Opinion: New MSM blood donation criteria do not go far enough

Paul Burstow MP recently wrote in these pages explaining the government’s decision to lift the lifetime ban on MSM blood donations. I have tabled an amendment to my motion at Conference next week, Science Not Stigma: Ending the Blood Ban, to oppose the deferral on the MSM group.

First and foremost, I’d like to emphasise that throughout this campaign, I have avoided use of the words “discrimination”, “homophobic” and “bigoted”. I am aware that this separates me from some others who have campaigned on the matter, but I think it’s really important. I have great respect for the NHS and the fantastic people who work within it and I personally believe that the methodology and the conclusions of the review were all the product of good intentions. Attempts by others who stand on my side of the campaign to malign doctors and nurses as “homophobic” or “bigoted” detracts the argument from the priority subject – the safety of the patient – and suggests that the lifting of the ban is all about us, the gay and bisexual men. It’s not.

I have spent the past year dissecting reports, opinions, articles and various other materials on the blood ban, the people who oppose/support it, the so-called medical justifications for it and of course the suggested alternative means of protecting the blood bank. I have always been a believer in reaching a conclusion based on sound evidence. This is why I didn’t cry “homophobia”. It is vital that if we want to win support, we must defeat those who propose the ban on their own terms – the scientific evidence.

On Thursday, when the ban was lifted, I was not experiencing the elation of many of my peers. Whilst I have been campaigning for an end to the blood ban, I have simultaneously been campaigning for more stringent criteria on the basis of each individual sexual behaviour to be applied across the board. I still cannot believe that after yet another review, SaBTO do not insist within their criteria that if somebody of any sexuality has had risky sex that they should have been tested for infection before they turn up to give blood. HIV, Hep B and Hep C don’t magically go away after 12 months – nobody should donate blood as a means of finding out their status and every medical organisation should be pushing for people to go and get tested.

Although I am still sifting through the SaBTO report (and will need the good grace of FOI to pick up any of the supporting information not currently publicly available), I have opposed the methodology of the review on the same grounds other medical professionals have. The ban is a product of a time where we didn’t understand HIV – we didn’t have the means to diagnose it early, nor the means to treat it. All we did know was who had it and, at the time, it was believed to originate and affect only gay men (it was referred to as Gay Related Immunodeficiency) in the ghettoised quarters of cities. Perhaps it made sense then to hedge bets when the data and information wasn’t available. But now we know how HIV is transmitted sexually – the high risk activity is unprotected sex (receptive anal sex being the highest). Most importantly, we know how to prevent HIV transmission. Peter Tatchell is absolutely right to suggest that gay men who use a condom are not high risk. Many doctors and nurses who work in sexual health will emphatically agree.

Paul Burstow argues specifically on the grounds of Hep B which is another virus not restricted solely to the MSM group. He fails to mention, however, that many gay and bisexual men (including myself) have been immunised against Hep B. Of course, it’s not a one-off immunity shot, but after the initial boosters you’re protected for 12 years with a predicted immunity of 25 years. The criteria could exclude those who have been immunised if Hep B is the primary concern, but it does not.

So the scientific stand-off comes to two camps – those who believe that we find a modelled correlation between societal groups; and those who believe we should base our criteria on the risk posed by each individual’s behaviour. I support the latter because it is nonsensical to me to place our faith in pigeonholed categories that not everybody who is high-risk fits into and a lot of people who are low risk do fit into. It is ridiculous to base the criteria on societal groupings when we know exactly how HIV is transmitted and can base the criteria on that instead. That way you don’t miss any of the exceptions. That way, you don’t exclude healthy donors from giving blood.

There will be one common argument against my proposals – what if the gay men who want to donate lie about their sexual history? It’s one that has been brought up already in relation to simply lifting the lifetime ban. The answer is simple – if somebody that badly wanted to lie to give blood, they’d have done it already. The blood service relies on two Ts – testing and trust.

One final point of consistency. I’m already a blood donor, technically. Nope, I haven’t lied on any forms or fraudulently made my way into a blood van. I am on the Anthony Nolan register of people to donate blood stem cells – I am allowed to be on that register because the criteria for being so is based on my individual risk. When I am no longer of this world, my organs will be harvested and used to save the lives of other people who need them. I am an organ donor because the criteria for being so is, once again, based on the risk of my individual behaviour. The National Blood Service remains an anomaly for judging my risk based on who I sleep with rather than whether I do it safely or not.

I don’t want to give blood because I feel I have a right to. Nobody has a right to give blood. I want to give blood because I feel the patient with haemophilia or sickle cell disease has a right to receive it. The blood ban campaign I have coordinated over the past years has never been about the gays and the bisexuals, it’s been about the patients. We want to give blood responsibly so we can save lives, not endanger them.

The 12-month MSM does not adequately protect the blood bank and it does not give it the many new donors it needs. It is a ban by any other name.

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5 Comments

  • Andrew Suffield 10th Sep '11 - 1:49pm

    those who believe that we find a modelled correlation between societal groups

    Those people are wrong – they’ve picked up the general idea from hearing about math and science, but haven’t applied it correctly. (I’m betting none of them are mathematicians)

    We are not interested in a correlation between groups of people and infection risk. We are interested in a correlation between restrictions on blood donation and contamination risk. More informally: we want to look at the effects of the rules, not the people. It sounds like they’re very similar because they are, but there are subtle differences.

    Is there a correlation between sexual orientation and risk of infection? Yes.
    Does restricting donation based on this reduce the risk of contamination? Yes.
    Is there a correlation between protective measures during sex and risk of infection? Yes.
    Does restricting donation based on this reduce the risk of contamination? Probably. No data.
    Does restricting donation based on sexual orientation reduce the risk of contamination if there is already a restriction based on protective measures? No data.

    That last correlation is the one we want to look at. Unfortunately, so far as I can see there’s not been a study examining it. We probably need one.

  • Well argued Chris.

    I was surprised to read that Hepatitis B was a key factor in the 12 month ban given that it’s possible to vaccinate against and that so many gay men have the vaccine.

    There must be a probabalistic relationship between “had a negative test result in the last X months” vs likelihood of being HIV positive now that would give a good enough criterion of whether to let someone give blood at any time.

    Is there a link for your blood donation campaign?

  • Adam Corlett 11th Sep '11 - 10:12pm

    It seems odd that, for example, two men who’d been in a monogamous relationship or even civil partnership for a decade still won’t be able to donate, regardless of their history or even any proof of seronegativity. They’re wary of “the introduction of [more!] extensive donor questions regarding sexual behaviour” but perhaps they could offer extra questions to those who are keen but would otherwise be excluded.

    But the new criteria are big progress!

    Relatedly, perhaps it should be mentioned at Conference that the Lords “HIV and AIDS in the UK” Select Committee concluded that “”the ban on HIV home testing kits… is unsustainable and should be repealed” as long as the tests were accurate and there was a support network for those who tested positive.” [BBC] Too late for an amendment now, but I see no reason why LibDems shouldn’t push for this.

  • Richard Underhill 9th Aug '15 - 12:54pm

    Blood donors are continually needed because, reportedly, large quantities of blood are thrown away when it gets stale.
    There are other uses. Athletes have, allegedly, been taking samples of their own blood, waiting while their bodies replace it, and then putting the saved blood back in. Therefore no performance-enhancing drugs have been added, but there is allegedly an enhanced capacity for the blood to carry oxygen and enhance performance.
    Reports of experiments on mice is that blood from young mice injected into older mice is rejuvenating. Blood from older mice injected into younger mice accelerates ageing. If this is also true in humans the consequences are important. The fashion for tattoos is a problem.

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