Australia’s policies on blood donation within the GBT community are out of step with international norms, writes Dr Sharon Dane and Rodney Croome.
The lifting of restrictions on people with new tattoos giving blood highlights another contentious restriction, the ban on blood donation by gay men, and bisexual men and trans women who have sex with men (GBT donors).
Debate about gay blood donation is likely to grow in coming months because Australia’s Lifeblood Service has proposed that GBT donors be allowed to give plasma but not whole blood. We are concerned this will replace an old form of discrimination with a new one.
We feel there is a better path forward with both the science and the international experience showing it is possible to have a safe blood supply and treat all donors equally regardless of sexuality or gender.
The ‘Plasma Pathway’
Last year Lifeblood asked the Australian Government to amend the blanket ban on gay blood donation so men who have sex with men can give plasma but not whole blood. The so-called ‘plasma pathway’ has since been approved by the government’s blood regulator, the Therapeutic Goods Administration.
Now, it will go to state and federal health ministers and the private blood trading company, CSL Behring, for their approval.
But there are significant problems with only allowing GBT people to donate plasma and not whole blood.
While it may increase the supply of plasma it entrenches discrimination and misses an opportunity to tap into a new source of safe whole blood that will help save lives.
The local and national situation
Currently in Australia, gay men, and bisexual men and trans women who have sex with men, are barred from blood donation unless they are sexually abstinent for three months prior to donation. This includes those in long-term, monogamous relationships.
That policy dates from the 1980s when a blanket blood donation ban was imposed on men who have sex with men to stop the spread of HIV through blood transfusion.
A lot has changed since then. Within just the last two years gay male blood donation has been allowed in the UK, Canada, the Netherlands, France, Germany, Greece, Israel and most recently the US.
Instead of barring all gay men, and some bi and trans people, these countries assess all donors for their individual risk, gay and straight, cis and trans.
In the UK, Canada and the US all donors are asked if they have had anal sex with a new partner, or multiple partners, in the previous three months and are deferred if they say yes. In other words, instead of turning away all gay men, and some bi and trans folk, and allowing all heterosexuals through, like the current Australian policy, individual risk assessment screens out everyone who may be at risk.
Lifeblood pushes back
The Australian Lifeblood Service has taken an inexplicably negative view of this rational and proven approach.
It has claimed individual risk assessment will decrease the blood supply by removing heterosexual donors who engage in anal sex with new or multiple partners, or by offending existing heterosexual donors who don’t want to be asked about anal sex.
What Lifeblood is effectively saying is that heterosexuals should be allowed to donate even if they engage in risky behaviour and that Australians are more prudish than Brits, Canadians and Americans. Australians would rightly be sceptical about both assertions.
Fortunately, science has a response to Lifeblood’s negativity.
The Canadian Blood Service conducted a survey at all its blood collection centres which found less than one per cent of existing donors would be deferred or offended by questions about anal sex during individual risk assessment screening.
What’s more, this small loss would be addressed by gaining new, safe gay, bisexual and transgender donors.
Lifeblood also tries to justify the current ban by claiming some GBT people may inadvertently donate during the short period between when HIV infection occurs and when it is detected, referred to as ‘the window period’. But as the rate of new HIV infection in Australia has drastically declined among gay and bisexual men, and blood screening technology has become more sensitive to detection, fears about window-period infections are no longer a convincing reason to exclude GBT people from blood donation.
Research from numerous countries that have lifted the ban has shown that the likelihood of a gay or bisexual man who has recently acquired HIV infecting the blood supply is so low it is no longer deemed a meaningful risk.
A dead end
Ignoring all this, Lifeblood remains committed to a gay plasma-only donation policy. Plasma undergoes a different treatment process which renders it safer in terms of blood-borne diseases. However, other countries that trialled the plasma-only option for gay men, notably Canada and Israel, quickly abandoned the idea and moved on to whole blood donation by gay men instead.
Why didn’t these countries go down the ‘plasma pathway’? A longitudinal study from Canada found that many gay and bisexual male participants felt that a plasma-only policy would ultimately make them “second-class donors” by creating a two-tier system.
Instead of removing discrimination, plasma-only donation simply served to highlight it. As one participant in the study explained it would result in an “us vs. them” system.
Put simply, plasma-only donation is to gay blood donation what civil unions were to marriage equality: an unsatisfactory substitute for true equality.
Many gay and bisexual men in the Canadian study also pointed out that, while donating plasma was a good thing to do for those in need, plasma donation was more difficult and inconvenient than whole-blood donation.
Plasma donation involves a more complex process and takes more time, with these factors acting as a deterrent to donors.
In short, the ‘plasma pathway’ is a dead-end.
Questions for government
Don’t get us wrong, we welcome a possible increase in plasma supplies. But that increase can and should happen without continuing discrimination against gay, bi and trans people.
Why hasn’t the Australian Lifeblood Service learnt from the failure of the plasma-only option overseas? Why is it so staunchly against individual risk assessment when that policy is working so well in many other countries, including those similar to Australia? And why does it think the LGBTIQA+ community, which is all-too-familiar with ‘separate and unequal’, will embrace the ‘plasma pathway’ as a substitute for full equality?
These are all questions we will be putting to Australia’s health ministers as they consider Lifeblood’s proposal.
Most of all we will be reminding health ministers that Australia needs more whole blood, that each whole-blood donation can save three lives and that thousands of gay men, and bisexual men and trans women who have sex with men, are ready to donate whole blood with no risk to the safety of the blood supply.
It’s time for Australia to stop mucking about with ‘pathways’ that lead nowhere and move instead toward the policy that offers a new source of safe whole blood and treats everyone equally.