A change of policy to include the HIV virus test alongside the antibody test would be safer, smarter and free up more much-needed blood
According to the Sunday Times, the government is planning to lift the blanket, lifetime ban on blood donations from men who’ve had oral or anal sex with men. This ban was introduced at the height of AIDS panic in the 1980s, on the grounds that gay and bisexual men are at greater risk of HIV. The public health minister Anne Milton is reportedly planning to modify the ban. Men who have had sex with men will be no longer be barred for life, but only for 10 years after the last time they had oral or anal sex. This ban will apply even if they always use a condom and even if they test HIV-negative.
A 10 year ban is too long. So is five years or even one year. These are needlessly cautious exclusion periods. Protecting the blood supply is the number one priority but ensuring blood safety does not require such lengthy time-spans during which gay and bisexual men should not donate blood.
The blood service could replace the blanket lifetime ban on blood donations from gay and bisexual men with a much shorter exclusion period. It should focus on excluding donors who have engaged in risky behaviour and those whose HIV status cannot be accurately determined because of the delay between the date of infection and the date when the HIV virus and HIV antibodies manifest and become detectable in an infected person’s blood.
HIV antibodies normally take a maximum of one to three months to become identifiable in lab tests. The HIV virus can take two weeks to be detected. The blood service currently tests all donated blood for HIV antibodies but not for the HIV virus. To be safe, perhaps it should do both tests on potentially risky blood donations?
Reducing the exclusion period for blood donations from gay and bisexual men should go hand-in-hand with a “Safe Blood” education campaign targeted at the gay community, to ensure that no one donates blood if they are at risk of HIV and other blood-borne infections due to unsafe sexual behaviour.
Moreover, the 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.
There is, in addition, a strong case for only excluding men who’ve had risky sex without a condom. At the moment the blood service makes no distinction between sex with a condom and sex without one. All oral or anal sex between men - even with a rubber – is grounds for refusing a donor under the current rules. This strikes me as odd. If a condom is used correctly, it is absolute protection against the transmission and contraction of HIV. Those who use condoms every time and without breakages should not be barred from donating blood.
In contrast to the suggested 10 year ban for gay and bisexual blood donors, a six month exclusion period would be sufficient. This would exclude male donors who have had oral or anal sex with a man without a condom in the previous six months. All men who last had unprotected sex with men more than six months ago would have their blood tested for HIV antibodies, as is the current practice. Although the six month exclusion period is more than twice as long as it takes HIV antibodies to appear in the blood of an infected person, this is may be justified to err on the side of caution and to reassure the public.
The exclusion period could, however, be much shorter than six months, with certain provisos. The blood service could decide to ban only donations from men who’ve had unsafe condomless oral or anal sex with a man in the last month. For men who’ve had unprotected oral or anal sex with a man in the preceding one to six months, the blood service could be extra safe and do both a HIV antibody test and a HIV virus test on their blood. Since the HIV virus shows up in blood tests within two weeks of the date of infection, the one month total exclusion period offers a double-length margin of safety. This would guarantee that the donated blood posed no risk to its recipients.
A change of policy along either of the afore-mentioned lines would not endanger the blood supply. With the specified safeguards, the blood donated would be safe.
The call for change is growing worldwide. The American Red Cross, the American Association of Blood Banks and America’s Blood Centres favour ending the lifetime ban on gay and bisexual men donating blood.
According to Dr Arthur Caplan, former Chair of the US Government Advisory Panel on Blood Donation: "Letting gay men give blood could help bolster the supply. At one time, long ago, the gay-blood ban may have made sense. But it no longer does.”
The truth is that most gay and bisexual men do not have HIV and will never have HIV. Both the lifetime and 10 year bans are driven by homophobic, stereotypical assumptions, not by scientific facts and medical evidence. For the vast majority of men who have sex with men, their blood is safe to donate. Far from threatening patient’s lives, they can and should help save lives by becoming donors.