the government’s Advisory Committee on
the Safety of Blood, Tissues and Organs,
which advises the National Blood Service on
its policy, requesting that it review the
restrictions.
The request for a NBS
policy review, taking into account outside
submissions, seems a sensible way forward.
According to the National
Aids Trust, the current HIV antibody test
used by the blood service to screen blood
donations is outdated and less reliable than
the minimally acceptable standard of test
required under UK national HIV testing
guidelines for use in all testing
laboratories (the fourth-generation assay).
This means that the NBS
is screening blood using an inferior, less
reliable test for HIV than is recommended.
This is outrageous and irresponsible. The
NBS is putting the blood supply at risk, yet
it points the finger of blame at gay and
bisexual men.
Since Italy lifted its
total ban and allowed some gay men to donate
blood, the number of people infected with
HIV through blood donations has fallen from
24 a year to 4. Gay donors do not therefore
increase the risk to the blood supply.
This big fall is partly
due to Italy’s implementing a new
donor-screening policy that focuses on the
safety or risk of individual sexual practice
– not on barring whole social groups on the
grounds that they are “high-risk”.
Mark Wainberg and Norbert
Gilmore of the McGill University AIDS Centre
in Montreal (and two of the world’s leading
researchers in the HIV field) have been
lobbying to have the policy changed, and
their arguments are convincing.
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McGill
University, Montreal |
They note that the
“prohibition against all gay men from being
blood donors forever fulfils no useful
scientific purpose” and results in a
tremendous loss of potential donors.
A recent Canadian study
estimated that lifting the lifetime ban
would result in 136,000 more donations
annually without compromising safety. The
same study calculated that there was a
theoretical risk of one more contaminated
unit of blood every 18 years, a risk that
was classified as “infinitesimally low”.
The Canadian Blood
Service has commissioned a risk assessment,
a survey of donors and at least three
academic studies of donations.
Most research looking at
the risk of blood donations by gay men has
focused on the high-risk population, those
with multiple partners. But few studies have
been done on those – the majority – in
long-term, stable relationships. There is no
reason to believe their risk profile differs
from most heterosexuals.
The UK ban
The UK’s blanket ban on
all gay and bisexual men donating blood is
not medically or scientifically sound. It is
driven by generalisations and stereotypes
about gay male behaviour. Some countries
have abandoned such a policy.
Italy, Spain, France,
Russia and South Africa would not have ended
their total ban on gay blood if they thought
it would put the blood supply at risk.
No one is saying that
giving blood is a right, but it should be
open to everyone unless there are concrete
medical reasons why their blood might be
unsafe.
Since the National Blood
Service already asks potential donors dozens
of questions to eliminate donations from
risk groups, adding a couple more questions
to differentiate between safe and at-risk
gay and bisexual men does not seem an
onerous request.
Please lift
this ban
John Forsythe, chair of
the Advisory Committee on the Safety of
Blood, Tissues and Organs (SaBTO) at the
Department of Health in London received this
letter in November from Deborah Jack of the
National AIDS Trust:
I am writing as Chief
Executive of NAT (the National AIDS
Trust) to ask that SaBTO undertake a
review of the lifetime bans currently in
place in relation to blood donation.
You will of course be
aware of the considerable controversy
surrounding the ban on any man who has
ever had sex with another man (MSM)
giving blood. We are aware of the
current rationale for the ban and have
had an immensely helpful discussion on
this issue with Dr Lorna Williamson and
Henrietta Joy from NHS Blood and
Transplant. We are, however, currently
unconvinced by the reasoning behind the
ban.
To give just two of
our concerns:
-
The current test
used by the blood service is less
reliable than the minimally
acceptable standard of test required
for use by UK national HIV testing
guidelines in all testing
laboratories (the fourth generation
assay).
-
The only two
options addressed in the defence of
the ban are no ban at all and a
one-year ban – but there are
alternatives such as the New Zealand
five-year ban. A lifetime ban
becomes increasingly indefensible
when, for example, there would be
next to no one with undiagnosed HIV
fifteen years after they were
infected.
As importantly, we
are unaware of any systematic
consideration of the ban on MSM since
the coming into force of the
Equality Act (Sexual Orientation)
Regulations 2007. You will know that
these Regulations prohibit
discrimination on grounds of sexual
orientation but at Regulation 28 refusal
of blood donation is permitted if the
risk assessment is based on “clinical,
epidemiological and other data which was
obtained from a source on which it was
reasonable to rely, and the refusal is
reasonable having regard to that data,
and any other relevant factors”. We
would respectfully suggest this placing
of the ban on a new and explicit legal
footing requires a systematic and
proactive review of the ban which
expressly considers its evidential basis
within the wider obligation not to
discriminate.
We would add that we
also have concerns in relation to some
of the other lifelong bans such as on
anyone who has ever been paid for sex or
ever injected drugs, where we have not,
as yet, been presented with the
epidemiological basis for such a policy.
We know that SaBTO
keeps all its donation rules “under
review” and that there are a number of
pieces of research and overseas
experiences where SaBTO has expressed an
interest in assessing results and data
to inform its deliberations. But in the
light of changing practice overseas,
improvements in testing technology,
wider behavioural and epidemiological
research, and the new legal context, we
recommend strongly that SaBTO goes
beyond what appears an essentially
passive approach and agrees to a
proactive review of all lifetime blood
donation bans.
Such a proactive
review should include:
-
agreement as to
the evidence and data necessary to
inform decisions on the continuation
of the lifelong bans
-
agreement with
relevant research institutions and
other bodies to access research
available and currently being
undertaken
-
commissioning of
research where it is clear that no
evidence exists or is being gathered
-
processes to
involve affected communities, and
-
clear timelines
for the progress and completion of
the review.
Of course research
takes time and the timeline for the
review may be over an extended period.
But as long as the process is
transparent and, to use the wording of
the Regulations, “reasonable”, we
believe there will be immense benefits
from such an approach for the robustness
of SaBTO’s own policies and for its
relations with relevant communities.
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