1st November 2015Adam Hilsenrath
Anyone who has donated blood will know that the minutes spent in the (oddly comfortable) chair, watching a small bag fill up with blood constitutes a tiny fraction of the entire process.
Before you are sat down, you are tested for anaemia and must fill in a lengthy health questionnaire. The first section on the form, entitled “Your Lifestyle”, is mainly about one thing: HIV. Whether you’ve had sex with a prostitute or with anyone from a country where HIV and AIDS are widespread, the National Blood Service doesn’t want your blood if there’s a chance of you having HIV. This, most would agree, is an understandable and efficient way of preventing donations from people with infected blood.
Yet it is the final two questions about “Your Lifestyle” which come across as archaic, nonsensical and bordering on the discriminatory.
In Great Britain, men who have had sex with men (MSM) in the last 12 months cannot give blood. Full stop. In Northern Ireland, no MSM can give blood at all, regardless of how recently they’ve had sex.
From one perspective you can see a semblance of logic. The United Nations estimates that between two and 20 percent of MSM are infected with HIV, though, clearly, in somewhere like the UK the percentage will be at the lower end of the scale. In 2009, the Centers for Disease Control and Prevention reported that MSM accounted for 61 percent of all new HIV infections, and of the nearly 800,000 people worldwide living with HIV, 51 percent are MSM. Considering that estimates on the non-heterosexual population range from four percent to ten percent, and that over half of these are women, this does point to a much greater chance of MSM having HIV compared with anyone else (about 60 times more than other men).
Furthermore, HIV can take, depending on the number of antibodies the body produces, about three months before it’s detectable. In about three percent of cases this can take up to six months, meaning that HIV-infected blood could be donated without anyone knowing (a serious problem considering that National Blood Service usually keep blood for only seven weeks). The focus on HIV is further understandable when it’s considered that other sexually transmitted diseases, such as gonorrhoea, can be detected within a matter of weeks.
However, that’s about as far as the logic will go. There are, on the other hand, many reasons why current practice is flawed.
Firstly, even if the 12 month window was kept to ensure that no one was inadvertently donating blood with HIV, under the current system there’s no space for those MSM who’ve had protected sex. Condom or no condom, MSM cannot give blood. On the other hand, heterosexual men, or any woman, can donate blood even if they sleep with a new partner every night without any protection.
Secondly, MSM in long-term relationships are also excluded. Two men who have been exclusively dating for years can often have unprotected sex, sure in the knowledge that neither man carries STDs and is unlikely to acquire one. But again, under present regulations there is no “I am in a long-term, exclusive relationship” box, and so blood cannot be donated.
Thirdly, sceptics might argue that some vindictive people might knowingly donate HIV-infected blood and that, because MSM are more likely to have HIV anyway, all MSM donations should be prohibited. If we, for a moment, ignore the crass offensiveness of this argument, one should bear in mind that anyone vindictive enough to donate HIV-positive blood would show up on the blood tests done automatically on all donations (because if they know they have HIV, then it’s already passed the three-sixth month period). What’s more, good-natured MSM who want to donate blood can already lie if they know they’re HIV-free.
At present, we are operating on decades-old blanket assumptions, which unnecessarily bar certain individuals from making a valuable contribution to society. Research on the correlation between MSM in long-term relationships and rates of HIV possession is yet to be done.
There is a simple remedy. If the law were altered so that any MSM who has either been in a relationship as long as the 12 month waiting period or has had adequately protected sex could donate blood, then the system would still prevent the possibility of HIV donations without unnecessary levels of discrimination.
It has been tried before. Michael Fabricant, MP for Lichfield, has campaigned on a number of occasions for such a legal amendment, but has always lacked support, though I can’t understand why. This is not only an issue of discrimination, but also of public health and liberty.
The current law is fundamentally outdated and homophobic, and at a time when blood stocks are low and the NHS in constant need of donations, it is irresponsible that people who want to save the lives of others are not allowed to do so.
Thirty men have been stopped from donating blood at clinics in Northern Ireland because they have had sexual contact with another man, a BBC investigation has found.
Elsewhere in the UK, there is a one-year deferral period for men who have had sex with men (MSM) to donate.
Northern Ireland has an outright ban.
But a judge ruled that former health minister Edwin Poots did not have the power to retain that ban. His ruling will be appealed in court later.
In the Northern Ireland Appeal Court on Monday, the current on-off health minister, the Democratic Unionist Party’s (DUP) Simon Hamilton, is appealing the judgement, alongside Health Secretary Jeremy Hunt.
They shall be asking who is in charge of blood policy and whether or not this is a devolved issue. The appeal is expected to last four days.
Following a Freedom of Information request, BBC News NI has seen emails sent between Northern Ireland’s Department of Health and the Northern Ireland Blood Transfusion Service (NIBTS), which is responsible for the collection, testing and distribution of blood.
