Whether men who have had sex with men (MSM) should be allowed to donate blood is not a matter of equality. It’s a matter of the safety of the UK’s blood supply. Johann Hari, writing in the Independent, was spot on when he said that ‘if gay donations really did endanger people, that would trump any commitment to anti-discrimination.’ However, despite the abolition of the lifetime ban on donations from MSM, expected on November 7th, the question remains as to whether the one year blanket deferral that will take its place is strictly necessary. The new regulations, while comparatively positive, certainly do not put gay men on an equal footing with heterosexuals. If they are to be upheld, it must be because they are supported by the evidence.
Thankfully, technological advances have enabled the government to remove the regulation preventing MSM from ever donating. Whereas the equipment used for testing blood donations was once capable of allowing infected blood to pass undetected through screening procedures, and into the blood supply, that risk no longer exists. Any virus is now almost guaranteed to be detected. The upshot of this is that MSM can now donate blood, one year after their last sexual encounter (defined as anal or oral sex, whether safe or not), because any infection they do have will show up during testing, allowing the blood to be excluded if necessary. There is a deferral time because of the ‘window period’, which exists between the contraction of a virus and its being detectable by testing. Since those who carry a virus from recent sexual activity could donate infected blood which is not caught by the screening process during this period, a deferral is necessary. However, the length of this deferral seems strangely long, given technology’s reduction of the window period to around two weeks. This is due to the strange behaviour of the Hepatitis B virus. For those individuals who naturally eliminate the virus, there is another window period near the end of its lifespan. Since people need not know that they are infected, it is necessary to have a deferral time which eliminates any possibility of the virus’s transmission into the blood supply during either of these window periods. The same one year deferral is already in place for other groups considered high risk, such as those who have visited Sub-Saharan Africa.
Many are still not content with the recent change, however. There is outrage that the male gay community (to whom the rule almost exclusively applies) is being treated as some single entity, rather than a group of individuals, the riskiness of whose sexual practices is varied and diverse. While it’s obvious that those who have, say, had unprotected anal sex within the past year ought to be deferred (the same is apparently not true of those who have had unprotected heterosexual sex, since the incidence of infection is considerably higher amongst MSM), it seems puzzling, and potentially prejudiced, to prevent a man in a long term monogamous homosexual relationship, who practises only safe sex with his partner, from donating blood.
Ultimately, it comes down to whether you believe the evidence. SaBTO, the advisory committee on the safety of blood, tissues and organs, maintains that sexual accidents, indiscretions, and non-compliance from donors, all of which transcend sexual orientation, are enough to require a blanket year-long deferral on blood donation from men who have had sex with men. Since the rate of infection amongst MSM is so much higher than amongst non-MSM, so the argument goes, every broken condom, every unfaithful boyfriend, and every blood donor that lies about his eligibility to donate, counts for that much more amongst MSM — so much so as to make a generalised rule necessary.
If this is not the case, several things follow. Firstly, it would mean that the lifetime ban that has been in force until now was ill-conceived, and not just because of technological advances. If the riskiness of MSM donation isn’t high enough to warrant a blanket year-long deferral, then, for as long as that same group has been of a similar risk level, the lifetime ban has been unnecessary: a man practising safe sex is only excluded for one year because of the possibility that he has an infection that he doesn’t know about (or is lying about his last sexual encounter). While the same possibility exists for non-MSM, the risk is deemed too high amongst MSM donors. If this is in fact not true, then MSM practising safe sex should have been eligible for donation even when tests were not as thorough — the inherent risk associated with MSM would not have been great enough to necessitate their being prevented from donating, just as the risk of a heterosexual man contracting a virus is not great enough to require his exclusion.
If the risk does not exist, there should be no hesitation in scrapping a rule which simultaneously retards the progress of gay rights, while doing nothing to make the blood supply safer. But the government’s priority lies in ensuring safe blood stocks. Any future decision to further alter the existing regulations should be based on evidence indicating that there will be no greater risk to patients receiving blood — and on nothing else.
