Blood NBS

DONATION NOT DISCRIMINATION   

NBS Policy

The National Blood Service, in line with UK policy, will not accept donations from men who have ever had sex with another man, even if it was protective sex and regardless of how long ago the sex took place.

The NBS ask gay men not to give blood because gay men, as a group, are known to be at an increased risk of acquiring HIV and a number of other sexually transmitted infections (STIs), many of which are carried in the blood. They argue, it is specific behaviours, rather than being gay, which places gay men at increased risk of HIV infection.

In the 2004 National Blood Service Report it said about the ban: “The fact is that the session conditions under which the NBS collects blood do not enable staff to gain full and detailed insights into the lifestyle of such men, as this requires a lot of time. The NBS, therefore, has to regard all gay men, whether monogamous or not, as constituting a single group of the population. It is this single group that is most at risk of transmitting infections such as HIV and Hepatitis B in any blood that they donate and this continues the justification for the current rule.”

The policy to ban men who have ever had sex with another man is issued by the Joint United Kingdom Blood Transfusion Services and Institute of Biological Standards and Control Professional Advisory Committee (JPAC), these guidelines are applicable to all four Blood transfusion Services in the UK. The committee is made up of over 100 people appointed because of their knowledge and expertise. However the guidelines are just that, guidelines, and implementation is a matter for individual Blood Transfusion Services.

The UK Blood Services are legally required to exclude anyone whose sexual behaviour puts them at high risk of acquiring severe infectious diseases that can be transmitted by blood (Blood Safety And Quality Regulations (No 50) 2005). These regulations were put in place because of a European Directive.

The policy to ban gay and bisexual men from giving blood was introduced in the 1980s, when HIV overwhelmingly affected the gay community and when AIDS was considered a death sentence.

The National Blood Service provides a vital supply of blood to those in need. It is important that any campaign to change the policy of the NHSBT does not affect the ability of the NHSBT to collect blood donations. This is why we are asking others to ‘give blood, because we can’t’. It’s important that students’ unions encourage blood donation on campuses and than no one is put off giving blood by our campaign.

Frank Boulton is a consultant haematologist for the NBS and writing in issue 19 of blood matters he moved to quash any suggestions that the ban is unjustified.

Men who have sex with men (MSM)
The evidence for barring MSM from donating blood is soundly based, though frequently (and vocally) contested by those who claim that our policy is unjustified – and even denies human rights – as more heterosexuals than MSM in the UK are now newly diagnosed with HIV each year. However, from HPA data and sociological surveys it can be estimated that approximate numbers of men newly diagnosed with HIV in the UK each year are very approximately 1 in 1000 for MSMs;

1 in 2,000 for men who are not homosexual or bisexual, but who may have other risk factors such as drug use or born overseas (especially in Africa);

1 in 40,000 for heterosexual men with no other identified factor which might put them at higher risk. We can expect continuing challenges to our policies, including from registered civil partners.Current criteria are consistent with the EU Directive which bars those whose sexual lifestyle puts them at relatively high risk, although occasionally MSM nationals from other EU countries state that they regularly donate at home. The NBS goes by UK epidemiology where higher risk in MSM is amply demonstrable.

Frank Boulton
Consultant Haematologist
On their website the NBS explains why they ask gay men not to donate blood. A guide for donors Securing the safety of the national blood supply is our number one priority. We followstrict rules and regulations when collecting and processing blood to make sure we supply the safest possible blood. We use two main strategies to keep blood donation as safe as possible.

1. Selecting ‘safe’ donors
2. Testing every donation

Selecting ‘safe’ donors means that we have to ask some people not to donate their blood. This includes all men who have had sex with other men.

Principles of selecting donors
There are over 450 rules guiding donor selection and there are many groups of people who we ask not to donate either for a short period or forever. Some people in these groups may have a very low risk of blood-borne infections and their blood would probably be safe to give to patients, but it is safest to ask everyone within the groups that have been identified, not to give blood. This request can be disappointing and frustrating to some people who wish to donate blood. Our decisions are based on information and research about the effects our policies will have on ensuring the safest blood supply possible, not out of a desire to discriminate against any particular group.

The aims of selecting donors are to:
1. select donors whose blood, as far as we can tell, is most unlikely to transmit any infection
2. collect enough blood to meet patients’ needs.
3. make sure that donors themselves come to no harm through giving blood.

We have to balance these three aims while also keeping the selection process clear and simple.

Why do we ask gay men not to give blood?
We ask gay men not to give blood because gay men, as a group, are known to be at an increased risk of acquiring HIV and a number of other sexually transmitted infections (STIs), many of which are carried in the blood. It is specific behaviours, rather than being gay, which places gay men at increased risk of HIV infection. Safer sex will keep most gay men free from infection, however research shows that allowing gay men as a group to donate blood would increase the risk of HIV infected blood entering the blood supply.

Testing does not detect all infections
We test all blood donations for HIV, hepatitis B and C , syphilis and HTLV. However, no testing process can be ‘perfect’. We may miss infected donations because of the ‘window period’ between getting an infection and the test showing a positive result. There is also always a small risk of mistakes being made in the laboratory. Selecting donors that are already in a low-risk group for these infections means that we will reduce the number of infected donations that could be missed by testing.

How the rule improves the safety of blood transfusions
Many gay men have not given blood since the AIDS epidemic began, and this has prevented many HIV infections being transmitted through transfusion. Also, the number of hepatitis B infections transmitted by blood transfusion fell considerably after this rule was introduced. Abolishing the rule for gay men would increase the risk of HIV infected donations entering the blood supply in England by about five times , and changing the rule to allow gay men to donate one year after they last had sex with another man would increase the risk by 60%, . (Reference: K Soldan & K Sinka, Vox Sanguinis (2003) 84, p265-273).

Keeping our rules simple
The rule about gay men is clear and simple. You can decide whether it applies to you without the need to discuss your personal life with our staff. The rule is based on an impartial assessment of available evidence. We ask that you observe it for the sake of blood safety.