With a global pandemic placing increasing pressure on our health system, Rodney Croome makes the case for an urgent review of laws that are putting even more pressure on a vital medical service.
Lots of conventions have been overturned by the corona pandemic.
Liberal governments are splurging taxpayers’ money on economic stimulus, while Labor governments are curtailing individual rights to prevent disease transmission.
I propose we overturn another convention in order to save lives: it’s time we stopped refusing blood donations from gay men.
Demand for blood is as high as ever but supply has gone down because self-isolation or fear of infection have resulted in fewer people donating.
The shortfall means 7000 more donations are needed before Easter Monday to avoid a blood shortage, according to the Director of Research and Development at Australian Red Cross, David Irving.
The United States Food and Drug Administration has already responded to the corona pandemic by easing restrictions on gay men giving blood in an effort to increase the supply of safe blood in that country.
Instead of insisting gay men must wait 12 months after having sex before giving blood, it now says three months is sufficient. But this is still unnecessarily restrictive at a time when we should be encouraging the greatest number of gay men whose blood is safe to donate.
Australia should go further. We should abolish the blanket ban on blood donation from all sexually-active gay men, and instead screen donors for the safety of their sexual activity.
It is not gay sex which creates risk, it is unsafe sex. Our blood screening policy should reflect that fact.
To understand why a new screening policy makes sense, let’s consider the historical and medical context of gay blood donation. Currently, the Australian Red Cross Blood Service refuses donations from all sexually-active gay men, no matter how safe their sexual activity may be.
To donate, gay men must abstain from sex for a year, an unrealistic requirement no heterosexual is asked to meet.
Reducing that deferral period to six or three months is also onerous and is unlikely to make much difference to how many gay men can donate.
All such deferrals are a hangover from the 1980s when HIV transmission was less well understood, tests for the virus were less reliable and being gay was synonymous with having AIDS. But all this has changed and it is now safe for the blanket ban to be lifted.
I am certain about this because I was the chief researcher during a landmark case on gay blood donation before the Tasmanian Anti-Discrimination Tribunal in 2008. The case was taken by young gay man, Michael Cain, who had been refused the opportunity to give blood in Launceston.
Epidemiologists, medical researchers, social scientists and mathematical modellers from across Australia and around the world presented evidence to the Tribunal in a hearing that lasted weeks.
It was my job to summarise the medical evidence presented to the Tribunal on behalf of Michael Cain so I had to understand that evidence and present it objectively. The Red Cross’ case for the existing gay blood ban was that HIV is still disproportionately prevalent among gay men.
The implication of high prevalence is that even those who practice safe sex and are monogamous are at higher risk, for example if the condom breaks or if a partner cheats.
But global experts challenged the Red Cross statistics saying they were chosen to give the highest possible impression of gay HIV risk.
One such expert was Dr Scott Halpern, then a senior scholar at the Centre for Clinical Epidemiology and Biostatistics at the University of Pennsylvania. Evidence presented by Dr Halpern, and other experts not linked to the Red Cross, unequivocally demonstrated this key fact: some gay men who currently can’t donate blood are at much lower risk of contracting and passing on HIV than many heterosexual people who currently can donate.
Given blood donation is regulated by the Federal Government, the Tribunal was not able to overturn the gay blood ban, but it did accept the fact blood from some sexually-active gay men is safe.
Since the Cain case, advances in HIV prevention have reduced the level of risk even further.
Gay men on PrEP (pre-exposure prophylaxis) are at much lower risk of HIV infection.
In short, there are gay men whose blood could save lives if it wasn’t for the irrational and outdated fear that our blood takes lives.
It should be easy to build a new screening policy on the foundation of the medical evidence I have referred to. The Red Cross would simply screen gay donors for the safety of our sexual activity, rather than the gender of our sexual partner.
The problem is that old regulations and even older attitudes also need to be updated. I know from experience that this can take a long time.
Because of the urgency of the situation, I propose that the new screening policy I have outlined is provisional and that blood donated by gay men be subject to a higher level of testing.
Extra testing would make doubly sure blood donated by gay men is safe for transfusion and provide evidence for a longer-term evaluation of the new policy.
HIV tests are now efficient and cheap enough to ensure the burden of extra testing would not outweigh the benefit of more donations.
There are thousands of gay men across Australia whose blood is safe and whose desire to help has never been greater.
Let’s invite them to give the gift of life before it’s too late and the blood shortage bites.
In these extraordinary times we are called on to take extraordinary measures to protect life. Compared to banning gatherings, closing borders and locking the elderly indoors, allowing gay blood donation hardly seems radical.
But it will save the lives of many vulnerable members of the community. And that should be our priority right now.
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