THE NHS is asking men to bleed for the country they love.
Men made up only one-third of those signing up to give blood in the past year, with women outnumbering men on the donor register by 100,000. The target of the campaign is to balance out the numbers. Running on both television and social media, the donation drive aims to appeal to a man’s sense of national duty. Unfortunately, not all men can serve.
Gay and bisexual men can not give blood. Though the NHS doesn’t discriminate against sexual minorities, they have procedures in place that prevent donations from non-straight men. Stating on their website: “Gay and bisexual men are not automatically prevented from giving blood. However, all men must wait 3 months after having oral or anal sex with another man before donating.”
The restriction dictates that only a non-sexual homosexual can give blood, an oxymoron at best and an odd way of avoiding accusations of discrimination at worst. Men who have sex with men (MSM) is the term used to group these individuals by the health service.
The restrictions against MSM donating blood were put in place during the ’70s and ’80s, after the rise of HIV and Hepatitis B. These changes came into effect after several blood transfusions resulted in patients contracting the virus. HIV was hard to detect after exposure, and it still is today – the World Health Organisation gives an estimate of between six weeks and three months after infection for results to manifest in an antibody test. Therefore until the cut-off period, infected blood could be undetected by this method of testing, hence the three-month figure used by the NHS.
There are other modern tests available: laboratory antigen tests can detect the virus within 18 to 45 days after exposure, and the nucleic acid test (NAT) can tell after as little as 10 to 33 days, according to the Centre for Disease Control and Prevention. NAT is prohibitively expensive for mainstream use, but does show the significant advances made in this field.
MSM are deemed high risk, along with other groups (those who inject drugs and sex workers), because they are more likely to contract the virus. This is still true today – Public Health England found in their annual report that 46.57% of transmissions are the result of sex between men, with heterosexual intercourse accounting for 46.2%, a disproportionately high percentage considering only 2.3% of British men are gay or bisexual, according to the Office for National Statistics. Those who inject drugs or perform sex work make up a considerably smaller percentage of HIV-positive individuals, though the statistical likelihood of infection in these groups remains high.
Expanding this data shows that there are around 750,000 gay and bisexual men in the UK and 43,494 registered men who contracted HIV through male on male sexual intercourse. However, the reason MSM are more likely to contract the virus remains indecipherable.
The issue remains that grouping individuals because they are MSM isn’t a way of identifying high-risk sexual behaviour. MSM is an attempt to place a large number of people under a single blanket term, in this case three-quarters of a million people (approximately the population of Edinburgh and Newcastle combined) are identified as posing the same risk. MSM is not a useful way to categorise people, obscuring the social dimensions of sexuality and sexual behaviour.
By utilising this means of classification the NHS are potentially missing out on thousands of male donors. The current system also allows for extremely high-risk sexual behaviour to be undertaken by straight people: having unprotected sex with several strangers, and even being infected with an STI won’t preclude a heterosexual from giving blood, whereas a monogamous gay couple are deemed high risk.
The probability of such a relationship, one where two uninfected men are sexually exclusive, is as likely to result in HIV infection as it is that either party should become pregnant. Unsurprisingly not all gay people have the exact same sex lives, just like straight people, some are single, others promiscuous, many are now married and naturally everyone is different. Sexually-risky behaviour does occur, and HIV infections can follow, this is why not all gay or bisexual men should give blood. Nonetheless, thousands of uninfected men could give blood but are forbidden from performing this vital act.
The NHS are cautious. The decision to lower the ban on MSM people giving blood, from twelve months after intercourse to three wasn’t taken until 2017, decades after HIV testing achieved results within 90 days. The ElISA test went into use in March 1985; 33 years later the NHS switched to a three-month ban. With modern medical advances in the field of HIV, they’re similarly reserved. Evidently, the NHS act inline with society’s perception of gay and bisexual people, rather than any scientific information available to them.
In a June 2019 interview with the BBC, Su Brailsford, a consultant in health protection at NHS Blood and Transplant (NHSBT) stated: “The safety of the seriously ill people who receive blood is our number one priority. Blood donation exists for patients, not for blood donors.”
Her position is that saving lives is more important than any perceived discrimination, a misunderstanding of why people call for change. The NHSBT needs to reevaluate their position regarding sexually active gay and bisexual men, not to right an injustice (though that surely isn’t a liability) but to save lives. According to their statistics, they need 25,000 more male plasma donors. In 2018, they feared stocks of O negative and B negative blood could have dropped below 2 days. On top of this they spend £1000 on advertising for every 24 new, heterosexual, male donors, according to an article in Wired.
A void in male donors exists, and if a safe solution is available, it should triumph over ignorance on this topic.
The UK is not the only country to face the possibility of a blood shortage, it is also not the only country that has people calling for change. In the US, the American Medical Association proposed that the FDA “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,” advocating for a science-based approach to blood safety.
Other countries already allow gay men to give blood: Spain, Argentina and other nations don’t screen blood donors based on sexual orientation. In 2001, Italy moved away from discriminating based on sexuality and implemented an individual sexual risk assessment and evaluation. Italy switching to an evidence-based approach has generated a wealth of data that was analysed in this US National Library of Medicine article. The results show there hasn’t been an increased transmission of HIV by blood transfusion, proving this can be done without damaging the safety of a nation’s blood supply. Britain could make this change, almost 20 years after Italy managed to do so successfully.
The NHS can start viewing people as individuals, assessing them on their risk, not institutionalised fear or ignorance. The term MSM is outdated, ineffective and British health professionals should transition to using language that properly describes a person’s individual risk when it comes to blood donation. Gay and bisexual men could give blood and save lives, it’s time to let them.