Monday, 7 November 2011

Allowing sexually active gay men to donate blood is not worth the risk

Gay men will now be able to give blood as Government restrictions are officially lifted, the Department of Health (DoH) has said.

A lifetime ban on blood donation by men who had had sex with another man was put in place in the UK in the 1980s as a response to the spread of Aids and HIV.

But following a review by the Advisory Committee on the Safety of Blood, Tissues and Organs (Sabto), men who have not had homosexual sex within a year will be able to donate if they meet certain other criteria.

The move will be implemented in England, Scotland and Wales.

Men who have had anal or oral sex with another man in the past 12 months, with or without a condom, will still not be eligible to donate blood, the DoH said. They said this was to reduce the risk of infections being missed by testing and then being passed on to a patient.

Sabto’s advisory panel, comprising leading experts and patient groups, carried out its review based on the latest available evidence and found it could no longer support the permanent exclusion of men who have had sex with men. They considered the risk of infection being transmitted in blood, attitudes of potential donors in complying with the selection criteria and improvements in testing of donated blood.

Dr Lorna Williamson, NHS Blood and Transplant's medical and research director, said: ‘The Sabto review concluded that the safety of the blood supply would not be affected by the change and we would like to reassure patients receiving transfusions that the blood supply is as safe as it reasonably can be and amongst the safest in the world. There has been no documented transmission of a blood-borne virus in the UK since 2005, with no HIV transmission since 2002.’

I have just listened to a BBC interview (still on line) where a bisexual man called John said that there was still not ‘equality’ and that there should not be even a twelve month waiting time. It was explained to him that this waiting time would still be in place because the incubation period for hepatitis B, which is carried in blood, is six months – and that the twelve month ban was there for reasons of patient safety. I might add that the time for sero-conversion for HIV (during which you can infect others but do not have detectable antibodies) is 20-90 days and can also be as long as six months.

Why am I unhappy about this new policy? I simply believe that allowing gay men who have been sexually active to donate blood is just not worth the risk.

First, the conclusion of the latest research is that over 10% of men who have sex with men (MSM) already knowingly defy the current lifelong ban. This suggests that many will also knowingly defy the twelve month ban and this will increase the risk of transmission, especially if John’s reaction above is in any way representative.

Second, the number of new donors this policy will produce will be very small. According to the Wellings’ survey only 2.6% of men report ever having had sex with men and the vast majority of these will have been active in the last year. Also two thirds of gay men participate in anal sex. So it will be only a very small fraction of an already small starting percentage who will even be eligible.

Third, the risks of HIV transmission with anal sex are very high indeed, 18 times higher than in vaginal sex. The risk of an HIV positive person passing the virus on in the course of a relationship involving anal sex is around 40% explaining why gay men are such a high risk group (see also original source).

Fourth, a subset of gay men are extremely promiscuous and the risk of HIV transmission goes up with the number of partners one has. Despite the popular media image of homosexual monogamy, several large early studies from the 1970s revealed that less than ten percent of homosexual men or women had ever experienced a relationship of greater than ten years duration. In one large early study, 74% of male homosexuals reported having more than one hundred partners in a lifetime, and 28% more than 1,000; 75% reported that over half of their partners were strangers. A more recent review of six studies showed that 87% of gay men displayed levels of promiscuity parallel to those of unmarried straight men with an average of five or six sexual partners in the last five years. But a significant minority were promiscuous to an extent seen rarely in straight men. 14.4% had 20-100 sexual partners in the previous five years and 4% had over 100!

So in summary – most gay men engage in high risk anal sex, some are extremely promiscuous, and a significant proportion lie about it. It’s simply not worth the risk allowing them to give blood given the small number of gay men who would actually qualify under the new guidelines.

If one person gets HIV from blood donated by a gay man it will be a tragedy. Banning all gay people giving blood donations may debar some who would very much like to help in this way. But safety should be the overriding priority. In a free society we accept, for reasons of public safety, that some people are not able to do what they very much would like to do – in all sorts of contexts other than blood donation.

In a much-quoted editorial published in Vox Sanguinis in 2004 J P Brooks argued that ‘The rights of blood recipients should supersede any asserted rights of blood donors’

The abstract of his review summarised the arguments as follows:

‘Some gay men have argued that the laboratory testing of blood is so accurate that continued deferrals based upon sexual activity are unnecessary and unjust. They also assert that they have a right to donate blood. There has been much debate over altering the rule barring donation from men who have had sex with other men since 1977, with blood organizations disagreeing over the best course of action. Two studies have indicated that changing the rule would increase the risk of human immunodeficiency virus (HIV) transmission. This dilemma is part of a broader issue, namely: what are the responsibilities of blood services to blood donors and recipients? Blood services should base decisions regarding donor suitability on science rather than on their donors’ desires. Blood services must recognize that the rights of blood recipients should supersede any asserted rights of blood donors.’

Quite!

But the final word goes to Andrew Marsh of Christian Concern who was interviewed on Radio Five Live breakfast show this morning.

He made the point that the safest donors, with respect to HIV, are those who have only had sex within the context of marriage, and that if there was no sex outside marriage there would be no HIV. Well now, there’s a radical idea!

9 comments:

  1. Completely agree Peter. It may be unpopular in the current climate of "greater tolerance and acceptance" (except if you disagree with my views) but we should base these decisions entirely on the medical risks, including the risks of donor non-disclosure of risk factors.

    What next - the "rights" of the HIV positive community to donate blood so that they are not discriminated against?

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  2. I'm a med student - We recently had a lecture on blood transfusion in which the lecturer told us that the majority of donated blood ends up in the bin! He said this was due to doctors being unnecessarily over-cautious by ordering more blood than is needed, combined with leaving it out of fridges for too long. The lecturer said he belived if donors knew of the waste than donations would probably half overnight! I was really disturbed by this and have wondered since how true it is...

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  3. I suspect this move is due to the inadequately low number of donors... there's been rumours for some time that rules may be relaxed in an attempt to bring numbers up. I wouldn't be suprised if there are more 'relaxations' in the future.

    Truth is there simply aren't enough donors to meet demand. I suggest that everyone who wants to voice their opposition to this relaxation rolls their sleave up once and a while to "do something amazing... give blood".

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  4. Did you know that there is a ban on Brits giving blood in Europe because of mad cow disease in the 90's? As a heterosexual, married for 18 years, my blood is not accepted in Greece. If Europe is so over-cautious, why is Britain not?

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  5. When on a trip back to the USA a few years ago I went to the local bloodbank to donate. I was refused because I had resided in the UK; fear of BSE. But the fact that I had had breast cancer several years ago was not a problem. In the UK I am barred from giving blood because I have had breast cancer, but the BSE factor is not an issue. That the DOH has taken the batty decision to change the lifetime ban on gay men donating does not surprise me. There is obviously much confusion on what constitutes a transmissable risk.

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