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Saturday 12 November 2016

The blood donation debate: An international perspective

Posted in: Health & HIV
By Craig Young - 23rd December 2013

LGBT communities don’t agree on everything, so how do we resolve those issues on which there is honest dissent and diversity of opinion? Take the issue of gay male eligibility for blood donor status, for example.

At present, various nations have various durational barriers to gay male involvement in the altruistic act of contributing blood for individuals who urgently require donor supplies in the context of accidents or medical conditions that require compatible donors. However, there is the question of HIV/AIDS…but should that disqualify all gay men who want to engage in responsible and altruistic supply of donor blood to others, even those of us who conscientiously engage in safe sex?
No, say Rainbow Wellington, the Tasmanian Gay and Lesbian Rights Lobby and others- the current donor eligibility restrictions aren’t based on realistic assessment of risk and discriminate against those of us who do want to engage in civic responsibility and donate blood to those in need.Yes,says the AIDS Foundation, Terrence Higgins Trust and other HIV service and prevention organisations and individual epidemiologists. Personal risk estimation is misleading and ambiguous in this context. It can only take one slip-up and lapse from safer sex for us to become exposed to HIV/AIDS and many gay men regularly engage in unsafe sex and are unaware of their actual current HIV status. The current blood donor ban is not discriminatory, but practice-based. However, questions remain about the extent and duration of any liberalisation.

To provide an international perspective on this debate,how have various countries tackled the question? Blood bank and transfusion eligibility is based on behavioural criteria and statistical risks of HIV, Hepatitis B and C transmission. Unfortunately, there is no international haemotological consensus on what the duration of MSM donor exclusion should be.

In 2012, NicoleGommers compiled a useful list in Dutch LGBTMatemagazine.

Several nations maintain lifetime deferrals and blanket bans on gay/MSM blood donation.Aruba(a Dutch Carribean dependency) maintains one, as doesCanada.For the last decade or so, Kyle Freeman and Canadian Blood Services have been locked in litigation since Freeman disclosed that he was gay and had donated blood on eighteen seperate occasions (1990-2002). In 2010, the Ontario Superior Court ruled that the exclusion was prudent and evidence-based. Despite this, Canadian Blood Services announced in September 2011 that it was reviewing its gay/MSM ban to see if prudent, evidence-based criteria were at work here.
Germany, Hong Kong, Singapore, Austria, Denmark, Estonia, Finland, France, Greece, Luxembourg, Malta, the Netherlands and Sloveniaall have lifetime deferrals as well. So does theUnited States,although the American Red Cross stated in June 2010 that it disagreed with the US federal Department of Health and Human Services Advisory Committee on Blood Safety and Availability about the continued maintenance of its national blanket ban. However, inBelgium, Cavaria, a Belgian LGBT rights organisation,supportedthe Belgian Red Cross lifetime exclusion policy. The Irish Blood Transfusion Service has said that given elevated HIV and STI risk amongst potential gay/MSM blood donors withinIreland,they would maintain their existing blanket ban. InIsrael, the Health Ministry is evaluating the evidential haemotological grounds for their blanket ban. In theNetherlands, Dutch blood banks are awaiting a forthcoming Council of Europe report on the matter, although Dutch blood bank Sanquin opposes any relaxation.
Given that Denmark and the Netherlands have otherwise robust LGBT rights legislation, is it therefore the case that blood transfusion bans neccessarily do correspond to other, more concrete forms of discrimination? Might they be based on evidence-based criteria about prudent risk management after all?
Meanwhile,Argentina, Australia, Brazil, Japan, Russia, Sweden and the United Kingdomall have one year deferral periods. Their blood services cite shortages of donor blood and satisfaction that existing blood donor risk management deferral criteria are now evidence-based and satisfactory.Swedenlifted its total gay/MSM blood donor exclusion ban in 2011, while theUnited Kingdomrevised its national policy in November 2011.
South Africahas a six month gay/MSM blood transfusion deferral policy, whileSpain and Italyhave no bans on gay/MSM blood donors per se. While there are no objections to gay men or heterosexuals donating blood if they can guarantee that they have been in strictly monogamous relationships, straight and gay donors alike will face a four-month donor stand-down period if they have initiated new relationships and changed sexual partners.
In this arena, different LGBT organisations and individuals engage in debates about expertise and its place in public policy. In these cases, though, it’s not as simple or straightforward as questions where there is consensus,In the case of blood transfusion status, we may need to be satisfied with reduced windows of exclusion from blood donation as a result of haemotological re-evaluation, because our self-perceptions of risk may not tally with our actual HIV or STI status. However, the debate continues.

Nicole Gommers: Blood Brothers:Mate: Summer 2012: 032-035.

Craig Young - 23rd December 2013

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