Shaun Griffin (pictured), Executive Director External Affairs at the Terrence Higgins Trust, separates fact from fiction on the issue of gay men and blood donations...
It is time to talk about blood donations. The perceived inequalities, the real inequalities, and the facts. The glaring necessity for a review, the energy whipped up from a community’s ire, and what we can all do about it.
Its been five years since the Advisory Committee on the Safety of Blood, Tissues and Organs (SaBTO) which advises the Governments of the four UK nations on the rules around blood donation recommended a delay period of 12 months for any man – gay, bi, straight or other – that has had sex with another man (or ‘MSM’ in medical terms) in the previous 12 months. This also applies to women who have had sex with a man who in turn had sex with a man.
It’s Not Just Gay Men. Others?
Policies on blood donations vary across the globe. Late last year the US Food and Drug Administration (FDA) recommended allowing MSM to donate blood one year after their last sexual contact - where previously it had been a lifetime ban. The one year rule applies in Finland, Brazil, and Australia. In Spain, Portugal and Russia there are no restrictions, whereas in Canada, the limit is five years.
Looking back towards home I think we can all agree that knowledge and science have moved on since 2011. We can no longer confidently assert that the12 month delay period is based on the most up to date evidence and the current restrictions must be examined.
However, the 12 month rule did reflect the evidence at the time. The fact is that MSM in the UK are at far greater risk than any other group of acquiring infections such as hepatitis B and C and HIV. The rules refer to MSM, and not to gay, bisexual or heterosexual men. It was neither homophobic nor discriminatory to have donation rules based on behaviour that increases the risk of viruses being passed on.
That is why Terrence Higgins Trust supported the 12 month delay period in 2011. Arguing that there is no difference between the risks posed by different groups ignores the facts and the reality of the HIV and hepatitis epidemics in this country.
HIV has never been a 'gay disease', but MSM are at significantly higher risk of acquiring the virus than their heterosexual counterparts in the UK. Certain behaviours make HIV transmission more likely, including anal and, to some extent, oral sex between men. One in 12 MSM in London (one in seven on the ‘gay scene’ itself) are now living with HIV; as are one in 20 elsewhere in the country.
How many in the mainstream population?
So, compared with sex between a man and a woman, it is statistically far more likely that sex between two men will involve at least one partner who has HIV. Additionally, about one in six gay or bi men who have HIV don’t yet know it, because they remain untested. This is a fact.
That risk is greater now than it has been at any time since the epidemic began more than 30 years ago. In 2013, in the UK there were around 3,250 diagnoses of HIV acquired through sex between men, compared to 2,490 through heterosexual sex. This is a disproportionate number when you consider that gay and bisexual men make up a small percentage of the population. This is a fact.
The 2011 SaBTO report stated that ‘it remains best practice to review the measures…in place to ensure they are…supported by the most recent data available’. Five years has passed – the data are no longer recent. We need a review. This is a fact.
We were the first organisation to say that the rules needed reviewing – we called for this in 2013, which we reiterated in June this year, and we continue to call for that review now.
That review, as well as considering the latest available data, should also address the contradictions attached to including the lifetime ban on former sex workers and intravenous drug users, which were not addressed then. However, the safety of the blood supply must come first.
The devastating impact that HIV has had on gay communities in the UK cannot be underestimated. Terrence Higgins Trust has consistently called for investment in initiatives that improve the sexual health of gay and bi men in the UK and address the very tangible inequalities we suffer. Inequalities that exist, because in the UK HIV still disproportionately affects gay, bi and other MSM.
Those inequalities remain because HIV prevention funding has decreased and is not prioritised at a time when HIV infections are rising among young gay and bi men, and many of them remain undiagnosed. And because of the Government’s refusal to make sex and relationships education statutory in all schools. These are the issues that deserve our ire, and the inequalities we need to pour our collective energy into addressing.
If the blood donation deferral period cannot be justified on current scientific evidence it should be changed. But our priority must be to end HIV transmissions among all groups at high risk.
By Shaun Griffin, Executive Director External Affairs at Terrence Higgins Trust. Twitter: @THTorguk