Blood Donation Discrimination

 
 

With bans on gay and bi-sexual men donating blood in Ireland, Ruth Murphy examines if it is simply in place for protection or if it is down to discrimination

It may be 2014, but a male who has had sex with another male can’t give blood in Ireland. The Irish Blood Transfusion Service (IBTS) will not accept their blood. Though it is seen by many as discriminatory and in spite of controversy, the IBTS stand by this. Whether grounded or not in reality, the MSM (from the medical term ‘men who have sex with men’) Blood Ban, as it is known, exists.

In 2011 the IBTS issued a press release on the matter. They claimed that “The reason for this exclusion rests on specific sexual behaviour (such as anal and oral sex).” However, it is not only men who have sex with men who have anal or oral sex. This can be found in heterosexual relationships as well as lesbian relationships. Conor Rock, UCD Arts and Celtic Studies Convenor mentioned in a proposal to student council that “a UCD report [which was published in 2006 on sexual health and relationships] found that over 70% of men and over 60% of women between the ages of 18 – 24 engage in oral sex” and that this “would indicate that the IBTS is unfairly targeting … gay men.” The IBTS also said “There is no exclusion of gay men who have never had sex with a man nor of women who have sex with women”.

Despite this statement a case occurred in 2013 where an Irish gay man was invited to talk to the IBTS to discuss his recent donation. It seemed that the IBTS were wary of using his blood because he identified as gay. This was despite the fact that he had told them that he had never sex. Indeed it seems a lot of this is based around the trust, or lack of it, that the IBTS has for gay men. Do the IBTS trust this man when he says he has never had sex? The IBTS stated that “individuals can only attest to their own behaviour when donating and not speak for their partner”. The IBTS won’t always trust a potential blood donor’s words and at the same time is placing the blame onto the partner who would not be present as the IBTS said that they don’t believe in performing more detailed interviews for blood donors as it would be inefficient.

The evidence is stating very clearly across countries that have changed their MSM blood donation regulations that this does not impact on any risk in any way to the blood supply

The IBTS do test blood for HIV before accepting it for donation. However they are aware that some infected donations may be missed due to the “‘window period’ between getting the infection and the test showing a positive result”. This is one of the main reasons the IBTS insists on the ban. The IBTS therefore feel that they must exclude those who are at a high risk of getting HIV from donating.

According to a report conducted by the HSE in 2013, 46% of cases of HIV found that year were among men who have sex with men (dropped from 49% in 2012). The second most common mode of transmission was heterosexual contact which accounted for 38% of cases. This gap of just 8% shows that that men who have sex with men do not “present a particularly high risk of blood-borne viruses” as the IBTS put it but are simply slightly more likely to get HIV. This same report found that men, that year, were 3 times more likely to get HIV than women. Nevertheless we all understand that to exclude such a large portion of the population from giving blood would be discriminatory and would only vastly decrease the blood supply. We must also consider that though the IBTS may not allow MSM men to give blood it does allow anyone who has had sex with someone who has HIV to give blood 12 months later. It’s difficult to deny that having sex with someone who has HIV would be much more likely to give somebody who has had a blood transfusion HIV than being a man who has sex with men.

This begs the question- is the blood ban sensible or just plain discriminatory? In Ireland a man still can’t marry another man. Gay couples do not have the same adoption rights as heterosexual couples. Could this ban simply be an extension of traditional Ireland’s homophobia? Aodhán O’Ríordáin has said that he believes “that an indefinite ban on Gay & Bi Sexual Men donating blood is outdated and based on preconceptions that are not supported by medical science.” This seems to be the opinion of lots of LGBTQ+ organisations as well as most people who are against the ban. Tiernan Brady, Policy Director for the Gay and Lesbian Equality Network (GLEN), in conversation with the Univeristy Observer, described the ban as “quite simply, bad science” and compared the blanket ban to “using a nuclear weapon to crack a nut”. He believed this issue was part of a larger issue of health services in Ireland and commented that “It sends a very negative message to gay and bisexual men about how they’re perceived by the health services.” The effects of this can be found in a report published for BelongTo and GLEN in 2008 entitled “Supporting LGBT Lives”. The report found that 76.9% of those surveyed strongly agreed that “healthcare professionals need to have more knowledge and sensitivity to issues related to being LGBT”.

Aodhán O’Ríordáin has said that he believes “that an indefinite ban on Gay & Bi Sexual Men donating Blood is outdated and based on preconceptions that are not supported by medical science.”

The UCD Arts and Celtic Studies Convenor Conor Rock has proposed that the Student Council take a stance against the MSM Blood Ban. His proposal states that “the giving of blood is vital for saving people’s lives, however this fact should not be used as an excuse for allowing an institution to have regulations that wrongly target a certain section of society.” The proposal was put to council on Monday 10th November and at time of going to print the results of this council meeting were unknown. Rock has said that “the fact that some students are being subjected to discriminatory policy not only in society but also in the University itself when the blood donations are on campus, is a just enough reason to take a stance and fight for our friends, family and fellow students rights.”

