Green Party LGBT News

Experts oppose gay blood ban	3 December 2008
Summary Experts oppose gay blood ban Call for review of blood service policy

Main Body

In response to yesterday's statement on the gay blood ban by the Terrence Higgins Trust:

A growing number of scientific and medical experts oppose the blanket, lifetime ban on gay and bisexual men donating blood.

Below is a selection of expert opinion, including the National Aids Trust, which is critical of the total ban (see NAT's letter below).

This expert opinion contradicts the support for the gay blood ban expressed by the Terrence Higgins Trust and Gay Men Fighting Aids.

You can quote me on any of the below.

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"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. Fear and prejudice are terrible reasons to let you or someone you love die."

Dr Arthur Caplan, former Chair, US Government Advisory Panel on Blood Donation - 4 November 2005

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The American Red Cross (ARC), The American Association of Blood Banks (AABB), and Americas Blood Centres (ABC) are all in favour of changing the lifetime ban on gay men donating blood.

These are highly responsible, professional bodies with expertise in the field.

If a lifetime ban was medically or scientifically justified, these bodies would support it. They don't. They oppose it.

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According to Johann Hari, writing in The Independent, the US epidemiologist and bio-ethicist Dr Scott Halpern has calculated if the gay blood ban is lifted and gay men who practice safe sex are allowed to donate, a single HIV-positive blood donation will slip through clinical screening once every 5,769 years. That's once between now and the year 7777 – the equivalent to it happening once since 3761 BC, when cities had not yet been invented.

See here: http://www.independent.co.uk/opinion/commentators/johann-hari/johann-hari-people-are-dying-because-gay-men-cant-give-blood-959316.html

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Let's put the risks in perspective:

The use of old blood (more than 15 days old) is thousands of times more risky than accepting donations from gay men who practice safe sex.

Dr Scott Halpern and Dr Lesley Cannold gave evidence against the blanket gay blood ban in Tasmania, Australia, in late 2008.

Dr Halpern, who is a bio-ethicist and epidemiologist at the University of Pennsylvania and a consultant to the US Centre for Disease Control and the US Food and Drug Administration, put the claims of the "increased risk" from blood donation from gay men in perspective.

He noted that blood older than 15 days (which comprises at least 13% of the Australian supply) poses a risk of mortality "thousands of times greater" than the very worst predictions of HIV infection stemming from unsafe male-to-male sex.

Dr Halpern said:
"I think we're talking about one in 100 risk of death on the one hand with using old blood, and about a one in a million risk of HIV on the other...much rarer than getting struck by lightening."

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Here is expert opinion in the UK, which opposes the blanket, lifetime ban on gay blood donors:

NAT (National AIDS Trust) is Britain's leading HIV charity.

It is questioning the lifetime ban on gay donors. NAT met with the National Blood Service recently and says it was unconvinced by the justifications they put forward for the ban.

NAT has publicly spoken out on the ban and last month wrote to the to the government's Advisory Committee on the Safety of Blood, Tissues and Organs, which advises the National Blood Service (NBS) on their policy, requesting that they review the restrictions.

The request for a NBS policy review, taking into account outside submissions, seems a sensible way forward.

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According to the National Aids Trust, the current HIV antibody test used by the blood service to screen blood donations is outdated and less reliable than the minimally acceptable standard of test required, under UK national HIV testing guidelines for use in all testing laboratories (the fourth generation assay).

This means that the National Blood Service (NBS) is screening blood using an inferior, less reliable test for HIV than is recommended.

This is outrageous and irresponsible. The NBS is putting the blood supply at risk, yet it points the finger of blame at gay and bisexual men.

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Since Italy lifted its total ban in the late 1990s and allowed some gay men to donate blood, the number of people infected with HIV through blood donations has fallen from 24 a year to 4. Gay donors do not therefore increase the risk to the blood supply.

This big fall is partly due to Italy implementing a new donor screening policy that focuses on the safety or risk of individual sexual practice - not on barring whole social groups on the grounds that they are "high risk".

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Mark Wainberg and Norbert Gilmore of the McGill University AIDS Centre in Montreal (and two of the world's leading researchers in the HIV field) have been lobbying to have the policy changed, and their arguments are convincing.

They note that the "prohibition against all gay men from being blood donors forever fulfils no useful scientific purpose" and results in a tremendous loss of potential donors.

