In New Zealand, you are not allowed to give blood “following oral or anal sex with or without a condom with another man (if you are male)” for 12 months. This ‘men who have sex with men’ (MSM) ‘deferral’ process as it is commonly known as, has a similar wait time in countries such as Australia, Belgium, the Netherlands and the United States. However, it is of the view of myself that this needs to change and these laws should be loosened. Currently, countries like Argentina, Italy and Spain have no deferral process for MSM blood donors. Not surprisingly, Italy specifically has not seen any incremental increase in the amount of blood donations contain the HIV virus.
What is ludicrous is that while the only possible argument for the banning is to stop the spread of the HIV virus, this is not a universal criteria. There is no check on heterosexual men at current. Further, there is currently no restrictions on people who take recreational drugs (excl. injected), haemorrhoids, gout, diabetes, herpes among others. Further, people who have contracted chlamydia only have to wait 4 weeks until donating.
So why can’t gay men donate blood? Nobody is really too sure. During the Aids crisis, Governments around the world implemented MSM ‘deferral’ processes to ensure that blood donations didn’t infect the blood supply. In 1983, the US Government banned gay men from donating blood for life. This was amended in 2015 so that gay men could donate after 1 year of enforced celibacy; while originally a response to a major epidemic that could be targeted towards one group, the current deferral of MSM blood donations are based on outdated and quite frankly homophobic tradition. Further, the archaic and somewhat confusing bar on gay men doesn’t seem to make any sense. How does the blood foundation know a male is homosexual or has participated in same-sex sex within the past 12 months?
STIs
According to the US National Library of Medicine, gay men are much more likely to contract gonorrhea, early syphilis and anal warts. In contrast, heterosexual men are more likely to contract nongonococcal urethritis, genital herpes, pediculosis pubis, scabies and genital warts.
Clearly, any prejudice that gay men are more likely to contract STIs is unfounded. In New Zealand, it is not illegal to donate blood if you contract an STI, so long as you await an incubation period. However, the common misconception is that gay men cannot donate blood as they are more likely to have STIs.
The reason for me raising this point is simply this. A gay man must wait the same amount of time in forced celibacy as someone who has contracted gonorrhoea. In my opinion, this is an absolutely disgusting comparator.
What about HIV?
According to the Centers for Disease Control and Prevention, it takes at most 90 days to detect HIV in the system, or at least 10. A more up-to-date op-ed from Dr C. Nicholas Cuneo, a resident physician in the Harvard combined program in internal medicine and pediatrics at Brigham and Women’s Hospital and Boston Children’s Hospital, has reported that technology can detect HIV in blood within 9 to 14 days of exposure. He cites The American Medical Association who propose the FDA uptake the Italian approach, to “ensure blood donation bans or deferrals are applied to donors according to their individual level of risk and are not based on sexual orientation alone.”
Let’s unpack this for a minute. The MDM referral laws were implemented during the height of the aids epidemic. Back then, HIV testing was much harder which was the reason why it spread among gay men rapidly. Nowadays, technology can pick up whether you have HIV within a fortnight. This has lead, as previously stated, many health professionals to question these outdated laws as it denies a sizable proportion of the population from donating blood purely due to sexual orientation.
As an alternative, the Italian model is being widely discussed and proposed, having been adopted already in countries such as Argentina. The European Human Rights Court are further hearing a case brought by a French citizen on the European adoption of this model.
So what is the Italian model?
Italian Blood Donation Model – Individual Risk Assessment
In 2001, the Italian Government changed the blood donation criteria from a life ban of homosexual men to the adoption of individual risk assessment of sexual behaviours. They then created a comparative analysis of the quality of blood before and after change.
This change in policy saw certified physicians putting every donor through a risk assessment examination, regardless of sexual orientation. In 2005, the Government put through a nation-wide system, where potential donors filled out a form declaring sexual activity, and then were interviewed for risk assessment.
What did they find? In basic terms, they found that the 2001 policy “did not significantly affect either the incidence or prevalence of HIV infection among blood donors or the distribution of MSM and heterosexuals among HIV antibody-positive blood donors” More specifically, comparing 1999 (before the change) with 2009, blood donors were upped from 775,357 to 1,425,791. Of this, the number of donors with HIV went from 23 to 57 for repeat donors, or 3.0 per 100,000 donors to 4.0 per 100,000 donors. Of first time donors, the number increased from 93,034 to 368,645, with 15 and 57 HIV donors respectively. This translates into 16.1 per 100,000 donors in 1999 and 15.5 per 100,000 in 2009.
While this increase seems large, compared to 2010 the numbers of HIV donors stagnated. In 2010, 1,441,350 people came back to donate blood. Of these, 55 donors were HIV positive, or 3.8 per 100,000. There were further 399,114 total first time donors, with 49 being HIV donors. This translates into 12.3 per 100,000.
While increased, the number of HIV donations are infinitesimal. The number of HIV donors per 100,000 increased by a maximum of 1 per continuous donor, and actually decreased with new time donors. Of those who did have HIV, around ⅓ reported sexual exposure more than 4 month before donation, 28.5% reported no risk exposure and the rest reported sexual exposure within the last 4 months. The key thing to note from this report, however, is that 52% of MSM reported sexual risk exposure within the last 4 months, and 50% of heterosexual men reported the same. This shows an equal risk factor regardless of sexuality.
When split into sexuality, they found more shocking results. In 1999, the total number of HIV donations were 38. Of these, MSM made up 4, heterosexuals 15, other 10 and not determined 9. After decree, in 2009, of the total 92 males who donated HIV positive blood, 26% were MSM, 35% were heterosexual, and 39% were either other or not determined. In 2010, MSM lowered to 26%, heterosexual rose to 48% and the remainder made up other or not determined.
So what does all this data tell us? Currently, the blood foundation disallows MSM donations. In 2010, Italy found that more heterosexual men actually donated HIV-positive blood than MSM. The “not determined” category would encompass those who do not disclose sexuality, so would still donate blood. So in Italy, and I repeat, heterosexual men are 22% MORE LIKELY to donate HIV-Positive blood than MSM.
Conclusion
As previously stated, our technology has increased phenomenally since the aids epidemic in the late 20th century. Nowadays, it is possible to detect HIV post-exposure within a fortnight. Our archaic laws prevent MSM from donating blood for 12 months, lumping us in the STI quarantine zone.
The conception that gay men are more likely to donate aids-infested blood is simply wrong. Italy conducted an in-depth study to prove just that. In New Zealand, we should adopt a more proactive donation system.
How would this look? I’m unsure at this phase. My middle-line solution would be to have gay men who have have HIV-exposed sex with another man who is not an exclusive partner to wait two weeks, have HIV testing, and then donate blood. The reasonable blood donation clinic would test all blood that is donated to them in order to ensure that it is not exposed to HIV or other diseases.
However, I propose a similar strategy to the Italians. Presuming that heterosexual men won’t have HIV purely because they are heterosexual is purely wrong. As Italy has shown, they’re actually more likely than MSM to donate HIV-positive blood. Further, from personal experience, gay men are much more proactive in HIV testing than heterosexual men, meaning in reality they are much more likely to know they have HIV.
Regardless of the policy adopted, it must be admitted that the current regulations are archaic and homophobic in nature.
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