Is the MSM ban on blood still justified?
By Caoilfhinn Hegarty | Oct 10 2018
In the mid-1980s the AIDS crisis was sweeping the globe and causing widespread panic. AIDS (acquired immunodeficiency syndrome), a condition which causes the gradual failure of the immune system and allows infections and cancers to grow unrestrainedly, is the result of the human immunodeficiency virus (HIV). In the 80s it was considered a death sentence. At the time, a person diagnosed with AIDS had anywhere between just nine to eleven years to live. Nowadays, with advancements in medicine and the introduction of pre-exposure prophylaxis (PrEP), every effort is being made to combat the prevent contracting the HIV virus.“Nowadays, with advancements in medicine and the introduction of pre-exposure prophylaxis (PrEP), every effort is being made to combat the prevent contracting the HIV virus.”
HIV is a sexually transmitted disease, but transmission can also occur through a number of bodily fluids, such as breast milk and - crucially - blood. On 10th December 1982, a Californian baby became the first known case of a person contracting AIDS via blood transfusion. At this time it was evident from statistics that certain demographics were at a considerably higher risk of being HIV positive: sex workers, frequent drug users, and men who had sex with men (MSM). Around the world, governments and organisations began placing lifetime bans on these men donating blood, including the Irish Blood Transfusion Service (IBTS)."In April 2016, the IBTS held a conference where data from countries who had adopted this abstinence period was displayed. According to the data there had been no increase in HIV positive blood donations since the change in policy”
In recent years, due to more sophisticated screening processes for the virus, several countries rescinded this lifetime ban in favour of allowing MSM to donate after a twelve month period of abstinence from all sexual activity. These countries, to name a few, included France, Germany, South Korea, and Australia. In April 2016, the IBTS held a conference where data from countries who had adopted this abstinence period was displayed. According to the data there had been no increase in HIV positive blood donations since the change in policy. As a result it was concluded that “international experience had shown that a one year deferral is as effective as a lifetime deferral from the point of view of protecting the blood supply against the risk of HIV transmission”. In January 2016, the one year deferral policy was brought in.However there is controversy surrounding the issue, with many LGBTQ+ groups claiming that the restrictions in place are discriminatory. The National LGBT Federation believes the restrictions are “unnecessary” and that “the ability to donate blood should be based on an individual's health service status and safe sex practices, not gender or sexual orientation”. Dr Martin Davoren, the Executive Director of the Sexual Health Clinic in Cork, also feels that blanket restrictions on certain orientations are unnecessary. He is of the opinion that the screening process for those who wish to make a blood donation should take a different approach and instead be more concerned with the “sexual risk taking activity”, of individual potential donors “whether they are a heterosexual or homosexual person” and that the IBTS needs, in all situations, to take into account “some of the risks their donors have undergone under the past few months”, regardless of orientation. He says that the IBTS needs to ensure that “it’s not about gender, it’s not about sexual orientation, it’s not about anything it shouldn’t be about”, with regards to screening blood donors.The screening of would-be blood donors has improved dramatically since the 1980s. Initially, in 1985, the first HIV antibody test was only designed to screen blood products - not diagnose AIDS. In addition to this was the complication of ‘the window period’, a period of roughly six months wherein it was a possibility that the virus could not be detected and HIV positive individuals could test as negative. This was a large factor in the decision to place the lifetime deferral on blood donations on MSM. Technology has advanced significantly since then. For example in November 2002, the U.S Food and Drug Administration (FDA) approved the first rapid HIV test which had a 99.6% accuracy rate and gave a result in 20 minutes. Due to these strides some countries have shortened their deferral time for MSM, with the United Kingdom currently holding the shortest deferral time for in the western world at just three months. LGBT groups have pointed to these factors as justification for reviewing and changing current policies on MSM blood donations, and ultimately replacing them with less stringent and, they feel, less discriminatory practices. The National LGBT Federation asserts that “any policy that conflicts with equality, as [the IBTS’s] clearly does, should be required to meet a very high standard of justification. In light of much improved and more robust screening processes in this area over the past 30 years, this policy falls well below that. It is now time Ireland joined the growing number of countries who are repealing these 1980s era restrictions in their entirety”.The IBTS have said that they will “continue to work in this area and review [their] donor deferral policies to ensure they reflect the most up-to-date scientific knowledge” but warn that “this process must be data-driven, so the timeframe for future changes is not something that can be predicted.” There is valid reason for concern as, in the year 2000, the World Health Organisation estimated that between 15% to 20% of new HIV cases worldwide were as a result of blood transfusion. For the IBTS, its number one priority is its commitment “to supplying Irish hospitals with blood that is as safe as it can be”. The Minister for Health Simon Harris supports this stance, commenting that “the IBTS provides a safe, reliable and robust blood service to the Irish health system and has the necessary programmes and procedures in place to protect both donors and recipients of blood and blood products.” “In a country like Ireland where only 3% of the population are active blood donors despite the fact that it’s estimated that 1 in 4 people will require a blood transfusion at some time in their lives”
In a country like Ireland where only 3% of the population are active blood donors despite the fact that it’s estimated that 1 in 4 people will require a blood transfusion at some time in their lives, the change in policy has largely been seen as a positive move. Whether or not the restrictions surrounding MSM blood donors will be relaxed in the future with the advancement of medical research and technology remains to be seen, but meanwhile the issue continues to be debated in the public forum.