A simple, long overdue change in New Zealand’s policy for blood donations would benefit everyone, writes Dr Oliver Armstrong-Scott.
The New Zealand Blood Service recently pleaded for Kiwis to continue donating blood during the Covid-19 lockdown to ensure supplies do not run out. As a medical doctor, I have seen firsthand the absolute necessity of a secure supply of blood donations to keep us, the New Zealand public, alive when we fall ill.
Despite this urgent need, many men, including myself, have been left humiliated after being turned away at donation centre doors. Because of this, vulnerable patients are now left wondering whether there will be enough life-preserving blood to go around.
Compare the following two cases: a married gay man in a faithful monogamous relationship for 30 years, versus a single, heterosexual man who has unprotected sex with multiple sexual partners regularly and was treated for chlamydia four weeks ago. The first man has a much lower risk of donating HIV-positive blood than the latter. Yet, unbelievably, the heterosexual man can donate blood in New Zealand while the gay man cannot. Consider whose blood you would prefer to receive to minimize your chances of HIV.
In New Zealand, if you are a male who has had sex with a man (even with a condom) in the past 12 months, the New Zealand Blood Service deems your blood too high risk. This rule is an unacceptable remnant of an antiquated, homophobic society that resulted from the HIV epidemic of the 1980s and must be changed.
By changing the rules so that each gay or bisexual man could donate just once per year, using statistics from the New Zealand Health Survey, an additional 120,000 units of blood could be available to Kiwis who need it each year. Although our blood service maintains an adequate supply during stable times, the coronavirus pandemic reveals just how fragile the system is. Meanwhile critical blood donations are being rejected due to unfounded and discriminatory regulations.
For gay and bisexual men, not being able to contribute to society through giving blood simply because of our sexual practices amounts to blatant discrimination. This only adds to the enormous amount of stigma that men who have sex with men (MSM) face. Having just returned from a year at the Yale School of Public Health, I have never been more aware of the strong link between stigma and poor health. For example, for MSM, stigma contributes to a rate of suicide attempts over five times that of their heterosexual counterparts.
Discriminatory donation policies only reinforce the ridiculous idea that same-sex sexual activity is wrong or unhealthy. Moreover, they have the potential to ‘out’ men asked to donate, for instance in the workplace, where some men may not want to reveal their MSM status because of the discrimination they would face.
So why is New Zealand Blood Service forcing MSM to be celibate for 12 months before donating, when many other countries around the world do not? Essentially, the service is concerned that MSM donors have a higher risk of providing a sample infected with HIV. This logic is flawed. Risk of donating HIV-positive blood is not based on simply being MSM; it is the level of risky sexual behaviours that determines risk of HIV, regardless of who you are having sex with.
Unquestionably, donating is not a right and the interests of the recipients and therefore the safety of the blood is paramount. Recipients are vulnerable and most often have no choice but to receive the blood. We do need policies that minimise risk to recipients but the MSM ban does not do this.
Screening should be based on high risk behaviour regardless of whom you have sex with. Several countries including Spain and Italy have implemented this individualised risk assessment policy, and research shows the policy caused no increased risk of HIV for recipients. Surely a country like New Zealand, the country which first gave women the right to vote, should be following suit?
Individualised risk assessment treats everyone the same. It also weeds out those high risk donors much more accurately than a blanket MSM ban. Changing the policy would therefore likely to lead to a reduction in the risk of recipients receiving HIV-positive blood.
To be sure, there is a higher rate of HIV in MSM folk in general. But remember, the risk of HIV in high risk heterosexuals is greater than in low risk MSM. Furthermore, all donated blood is tested for all sorts of conditions. Even if an HIV-positive donor gave blood, in most cases it would be detected and the sample thrown away. The fact of the matter is that with the right implementation, allowing people to donate regardless of who they have sex with is both possible and safe – and is the moral thing to do.
In response to Covid-19, the US has just reduced its blood donor ban, previously the same as New Zealand’s, to three months of celibacy for MSM. Some countries like Canada and the UK have also changed their policies in recent years. (Three months is the period during which someone can have acquired HIV but tests may not pick it up). The relaxation of rules overseas only underlines how outdated New Zealand’s 12 month ban is, but the wider point is that the rule should not exist at all for MSM specifically. High risk heterosexuals may also have undetectable levels of HIV in their blood within three months of sexual activity and can donate, while low risk MSM cannot. This does not make sense.
Like the US, we too should use Covid-19 as a stimulus to change our outdated policies. An individualised policy allowing men who have sex with men, with low risk sexual behaviour, to donate blood would return New Zealand to its status as a world leader in anti-discrimination policy. Such a change is desperately needed to counter bi- and homophobic stigma, increase the supply to New Zealand’s blood banks, and reduce the risk of HIV in blood donations. This is a win-win strategy for everyone in New Zealand. Let’s change this obsolete ban on blood donations and save lives.