Monday, March 17, 2008

Blood donation

Just a few words about the rather long running issue of complaint by gay and bisexual men who feel excluded by not being able to donate blood.

This is one of the issues that has been campaigned on by the NUS LGBT Campaign - I think it's a great campaigning opportunity for student LGBT groups because it allows for greater LGBT visibility on campus and highlights different ways in which LGBT people may be treated differently within society.

But it is important for us not to miss the wider picture of rights.

It has also been debated at UNISON LGBT Conference, UNISON National Delegate Conference and UNISON's Health Conference and the TUC LGBT Conference and has gained recent prominence in reporting by the BBC and Pink News.

In my view the approach taken by UNISON's National Delegate Conference is a sensible balanced one, demonstrating the need for decisions on who may and may not be able to give blood to based on medical evidence relating to the risk posed. I think that's the right approach.

It's an important issue - donor selection should not be without scrutiny and there can be a damaging impact from banning a whole section of the community from donating blood.

Obviously a set of criteria based on sexual activity is far preferable than one based on belonging to a group (in this case men who have had oral or anal sex with other men - gay men per se are permitted to give blood and many men who self define as gay or bi may not have engaged in oral or anal sex - equally there are many heterosexual men who have engaged in oral or anal sex with men).

So if possible I would prefer for us to move away from a lifetime blanket ban, provided it is supported by scientific evidence.

This would enhance gay and bisexual men's sense of citizenship and inclusion in society - an important goal in itself. It would tend to reinforce messages of safer sex (I stress the word safer because anal and oral sex are still risky activities and even use of condoms does not eliminate that risk entirely).

Whilst equitable treatment of potential donors is important the rights of recipients take precedence. They must do, if they clash in any way. Blood donation isn't for the good and well being of the donors - it's for the recipients. The right to life is more important than the right not to feel rejected.

So where are we now?

Australia has removed its lifetime ban and replaced it with a 12 month deferral for anyone who has had "male to male" sex. It seems like a sensible policy, but it's one that the UK, Canada, the US and Sweden have declined to follow. Recent statistical modelling has indicated even the Australian model would lead to an increase of risk of infected blood within the blood supply. This does of course remain to be seen in practice. In a few years' time we'll have actual evidence of the quantity of infected blood in Australia and whether it's gone up, down or stayed the same.

Although all blood donations are screened for HIV and other infections, these tests aren't 100% effective - the tests aren't 100% accurate (i.e. they have error rates, though small), there is a window period - 3 month, though it may be much more reduced than that and there is human error in the lab. So there is still a risk and a good rationale for preventing donations through donor screening if it can effectively be done.

Currently between a half and a third of infected donations in the UK are given by men who have had sex with men and have in some instances given blood on a previous occasion. That is to say that a group compirisng about 3% of the polulation accounts for between 33% and 50% of infected donations even when there is a ban in place supposedly preventing them from donating. So clearly we are dealing with a high risk group for HIV (we'd all prefer it wasn't the case but the figures are there and can't be argued with - by these figures between 10 and 20 times higher than the general population that is not otherwise in a high risk group).

So, yes, it would be great if we could adopt the Australian model. Only time will tell if it is effective. I hope it is.

But any such move in the UK should be evidence based and not based purely on write ins, petitions and popular opinion, which don't always take account of the bigger picture of the need to safeguard a supply of blood for those who need transfusions.

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