In Australia, men who have sex with men (MSM) cannot donate blood for 12 months after having homosexual intercourse. In practice, this means all sexually active MSM, irrespective of safe sex practices, are barred from donating blood. Concerns that this policy is a form of homophobic discrimination have made it a source of contention for decades, coming to a head in an unsuccessful 2009 challenge in the Tasmanian Anti-Discrimination Tribunal. The issue gained particular urgency in the media in 2016, after US health agencies turned away queer male donors seeking to aid victims of the Orlando nightclub shooting.
A quick refresher:
HIV (human immunodeficiency virus) is the virus responsible for a sexually transmissible infection which weakens the immune system. Late stage HIV infection is known as AIDS (acquired immune deficiency syndrome), a disease state in which profound weakening of the immune system means the body can develop diseases that would not normally affect a healthy person. HIV can be transmitted through blood, semen, vaginal fluids, and breast milk. All forms of penetrative sex, including anal sex and, in rare cases, oral sex, can transmit the virus. In the absence of blood exposure, HIV cannot be transmitted through kissing or casual contact.
The probability of HIV transmission in a single instance of unprotected anal intercourse is between 0.24-3%. In 2014, the Kirby Institute found that MSM accounted for 75% of new HIV infections in Australia, and the prevalence of HIV among “gay community-attached men” was 8-12%. It is important to note that with the availability of antiviral medication to manage the disease, and the development of pre-exposure prophylaxis (antiviral medication taken by HIV-negative individuals prior to possible exposure), HIV is no longer as terrifying as it once was.
The Red Cross screens blood for HIV, Hepatitis B and C, Human T-lymphotrophic virus, and syphilis. This screening process is not perfect. During an initial ‘window period’ (about 5.6 days for nucleic acid testing, and 22 days for antibody testing), HIV will not be detected. There is also the possibility of a false negative result. Concern over these two issues is such that the Red Cross strongly discourages ‘test-seeking behaviour’ (donating blood for the purpose of getting a blood test), reportedly practiced by 0.74% of donors.
Above all else, the crucial statistic relied upon by the Red Cross, derived from their mathematical modelling, is that “even men in a declared exclusive gay relationship have, on average, a 50 times greater risk of HIV infection, compared to heterosexual Australians with a new partner.” For reference, the rate among MSM generally is 113 times that of new heterosexual couples.
Reputation and risk:
Any intersection between a cultural struggle for recognition, and a bureaucratic risk assessment, is bound to be messy. In this particular mess, it is no surprise that the Red Cross is particularly risk-averse. Not only is the risk to recipients a concern, but the Red Cross is also hesitant because it relies so heavily on reputation and community goodwill to carry out its work. It doesn’t have the authority of government (though it’s largely funded by the government) and it doesn’t pay blood donors.
Furthermore, the Red Cross has a veritable history of scandal – take, for instance, the tainted blood scandal of the 1980s, which left thousands of patients infected with HIV and Hepatitis C, owing to the sourcing of blood from overseas companies and prisoners. More recently, there was the 2016 database leak, in which half a million blood donors had their private information, including whether they had “engaged in at-risk sexual activity in the past 12 months,” deposited on the internet.
Faced with this matrix of indiscretions waiting to happen, hesitation to allow queer men to donate blood would be entirely understandable; the Red Cross, however, isn’t hesitating. In fact, they’ve been ready for years. It’s the Department of Health that’s standing in the way.
In 2011, Australian Red Cross Blood Service established an expert review committee which advised that the deferral on MSM blood donations should be reduced from 12 months to 6 months. This is still far longer than the most conservative estimate of 76 days needed for HIV to appear in antibody testing. Instead, it aimed to account for the longer incubation period of Hepatitis C (188 days). The Blood Service followed up with a ‘compliance study’ to inform the decision by finding out how often people lie on their donor forms (don’t do this – you could face a $5500 fine and be imprisoned for a year).
However, in December 2013, the Therapeutic Goods Administration (TGA), a division of the Department of Health, knocked back the Blood Service’s proposal, stating it “could increase the risk of an infection being passed on to a blood recipient with no significant boost to donor numbers, or to the blood supply.” As justification, the TGA cited the 10% increase in reported HIV infections in 2012, as well as the compliance study’s finding that 0.23% of male blood donors had failed to report having sex with a man in the 12 months before donating.
At this point it is worth asking ourselves, for what reason do we want change? Homophobic discrimination is fundamentally a social question, not a medical one. By their own admission, the TGA is not considering the social value of recognising the autonomy of queer men; they merely made an assessment “on the basis of risk-benefit to the blood supply”. As such, there can be no coherent debate on this issue, because the TGA and its critics are having different conversations. Nonetheless, the Red Cross commenced another review of the deferral regime in mid-2017, and will be making another submission to the TGA in the coming years.
Whatever the outcome of the 2017 review, the legitimate struggle for recognition and autonomy among queer men should not be seen as diminished by the decision of the TGA. There remains a genuine and ongoing disagreement between the Blood Service and the TGA on whether the deferral period should be shortened from 12 months to 6 months. The role of the decision-maker, forced to act on incomplete scientific knowledge, is unenviable. In the ‘tainted blood’ saga of the 1980s, plasma infected with Hepatitis C was deliberately returned to the blood supply because it was wrongly thought that processing would kill the pathogen. But a judgement must be made, and we all, including medical decision makers, must do the best we can in imperfect circumstances.
So have a look at the Red Cross website and, if you can, book an appointment to donate blood – on behalf of those among us who can’t.
- Australian Red Cross Blood Service, Blood Service deferrals, [website], 2017, http://www.donateblood.com.au/blood-service-deferrals.
- See for example, J. Worland, ‘Gay Blood Donation Ban Under Fire in Wake of Orlando Shooting’, Time Magazine, 12 June 2016, http://time.com/4365460/orlando-nightclub-shooting-gay-blood-ban/.
- V. Pitt, Review of Australian Blood Donor Deferrals Relating to Sexual Activity, [pdf], 2012, http://www.donateblood.com.au/sites/default/files/blood_review_report_may_2012_electronic_version.pdf, p. 45.
- Kirby Institute, HIV in Australia: Annual Surveillance Report 2014 Supplement, [pdf], 2014, https://kirby.unsw.edu.au/sites/default/files/kirby/report/SERP_Annual-Surveillance-Report-HIV-Supp-2014.pdf, p. 12.
- Pitt, op. cit., pp. 23-24.
- T. Lucky et al., ‘Understanding donor noncompliance with selective donor deferral criteria for high-risk behaviours in Australian blood donors’, Transfusion, vol. 54, July 2014, p. 1745.
- Australian Red Cross Blood Service, op. cit.
- Pitt, op. cit., p. 47.
- Ibid, p. 7.
- Ibid, p. 52.
- Lucky et al., op. cit.
- J. Skerritt, Re: proposal for changes to blood donor guidelines, [letter], 13 December 2013, https://www.tga.gov.au/sites/default/files/foi-322-1415-01.pdf (document released 19 August 2015).