A recent Canadian study estimated that lifting the lifetime ban would result in 136,000 more donations annually without compromising safety.
The same study calculated that there was a theoretical risk of one more contaminated unit of blood every 18 years, a risk that was classified as "infinitesimally low."

The Canadian Blood Service has commissioned a risk assessment, a survey of donors and at least three academic studies of donations.

Most research looking at the risk of blood donations by gay men have focused on the high-risk population, those with multiple partners. But few studies have been done on those - the majority - in long-term, stable relationships. There is no reason to believe their risk profile differs from most heterosexuals.

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The UK's blanket ban on all gay and bisexual men donating blood is not medically or scientifically sound. It is driven by generalisations and stereotypes about gay male behaviour.

Some countries have abandoned such a policy.

Italy, Spain, France, Russia and South Africa would not have ended their total ban on gay blood if they thought it would put the blood supply at risk.

No one is saying that giving blood is a right, but it should be open to everyone unless there are concrete medical reasons why their blood might be unsafe.

Since the National Blood Service already asks potential donors dozens of questions to eliminate donations from risk groups, adding a couple more questions to differentiate between safe and at-risk gay and bisexual men does not seem an onerous request.

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Mr John Forsythe
Chair
Advisory Committee on the Safety of Blood, Tissues and Organs Area 530 Department of Health Wellington House
133-155 Waterloo Road
London SE1 8UG

12 November 2008

Dear Mr Forsythe

I am writing as Chief Executive of NAT (the National AIDS Trust) to ask that SaBTO (the Advisory Committee on the Safety of Blood, Tissues and Organs) undertake a review of the lifetime bans currently in place in relation to blood donation.

You will of course be aware of the considerable controversy surrounding the ban on any man who has ever had sex with another man (MSM) giving blood. We are aware of the current rationale for the ban and have had an immensely helpful discussion on this issue with Dr Lorna Williamson and Henrietta Joy from NHS Blood and Transplant. We are, however, currently unconvinced by the reasoning behind the ban. To give just two of our concerns:

• The current test used by the blood service is less reliable than the minimally acceptable standard of test required for use by UK national HIV testing guidelines in all testing laboratories (the fourth generation assay).
• The only two options addressed in the defence of the ban are no ban at all and a one-year ban – but there are alternatives such as the New Zealand five-year ban. A lifetime ban becomes increasingly indefensible when, for example, there would be next to no one with undiagnosed HIV fifteen years after they were infected.

As importantly, we are unaware of any systematic consideration of the ban on MSM since the coming into force of the Equality Act (Sexual Orientation) Regulations 2007. You will know that these Regulations prohibit discrimination on grounds of sexual orientation but at Regulation 28 refusal of blood donation is permitted if the risk assessment is based on 'clinical, epidemiological and other data which was obtained from a source on which it was reasonable to rely, and the refusal is reasonable having regard to that data, and any other relevant factors'. We would respectfully suggest this placing of the ban on a new and explicit legal footing requires a systematic and proactive review of the ban which expressly considers its evidential basis within the wider obligation not to discriminate.

We would add that we also have concerns in relation to some of the other lifelong bans such as on anyone who has ever been paid for sex or ever injected drugs, where we have not, as yet, been presented with the epidemiological basis for such a policy.

We know that SaBTO keeps all its donation rules 'under review' and that there are a number of pieces of research and overseas experiences where SaBTO has expressed an interest in assessing results and data to inform its deliberations. But in the light of changing practice overseas, improvements in testing technology, wider behavioural and epidemiological research, and the new legal context, we recommend strongly that SaBTO goes beyond what appears an essentially passive approach and agrees to a proactive review of all lifetime blood donation bans. Such a proactive review should include:

• agreement as to the evidence and data necessary to inform decisions on the continuation of the lifelong bans
• agreement with relevant research institutions and other bodies to access research available and currently being undertaken
• commissioning of research where it is clear that no evidence exists or is being gathered
• processes to involve affected communities, and
• clear timelines for the progress and completion of the review.

Of course research takes time and the timeline for the review may be over an extended period. But as long as the process is transparent and, to use the wording of the Regulations, 'reasonable', we believe there will be immense benefits from such an approach for the robustness of SaBTO's own policies and for its relations with relevant communities.

I look forward to hearing from you.

Yours sincerely

Deborah Jack
Chief Executive

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