Some gay men should be allowed to give blood, argue Canadian researchers

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HIV-negative gay men who have been in a stable, monogamous relationship for at least one year should be allowed to give blood, a team of Canadian investigators argue in the online edition of the Canadian Medical Association Journal.

Currently gay and other men who have sex with men in Canada and the US, as well as the UK and a number of other countries, are permanently banned from giving blood.

The prohibition in North America was introduced in 1983. Thousands of individuals were infected with HIV after receiving blood products infected with the virus before effective screening was developed.

Glossary

exclusion criteria

Defines who cannot take part in a research study. Eligibility criteria may include disease type and stage, other medical conditions, previous treatment history, age, and gender. For example, many trials exclude women who are pregnant, to avoid any possible danger to a baby, or people who are taking a drug that might interact with the treatment being studied.

epidemiology

The study of the causes of a disease, its distribution within a population, and measures for control and prevention. Epidemiology focuses on groups rather than individuals.

Food and Drug Administration (FDA)

Regulatory agency that evaluates and approves medicines and medical devices for safety and efficacy in the United States. The FDA regulates over-the-counter and prescription drugs, including generic drugs. The European Medicines Agency performs a similar role in the European Union.

window period

In HIV testing, the period of time after infection and before seroconversion during which markers of infection are still absent or too scarce to be detectable. All tests have a window period, the length of which depends on the marker of infection (HIV RNA, p24 antigen or HIV antibodies) and the specific test used. During the window period, a person can have a negative result on an HIV test despite having HIV.

risky behaviour

In HIV, refers to any behaviour or action that increases an individual’s probability of acquiring or transmitting HIV, such as having unprotected sex, having multiple partners or sharing drug injection equipment.

But the investigators argue the ban has been overtaken by improvements in HIV testing technology, and that replacing the ban with a one-year deferral would mean that only one HIV-infected unit of blood per eleven million would enter the blood supply.

The investigators comment that although the ban was justified in the early 1980s, it “no longer makes sense in 2010, and with each passing year makes less sense”.

Temporary, rather than permanent bans on gay men giving blood, ranging in duration from one to ten years are already the policy in place in a number of countries. One-year deferrals are already the policy in a number of countries, including Sweden, Australia and Japan.

Under the new Canadian proposal, gay men with multiple partners would still be excluded from donating blood.

The background to the ban dates back to the early days of the HIV epidemic. Gay men are a focus of the HIV epidemic in many industrialised countries. This has been the case since the epidemic first emerged. In 1983 a ban was introduced in Canada and the US on blood donations by men who had had sex with another man since 1977. At around this time, a similar ban was introduced in the UK.

The investigators argue that the ban made perfect epidemiological and ethical sense at this time, especially as a test for HIV was not developed until 1985. All blood donations are tested for HIV and other blood-borne infections, but the maintenance of the ban has since been justified because of the risk of samples falsely testing negative entering the blood supply.

Although the investigators acknowledge that HIV prevalence amongst gay men is 67-fold higher than that in the general Canadian population, they note that 94% of gay men are HIV-negative.

Moreover, improvements in HIV testing technology have substantially reduced the 'window period' between infection with HIV and the development of antibodies, and the use of nucleic acid testing to check pooled samples of donations means that the window period can be further reduced. All these technologies reduce the risk of an HIV-infected donation entering the blood supply to a negligible level, the researchers argue.

Individuals wishing to give blood in Canada (and other countries) are asked to complete a questionnaire about their HIV risk behaviour. Gay men, individuals who have engaged in transactional sex, and injecting drug users are currently permanently excluded from donating blood in Canada.

But bans for other groups are based on individual behaviour. Heterosexuals with multiple partners are only asked to defer giving blood for one year.

The investigators believe that this is discriminatory and advocate the replacement of the lifetime ban with a deferral. This would allow HIV-negative gay men who have been in a stable monogamous relationship for one year or more to give blood.

Replacing the life-time ban with the one-year deferment would, the authors argue, increase the pool of potential donors with only a “negligible” increase in the risk of an HIV-infected donation entering the blood supply.

Donation policy was recently changed in Canada to allow Haitians to donate blood. The authors believe that it is time to change policy again.

They write, “when a discriminatory policy isn’t justified by the science, it leads to controversy.”

But many believe that the epidemiology of HIV in gay men justifies the maintenance of the ban. In 2007, the US Food and Drug Administration reaffirmed the lifetime ban on gay men donating blood. They highlighted that even the most sophisticated testing technology was not sufficiently sensitive to detect all infected donations. The FDA estimated that there was a one-in-two-million risk of an HIV-infected donation entering the blood supply.

In the UK, the lifetime ban on gay men giving blood is the subject of periodic controversy. The human rights activist Peter Tatchell advocates the replacement of the ban with a deferment, and the National Union of Students is also a vocal advocate for the removal of the lifetime ban.

In 2009, the UK’s National Blood Service issued a position paper explaining the current prohibition, explaining that the majority of HIV transmissions in the UK are amongst gay men, and that rates of blood-borne sexually transmitted infections such as syphilis and hepatitis B are also much higher in gay men than in the general population.

The UK ban was last viewed in 2001. At that time, Terrence Higgins Trust, the UK's largest HIV charity, supported maintaining the lifetime ban on gay men donating blood. A further evidence review is currently underway, and its findings will be published later this year.

References

Wainberg MA et al. Reconsidering the lifetime deferral of blood donation by men who have sex with men. CMAJ, online edition, DOI: 10.1503/cmaj.091476, 2010.

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