07 Aug 2008
Still a biohazard
The Irish Blood Transfusion Service recently confirmed it had absolutely no intention of revisiting its ban on blood donation from gay men.
A court in Tasmania said this week that the state's ban on gay blood donations was homophobic.
Russia and Thailand accept gay blood.
The Journal of the American Medical Association says that HIV infection rates among gay men, which never really did anything more than stabilise, are now rising once again, as men who actively avoid discovering their HIV status have unprotected sex, quite often while they have another STI, which makes them even more HIV-infectious.
Leaving aside why gay men continue to get HIV and infect others with it, what should we make of the blood ban? I remember as a kid being told that I wouldn't 'ever' be able to give blood because I had got jaundice. I don't believe that's true any more, as understanding of how the various Hepatitis viruses work and persist in the body, as well as the development of simple tests to detect them, make past Hepatitis infections less of a problem.
That Hepatitis analogy doesn't currently apply to HIV because, in the argument presented by the IBTS and other blood services, blood can be infectious during a window period (of between one month and a year, but typically three to six months) when antibodies to HIV won't show up in the tests used on blood donations. So blood donations from sexually active gay men who aren't using condoms are potentially infectious.
However, as those smug TV ads with the smug people whose blood is acceptable show, there is a constant shortage of blood and blood products. Most of us think blood donations are largely used during emergency surgery on accident victims or during major surgery, however, other people require blood products too. As the population ages, more and more people with conditions that cause severe life-threatening anaemia (chronic kidney disease, cancer and its treatments, liver failure) desperately need blood products.
In medical archetypes, a portentous voice tells doctors never to do anything that might harm the patient. But real medicine is often a weighing up of different risky actions, all of which may harm the patient. That's why medical insurance (for doctors rather than patients) is so high. If I was sure to die within six months of chronic kidney disease, I think I would take the small risk that the purified blood product my body needed might have some HIV particles in it.
And it's worth remembering that tests for HIV and its antibodies continue to develop. That danger period is already easy to disregard if you use costlier direct tests for HIV. That may not be practicable in mass testing situations such as the blood service, but that's right now. If there's a will, and more importantly a market, then it's certain these tests will become financially viable.
It is important the the IBTS and others blood services regularly revisit the possibility of accepting gay blood in an evolving medical environment. Gay blood should not be forced into the national supply if it is statistically unacceptable (a whole other can of worms), but nor should it remain unacceptable when the risk from it can be removed or reduced to an acceptable probability. If it doesn't, the blood service will deprive itself and future patients of treatment possibilities and a situation akin to banning people with HIV from swimming pools will be created.
On more than one occasion, my life has been saved by blood transfusions. It is a measure of my membership of this thing we agree to call society that I should be able to return the favour.