The NIBTS also said it had stopped 30 men from donating blood at their clinics since 2011 after they informed staff that they had sexual contact with other men.
The BBC asked the NIBTS how confident it would be that its blood is screened correctly and that it would be safe for MSM to donate after the one-year deferral period.
It said: “All blood donations are subjected to the testing regimes required by the Blood Safety and Quality Regulations 2005.
“As such, NIBTS is confident that all blood samples are screened correctly.”
The BBC has also seen instructions sent to the NIBTS from Dr Elizabeth Mitchell, the deputy chief medical officer, instructing the organisation how to respond if approached by the media about the ban remaining in place.
Dr Kieran Morris, the former chief executive of the NIBTS, replied showing some concern about the process and how he would answer questions from his own staff.
“As chief executive officer and accountable officer for the NIBTS special agency service, I require from the Department of Health a written direction, giving me a clear line as to how we manage and control the situation,” he said.
“There is no doubt in my mind that referring all matters to the Department of Health press office will not be sustainable for more than a few days.”
A BBC investigation earlier this year found the Department of Health does not have any medical evidence of its own to support a permanent ban on gay men donating blood.
The ban was put in place across the UK during the Aids crisis of the 1980s, but was lifted in England, Scotland and Wales in November 2011.
New rules were introduced that allowed blood donations from men whose last sexual contact with another man was more than a year earlier.
But Northern Ireland did not follow suit.
A gay man, granted anonymity due to his perceived vulnerability, launched a judicial review challenge over then health minister Edwin Poots’s decision not to adopt the same policy on this side of the Irish Sea.
A judge ruled that Mr Poots’ decision was “irrational” and “infected with apparent bias”.
Mr Poots said he had kept the ban on the basis of ensuring public safety.
In April, the European Court of Justice (ECJ) ruled that a lifetime ban may be justified in member states if no effective detection techniques exist within the country.
The ECJ said countries must establish if such donors were at high risk of acquiring infectious diseases like HIV.
Mr Hamilton said he would study the ruling.
A number of issues will be looked at in the Court of Appeal, including whether blood policy should be a devolved matter.
The appeal is expected to last for four days.
The NIBTS did not respond to the BBC to give an additional comment.
A Department of Health spokesman said: “It would not be appropriate at this stage to comment on matters that are before the courts.”
The US Food and Drug Administration (FDA) has recommended the end of a three-decade ban on blood donations from homosexual and bisexual men.
However, some restrictions will remain, as the FDA said it favours replacing the blanket ban with a new policy barring donations from men who have had gay sex in the previous year.
Some gay activists have responded to the announcement by complaining it is unrealistic and stigmatises the LGBT community.
Having examined scientific evidence surrounding blood donation for men who have sex with men, the FDA said in a statement that it will recommend a change to the blood donor deferral period from indefinite to one year since the last sexual contact.
The current rule has been in place for 31 years and dates from the first years of the AIDS crisis, and was intended to protect the US blood supply from exposure to the little-understood disease.
Under the policy, blood donations are barred from any man who has had sex with another man at any time since 1977 — the start of the AIDS epidemic in the US.
But medical groups, including the American Medical Association, say that the policy is not supported by science, given advances in HIV testing.
Last month, a panel of blood safety experts convened by Department of Health and Human Services voted 16-2 in favour of ditching the lifetime ban, and recommended barring donors who have had male-on-male sex during the previous 12 months.
In the US, all donated blood is tested for HIV, however, the test only detects the virus after it’s been in the bloodstream about 10 days – allowing a brief window when the virus that causes AIDS can go undetected.
If the new advice is put into place, US law will be put in line with other countries including the UK (except Northern Ireland), Australia and Japan.
Patient groups that rely on a safe blood supply, including the National Hemophilia Foundation, have also voiced support for dropping the ban.
But LGBT campaigners say it does not go far enough.
“Some may believe this is a step forward, but in reality, requiring celibacy for a year is a de facto lifetime ban,” the organisation Gay Men’s Health Crisis, a New York-based nonprofit that supports AIDS prevention and care, said after the announcement.
The FDA will publish its advice in draft guidelines early next year, and will move to finalise them after taking comments from the public, officials said.
FDA Deputy Director Dr Peter Parks declined to give a deadline for the process but said, “we commit to working as quickly as possible on this issue.”
According to government figures, men who have had sex with other men represent about 2 percent of the US population, yet account for at least 62 percent of all new HIV infections in the US.
The recommendation is the culmination of a push for new policy which gained momentum in 2006, when the Red Cross, the American Association of Blood Banks, and America’s Blood Centers called the ban “medically and scientifically unwarranted.”
Additional reporting by AP