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Saturday 11 April 2015


The blood debate: one year deferral?

Posted in: HIV, Features
By Jacqui Stanford - 13th December 2013

The NZAF backs a move to cut the stand down period for gay men giving blood to a year. Rainbow Wellington says decisions should be made on a case-by-case basis. Here is the lowdown on the latest developments on the divisive issue.

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Currently any man who has had anal or oral sex with another man in the past five years is banned from giving blood, due to higher HIV rates among the group.

The New Zealand Blood Service has asked a review group to look at this rule, and it has put together a draft report (*see who is in the review group at the bottom of this story).

What does the review group say so far?
It recommends dropping the ban period for gay and bisexual men from five years from the time they have had anal or oral sex with another man, to one year.

On what grounds?

  • It has to balance maintaining the safety of the blood supply, with interfering as little as reasonably possible with the rights and freedoms of potential donors.
  • Australia has had a twelve month stand-down for the past ten years, with no evidence of HIV transmission.
  • Advances in donation testing and handling mean errors have now been virtually eliminated from the system.
  • The biggest risk of HIV entering the blood supply is during the very early ‘window period’ when it can’t yet be reliably detected.
  • There has also apparently been a high level of compliance with the five year ban among gay and bi men.

What about other options?
While it also considered a six month deferral period, this was dismissed “largely on the basis that there is no evidence of how it will work in practice, nor evidence from modelling, and there is less margin for error in misjudging time since last sexual contact.”

The group also rejected a risk based assessment of actual sexual behaviour, as no research has been published in the area, and it would also mean gay and bi men would be hit with invasive in-depth questions about their sex lives.

“There is evidence that some MSM who do not comply with donor deferral already find questions about sexual risk too personal,” the group says.

“Furthermore, people are not reliable at assessing their own risk. A recent survey in New Zealand found that most MSM who had undiagnosed HIV infection believed that they were definitely or probably uninfected, and many had had a recent negative HIV test.”

Who agrees?

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The New Zealand AIDS Foundation. “Based on the evidence provided in the draft Blood Donor Deferral Report, NZAF supports the proposal to reduce the deferral period for gay and bisexual men from 5 years to 1 year in New Zealand” says Executive Director Shaun Robinson.

While it doesn’t want to comment further till the proposals move beyond the draft stage, the NZAF has in the past taken a firm stance, saying: "Safe sex will almost certainly protect individuals from HIV infection, and will be sufficient to end the sexually-transmitted HIV epidemic among MSM if consistently practiced. However, risk reduction is not sufficient to fully protect the blood supply, which instead requires a 'higher bar' of 100 per cent risk elimination to ensure blood safety."

A higher bar for the blood supply is deemed necessary because of the very high risk of infection via blood transfusion, and because people in urgent need of blood services have little or no choice as to whether they accept blood given to them.

The NZAF has ion the past noted that population groups "who engage in activities that involve a greater risk of HIV transmission, and who also have high levels of HIV prevalence, will inevitably pose a greater risk to the blood supply." As a result, it says, "blood safety policy must take account of the prevalence of HIV in specific population groups as well as individual risk behaviours, and the only practical way to do this is by epidemiologically-based donor deferral."

Who disagrees?
 

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Blood donation has long been a hot issue for the lobby group Rainbow Wellington, and in light of the recent developments it maintains there should be no blanket ban on gay and bisexual men giving blood in New Zealand, but individual risk assessments instead.

Rainbow Wellington says a blanket ban is discriminatory and risk based assessment of actual behaviour should be the goal.

It points to this year’s policy change of the American Medical Association, which now opposes the lifetime ban still imposed by the US FDA. As part of that, board member Dr William Kobler said in a statement: "This new policy urges a federal policy change 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."

Rainbow Wellington is urging to the New Zealand review group to look at this further.

It also disagrees with the assertion that the in-depth questioning which would be necessary for individual risk assessment would be too intrusive.

“As it is, a substantial number of gay men wish to donate blood. At present if they are at all sexually active they cannot do so, and would we believe welcome the possibility of doing so, even if it led to more detailed questioning,” it says.

“We suspect that it is more likely to be the extra work, and the extra training required in the NZBS for such an approach which is perceived to be a problem.”

Rainbow Wellington says it’s clear that the blood testing procedure of the NZBS is now very robust.

“We believe that, rather than discouraging MSM from coming forward at all, which is clearly the current policy, it would be better to encourage participation as a useful way of getting people to test themselves more regularly.

“Given that all blood is tested anyway, this could be a generally useful development, even if initially a smaller blood sample was taken, with the full amount being donated once the blood was passed as suitable.”

In its submission on the issue Rainbow Wellington also touches on the stigma for gay men of not being able to give blood.

“In situations like workplaces or schools, a blood donation campaign can see considerable peer pressure placed on people to donate blood.

“If you are an active gay man, this can have various consequences. Some can be considerably embarrassed, if they are not ‘out’ in that environment, and do not wish to state why they cannot donate. More often we suspect that they lie and give blood anyway.”

*Who is in the review group?

Chair: Emeritus Professor Charlotte Paul
Members: Associate Professor Andrew Moore, Department of Philosophy, University of Otago. Associate Professor Nigel Dickson, Director, AIDS Epidemiology Group, University of Otago. Mr Grant Storey, Principle Technical Specialist (Blood), Communicable Diseases, Population Health Protection, Public Health Directorate, Ministry of Health. Dr Julia Peters, Professional/Clinical Director, Auckland Regional Public Health Service. Dr Steve Richie, Senior Lecturer, Anatomy with Radiology, School of Medical Sciences, University of Auckland.
Dr Peter Saxton, New Zealand AIDS Foundation Fellow, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland.
Mr Richard Scott, The Haemophilia Foundation of New Zealand Inc. (HFNZ). Dr Paul Parish, NZBS donor representative

Review Group Advisors:
Dr Peter Flanagan, National Medical Director, NZ Blood Service
Legal advisor
Professor Paul Rishworth, Barrister, Auckland
Secretariat/researcher
Dr Gabrielle McDonald, Public Health Physician

 
Jacqui Stanford - 13th December 2013

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