Thursday, June 03, 2004
Here's some background information to this post:
- The NBS has for a long time had a policy of not allowing men who've had anal or oral intercourse with another man to give blood. Ever.
- Every other possible risk-giving activity - piercing, tattooing etc - has a window period (usually 12 months) except prostitution.
- There is a window period of 12 months for someone who has had sex with a man who has had sex with another man (suggesting this question is aimed at females).
- The rationale online for its provisions is that ‘Although the chances of infected blood getting past our screening tests are very small, our tests do not always show if you are infected. This is why we must take care in choosing donors and why you must not give blood if you are infected.’
Obviously this doesn't explain the severity of the gay men exclusion, and the website doesn't try to do so. I got on the research path today to see why.
On the phone, I asked the first person to confirm what the current policy was on men who've had oral or anal intercourse with other men giving blood. He did so, but as soon as I asked why, he couldn't give even the most explanation; instead, he asked me to hang on, as he'd put me through to the referral service. Strike one against them - you should surely be able to give a reason, even a basic one, to a normal enquiry.
The second person was a woman. This time I asked her what was the rationale behind it. She said it was to do with the bodily fluids exchanged which might cause HIV/AIDS at the start of the epidemic. As soon as I pointed out that bodily fluids are exchanged in a lot of non-gay situations, she said she'd put me through to a doctor. Strike two.
I got the full lowdown with the doctor. People who have had gay anal sex are at a higher risk as a group than others. In resopnse to my question - what about if you're using condoms? - he said that condoms weren't always effective, and that there are a number of factors involved apart from the exchange of fluids, one of which is the blood that comes from the lining of the body during anal intercourse, which he followed with the exact words 'the anus isn't designed for that'. I pointed out that a lot of heterosexual couples engage in anal intercourse. He said that he was aware of this and that they were looking at changing their policy for said straight couples. Since they could have been doing this a long time ago, that can't be all that's involved.
He told me that it was a combination of factors that was involved in making 'people in the process of being involved with' gay sex at higher risk as a group, not as individuals. Gay anal sex still being way above in the HIV/AIDS stats, above drug use and African sex (I didn't have latest stats with me to check this, so I didn't question it, though I pointed out as often as possible that the stats were rising very sharply, and at a much quicker rate among the (young) straight population. He said that if testing were infallible there would be no problem, but that it isn't. I asked why there should be some fixed time limit, perhaps five years, that was ultra-safe, since as far as I'm aware - and he didn't directly contradict me - all research shows that the risk of HIV infection goes within a year. To this he answered that the virus replicates in a person and at a point it converts and the body starts making anti-bodies. They couldn't be sure which point, and before that point it is completely undetectable even by the most sensitive - PCR(?) - processes. He reverted to a lot of technological language here, I think designed to put me off. He basically succeeded, because I couldn't take issue with the specific analysis of processes involved.
At one point he, unbelievably, became almost joky. After talking about the need to comply with regulations as a member of the EU - not quite sure how this is relevant in this regard - he said, in response to my question about not having the same provision for straight people who haven't even used protection, that it was unusual that all these factors [which could cause HIV/AIDS in a condomed gay sex situation, I guess] would come together, but that they had to be like Brunel with his bridges. He worked out the maximum load they would bear, then built them at twice that to be safe. Like him, the NBS needs to aim beyond what's likely. He then tripped up on his metaphors and said that they needed to look at the worst case scenario, then stammered a little before saying, and beyond that.
Final words from him - 'We're trying to be openminded, but we have to make worst case scenario judgements, which will be unfair to certain individuals'. Strike out.
Much of the language he used - outlined above, and I won't point to specific phrasings - suggests a deep-seated prejudice within the blood service policy, something confirmed by the fact that the online question regarding gay sex used to say in scare-quotes "(even 'safe sex')", but has been changed with a lot of pressure to "(even sex with a condom)".
This also suggests why no one could answer my questions at a lower level. It's simply incoherent, and the provisions are not replicated for any other group with similar factors. The general defence he used, because it's one that's hard to answer I guess, is that it's the combination of factors involved in the gay sex case which make the exclusion so severe. But then, there should be a much longer form involved for donating blood, which asks whether you've had a tattoo, and a piercing, and slept with someone who's been infected with hepatitis sometime in the distant past. Such a combination of factors must surely exclude them for life...
One last point - interestingly, there doesn't seem to be an exclusion, even a window period one, for people who've slept with a prostitute, though prostitutes, like gay men, are barred for life. I could be cynical and say that this suggested even more traditional patriarchal prejudices at work - a man has to be allowed to go to a prostitute after all (if only to stop him going to another man!) - but that's a whole other phonecall...
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