On Sept. 8, the U.K. Dept. of Health announced it would lift its lifetime ban on blood donation by men who have sex with other men, a policy that gay activists have long criticized as unfair.
The policy shift, which will affect England, Wales and Scotland, but not Northern Ireland, is a direct result of a review of data [PDF] by the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO), which determined what many critics of the ban have been arguing for years: that permanently excluding gay men from donating blood is unmerited and not based on any scientifically proven increase in risk to the blood supply.
The longstanding British ban, similar to the one that has been in place in the U.S. since 1983, prohibits men who have ever had oral or anal sex with another man — regardless of when or how frequently — from donating blood. The policy is premised on the idea that, as a group, gay men are at increased risk for HIV, hepatitis B and other transmissible infections and, therefore, pose a greater risk to the blood supply.
Supporters of such restrictions point to HIV statistics and advocate for erring on the side of safety: in 2009, for example, Centers for Disease Control and Prevention (CDC) data estimated that more than half of all new HIV infections in America occurred in men who have sex with men — or MSM, as they’re known by epidemiologists.
But critics of the ban say it’s simply a holdover from an era when fears ran rampant about gay men and the AIDS epidemic. Current CDC data also show that the rate of HIV infection is eight times higher in black men than in white men — and 19 times higher in black women than in white women — and yet the U.S. does not impose blood-donation restrictions by race.
SaBTO agrees that the lifetime ban is unfair, particularly since modern blood tests render the blood supply safe. By ditching the ban, the U.K. joins countries such as Australia, Japan, Sweden, South Africa and New Zealand, which have made similar allowances. (The ban still stands in the U.S. and Canada.)
Gay activists say the U.K.’s move is a big step in the right direction, but many argue it still falls short of a victory. Although the ban is being rolled back, there will be in its place a new regulation, a deferral: starting Nov. 7, men who have sex with men may donate blood, but only if it’s been a year since their last oral or anal sexual encounter.
As Slate’s William Saletan reported, the reasoning goes like this:
[SaBTO] noted that the “window” period for the relevant viruses — the period during which you might be infected (from a sex act) but not yet show up as infected on donor blood tests — is now nine to 15 days for HIV and 38 to 67 days for hepatitis B. … In the case of hepatitis B, blood tests might miss the tail end of the infection as well as the beginning. To avoid this second window, the committee proposed a “deferral” period of one year. If you’ve had sex with another man in the last year, your blood could be undetectably infected. Past that point, blood tests are reliable, and you can donate.
The committee calculated that under the current lifetime ban on MSM donors, the projected frequency of HIV-infectious blood escaping detection in England and Wales was one per 4.41 million donations. … Under a five-year deferral (allowing MSM to donate if they hadn’t had oral or anal sex with another man in the last five years), the frequency of infectious blood escaping detection would be one per 4.39 million donations. Under a one-year deferral, it would be one per 4.38 million donations. In short, no difference.
Logical? Sure. But the problem is that the new regulation is based on the same misguided assumption as the old one: namely that gay sex equals risky sex.
Whether the ban lasts a year or a lifetime, it is still inherently biased, because it makes assumptions about an entire population without asking questions about individual behavior. The 12-month deferral doesn’t take into account whether men are having sex with men using a condom or without. It doesn’t separate those who are monogamous from those who engage in casual sex with strangers.
It puts a gay, HIV-free man in a decades-long monogamous relationship in the same high-risk category as a heterosexual man who has unprotected sex with prostitutes and intravenous drug users.
A better method of screening out risky donations, activists argue, is to ask potential donors for more details about their individual sexual behaviors. “[T]he questionnaire that would-be blood donors have to answer should be made more detailed for men who’ve had sex with men, in order to more accurately identify the degree of risk, if any, that their blood may pose,” wrote Peter Tatchell, a British gay activist, in The Guardian.
Others suggest that all donors, regardless of sexual orientation, should undergo the same type of questioning.
It’s unclear whether that will happen anytime soon, at least not on this side of the pond. Despite continued pressure from activists, politicians and even the American Red Cross, in June 2010 a U.S. Food and Drug Administration (FDA) advisory committee voted 9 to 6 to uphold the lifetime ban on blood donation by any man who has had sex with another man since 1977, even while the panel acknowledged that the ban was “suboptimal” and based on unfair generalizations.
The new data review by SaBTO may spur the FDA to reconsider. Until then, the strapped U.S. blood supply continues to miss out on thousands of extra pints of potentially life-saving blood: research from the Williams Institute for Sexual Orientation Law and Public Policy at the University of California, Los Angeles, School of Law estimated that some 219,000 extra pints of blood could be available every year if the lifetime ban were lifted.