Science or Stigma?

The policy contradicts what we know about how HIV spreads, because it makes social distinctions where the virus does not.

Feature by Tom Calverley | 16 Apr 2006

The turning point in the 1980s AIDS crisis was when haemophiliacs started dying, infected by their supposedly lifesaving blood donations. Attitudes changed overnight, and what had been a disease of the marginal became everybody's problem. It also exposed the vulnerability of blood stocks, especially as many donations are pooled to extract platelets and plasma, so one infected pint could contaminate many. The response was to introduce a series of targeted questions to prevent certain 'high risk' groups from donating, including gay and bisexual men. While all donations are now tested for HIV regardless, the questions are still considered necessary because as the Blood Service website states, "although the chances of infected blood getting past our screening tests is very small, our tests do not always show if you are infected."

However, examining the actual line of questioning reveals some troubling inconsistencies and assumptions. If you have ever "injected drugs", "received payment for sex with drugs or money", or if "you are a man who has had anal or oral sex with another man (even if you used a condom)" then you are forbidden from ever giving blood. Yet you can donate if you have had sex with anyone who has done these activities, as long as it was more than twelve months ago. This idea that one degree of separation makes you safer from infection is based on statistics, not science. The questions impose a hierarchy of risk, judging whether you are in a high risk group, not if you engaged in a high risk activity. Accordingly they suggest you are more likely to get HIV if you receive money for sex than if you pay for it, and that male-male oral sex (with an estimated transmission risk 0.04 % per contact) is more dangerous than vaginal sex. Most significantly heterosexual sex is treated as risk free. In this way the Blood Service stereotypes sex workers and men who have sex with men as uniformly likely to have HIV, while other groups are at risk only if they have recently been exposed to these 'sources' of infection.

The policy contradicts what we know about how HIV spreads, because it makes social distinctions where the virus does not. In fact since 1999 there have been more newly diagnosed cases of HIV every year among heterosexuals, than among gay men. It also totally undermines the NHS safe sex message by disregarding condoms; suggesting they are either ineffective or gays can't be trusted to use them properly. In fact the opposite is true, and condom use is the norm within the gay community, unlike among heterosexuals, which explains the change in infection rates.

In response to these issues, LGBT students across Scotland have started a campaign to persuade the Scottish National Blood Transfusion Service (SNBTS) to reconsider their policies on donation. While campaigners do not contest the service's right to screen donors, they disagree with their risk assessment. Scott Cuthbertson, LGBT officer for NUS Scotland and campaign coordinator explains: "It's not your sexual identity that puts you at risk of HIV, it's your behaviour. The reason gay men are banned is that they are easier to target than heterosexuals who have unprotected sex. The service can detect HIV within nine days of infection, but very rarely this varies by up to three months. That's why we believe that moving from a permanent ban to a time limited deferment would be an option. Regardless it should be a system based on individual risk."

Whatever they might choose, Scott does not see maintaining the ban as an option. "According to the SNBTS, gay men make up 28% of infections detected in blood stocks. I'm not sure how they got that statistic, but if that is the case, it must mean thousands of gay men are lying to give blood. Why? Probably because they believe the ban is unjust. We think that going to individual assessment would create a fairer and more honest system that would actually protect the blood supply." The service is also going to have to deal with the growing international movement opposing the policy. In Spain and Australia, bans have been lifted, while in South Africa, a High Court ruled the ban to be discriminatory.

Last month the NUS campaign brought pressure on the medical establishment here in Scotland, with demonstrations outside blood donor clinics in Edinburgh, Glasgow, Aberdeen, Dunfermline and Kilmarnock on March 9. Scott makes clear these were not boycotts, instead the protests aimed "to encourage those able to give blood to donate on our behalf. We restricted numbers to 20-30 people at each site because we didn't want to put donors off. All the events went very well and we got thousands of signatures for our petition. In fact at Edinburgh someone from the service came out and asked us to stop, because they had reached capacity and couldn't take any more donors." It is hard for SNBTS to ignore the resounding success of the message, and Scott says the dialogue with them has been really positive. "They've helping us out and gave us materials to hand out. However, they still believe in the ban, and that has come across consistently."

Though the Blood Service has not yet been won over, the campaign has raised the profile of an issue that few knew about. At the least many who might have been turned away from donating have now been warned about the possible rejection, while many more are fired up by the injustice of the issue and keen to demand change. Plans for an eventual nationwide campaign are in the pipeline, but until then those who want to help would do well to visit, find out if they are eligible and donate their blood, because still so many of us can't.