Sunday, January 15, 2006

Your blood's no good here

Last week, the Gay and Lesbian Alliance of South Africa staged an unusual protest. Some of its male members donated blood, violating the blood donation criteria of the South African National Blood Service (or SANBS), which forbids donations from men ‘who have had sex with other men in the last five years.’ The Alliance claims the SANBS donation criteria is discriminatory, because the blood of young women between the ages of 18-24 -- the group with the highest HIV prevalence in the country – can be accepted. Furthermore, the SANBS has high-tech equipment that detects HIV in donated blood before it is used, and this constitutes another layer of protection. While such equipment cannot detect HIV in the blood of newly infected persons, this is in itself no reason to reject ‘gay’ blood and accept the blood of young women. For its part, the SANBS argues that it is merely following international guidelines to protect the safety of the blood supply.

The issue of the ‘gay blood ban’ extends far beyond Africa’s borders. A few years ago, protests were staged in Hong Kong. In Australia, a gay man has recently filed charges against the Australian Red Cross. The ban has been the object of student protests from Ireland to Montreal. In the United States, while the scientific basis of the ban has been questioned a number of times, a proposal to relax the ban was narrowly rejected by a Food and Drug Adminstration committee back in 2000.

The FDA rules on blood donation are really the heart of the matter, because they form the basis of the donation criteria for the American Red Cross and the Red Cross in most (if not all) other countries. In 1985, the FDA proposed the rule that a man could not donate blood if he had sex with another man – even once – since 1977. The rule obviously harks to a time when HIV/AIDS was considered a ‘gay disease’.

But how should this rule be considered in areas of the world, such as sub-Saharan Africa, where HIV/AIDS is largely transmitted heterosexually? The WHO states that blood donations should come from groups with low risk of TTIs (transfusion transmissible infections) but seems to acknowledge that high risk groups may be different in different regions of the world. Should blood donation criteria be determined by the most current epidemiological data on HIV prevalence among social groups, or should one forget social groups altogether, and concentrate on the risk behavior of individuals who wish to donate their blood? In either case, it seems irrational -- if not unethical -- to exclude people from donating blood on the basis of their sexual orientation alone.


Blogger sklail said...

It is very hard to make a stand on either side of this issue since each side makes valid arguments for their positions. Changing the blood donation limitations for specific regions would probably be the best start. A blanket policy is very hard to justify since there are so many differences in regional infection vectors and what may be the status quo for one region may not stand up in another. Althought I think it is probably a good idea to keep the stance that no homosexual blood is used for transfusion, it does smack of discrimination. It is a very hard question and I'm sure a doctoral thesis is in there somewhere for the taking. Thanks again for your blog Stuart, it is very thought provoking.


5:23 AM  
Blogger Stuart Rennie said...

Sklail: Thanks for your comment. I think it is also a difficult issue without a clear solution, and I fully agree with you. Due to the ongoing discrimination and stigmatization of gay men -- not just in matters concerning HIV/AIDS -- one has to be on the lookout for homophobia disguised as arguments in defence of public health. If in a region gay men has a disproportionately high prevalence of HIV relative to other groups, there is nothing homophobic about rejecting their blood donations. But if there are other groups in a given society with similar HIV prevalence, then I think it would be wrong -- from both ethical AND public health perspectives -- not to refuse their blood too. The blood donation criteria should be context-sensitive and based on current epidemiological data, though the fact that people travel from one region to another causes further problems ... Like you say, a PhD thesis waiting to be written.

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