How Clean is your Blood?

We are consistently encouraged to give blood, and rightly so – there naturally needs to be a constant supply of healthy blood in the NHS so that it's readily available when people need it. However, when you actually go to give blood you're asked to fill in a form designed to weed out anyone considered at risk of having a disease or infection that may impact the quality of their blood. The National Blood Service is particularly concerned with making sure you do not have HIV or hepatitis B or C.

Everyone in the United Kingdom has to fill out the same form when they go to give blood and that form explicitly states that men who have sex with men are unable to give blood. The Scottish Blood Service states on their website that there are two main reasons why you shouldn’t give blood. These reasons are: if it could affect your health; and if you could potentially transmit an infection to the recipient of your blood. They list an example of the latter as “If your lifestyle puts you at risk of HIV or hepatitis.”

The National Blood Service itself breaks this category down into a number of different parts. Gay men and prostitutes can never give blood and someone who has had sex with a gay man or a prostitute cannot give blood for twelve months. The service also urges you not to give blood if you’ve had sex with someone you think might have HIV or hepatitis, or if you think that you may have these diseases yourself, but it does not ban you from donating and it does not ask any further into your sexual practices.

The issue has been in the news recently because there has been talk of reducing the deferral period for men who have sex with men. At the beginning of April two national papers reported that the government was considering introducing a ten-year waiting period instead of a lifetime ban.

So why can’t gay men give blood now? The general perception is that gay men are more promiscuous; that they have unprotected sex with new partners more frequently than the rest of the population and thus their ‘lifestyle’ puts them at risk of sexual infection. There are two main problems with this assumption – one is that it is incredibly difficult to get accurate statistics of people’s sexual practices and the other is that it places the focus on sexuality and not behaviour.

If you have unprotected anal sex with a new partner you are at risk of contracting HIV (and many other sexually transmitted diseases) whether you are heterosexual, homosexual, bi-sexual or pan sexual. Whether you could (or should) call having unprotected sex with strangers a lifestyle is a different question but it is certainly a step forward in terms of language.

There have been a number of campaigns running recently to try and get the government to reduce the amount of time that men who have sex with men would have to wait before giving blood. Their argument is that the current legislation is sending out the wrong message about homosexuality, safe sex and STI infection particularly in relation to HIV. Laura Rose, the current president of Dundee University LGBT (Lesbian, Gay, Bi-sexual and Transgender) society says: “We believe the ban on men who have sex with men giving blood to be promoting the wrong message about safe sex because it reinforces a promiscuous image of the gay community. The blood service should not assume that gay men are having unprotected sex – straight couples have high-risk sex too, they're just not asked about it in as much detail when they go to donate!”

Some campaigners, however, have been quicker to accuse the Blood Service of homophobia. Ben Collier, an LGBT activist in the University of Edinburgh’s Feminist Society and LGBT Society blood ban campaign has this to say: “While I agree that they should measure based on accurate behavioral characteristics, that isn't the issue which we're debating. We're not protesting the blood ban because it reduces the amount of blood in the system, we're protesting it because it is homophobic, non-pragmatic and non-empirical.”

His opinion is backed by prominent gay rights campaigner Peter Thatchell who wrote in another national paper recently, “The truth is that most gay and bisexual men do not have HIV and will never have HIV. Both the lifetime and ten-year bans are driven by homophobic, stereotypical assumptions, not by scientific facts and medical evidence. For the vast majority of men who have sex with men, their blood is safe to donate and they can and should help save lives by becoming donors.”

While this line of argument seems attractive at first, two important points must be kept in mind. Firstly it is unlikely the NBS implemented the ban out of fear or hatred of homosexuals (lesbians are able to donate blood and gay men are able to donate organs) and secondly gay men ARE at more risk of contracting HIV than other groups, although how much more at risk is debatable. The problem is more to do with the way that gay men have been excluded, with the mixed messages that the blood service is sending to the whole population about homosexuality, safe sex and HIV risk. If we return to the wording of the NBS form then we can see that it says you can never give blood if you’re: “A man who's had sex with another man, even safe sex using a condom.”

This implies that all sexual activity between two men is equally dangerous – which it isn’t. The risk of contracting HIV (or any other sexual disease) through oral sex with a condom is incredibly low. Or to put it another way if you’re a man you’re more likely to contract HIV by having unprotected penetrative sex (even vaginal, we’re not just talking about anal sex here) with a woman than by having oral sex using a condom with a man.

Fundamentally, you shouldn't give blood if you have had unprotected sex with a stranger until you know that you have not contracted anything from that unprotected sex. HIV and hepatitis take a little time to show up in your blood – if you get tested immediately after having unprotected sex with a new partner then you may get a false negative result. It’s the same with pregnancy tests. Unlike pregnancy, though, HIV or hepatitis can hide in your system without making you ill. Many sexually transmitted diseases are like this – we do not know exactly how many people have an STI and are not aware of it.

This is the crux of the issue – the debate is built on educated guesses and estimating how much more at risk a particular group in society is compared to the norm. The National Blood Service sets their norm roughly as a 17 to 65 year old, in good health who weighs at least 7st 12Ib. However, this is only true as long as they are not in a ‘risk group’. The main risk groups are gay men, prostitutes and intravenous drug users. Or men who have slept with other men, people who have had sex for money and people who have injected illegal substances. You can see that there are a lot of different things going on in excluding these three groups that has nothing to do with blood.

The last group that have a lifetime ban from giving blood are people who: “Have ever had syphilis, HTVL (Human T - lymphotorpic virus), hepatitis B or C or think [they] may have hepatitis now. ” There is a huge difference between having a disease and being at risk of having a disease. It seems fairly obvious that people who have a permanent viral infection that is blood related cannot give blood.

People have all different kinds of sex. Nearly all of them can be done safely. The safer the sex, the less likely they will be to catch HIV, hepatitis or any other sexually transmitted disease and thus their blood will be safer.

Whether the lifetime ban is overturned or not, the fact still remains that the emphasis on sexual orientation is unhelpful. To ban all gay men from giving blood perpetuates the idea that all gay men are promiscuous, it implies that all gay sex is risky and it encourages everyone to think in terms of risk groups and not in terms of risky behaviour.

Buggery is not illegal anymore. The moral conversation is over. We need to move out of this being a gay rights issue into it being a safe sex issue and for that to happen the wording of the form you fill in when you give blood needs to be changed. A blanket ban on any risk group sends the wrong message to all of us.