Donor discrimination comes down to trust

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In 2017, the Australian Red Cross Blood Service began a review on its sexual activity deferrals. You would not be alone if you have not heard much since. As of June 2019, the Blood Service announced that it received the report from its external committee and would consider different options before its submission to the Therapeutic Goods Administration (TGA).

Close up of blood bag (Image credit: toeytoey2530 / Getty)Currently, the Blood Service's guideline defers people for 12 months based on its list of risky sexual activity. This includes men who have had sex with men (MSM) including anal or oral sex with or without a condom. This policy, however, has been accused of being discriminatory, an assessment with which I would agree.

The general principle behind blood donation deferrals is to either protect patients from infectious diseases or to protect potential donors from any possible complications. In the case of sexual activity deferrals, it is the former. In order to protect patients, the Blood Service tests all blood donations for HIV, Hepatitis B, and Hepatitis C. Syphilis and HTLV are also tested for, unless a donation is only being used to create plasma products.

The primary argument for the MSM deferral is that gay and bisexual men have higher levels of HIV transmission and therefore pose a risk to patients. In a FAQ on the MSM deferral, the Blood Service suggests HIV as being the primary reason for this deferral. However, there is one point where the FAQ is somewhat misleading.

The Blood Service mentions that while it tests all donations for HIV, it cannot rely on testing alone. This is due to its window period, the time when a recent infection cannot be detected. However, what is not mentioned is the length of the window period for HIV.

Both HIV and Hepatitis C are normally considered to have maximum window periods of three months. In particular, fouth generation antigen/antibody HIV tests detect infections in 95 per cent of people by four weeks. However, these are nowhere near the 12-month deferral period the Blood Service has in place.

By this understanding, it would not make sense to have a deferral period of more than three months, or four months if you were being very cautious. If you could be certain of the accuracy of these tests, then regardless of the number of positive results, there would not be any increased risk to the blood supply.

 

"This not only perpetuates harmful stereotypes but ignores current HIV trends."

 

However, the issue seems to be with trust. A shorter deferral period or even an individual risk assessment would not negatively impact blood supply if risks were managed correctly and potential donors gave accurate information. If everyone who donated blood correctly identified when their last sexual contact was, and it was at least three months ago, then you could be sure that their test results were accurate.

Yet, it seems that gay and bisexual men cannot be trusted to give accurate information about their sexual history or to understand their sexual risk. This not only perpetuates harmful stereotypes but ignores current HIV trends. Rates of HIV infection between gay and bisexual men have decreased 30 per cent over the last five years.

Blood donations are regularly needed, and the Blood Service frequently asks for more donors. Given this, it makes no sense to keep the current 12-month sexual activity deferral or any deferral based on infection risk such as recreational drug use for longer than their actual window periods.

Instead, the Blood Service should strive to educate potential donors on the importance of giving accurate information and testing for infections beforehand. This, in turn, could ensure the safety of the blood supply while increasing the number of donors. These discriminatory policies do nothing for anyone, and their change is long overdue. The Blood Service and TGA have ample opportunity to do end this discrimination.

 

 

Wilson HuangWilson Huang is a history and philosophy of science student at the University of Sydney and a part-time student at the University of Divinity. He has written for Honi Soit and Pulp Media. 

Main image credit: toeytoey2530 / Getty)

Topic tags: Wilson Huang, blood donations, LGBTQI

 

 

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Existing comments

Discrimination is put up as the problem here, when in fact sophisticated state-of-the-art discrimination is the solution. Accept blood from all donors, screen it with the best available tests, and then carefully classify the products according to the reported (or otherwise determined) sexual behaviour history, date of donation, date of screen test, etc of the donor. Then let the recipients exercise their right of bodily autonomy by nominating which class of blood they will accept. Each recipient makes their own decision on their assessment of the balance of risks involved. Ideally they would have an advance directive which they carry about in case of emergency. (Obviously there would be a default policy in case of no such indication of preference.) If there's no blood available in the class they've insisted upon, they'll die. So be it! Nobody would be to blame, morally or legally.
HH | 07 September 2019


An interesting article. I wonder if ES would ask the Red Cross Blood Service to respond to the suggestions made here, just to get a fuller understanding of the issue.
Brett | 11 September 2019


I think it's important to put yourself in the shoes of the blood recipient. You wouldn't want to take the risk that the screening tests were 95% safe. You wouldn't want to take the risk that a donor might 'forget' a fleeting unsafe encounter. This is not being discriminatory - it applies to heteros as well as gays. By all means support better education for donors. But let's not paint this as an anti-gay issue.
MM | 13 September 2019


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