Sam Blanckensee, the UCD SU LGBT Co-ordinator is also against the ban, saying that it “is discrimination due to fear mongering and stereotyping. I believe that a ban on people who have practiced more at risk sexual acts with a new partner since their last STI test would be founded and a very clever practice to adopt. This is nothing like that. This is a blanket ban on someone not based on their STI status but their sexual partner which is downright discriminatory and prevents people who know their STI status from donating.” A man who has been tested for STIs and has proof that he doesn’t have any still can’t give blood if he has had sex with another man at any point in his life.

Answering yes to this question on the IBTS website brings the user to a page describing why they do not accept blood from MSMs.
Answering yes to this question on the IBTS website brings the user to a page describing why they do not accept blood from MSMs.

With many other options being offered such as more rigorous interviews or testing of donors, asking people to get checked for STIs or having specific questions based on sexual tendencies, it seems apparent that the IBTS do have other options to this blood ban. However, if they did ask people about specific sexual tendencies and banned anyone who frequently had oral or anal sex, acts which they have described as “high-risk”, they would have to exclude a large portion of the population as these acts are much more common than the MSM Blood Ban would indicate.

Australia, New Zealand and the UK (excluding Northern Ireland) have all altered their policies surrounding MSM blood donations. A report published on the altering of the MSM blood ban to a 12 month deferral in Australia “found no evidence that the implementation of the 12-month deferral for male-to-male sex resulted in an increased recipient risk for HIV in Australia”. The report was conducted by the Australian Red Cross along with several universities and other institutions of research. It also found that more problems were created by donors lying than having had sex with men. Brady argues that “The evidence is stating very clearly across countries that have changed [their MSM blood donation regulations] that this does not impact on any risk in any way to the blood supply”. Some may argue, however, that it could increase the risk in some cases by 1 or 2%.

In 2013, Aodhán O’Ríordáin now a Minister of State for New Communities, Culture and Equality posed a question to Dr James Reilly, then Minister for Health about the ban. In his reply the minister stated that “The permanent deferral of men who have sex with men [MSM] … by the IBTS, is an important safety measure for blood transfusion” and that the “the decision is not based on sexuality or orientation”. His words echo the IBTS but still come out hollow and lacking in sources to back them up. The IBTS is run by the state and the state is defending this ban. The IBTS will not alter this ban without state approval. It is for this reason that Dr Reilly’s words are highly significant.

This issue, however, is not the only controversial banning of a segment of the population from giving blood in Ireland. You must not give blood if you weigh under 50kg. This does not take into account your height or BMI. The most surprising of all may be that you can’t give blood if you “spent 1 year or more in the UK between the years 1980 – 1996, including living, working, or on holidays”. This is due to cases of variant Creutzfeldt-Jakob Disease (vCJD) that occurred in the UK in the 1980s and because the plans to prevent further infection were only fully implemented by 1996. This disease originated in cattle and then people contracted the disease by eating infected beef. The IBTS say on their website that “the risk of contracting vCJD through travelling and living in the UK in this period is considered to be low. It should be noted that in the UK where tens of millions of people were potentially exposed to vCJD through eating infected food, there have only been 176 cases of the disease to date.” Though this risk only applies to those who eat beef the ban still applies to vegetarians. It is this same disease that prevents people who have received a blood transfusion in Ireland since 1980 from giving blood. The IBTS say on their website that “On the available evidence, the risk to patients from blood and blood products in the Republic of Ireland is extremely small and may be zero.” However they have also said that this is a very serious disease and that there is no known test for it.

It is clear that there are multiple issues with the donor application process and that they won’t go away in the near future. The state is currently focusing on the marriage equality referendum and one might hope that this would be the next issue in line. Nevertheless, it’s certainly possible that this will be pushed to the back burner as the LGBTQ+ community try to fight a war against conservative Ireland one step at a time.

The Minister for Health James Reilly has said that “the number of donations likely to be obtained from MSM is unlikely to resolve any supply issues.” It is impossible to guess the number of donations that would be obtained by MSM men if the ban was lifted. It’s likely that were the ban lifted there could potentially be a sudden surge in blood donations. This would be both from homosexual men who couldn’t donate before and also from those who were previously against the IBTS because of the ban and would be more comfortable donating with the ban lifted. The IBTS 2013 annual report revealed that during that year men gave 47,272 blood donations while women only gave 35,425. With men already giving more blood than women the lifting of the ban should increase these numbers greatly. If there is a crisis in blood supply in Ireland’s future could the IBTS be forced to accept the blood of those whose behaviours are at “high risk”?

There are two sides to the blood ban debate, both staunch in their position. It would take a lot of campaigning and State backing for this ban to ever be overturned. With so many difficulties existing in blood donation the IBTS may have to review their whole donation process if they want to even consider this issue. The Equal Marriage referendum could help or hinder this debate on both sides. LGBTQ+ rights could begin to increase steadily or all the campaigns could provoke conservatives into strong protests against LGBTQ+ issues such as this.

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