|Even in 2005, being a gay man automatically makes you unwelcome as a blood donor because it's feared you may have HIV. Has public paranoia overridden safety concerns in the formulation of blood donor policy? Unless you're celibate, being a gay man will automatically rule you out from donating blood almost anywhere in the world.
It's a ban that has been in place ever since the explosion of HIV/AIDS in the early 1980s, at which time the disease was most prevalent in the MSM (men who have sex with men) community. It also was in place at a time when blood was not screened for HIV, resulting in cases of infected blood being unwittingly passed on to patients who required transfusions. But is it time, twenty years on, to review this policy? After all, we live in a world where HIV/AIDS is no longer just a "gay" disease, and our knowledge about how the disease is transmitted infinitely more reliable. Late last month, Sweden's Prime Minister Göran Persson added his voice to growing calls for a review on the ban, the first time a world leader has done so. 22-year-old Tasmanian Michael Cain thinks the ban is discriminatory, and has gone as far as launching a legal challenge with the Tasmanian Anti-Discrimination Commission and the Australian Human Rights Commission over the policy, after he was turned away from donating blood to the Red Cross in October last year. "If the Red Cross wants to make sure the blood supply is as safe as possible, it should be screening people on the basis of whether or not they have safe sex, not on the basis of who they have sex with," he said. Cain said the Red Cross nurse told him that “you people” – referring to gay men – had a higher risk of blood contamination due to unsafe sex practices. “I know that I have safe sex ...It almost felt like I was being accused of being a dirty person,” he said. Dr Peter Flannagan, director of the New Zealand Blood Service, says they haven't the time when screening donors to get into people's sexual histories. “Nor are we in a position to undertake what I would call formal and appropriate pre-test counselling for HIV, for those individuals who have been at risk,” he says. “And therefore our whole strategy is to say to people, if you've been at risk, and you need a test, then this isn't the place to come and get that test.” But what if you haven't been at risk of HIV? The problem here is that blood banks automatically assume you're “at risk” simply because you're a gay man. Flannagan says he has some sympathy with those who feel discriminated against, as he also falls into a category that is banned from donating blood – anyone who has lived in Britain for a period of six months or more between 1980–1996, a ban that was put in place following the variant CJD (more popularly known as mad cow disease) scare. “I don't for a minute believe there is a whole group of people in New Zealand who are likely to come down in the near future with variant CJD,” he says. “What I do know is that if variant CJD is to occur in New Zealand, that it is that group of individuals who are likely to have it. So with all of the criteria we use, we will inevitably exclude a large number of people who aren't at risk. And our justification for doing that is, again, balancing safety with sufficiency, which is our primary goal.” But does public paranoia also fuel the decision-making process? “I was involved in a very problematic review of practices by the Australian Red Cross following the first documented transmission of HIV in Australia in 2000,” he says. “The level of emotion that occurred in the very rare instance that these type of infections are transmitted is such that blood services are very conservative organisations – and so they should be. Because our primary goal is safety.” And “safety” when it comes to the gay blood ban equates to what Flannagan calls “a pragmatic view based on the known epidemiology”. In other words, the majority of new HIV infections in New Zealand are still among men who have sex with men. “We are consistent with international practice on the MSM exclusion,” he says. “Almost every international blood service I'm aware of adopts an approach similar to, or more rigorous than New Zealand. We need to ensure public confidence in safety in New Zealand's blood supply.” Gay rights groups feel the policy helps reinforce stereotypes about the health of gay men and who HIV can affect, with a logic akin to introducing a blanket ban on Asian immigrants to stop more sushi bars being opened. Tasmanian Gay and Lesbian Rights Group spokesman Rodney Croome says the donor screening process is out of date, and technology has progressed to a point where HIV can be detected more successfully. "As every year goes on and the technology improves (the ban) seems even more irrational," he told The Australian. "We can't afford to keep anyone shut out when blood supplies are so low. This ban will cost lives." Croome's last point is not relevant in New Zealand. Flannagan says New Zealand doesn't have a blood crisis, and is unlikely to have one in the near future. “In New Zealand we're very fortunate. We are able easily to collect sufficient blood to meet the needs of New Zealanders.” So why the promotional drives to encourage donors? “I do keep on talking to people within the service in terms of the way that we promote the message. We need more regular donors, that I will accept, because increasingly, we're putting a greater burden on a small number of people. But New Zealand, unusually in the international context, is easily able to meet all of the demands placed upon it." But if a crisis were to occur, would the criteria be reviewed then? "If it did happen, my suspicion is – if you look at other countries experience, like Canada – as they started to experience shortages, they first reviewed the VCJD (mad cow disease) criteria, not the ones relating to HIV," he says. Besides, gay blood donors simply aren't needed: “If supplies of blood fell, and if I were to go public and say this, we would get a dramatic response from the New Zealand population." Concern about HIV among blood recipients remains high, says Flannagan. "The haemophiliac community in New Zealand was heavily damaged by transmission of HIV in the late 70s and early 80s, before we were able to properly heat treat the products that we made available to them. It's these communities that we're dealing with on a day to day basis that we have to provide reassurance that the blood that we provide is as safe as possible." So are haemophiliacs harbouring a fear of being infected by gay blood? "I don't believe so. It's a non-specific anxiety, whereby the media reporting of blood issues over the last many decades has reinforced concerns around safety and scares around HIV," Flannagan says. "And so inevitably in that scenario we're going to be very cautious about changing a policy which has demonstrably worked in terms of safety. There has been no transmission of HIV by tested blood in New Zealand since 1985 that we're aware of." Nevertheless, despite the official ban on gay men donating blood, around one or two cases of HIV-infected blood still pop up per year in the post-screening process. "But what worries me isn't the donors we detect, it's the donors in the early stage of infection. Our tests won't detect it, but it will be transmitted." But how long is the incubation period for HIV? If you're a man who's had sex with a man (any sort, they don't get into specifics) in the last ten years, you're automatically turned away. "You would be politely turned away," Flannagan clarifies. "Of course, you'd be turned away by a nurse who hopefully would explain why." In Australia, the Red Cross only exclude men who've had sex with another man in the last twelve months. However, other countries are stricter – the UK enforces a lifetime ban, the USA has set a date of 1977 for MSM sexual contact. There are also geographic HIV exclusion crtieria in effect here, in recognition of those countries where HIV is a problem in the population generally. Those policies are under constant review. However, Flannagan says he'd be very surprised if any significant changes were made to the gay blood ban in the near future. "Clearly, if the evidence suggested that the time had come when the epidemiology of HIV had changed sufficiently, that would be a point at which New Zealand would look carefully at what it was doing," he says. Chris Banks - 30th August 2005